"Knee-To-Knee" Position for Minor Procedures in Infants and Toddlers- Dentists Attitudes.

OBJECTIVE: The objective of this survey was to assess attitudes of pediatric dentists in Israel toward using "knee-to-knee" positioning for dental examinations and for minor procedures in infants and toddlers. STUDY DESIGN: An anonymous questionnaire was distributed among specialists in pediatric dentistry. Eleven questions accessed demographic data, professional experience and attitudes toward the use of the "knee-to-knee" position. RESULTS: Of 68 respondents, 66 (97%) reported using "knee-to-knee" positioning for dental checkups. In addition, 52 (76%) reported performing other procedures in the "knee-to-knee" position. Fluoride application and oral hygiene instructions are the most common procedures performed in the "knee-to-knee" position. CONCLUSIONS: "Knee-to-knee" positioning was found very convenient for dental examinations and other simple procedures in very young children.

Modeling, validation and verification of three-dimensional cell-scaffold contacts from terabyte-sized images.

BACKGROUND: Cell-scaffold contact measurements are derived from pairs of co-registered volumetric fluorescent confocal laser scanning microscopy (CLSM) images (z-stacks) of stained cells and three types of scaffolds (i.e., spun coat, large microfiber, and medium microfiber). Our analysis of the acquired terabyte-sized collection is motivated by the need to understand the nature of the shape dimensionality (1D vs 2D vs 3D) of cell-scaffold interactions relevant to tissue engineers that grow cells on biomaterial scaffolds. RESULTS: We designed five statistical and three geometrical contact models, and then down-selected them to one from each category using a validation approach based on physically orthogonal measurements to CLSM. The two selected models were applied to 414 z-stacks with three scaffold types and all contact results were visually verified. A planar geometrical model for the spun coat scaffold type was validated from atomic force microscopy images by computing surface roughness of 52.35 nm ±31.76 nm which was 2 to 8 times smaller than the CLSM resolution. A cylindrical model for fiber scaffolds was validated from multi-view 2D scanning electron microscopy (SEM) images. The fiber scaffold segmentation error was assessed by comparing fiber diameters from SEM and CLSM to be between 0.46% to 3.8% of the SEM reference values. For contact verification, we constructed a web-based visual verification system with 414 pairs of images with cells and their segmentation results, and with 4968 movies with animated cell, scaffold, and contact overlays. Based on visual verification by three experts, we report the accuracy of cell segmentation to be 96.4% with 94.3% precision, and the accuracy of cell-scaffold contact for a statistical model to be 62.6% with 76.7% precision and for a geometrical model to be 93.5% with 87.6% precision. CONCLUSIONS: The novelty of our approach lies in (1) representing cell-scaffold contact sites with statistical intensity and geometrical shape models, (2) designing a methodology for validating 3D geometrical contact models and (3) devising a mechanism for visual verification of hundreds of 3D measurements. The raw and processed data are publicly available from https://isg.nist.gov/deepzoomweb/data/ together with the web -based verification system.

Levels of Stress among General Practitioners, Students and Specialists In Pediatric Dentistry during Dental Treatment.

OBJECTIVE: To assess self-reported stress during the performance of different procedures in pediatric dentistry, according to the professional experience of the dentists. STUDY DESIGN: During the years 2010 to 2011, an anonymous survey was administered by means of an internet link, and by distribution at professional meetings of dentists . RESULTS: No statistically significant differences in stress were reported for maxilla and mandibular procedures. Placement of a rubber dam was rated as the most stressful procedure among dental students. For general practitioners and specialists, injection of local anesthesia to an anxious child was the most stressful procedure, regardless of age, sex, or years of professional experience. A negative correlation was found between years of experience and level of stress for all the procedures surveyed, but not for the use of nitrous oxide. No differences were found between male and female dentists in stress scores for any of the procedures. CONCLUSION: Higher rates of stress during operative procedures were reported among dental students than among experienced dentists. Anxiety of the pediatric patients, but not the location of the procedure: maxillary or mandibular, affected the dentists' reported level of stress.

Oral hygiene habits, dental home, and toothbrushing among immigrant and native low socioeconomic class populations.

