In vitro remineralization of adjacent interproximal enamel carious lesions in primary molars using a bioactive bulk-fill composite.

BACKGROUND: Surface remineralization is recommended for the management of active non-cavitated interproximal carious lesions in primary teeth. According to the American Academy of Pediatric Dentistry, a recently recognized category of materials called bioactive restorative materials can be used for remineralization. This study aimed to evaluate the release of fluoride (F), calcium (Ca) and phosphate (P) ions from Predicta® Bioactive Bulk-fill composite compared with EQUIA Forte® and Filtek™ Z350 and to determine the remineralization effect of these 3 restorative materials on adjacent initial interproximal enamel carious lesions. METHODS: The release of F, Ca and P ions from 3 groups ((n = 10/group) (Group 1- Predicta®, Group 2- EQUIA Forte® and Group 3- Filtek™ Z350)) was determined at 1st, 4th, 7th and 14th days. After creating artificial carious lesions, human enamel samples were randomly assigned into 3 groups (n = 13/group) which were placed in contact with occluso-proximal restorative materials and exposed to a 14-day pH cycling period. Surface microhardness was determined using a Knoop microhardness assay at baseline, after artificial carious lesions formation and after pH cycling. The difference in the percentage of surface microhardness recovery (%SMHR) among groups was compared. Mineral deposition was analyzed with energy-dispersive x-ray spectroscopy (EDS) and the enamel surface morphology was evaluated with scanning electron microscopy (SEM). Kruskal-Wallis's test with Dunn's post hoc test and one-way ANOVA with Tukey's post hoc test were used for data analysis. RESULTS: EQUIA Forte® released the highest cumulative amount of F and P ions, followed by Predicta® and Filtek™ Z350. Predicta® released higher amount of Ca ions than EQUIA Forte® and Filtek™ Z350. Predicta® demonstrated the highest %SMHR, followed by EQUIA Forte® and Filtek™ Z350. There was a significant difference in the %SMHR between Predicta® and Filtek™ Z350 (p < 0.05). However, EQUIA Forte® demonstrated the highest fluoride content, followed by Predicta® and Filtek™ Z350. The SEM images of EQUIA Forte® and Predicta® revealed the greater mineral deposition. CONCLUSION: Predicta® demonstrated a marked increase in surface microhardness and fluoride content of adjacent initial interproximal enamel carious lesions in primary molars compared with Filtek™ Z350. Predicta® is an alternative restorative material to remineralize adjacent initial interproximal enamel carious lesions in primary molars, especially in high-risk caries patients.

Comparing the relative influence of obesity and ancestry on timing of dental development.

INTRODUCTION: The dentition is one of the most accurate features for age estimation in children. However, there is some evidence that timing of dental development varies across populations. Recent research suggests that dental development may also be susceptible to influence by environmental factors, such as obesity. Given that there are also population differences in average body mass, it is possible that this may be a confounding variable that was not accounted for in prior work. We aim to compare the relative association between body mass index (BMI) and ancestry with timing of dental development. METHODS: A retrospective cross-sectional chart review was undertaken using panoramic radiographs of 6- to 12-year-olds (n = 281). Age, ancestry, sex, height, and weight were obtained. Dental development was assessed using the Demirjian method, and chronological age was subtracted from estimated dental age to determine relative timing of dental development (ΔAge). BMI was calculated based upon recorded height/weight within 6 months of time of radiograph. RESULTS: We found no difference in timing of dental development (accelerated/delayed) across ancestry groups (African-American, Euro-American, Hispanic, Asian; P = .15). Overweight/obese subjects had statistically significantly advanced (precocious) dental development (P < .001). Compared to normal-weight subjects, children who were overweight's age were overestimated by 5.76 months (0.48 years) and children with obesity by 5.97 months (0.49 years) on average. CONCLUSIONS: BMI appears to have a greater impact on relative timing of dental development than ancestry in this population. Our results support other findings that obesity results in accelerated growth and development.

Vaso-occlusive Pain Crisis Mimicking Mandibular Abscess in an Adolescent with Sickle Cell Disease.

