The influence of location of local anesthesia and complexity/duration of restorative treatment on children's behavior during dental treatment.

PURPOSE: The purpose of this study was to investigate whether the region of local anesthetic injection and the complexity and duration of restorative treatment were associated with children's behavior during and immediately after dental treatment. METHODS: This study examined 90 children, divided into two age groups (2-3.5 years old and > 3.5-5.5 years old), who underwent dental treatment while lightly sedated. The region of local anesthesia (maxillary infiltration or mandibular block), complexity and duration of treatment, and behavior during and after treatment were assessed. RESULTS: Children's behavior during and after dental treatment, within and between age groups, was not found to be associated with the region of local anesthesia or complexity of treatment. For both age groups, more children exhibited negative behaviors during treatment when procedures exceeded 30 minutes. For younger children, more negative behaviors were also observed after longer vs shorter procedures. CONCLUSION: Treatment duration, not the region of local anesthesia or complexity of treatment, was associated with children's behavior during and after dental procedures.

Oral health status and salivary properties in relation to gluten-free diet in children with celiac disease.

BACKGROUND: Patients with celiac disease (CD) have a wide variety of symptoms, from being asymptomatic to having chronic diarrhea, abdominal pain, and extraintestinal symptoms. In the oral cavity, enamel defects and recurrent aphthous stomatitis are the most common symptoms. The aim of the study was to assess oral health, bacterial colonization and salivary buffering capacity of patients with CD at diagnosis were compared with patients with CD receiving a gluten-free diet (GFD) and healthy children. METHODS: Three groups were prospectively investigated: newly diagnosed CD, CD treated with GFD, and a control group. All of the children were examined by pediatric dentists, and saliva samples were collected for bacterial and pH analysis. RESULTS: Ninety children were enrolled in the study, 30 in each group. A higher prevalence of enamel hypoplasia (66%) was found in children with CD. Plaque index was significantly lower in the celiac-treated group, which correlated with oral health behavior: teeth brushing and frequency of eating between meals. Children receiving GFD brushed their teeth and used fluoride significantly more often than other children in the study. No difference between groups was found in snack consumption, mutans streptococci and lactobacilli counts in saliva, as well as pH and buffer capacity. CONCLUSIONS: A lower degree of plaque was found in children with CD receiving GFD. This finding could not be explained by salivary properties or bacteria, but rather by better oral hygiene. The results should raise the awareness of pediatric gastroenterologists toward oral health-related issues in children with CD.

Salivary bacteria and oral health status in medicated and non-medicated children and adolescents with attention deficit hyperactivity disorder (ADHD).

OBJECTIVES: Attention deficit hyperactivity disorder (ADHD) is a childhood neurological disorder. Studies have shown that children with ADHD are more prone to caries than those without. The study investigated children diagnosed with ADHD, both with and without pharmacological intervention, and the following: DMFT\dmft, plaque index (PI), mutans streptococci (MS) levels, lactobacilli (LB) levels, salivary flow, salivary buffer capacity, oral hygiene, and diet. STUDY DESIGN: DMFT/dmft index, PI, MS and LB levels, salivary flow, and salivary buffer capacity were examined in three groups of children: ADHD1-diagnosed with ADHD with no pharmacological intervention (N = 31), ADHD2-treated with medications for ADHD (N = 30), and a healthy control group (N = 30). Diet and oral health habits were assessed through questionnaires completed by parents. RESULTS: There were no differences in the DMFT/dmft index, MS and LB counts, salivary buffer capacity, and parent reported diet and oral health behavior between the three groups. Children with ADHD demonstrated a higher plaque index. CONCLUSIONS: Although children with ADHD did not report different diet and oral health behavior from children without ADHD, this group had significantly higher levels of plaque than the control group, which combined with hyposalivation may be a risk factor for caries at an older age. CLINICAL RELEVANCE: Medicated and non-medicated ADHD children were similar to control children in their caries rate, MS and LB counts, salivary buffer capacity, and diet and oral health behavior. They differed in the amount of plaque found on their teeth. As a group, ADHD children demonstrated hyposalivation compared with the control.