UNLABELLED: About 45,000 people immigrated to Israel from Ethiopia over the last 30 years. The purpose of this study was to compare oral hygiene habits in preschool children from low socioeconomic neighborhoods offspring of immigrants from Ethiopia to offspring of native Israelis. METHOD: Parents of children attending 21 nursery schools were asked to respond anonymously to 7 questions about their children's visits to a dentist and toothbrushing habits. RESULTS: Parents of 719 children (382 Ethiopian and 337 native Israeli) responded. Of children aged 49-82 months, 15% offspring of Ethiopian and 25% of native Israelis were reported to have visited a dentist; and 45% and 65%, respectively, to brush their teeth at least once daily. More than 90% of children of both populations were reported to have toothbrushes. Of children aged 18-48 months, 28% of Ethiopian and 65% of native Israelis were reported to brush their teeth at least once daily. CONCLUSION: After more than 20 years residence in a new country, the dental home of an immigrant population was significantly different from that of the native population, of the same low socioeconomic neighborhoods. Discrepancies in parental responses highlight the importance of addressing information bias.

[Esthetic restorations of primary anterior teeth].

Esthetic treatment of primary teeth is one of the greatest challenges to pediatric dentists. A variety of restorative options using full coverage are available for anterior primary teeth. In the last half century the emphasis on treatment of severely decayed primary teeth shifted from extraction to restoration. In the past, restorations consisted of placement of stainless steel crowns on severely decayed teeth. However, they are esthetically unacceptable today. Over the last decade parents expect a higher esthetic standard for their children's primary teeth. Thus, the restoration should provide esthetic appearance and durability in addition to restoring function. The purpose of this review is to describe the types of full coverage options for anterior primary teeth currently available.

Premedication intake behavior--does it predict behavior during dental treatment?

OBJECTIVES: To investigate whether behavior during hydroxyzine administration predicts children's behavior during dental treatment and whether behavior during treatment is affected by the complexity of treatment. MATERIALS AND METHOD: 118 children aged 2 to 6.5 years old were treated under conscious sedation with oral premedication (3.7 mg/kg of hydroxyzine in a concentration of 50 mg/5 cc. hydroxyzine) and 50% nitrous oxide/oxygen sedation. Children were divided in two age groups: aged 2 to < or = 4 years old, and aged 4 > to 6 years old. Behavior during first examination; cooperation during premedication administration, cooperation during nitrous oxide nose-mask placement, behavior during dental treatment, treatment duration and complexity of treatment were recorded. RESULTS: More children in the older group took the premedication willingly (p = 0.026). Significant correlation (p = 0.002) between behavior during examination and nitrous oxide mask acceptance was found in the older age group. No correlation was found regarding the cooperation during premedication intake and behavior during treatment within and between age groups. No statistical differences within the groups and between the groups were found between complexity of treatment and behavior during treatment. CONCLUSIONS: Premedication intake is not a reliable predictive tool for behavior during treatment in children aged 2-6.5 years. Complexity of treatment does not influence behavior during treatment in children aged 2-6.5 years.

Mandibular block or maxillary infiltration: does it influence children's opposition to a subsequent dental visit?

PURPOSE: Local anesthesia by mandibular block or maxillary infiltration is commonly administered to children receiving dental treatment of primary molars. Discomfort, when presenting, most often involves the lower lip. The purpose of this study was to investigate whether children would be more opposed to attending a dental treatment following anesthesia by mandibular block than by maxillary infiltration. METHODS: Each of 102 children in two age groups: 3 to 5 years, and 6 to 9 years, received the two types of local anesthesia at dental appointments one week apart. Their opposition to attending a subsequent appointment was assessed by parent report. RESULTS: More adverse reactions were observed during and following anesthesia with mandibular block than with maxillary infiltration. Few of the children in either age group expressed opposition to attend a dental visit after receiving mandibular block or maxillary infiltration in the previous visit. CONCLUSIONS: Though more adverse reactions were observed in children following mandibular block than maxillary infiltration, this did not result in increased opposition to attend a subsequent dental appointment.

Increased dental trauma in children with attention deficit hyperactivity disorder treated with methylphenidate--a pilot study.

The purpose of this pilot study was to investigate the prevalence of trauma to incisor teeth in children with normal overjet and lip competence, treated with methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD). The study group consisted of 24 children (19 boys, 5 girls) aged 5-12 years (mean 8.45 +/- 2.25), diagnosed with ADHD and treated with methylphenidate at a minimal dosage of 10 mg per day. The control group consisted of 22 healthy children (13 boys, 9 girls) aged 5-12 years (mean 9.15 +/- 2.28). The dental examination included incisor relation measurements in the anterior segment (overjet), which was recorded using an orthodontic ruler. Lip competence was clinically determined, and anterior teeth were examined for dental trauma. The prevalence of dental trauma was significantly higher in the study group than in the control group (29.1% vs. 4.5% P = 0.02, t-test one tail). In conclusion, children with ADHD treated with methylphenidate have a high-risk for dental trauma. We believe that preventing dental trauma in this high risk group is possible. Consequently, the pediatrician and all medical staff attending to these children should encourage parents to consult frequently with a pediatric dentist to diagnose dental trauma and provide early treatment when needed.