In people with sickle cell disease (SCD), oral abscesses are concerning clinical conditions and carry a high risk of postoperative sickle cell complications. We present an unusual case of a 14-year-old girl with SCD whose initial presentation of facial swelling, headaches, jaw pain, and paresthesia mimicked an odontogenic abscess. She was diagnosed with vaso-occlusive crisis in the mandibular bone and successfully managed noninvasively. This is among the youngest cases of paresthesia in the lower lip in SCD, which provided a clue that postponing invasive aspiration or biopsy was possible under empiric antibiotics and close observation.

Dental Considerations in Patients with Loeys-Dietz Syndrome: A Review of the Literature and Case Report.

Loeys-Dietz Syndrome (LDS) is a rare connective tissue disorder with an autosomal dominant pattern of inheritance, linked to heterozygous mutations in six genes from the transforming growth factor beta receptor complex. The classical syndrome characteristics include aortic aneurisms with generalized arterial tortuosity, hypertelorism and cleft palate or bifid/broad uvula. LDS is also associated with a wide range of skeletal, craniofacial, cutaneous and ocular abnormalities, as well as allergic, atopic and inflammatory diseases. Common oral findings include high arched and/or narrow palate, enamel defects and class II skeletal malocclusion. Dental management of patients with LDS is complex and includes approaches to prevent medical complications, as well as considerations for safe delivery of dental care. The purpose of this report, reviews the literature related to LDS oral manifestations as well as to describe the comprehensive dental management of an adolescent patient with LDS and discuss the challenges that dental practitioners may face when providing treatment for these patients. LDS is a newly described syndrome and the literature reviewing its oral manifestations is limited. Patients are reported to have lower oral health-related quality of life as a result of tooth sensitivity and malocclusions. Dental management is compounded by the complexity of medical factors that should be taken into consideration for the safe delivery of care. The presented case is an example of the challenges that dental practitioners may face when providing treatment for LDS patients.

Success of Biodentine and Ferric Sulfate as Pulpotomy Materials in Primary Molars: A Retrospective Study.

OBJECTIVE: To determine the clinical and radiographic success of Biodentine® (BD) and Ferric Sulfate (FS) as primary molar pulpotomy materials and to compare their outcomes. STUDY DESIGN: Retrospective data was obtained from the electronic health records (EHR) of a university-based pediatric dental clinic. Participants were enrolled according to specified inclusion and exclusion criteria. Two trained and calibrated examiners evaluated the EHR using validated criteria for clinical and radiographic outcomes. Study data was numerically coded and analyzed. Cohen's Kappa and Chi-square tests were used (p<0.05). RESULTS: Eighty-three participants (62.7% females, age range two to eight years, average age of 4.5 years) with 102 pulpotomies were enrolled. FS was used in 78% (n=79) and BD in 22% (n=23) of the cases. Follow-up periods ranged from six to 36 months (mean of 17 months). BD showed 100% clinical and radiographic success, while FS demonstrated 84% clinical and 70% radiographic success. The two groups were compared at one year with no statistically significant differences. At 18 months, BD outperformed FS clinically (p=.012) and radiographically (p=.001). Intra-rater and inter-rater agreement were κ>0.88. CONCLUSIONS: Both materials can be recommended for clinical practice, however BD may be the preferred choice for its better outcomes at 18 months.

Gender Differences in Pediatric Dentistry Chairs in the United States and Canada.

OBJECTIVE: To analyze gender differences in personal and professional demographics, job perceptions and work satisfaction between male and female pediatric dentistry academic leaders in the United States and Canada. STUDY DESIGN: A 40-question survey was sent electronically to department chairs requesting information about demographics, current circumstances of the position, professional history, and opinions about the position. Data was analyzed by the sex of the respondent. RESULTS: Eighty-eight surveys were distributed electronically and 55 chairs responded (response rate: 62.5%). Women comprised 29.5% of the sample, were younger and had less leadership training than men. Men had served longer in the position (t(41)=2.02, p=0.05) and had higher ranking academic titles. Women spent more time managing personnel (p=0.026), creating courses and programs (p=0.029), and teaching (p=0.006) than men. Female chairs perceived to have a difficult relationship with the faculty (p=0.027), felt they received less faculty support (p=0.002), and were significantly more dissatisfied in the job (p=0.037). Men were more stressed about a heavy workload than women (p=0.001). CONCLUSION: Gender was significantly related to the demographics, experience, perceptions of the skills and abilities required for job performance, time management and job satisfaction for pediatric dentistry department chairs in American and Canadian institutions.