Validation of a Hebrew version of the child-OIDP index, an oral health-related quality of life measure for children.

PURPOSE: Sociodental indicators assess to what extent oral conditions interfere with normal social functions and alter behaviour such as attending work or school, parenting or home chores. The child OIDP (oral impact on daily performance), a sociodental indicator developed by Adulyan and Sheiham, is easy to apply and has a scoring system that quantifies the effect both by extent and frequency. The purpose of this study was to adapt the child OIDP into Hebrew and evaluate its validity and reliability. MATERIALS AND METHODS: The questionnaire was translated from English into Hebrew and back again. After receiving permission from parents and from the children attending the consultation clinic of the Department of Children's Dentistry at the Hebrew University-Hadassah Dental School, we examined their dental condition and asked them to answer the questions. According to the results, we analysed the reliability and the validity of the questionnaire. RESULTS: 179 children aged 6-11 years answered the questions. 88.8% of the children that attended the dental clinic experienced an oral or dental problem and 52.5% of them experienced interference in at least one of 8 everyday activities because of oral or dental problems in the 3 months prior to the interview. The OIDP was found valid in the aspects of Face, Content and Construct validity and with good internal reliability. CONCLUSIONS: The validity and the reliability of the Hebrew child OIDP found in the present study enables its use in future studies to assess the impact of oral health on children's quality of life.

The traditional practice of canine bud removal in the offspring of Ethiopian immigrants.

BACKGROUND: The custom of canine bud removal has detrimental consequences on children's general health and dental care. The objective of this study was to assess whether the prevalence of missing primary canines and dental defects in offspring of emigrants from Ethiopia is greater than in offspring of native Israeli parents of similar socioeconomic class. METHODS: 477 children of Ethiopian descent and 317 offspring of native Israeli parents, from 21 nursery schools and kindergartens, underwent dental examinations aimed to determine the presence or absence of primary canines and of developmental enamel defects on adjacent teeth to the primary canines. For purposes of analysis, children were classified into two age groups: younger (ages 18-48 months) and older (ages 49-82 months). RESULTS: Canines were present in more Israeli than Ethiopian younger children, 87.5% vs. 42.3%, p=0.0001; and in more Israeli than Ethiopian older children, 92.6% vs. 40.4%, p=0.0001. More dental defects were detected in Ethiopian than in Israeli younger children, 32% vs. 3.9%, p=0.0001; and in more Ethiopian than Israeli older children, 31.2% vs. 5.8%, p=0.0001. CONCLUSIONS: The prevalence of missing primary canines and dental defects was greater among offspring of parents who had emigrated from Ethiopia 15-20 years earlier than among offspring of native Israeli parents living in the same low socioeconomic neighborhoods.

Elevated salivary potassium in paediatric CKD patients, a novel excretion pathway.

BACKGROUND: Hyperkalaemia is one of the complications of chronic renal failure. Gastrointestinal excretion and cellular uptake are two adaptive mechanisms for extra-renal potassium (K) disposal in these patients. The salivary glands' secretion system can actively excrete K into the oral cavity. METHODS: We examined salivary K levels in four groups of paediatric chronic kidney disease (CKD) patients: 25 pre-dialytic (PreD) patients, 18 patients on maintenance dialysis (D), and 31 transplanted patients with a functioning graft (T), compared with 32 healthy children (C). RESULTS: Salivary K levels were significantly higher in the D and PreD groups than the C group (P = 0.03 and P = 0.0004, respectively). Interestingly, a significant negative correlation was found between glomerular filtration rate and salivary K in PreD and T patients. CONCLUSIONS: We suggest an extension of the gastrointestinal adaptive K pathway via salivary gland secretion in patients suffering from hyperkalaemia.