Attitudes of EAPD members toward using the "knee-to-knee" position.

AIM: This survey assessed the attitude of paediatric dental EAPD members toward using "knee-to-knee" positioning for dental examinations and minor procedures in infants and toddlers. METHODS: An anonymous electronic online questionnaire was distributed among EAPD members. The survey consisted of 12 questions and assessed demographic characteristics, professional experience and attitudes toward the use of the "knee-to-knee" position. RESULTS: Of the 162 respondents, 148 (91%) reported using "knee-to-knee" positioning for dental examination. In addition, 97 (63%) reported performing other procedures in the "knee-to-knee" position. Fluoride application and oral hygiene instructions were the most common procedures performed in the "knee-to-knee" position. CONCLUSIONS: Most of the paediatric dentists who responded to this survey reported performing dental examinations in toddlers up to 2 years old using the "knee-to-knee" position. Majority of respondents also used this position to instruct parents regarding oral hygiene and to apply fluoride varnish.

Dentists, dental hygienists and dental students' knowledge regarding recommended fluoride concentration in toothpaste for children.

PURPOSE: The objective of this study was to assess the knowledge of dentists, dental hygienists and dental students regarding the Israeli Ministry of Health guidelines for using fluoridated toothpaste. MATERIALS AND METHODS: An anonymous questionnaire was distributed to dentists, dental hygienists, and dental students in their final years at the Hebrew University-Hadassah School of Dental Medicine. Participants were queried regarding their knowledge of Ministry of Health fluoride concentration guidelines in toothpaste by the following age categories: under 2 years, 2-6 years, and above 6 years. RESULTS: Thirty-two paediatric dentists (specialists and residents), 63 general dentists, 68 dental hygienists, and 69 students responded to the survey. Analysis of survey respondent's knowledge of Ministry of Health fluoride toothpaste guidelines by age group found that 81%, 75% and 88% of participants selected a fluoride concentration within the recommended range for those under 2 years, 2-6 years and greater than 6 years, respectively. Only 58% of respondents were aware of the recommended fluoride concentration for all three age groups. Among respondents who answered all three questions, there was a significant association between correctly answering the fluoride questions and respondent's profession (P = 0.026), with a larger percentage of paediatric dentist (76%) and dental students (66%) correctly answering all three questions. CONCLUSIONS: Israeli dental practitioners should be educated about the Israeli Ministry of Health fluoride concentrations in toothpaste guidelines. The guidelines should be emphasised at annual meetings and in continuing education courses.

Chemo-mechanical removal of caries in an adolescent patient using a papain gel: case report.

The chemo-mechanical model of caries removal has been introduced as an alternative method of caries removal and is indicated to overcome the inconvenience of using burs and local anesthesia, causing less discomfort to the patient, and preserving healthy dental structure. Papacarie is a papain gel composed basically of papain, chloramines, and toluidine blue. Papain interacts with exposed collagen by the dissolution of dentin minerals through bacteria, making the infected dentin softer, and allowing its removal with non-cutting instruments without local anesthesia and burs. This paper proposes the use of a papain-based gel for the removal of active caries with infected tissue followed by a glass ionomer restoration in an adolescent patient. Removal of caries tissue with Papacarie proved to be efficient, easy and comfortable for the patient.

Professional education and practice arrangements: are there gender differences among paediatric dentists in Israel?

AIM: To assess gender differences in professional education, practice setting and working arrangements among dentists in Israel, who primarily treat children. SUBJECTS: All 112 participants in the meeting of the Israeli Society of Dentistry for Children that was held in February 1999. METHODS: A questionnaire completed during the meeting. RESULTS: Seventy participants (63 per cent) completed the questionnaire and returned it. There were 43 females and 27 males. Less than half of the population were specialists (40 per cent of the females, 48 per cent of the males). No significant differences were found in the educational background and working in academia between females and males. With regard to practice arrangement, males significantly reported more frequently working in two clinics or more, than females (P = 0.049), and working in clinics with general practitioners (GPs) and specialists in various fields in dentistry, while more women reported working with either GPs or specialists (P = 0.007). In all other variables, no significant gender differences were found. The results of our study show that paediatric dentistry in Israel appears as a branch of the profession which shows great sexual equality of opportunity.

Partial pulpotomy in a traumatized primary incisor with pulp exposure: case report.