Articaine Infiltration Versus Lidocaine Inferior Alveolar Nerve Block for Primary Mandibular Molars: A Double-blind Randomized Controlled Clinical Trial.

Purpose: To compare the effectiveness of articaine local infiltration with lidocaine inferior alveolar nerve block (IANB) for restorative treat- ment of primary mandibular molars (PMMs). Methods: In this double-blind, parallel-design, randomized, controlled, clinical trial, participants were enrolled according to specified inclusion criteria (four to 10 years of age, need of PMM restorations, Frankel four behavior) and randomly assigned into either an articaine or lidocaine group. One investigator administrated all local anesthesia (LA). Nineteen trained and calibrated exam- iners, blinded to LA type, evaluated participants' reactions during LA administration and treatment using Modified Behavioral Pain Scale (MBPS). Participants rated their experiences using Wong-Baker FACES Pain Rating Scale (WBFS). The subjects' blood pressure and pulse were recorded throughout procedures. Statistical analysis employed Mann Whitney-U test, repeated measures analysis of variance (P<0.05), and Cohen's kappa. Results: A total of 110 participants (n equals 55 per group; mean age equals 6.42 years; 60 percent males) were enrolled. The mean MBPS rating during LA administration was higher for lidocaine IANB (3.89) compared to articaine infiltration (2.24; P<0.001). The mean MBPS rating through- out treatment was higher for the lidocaine group (2.51) compared to articaine group (1.69; P=0.012). The lidocaine group had a mean WBFS score of 1.64, while for the articaine group WBFS was 0.872 (P=0.089). All physiological measurements were within normal limits with no difference between groups. Conclusions: This study demonstrated that local infiltration with articaine was less distressing upon administration and may be considered safe and effective alternative to lidocaine IANB for restorative treatment in PMMs.

The effects of poverty on children's development and oral health.

According to the US Census Bureau, the poverty rate for children under 18 years of age increased to 22% in 2010. Poverty leads to adverse health outcomes in children and adolescents such as harmful effects on learning, psychosocial development, physical health, productivity and family life. Because the citizens and residents of a country are its most valuable assets, it is unwise to allow housing instability, food insecurity and hunger to continue to exist at its current levels. Reducing poverty is likely to prevent illnesses, decrease hospitalizations, and lead to lower health care costs. There is also a need for intervention strategies to ensure equitable access to healthy foods across the world. Children who are food insecure are more likely to be in poor health and to have poor nutritional outcomes. Poverty may lead to poor dental health due to malnutrition or incorrect diet and it may also have an effect on the child's behavior in the dental office. An understanding of poverty will lessen the anger, frustration and prejudice that pediatric dentists may feel when working with low-income families. This manuscript presents a concise overview of the effects of poverty in children's lives.

Osteoporosis: an increasing concern in pediatric dentistry.

Increasing numbers of children are being affected by low bone density and osteoporosis. Bone fractures are the main reason for hospitalization between 10 and 14 years of age and, over the past 3 decades, there has been an increase in the incidence of fractures in children. Childhood factors such as lifestyle, diet, chronic illness, and medications have a vital short-term impact on bone health and a long-term effect on the achievement of peak bone mass, with the potential for morbidity in adulthood. The primary forms of osteoporosis consist of rare inherited conditions, but the secondary forms are becoming more common given that chronically ill children are surviving longer. This subject should be of interest to pediatric dentists, because low mineral density and osteoporosis, together with drugs used to treat them (eg, bisphosphonates), may cause adverse effects in the oral cavity. Furthermore, the pediatric dentist is an important health care professional to counsel patients about healthy lifestyles that can help prevent the condition from an early age.