Salivary bacteria and oral health status in children with disabilities fed through gastrostomy.

OBJECTIVES: This study examined caries level, amount of calculus, and oral microbial environment in gastrostomy tube (GT)-fed children compared with healthy children and children with disabilities orally fed (PO). STUDY DESIGN: The study group consisted of 12 GT-fed children and the two control groups consisted of 16 children with disabilities orally fed and 17 healthy children. DMF-T/dmf-t index, calculus index, Mutans Streptococci (MS), Lactobacilli (LB) levels and salivary buffer capacity were examined. RESULTS: DMF-T/dmf-t index was significantly lower in the tube-fed group. Calculus index was highest in the tube-fed group. MS and LB levels were the lowest in the tube-fed children. Correlation was found between MS and DMF-T/dmf-t. CONCLUSIONS: Tube-fed children demonstrated significantly higher calculus levels and less caries, MS, and LB levels then healthy children or children with disabilities eating PO.

The correlation between dental calculus and disturbed mineral metabolism in paediatric patients with chronic kidney disease.

BACKGROUND: Vascular calcifications have been documented in children with end-stage renal disease. However, only a few reports have described abundant dental calculus formation in children suffering from chronic kidney disease (CKD). Moreover, dental calculus scores (DCS) and their correlation with renal disease severity have not been studied. METHODS: DCS in 74 young CKD patients were evaluated: 25 pre-dialytic (PrD), 18 on dialysis (D) and 31 with transplants (T) compared to 32 healthy participants (C). Saliva and serum analysis included creatinine (Cr), urea (U), calcium (Ca), phosphorous (P), magnesium (Mg) as well as intraoral pH levels. RESULTS: All patient groups presented high DCS. DCS and pH levels were higher in the D group with a positive correlation between pH and lower incisor DCS (r = 0.56, P = 0.017). The highest salivary Ca was found in the PrD group. Salivary P in the PrD group was found to be higher than in the T and C groups. The lowest salivary Mg was found in the D group while the highest salivary Ca x P product was found in the PrD group. In all patient groups, salivary U was higher than in the C group with a 2.5-fold increase in the D group. Salivary Cr resembled the U salivary concentrations. CONCLUSIONS: Alterations in salivary Ca, P, Mg, U, Cr and intraoral pH levels were observed in the patient groups. DCS correlated with renal disease severity and therefore may be a reflection of other tissue calcification pathologies found in these patients.

Orthodontic treatment for the special needs child.

The prevalence and severity of malocclusion is especially high in Special Needs individuals. Many have medical limitations to the various procedures that are often needed in the pursuit of excellence from orthodontic treatment and almost all have moderate to severe behavioural problems that make treatment delivery difficult or even impossible to achieve, with any degree of reliability. Nevertheless, the parents are highly motivated to "do the best for their child" and are prepared to become integral members of the treatment delivery team. The present article analyzes the difficulties involved and makes recommendations as to how these may be overcome, based on the authors' published studies in this area and on their broad experience in treating these compromised individuals. Emphasis is placed on the use of pharmacological modalities as the means to providing therapeutic access to many of the more difficult patients. Two case reports are provided to illustrate many of the important principles that pertain to these cases.

Fasting state and episodes of vomiting in children receiving nitrous oxide for dental treatment.

PURPOSE: The purpose of this controlled-crossover study was to determine the frequency of vomiting during nitrous oxide / oxygen analgesia (NOA) and assess the relationship between fasting status and vomiting. METHODS: One hundred and thirteen children (64 male, 49 female), ranging in age from 24-160 months (mean = 74) and a mean weight of 23 kg (range 11-60 kg), participated in the study. At the initial examination, subjects were randomly assigned to be either fasting on the first appointment and non-fasting during the second appointment or alternatively be non-fasting for the first appointment and fasting for the second. RESULTS: The average time interval between eating and treatment in the fasting sessions was 6 hours and in the non-fasting group, 1 hour before treatment. Vomiting occurred in only one subject, immediately after cessation of treatment resulting in a frequency of 1% of subjects or 0.5% of sessions. No other differences were found between fasting and non-fasting subjects. CONCLUSION: During dental treatment with NOA using the rapid induction method, constant nonfluctuating concentration/ flow, and treatment time of under 35 minutes, the frequency of vomiting during NOA was found to be 0.5%.