Crown fracture with pulp exposure in primary incisors is a rare condition. Despite the fact that the vitality of the pulp can be preserved, such teeth are usually extracted due to lack of patient cooperation. This article reports a successful conservative treatment of a fractured primary incisors with pulp exposure and undeveloped root. The child was sedated with midazolam and nitrous oxide, and partial pulpotomy was performed using calcium hydroxide. Follow-up radiographs 21 weeks later revealed closure of the apex and apposition of a dentin bridge close to the amputation site.

Sequelae and prognosis of intruded primary incisors: a retrospective study.

PURPOSE: This study was designed to assess the sequelae and prognosis of intruded primary incisors. METHODS: Of 196 children who visited the emergency clinic due to intrusion of 310 maxillary primary incisors, 110 children (172 teeth) were available for follow-up examination (study group). Eighty-six children (138 teeth) did not show for the follow-up examination (non-respondents group). Male/female ratio was 1.7:1. Age range of children at time of injury was 12-72 months (mean 28). Follow-up time ranged between 0 and 59 months (mean 27). RESULTS: Fifty-seven percent of all teeth were completely intruded. In 80%, the root was pushed labially. All but two ankylosed teeth re-erupted, and 37% of these re-erupted into an ectopic position. Completely intruded incisors re-erupted into an ectopic position in a higher percentage (45%) than partially intruded teeth (30%). Fifty-two percent of the teeth presented pulp canal obliteration (PCO). Sixty-four percent of the completely intruded incisors presented PCO compared to 40% of partially intruded teeth. Arrest of dentin apposition was found in 15% of the teeth, and was not affected by the degree of intrusion. Twenty-three teeth were extracted shortly after the injury due to suspect of contact with the developing permanent successor (19 teeth) and severe caries (4 teeth). Sixty-eight percent of the intruded teeth survived more than 36 months after the injury. Twenty-three percent were extracted due to periodontal breakdown and 5% due to repeated trauma. Antibiotic therapy did not have any effect on the survival rate. CONCLUSION: The majority of intruded primary incisors may re-erupt and survive with no complications after more than 36 months post trauma even in cases of complete intrusion and fracture of the labial bone plate.

Reactions of children to maxillary infiltration and mandibular block injections.

PURPOSE: The purpose of this study was to assess children's reactions to the administration of local anesthetic injection in the mandible and in the maxilla, and to study their sensation of pain after each type of injection. METHODS: Twenty-six children between the ages of 4 to 6 (mean age 5.3+/-0.7 years), and 34 children aged between 7 to 10 (mean age 8.1+/-1.1 years,) who were undergoing dental treatment in a pediatric dental clinic, were selected for this study. A random crossover design was used. Each patient was randomly assigned to receive either maxillary infiltration or mandibular block on the first visit, and the remaining local anesthesia on the second visit. During the injection, the modified Behavioral Pain Scale, was used. It comprised the following parameters: a) facial display, b) arm/leg movements, c) torso movements, and d) crying. Immediately after administering the local anesthesia, children were asked to rate their feeling according to the Facial Affective Scale. RESULTS: The children in each group responded positively to both techniques revealing that there was no difference in either one. Subjective and objective evaluation disclosed no difference when mandibular block was administered during the first or second visit. Regarding the objective evaluation, in all parameters, more children reacted positively during administration of mandibular block than during maxillary infiltration. CONCLUSION: a) mandibular block and maxillary infiltration are similarly accepted by children when first administered, and b) children may feel inconvenience or pain and react by crying, yet may report a positive feeling in general.

Clinical performance of esthetic posterior crowns in primary molars: a pilot study.

PURPOSE: The aim of this pilot study was to assess the clinical performance of esthetic crowns and to compare these to conventional stainless steel crowns (SSC). METHODS: Twenty two crowns (11 conventional and 11 esthetic) were placed in mandibular primary molars obeying the following criteria: the tooth was not mobile; no fistulae were present; the tooth had at least one caries free or properly restored antagonist and had to be in contact with one adjacent tooth mesially, in the case of the primary second molars or distally in the case of the primary first molars. Crown preparation was done in a conventional manner, but reduction was more extensive for the thicker esthetic crowns, to allow for proper occlusion. The crowns were evaluated clinically and radiographically after 6 months and the following parameters were assessed: gingival health, marginal extension, crown adequacy, proper position or occlusion, proximal contact, chipping of the facing (for esthetic crowns) and cement removal. RESULTS: At the 6 month evaluation all esthetic crowns were intact, without chipping of the facing, and no excess of cement was observed in both groups. No difference was found for marginal extension, occlusion, proximal contact, crown adequacy, and bone resorption, but a significant difference was found for periodontal health between esthetic crowns and conventional SSC (P < 0.001 McNemar test). CONCLUSIONS: The esthetic crowns assessed had several inconveniences, as they resulted in poor gingival health, are very expensive, and, although not measured, are bulky and without a natural appearance.