Old drugs, new uses.

Advances in pediatric health care have prolonged lives and improved the quality of life for children and adolescents. These advances include not only high-tech devices and new medications but also re-application of available medications to take advantage of unexpected benefits which may not have been known previously or even side effects that can have therapeutic value for diseases and conditions refractory to other treatment. This review describes new uses for anti-epileptic medications, thalidomide, intravenous immunoglobulin, hydroxyurea, methotrexate, botulinum toxin, bisphosphonates, and aspirin in the medical care of children. Methods of action and concerns for the pediatric dentist are described for children benefiting from these new applications.

Caregivers' Comfort Answering Sensitive Questions About Themselves and Their Children in a Pediatric Dental Setting.

Purpose: The purpose of this study was to explore caregivers' comfort levels and preferences for answering sensitive questions about themselves and their children in a pediatric dental setting. Methods: An electronically delivered survey was completed by 206 caregivers in the waiting area of a dental school's pediatric clinic. The survey items assessed were demographic, general health, behavioral health, oral health, and living conditions. A factor analysis was conducted for each set of questions, and a mean comfort level was calculated for each factor. Comfort levels were assessed on a five-point Likert scale, with one being least comfortable and five being most comfortable. Results: The questions caregivers were less comfortable answering about themselves were concerning traumatic events, stress, coping (mean equals 3.39), and living conditions (mean equals 3.24) versus demographics (mean equals 3.84) and physical and oral health (mean equals 3.99; P<0.001). They were also less comfortable answering questions about their children's trauma, stress, coping (mean equals 3.65), and experiences with violence and sexual activity (mean equals 3.13) than about demographics/general health (mean equals 4.11) and oral health (mean equals 4.21; P<0.001). The main reasons for the discomfort were the questions' sensitive nature and their belief that they had any relationship to their children's oral health. Conclusion: This study provides knowledge of caregivers' lower comfort levels discussing sensitive topics in a dental setting and provides context for interventions focused on how dentists can better communicate with caregivers about their own adverse experiences as well as their children's.

Nitrous Oxide for Dental Procedures in Pediatric Patients with Sickle Cell Disease: A Pilot Study.

Purpose: The purpose of this pilot study was to evaluate the safety of nitrous oxide (N2O) during dental procedures in pediatric patients with sickle cell disease (SCD). Methods: Patients three to 15 years of age received N2O with oxygen (N2O:O2) during their dental procedure in a university pediatric dental clinic between March 2019 and December 2020. Blood oxygen levels were monitored via pulse oximetry throughout the visit. Caregivers received a follow-up call to assess for postoperative complications. Results: Twenty-three patients were enrolled. The duration of N2O sedation was 20 to 50 minutes. Oxygenation levels during (P<0.001) and after (P=0.004) the procedure were higher than for baseline. No adverse effects were reported in the three days after N2O use. Conclusions: Following dental guidelines for sedation, treatment with up to a 50:50 mixture of nitrous oxide with oxygen increased blood oxygen levels and did not cause postoperative complications in children with sickle cell disease. This is the first formal study confirming the safety of nitrous oxide use in the dental care of SCD patients.

Oral Health Implications of Risky Behaviors in Adolescence.

Adolescence is a time for new discoveries, which may lead teens to engage in impulsive behaviors. Although social media and the Internet have brought great benefits to the world, they can also have a negative influence on adolescents, facilitating their engagement in risky behaviors. Positive parenting and healthy friendships in adolescence have a protective effect against sensation-seeking behaviors. Dental practitioners also have a significant role in steering young patients toward healthy behaviors. They play an essential role in the early recognition, initiation of appropriate interventions, and referrals for treatment of youth at risk.

Articaine Infiltration Versus Lidocaine Inferior Alveolar Nerve Block for Anesthetizing Primary Mandibular Molars: A Randomized, Controlled, Double-Blind Pilot Study.