Effects of frequent oral hygiene instructions on microbial levels and salivary buffer capacity in orthodontic patients and their parents.

AIM: To assess whether parental involvement can improve children's oral health as a strategiy to reduce caries risk in children undergoing orthodontic treatment. METHODS: The study population consisted of 40 healthy children aged 7 to 15 years (mean 10.93 ± 2.78) and their accompanying parents (mother or father). Oral hygiene instructions were given simultaneously to all children and accompanying parents every 6 weeks at their regular orthodontic appointments. Levels of Streptococcus mutans and salivary buffer capacity were assessed for both children and parents before and 9 months into orthodontic treatment. RESULTS: The majority of children (74%) and parents (92%) expressed unchanged levels of Streptococcus mutans and stable salivary buffer capacity throughout the study. When analyzing child-parent pairs with respect to Streptococcus mutans and salivary buffer capacity, no significant differences were found prior to treatment. Nine months into treatment, 57% of the children and parents still showed similar Streptococcus mutans counts and buffer capacity. CONCLUSION: The child-parent approach succeeded in preventing deterioration of children's oral hygiene. Parental involvement has an essential part in maintaining children's oral health. Oral health care professionals should partner with parents when implementing any kind of health behavior.

Clinical solutions for developmental defects of enamel and dentin in children.

Developmental defects of enamel (DDE) are frequently observed in pediatric dental patients. Proper diagnosis may improve the clinician's dental care. The purpose of this article is to present the clinical management of some common dental defects: (1) hypoplasia; (2) diffuse and demarcated opacities; (3) fluorosis; (4) amelogenesis imperfecto (Al); and (5) dentinogenesis imperfecto (DI). The comprehensive management of DDE in children and adolescents should include: (1) active follow-up and observation involving oral hygiene instructions; and (2) dietary consultation. Preventive care should be individually tailored according to the patient's risk-assessment analysis. The treatment of DDE involves an approach that includes several disciplines, including: (1) pediatric dentistry; (2) orthodontics; (3) perioprosthetics; and (4) psychology. A close follow-up is essential to achieve long-term success.

Overcoming the oral aspects of -self-mutilation: description of a method.

BACKGROUND/AIM: Self-injurious behavior (SIB) is a serious and chronic condition frequently seen in special needs populations, affecting 10% to 17% of individuals diagnosed with intellectual and/or developmental disabilities. A 2.5-year-old infant with SIB, whose presenting symptoms were severe tongue and lip lacerations accompanied by much hemorrhage, is presented here to illustrate the problem and to show how this may be prevented. MATERIALS AND METHODS: An appliance is described which effectively limits the damage caused by SIB and permits rapid healing of existing injuries. RESULTS: The method provides for a stable, retentive, and comfortable device on the infant's undererupted and largely nonretentive crowns of the deciduous teeth as well as for all permanent teeth in children, adolescents, and adults. CONCLUSIONS: The appliance has been successfully employed for the past 10 years in patients with SIB who have attended for treatment in the Special Needs Clinic in our Department.

Dyskeratosis congenita: dental management of a medically complex child.