The composition of subgingival microflora in two groups of children with and without primary dentition alveolar bone loss.

The is study examined the relationships between the microbial composition of the subgingival plaque, contact loss caused by caries and alveolar bone loss (ABL) in primary molars. The study included 10 children with contact loss in at least two sites, one with ABL and one without ABL, and 10 children without ABL with sites with or without contact loss. The microbial composition of subgingival plaque was examined by dark-field microscopy and by cultures of total anaerobic bacteria, Actinobacillus actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg). Dark-field microscopy confirmed that spirochetes and motile rods may be part of the indigenous flora of the oral cavity. More spirochetes and motile rods were observed in sites with ABL than in control sites in the same subject and control subjects without ABL. Lower numbers of cocci were seen in sites with ABL than in sites in children without ABL, but a significant difference was not observed between sites with ABL and healthy sites within the same subjects. No significant differences in the dark-field values were evident in sites without ABL, with or without contact loss. Aa and Pg were found in children and sites with or without ABL. In sites with Aa, larger proportions of spirochetes, lower values of cocci, and more colonies of Pg were evident. No significant differences in anaerobic bacteria were evident between sites with or without contact loss or with or without ABL. ABL in the primary dentition was found to be related to the microbial composition of the subgingival plaque, but not related to contact loss per se.

Assessment of two doses of intranasal midazolam for sedation of young pediatric dental patients.

The purpose of this study was to assess the effectiveness of two doses of intranasal midazolam on sedation of young children for dental treatment. Thirty uncooperative children, mean age of 32 months, who needed at least two restorative visits, participated in this study. The patients were assigned randomly to receive either 0.2 mg/kg or 0.3 mg/kg of midazolam intranasally, with the alternate regimen administered at the second appointment. All the children received 50% nitrous oxide, and were restrained in a Papoose Board (Olympic Medical Group, Seattle, WA) with a head holder. Degree of alertness, crying, and movement were evaluated at baseline and at 5-min intervals throughout the procedure. Evaluation of overall behavior at each session was performed by one investigator, blind to the dose, using a separate rating scale. The reliability of ratings was assessed by two investigators from videotapes of the procedures. Statistical analysis showed no differences (P > 0.05) in the behavior of the children receiving the two doses. Successful sedation, as assessed by lack of or minimal crying and/or movement that interrupted treatment, was observed in all the treatment visits with both doses (mean score 4.66 +/- 1.09 for 0.3 mg and 4.40 +/- 1.04 for 0.2 mg). No adverse effects were observed, and all the treatments were completed successfully.

Composite crown-form crowns for severely decayed primary molars: a technique for restoring function and esthetics.

Current developments in esthetic dentistry center around new techniques and materials that improve the ability of the clinician to provide esthetic services. This article describes a step-by-step method of placing composite crown-form crowns on severely decayed primary mandibular molars. The described technique allows for restoring, as close as possible, form and function lost to caries in an esthetic mode in cases of severely decayed primary molars that would have required stainless steel crowns had they been treated traditionally. Disadvantages of this treatment mode are that dryness may not be prevented in the proximal margins, especially where subgingival carious involvement is encountered and the margin areas may be contaminated with gingival fluid or blood. Although no long-term follow-up has been reported for the technique, when strong opposition by the parent or child to the stainless steel crown is encountered, and a desire for esthetic restoration is strongly expressed, the composite crown-form crowns may be considered as an alternative.

Subgingival bacteria in a case of prepubertal periodontitis, before and one year after extractions of the affected primary teeth.

The treatment of children with prepubertal periodontitis (PP), may be complicated by the extent of the lesions and the possibility of tetracycline stain of the developing permanent dentition. Therefore, with the purpose of preventing the infection of permanent teeth during the mixed dentition, it has been recommended that the treatment of children with PP, should include the early extraction of the primary teeth affected with alveolar bone loss (ABL). Still, there is little evidence which confirms that extraction of the affected primary teeth do in fact reduce the periodonto-pathogens load of the subgingival plaque. The present study reports values of colony forming units (CFU) of total anaerobic bacteria, Actinobacillus actynomicetemcomitans (Aa) and Porphyromonas gingivalis (Pg) from the subgingival plaque from a child with PP, collected immediately before and 1 year after extractions of the primary teeth affected with ABL. CFU of Aa and Pg developed only from the subgingival plaque collected before the extraction of the primary teeth affected with ABL. These findings suggest that in cases of PP, extraction of the affected primary teeth may reduce the possibility of infection of the periodontum of the permanent teeth during the mixed dentition period.