Purpose: The purpose of this study was to compare the effectiveness of articaine local infiltration to lidocaine inferior alveolar nerve block (IANB) for restorative treatment of primary mandibular molars (PMM). Methods: Four- to 10-year-old children who needed PMM restorations were enrolled according to inclusion criteria and randomly allocated into the articaine or lidocaine group. One operator administered all local anesthesia. Using the Modified Behavioral Pain Scale (MBPS), 15 trained and calibrated examiners, blinded to LA type, evaluated the subjects' reactions during LA administration and treatment. Children rated their experience using the Wong-Baker FACES Pain Rating Scale (WBS). Subjects' blood pressure and pulse throughout the visits were recorded. Statistical analysis included independent t-tests, Mann Whitney-U, and repeated measures analysis of variance (P<0.05). Examiner reliability was determined by Cohen's kappa score. Results: Thirty subjects (53 percent male; mean age: 6.3 years) participated. While the mean total scores for articaine (2.13 MBPS; 0.53 WBS) were better than for lidocaine (3.07 MBPS; 1.33 WBS), there were no statistically significant differences between groups. All physiological measurements were within normal limits. Conclusions: This pilot study indicated that articaine infiltration might be as effective as a lidocaine inferior alveolar nerve block for restorative treatment of primary mandibular molars; however, a larger sample is required to confirm these findings.

Prevalence of Radiographically Identifiable Dental Anomalies in Children and Association with Health Status.

Purpose: The purpose of this study was to describe the prevalence of radiographically identifiable developmental dental anomalies (DDA) in a university-based pediatric dental clinic and to assess for associations between DDA and health status. Methods: Retrospective data, obtained from the electronic dental records of a three-year pediatric patient cohort, were evaluated by two trained and calibrated examiners. Strict inclusion/ exclusion criteria were applied. A validated image quality grading system was used for radiograph assessment, and the physical status classification of the American Academy of Anesthesiology was utilized. A chi-square test and bivariate logistic regression were used for statistical analysis. The inter- and intraexaminer reliability was assessed using Cohen's Kappa. Results: A total of 1,478 subjects (69 percent medically healthy) were enrolled. DDA were identified in 25 percent of the subjects, with hyperdontia, hypodontia, and microdontia being more common. A statistically significant association was found between the presence of DDA and health status (P<0.001) and between DDA and asthma (P=0.035). Patients with systemic disturbances showed 2.12 times greater odds of having DDA (P<0.001, 95 percent confidence interval equals 1.7-2.7). Conclusions: The prevalence of developmental dental anomalies was high, with one in four patients affected. DDA in number were the most common. Patients with systemic disturbances had greater odds of having DDA.

Dental and oral care for chronically ill children and adolescents.

Dental care is the most unmet health care need of children and adolescents who have chronic conditions and diseases. Because advances in therapy and medical technology have extended the lives of this population, it is very likely that these children will seek care in general dental practices. It is extremely important for dental practitioners to be knowledgeable about their patients' history and medical treatment to deliver care safely. This article reviews four chronic diseases of childhood (asthma, cystic fibrosis, cancer, and sickle cell disease) and discusses recommendations for oral and dental treatment.

Female Caregivers' Depression Risk Affects Children's Attendance to Dental Appointments: A Pilot Study.

Purpose: This pilot study aimed to evaluate the association between women's depression risk and their children's return for dental treatment. Methods: A total of 175 female caregivers of children presenting for an initial dental examination between May and October 2019 at a university clinic answered demographic questions and a validated survey on depression risk. An analysis of caregiver's depression risk relative to children's attendance at the next treatment appointment was made. Results: One hundred and eight female caregivers were included in the analysis. Average age was 33 years (standard deviation ± 6.5 years), and 52 percent were Hispanic. The rate of risk for depression was 17.5 percent. Most women at risk lived at least 20 miles away, had an income of less than $29,999, were unemployed or employed part-time, and had no help with childcare. White caregivers were more likely to fail to attend their child's appointment (chi-square [X²] = 7.80, P=0.02) while Hispanic women were more likely to return (X² = 4.10, P=0.04). Caregivers with low depression risk were more likely to return for the child's scheduled appointment (X² = 13.37, P<0.001). Thus, there was a positive association between high depression risk and failed appointments (r=0.474, P<0.01). Conclusion: Children of women at risk for depression are more likely to fail to attend their dental appointment.

The impact of oral health on the quality of life of young patients with congenital cardiac disease.

The purposes of our study were, first, to determine the prevalence of dental caries in young patients with congenital cardiac disease, second, to determine the effect of oral health in their quality of life, third, to examine parental knowledge about associations between oral health and cardiac health, and fourth, to examine parental perceptions regarding access to dental care. A standardized questionnaire was given to a convenience sample of parents of 43 children with cardiac disease and 43 healthy controls from 12 to 71 months of age. In every patient, we performed a dental examination. Descriptive statistics, the two-tailed t-test, and Fisher's exact test were used for statistical analysis. Of the children with cardiac disease, 17% had caries, compared to 13% of the control group. Almost half of those with cardiac disease had never seen a dentist, compared to 35% of the control subjects. Of the parents of those with cardiac disease, one-fifth did not know whether oral health was important for the heart, compared to one-tenth of controls. Insurance and access to care were not barriers to obtain dental treatment. Statistically significant differences were, first, parents of children with congenitally malformed hearts felt more guilt about their child's oral health than control parents (p = 0.026), second, they were more upset about the dental problems and/or treatments of their children (p = 0.012), and third, they thought that dental problems and/or dental treatment made their children more irritable (p = 0.012). Our findings indicate that it is of paramount importance that cardiologists and their associated staff educate patients and families about oral health and other issues associated with congenital cardiac disease.

Characteristics and Professional Development Needs of Pediatric Dentistry Chairs in the United States and Canada.

Purpose: To describe the demographics of pediatric dentistry department chairs in the United States and Canada, characterize the skills and abilities required for the job, understand how they spent their time, and identify their professional development needs. Methods: An electronic survey was sent to 88 department chairs about personal demographics, leadership, management and personal qualities important for the job, and professional developmental needs. The data were analyzed using descriptive statistics. Results: The response rate was 62.5 percent. The respondents' mean age was 54.5 years (±8.9 years standard deviation); 68.2 percent of respondents were male, and 57 percent were Caucasian non-Hispanic. Most obtained their dental degree and specialty training in the USA, and 85 percent were board certified. They worked an average of 49.4 hours a week, spending a lot of time dealing with communications, teaching, and administrative materials. More than 80 percent lacked clear job expectations provided to them or they were only reviewed verbally. A minority (10.8 percent) was dissatisfied or very dissatisfied with the job. Conclusions: Most chairs were Caucasian, male, challenged by faculty and administrative issues and received no clear expectations for the job but were satisfied overall. Developing leadership and mentorship skills were important for the job execution.

Effect of Overlying Material on Final Setting of Biodentine ® in Primary Molar Pulpotomies.

Purpose: The purpose of this study was to evaluate and compare in vitro the effect of overlying materials, including zinc oxide eugenol (ZOE), resin-modified glass ionomer cement (RMGIC), and stainless steel crowns (SSC) cemented with glass ionomer cement (GIC), on the setting of Biodentine ® (BD) used as a pulpotomy agent in primary molars that were restored definitively in a single visit. Methods: Forty extracted primary molars were prepared to replicate pulpotomy procedures. The teeth were randomly allocated to four restorative groups: (1) BD, ZOE, SSC; (2) BD, RMGIC, SSC; (3) BD, SSC; (4) BD only (control). All samples were incubated for 24 hours, sectioned mesial-distally, and polished. BD setting was measured as a function of Knoop hardness value (HK) using a Leco Microhardness Tester. Each sample was tested in three zones with 50 gf load force and 30 seconds dwell time and at one, two, and three mm distance from the BD-material interface. A one-way analysis of variance was used to determine statistical significance between groups (P<.05). Results: There was no statistically significant difference between the mean HK value among the four groups and three zones. Conclusions: Overlying materials, including zinc oxide eugenol, resin-modified glass ionomer, and stainless steel crowns cemented with glass ionomer cement, showed no effect on the BD final set. This in vitro study found no evidence against immediate definitive restoration of Biodentine ® pulpotomies.