Dyskeratosis congenita (DKC) is a rare syndrome characterized by cutaneous hyperpigmentation, nail dystrophy, leukoplakia, and pancytopenia. The purpose of this case study was to describe the management of a 7-year-old girl diagnosed with DKC who urgently needed dental treatment under general anesthesia before bone marrow transplantation (BMT). The patient presented normal skin, nails, and hair, but oral examination revealed a number of ulcers, leukoplakia, gingival recessions, alveolar bone loss, and dental caries. Hematologic preparation included raising blood parameters, and the anesthesiologist to had consider pulmonary infection. The alveolar bone loss and the gingival recessions required the consultation of a periodontist. Avoiding stainless steel crowns was necessary due to potential plaque accumulation in the crown margins. The goal of this dental treatment was eliminating potential sources of infection before transplantation was conducted. It is important for the pediatric dentist to recognize the medical aspects associated with dental management prior to BMT, and to incorporate them into the treatment plan.

Comparison of oral midazolam with and without hydroxyzine in the sedation of pediatric dental patients.

PURPOSE: The purpose of this study was to compare the effectiveness of midazolam (MDZ) alone to a combination of MDZ and hydroxyzine (MDZH) when sedating young children for dental treatment. METHODS: This was a prospective, double-blinded, crossover clinical study of young uncooperative children in need of at least 2 restorative visits. Twenty-eight children, ages 21 to 56 months, with a mean age of 36.6 months, participated in this study. The subjects were assigned randomly to receive either 0.5 mg/kg of oral MDZ 20 minutes prior to the beginning of dental treatment or the combination of 0.3 mg/kg oral MDZ with 3.7 mg/kg of hydroxyzine 30 minutes before treatment. The alternative drug regimen was administered at the second appointment. All subjects also received 50% nitrous oxide and were restrained with a papoose board. The child's behavior (quiet or crying, relaxed or moving) was evaluated every 5 minutes by an experienced pediatric dentist who was unaware of the drug given to the child. At the conclusion of treatment, each session was evaluated for overall effectiveness. RESULTS: Regardless of the type of premedication, more patients exhibited quiet behavior at the beginning of treatment, with an increase in crying and movement toward the end of treatment. Regarding movement, a significant difference was observed during the first 20 minutes between the 2 regimens. MDZ showed more children exhibiting movement. During the first 30 minutes of treatment, more children cried in the MDZ group, while MDZH presented more children asleep or quiet. No significant differences were found in behavior as a function of the order the sedative regimens were given. No significant differences between the 2 regimens regarding overall behavior and success (t=0.655 at 27 degrees of freedom; P=.518) were found. CONCLUSIONS: The combination of hydroxyzine (3.7 mg/kg) with MDZ (0.3 mg/kg) administered 30 minutes before treatment resulted in safe and effective sedation for the dental treatment of young children. This combination's use might be more advantageous when compared to MDZ alone, resulting in less crying and movement during the first 30 and 20 minutes, respectively.

Cytokine levels in gingival crevicular fluid of erupting primary teeth correlated with systemic disturbances accompanying teething.

PURPOSE: The aim of this study was to investigate whether there are increased levels of the inflammatory cytokines IL-1beta, IL-8, and TNFalpha in the gingival crevicular fluid (GCF) of erupting primary teeth. This increase could explain such clinical manifestations as fever, diarrhea, increased crying, and sleeping and eating disturbances that occur at this time. METHODS: Sixteen healthy children aged 5 to 14 months (mean=9.8 months) were examined twice a week over 5 months. Gingival crevicular fluid samples were taken from erupting teeth. As a control, GCF was collected from the same teeth 1 month later. Cytokine production was measured by ELISA. Signs and clinical symptoms were listed. Pearson correlation coefficients were used in the comparisons described below. A paired t test was used to analyze the same variable at different times. RESULTS: Fifty teeth of the 16 children were studied. GCF samples were collected from 21 of these teeth. Statistically significant differences (P<.05) were found with regard to the occurrence of fever, behavioral problems, and coughing during the teething period and the control period. During the control period, 72% of the children did not exhibit any clinical manifestations, whereas during the teething period only 22% of the children did not exhibit any clinical manifestations. The study revealed high levels of inflammatory cytokines during the teething period, with a statistically significant difference in TNFalpha levels (P<.05) between the teething period and the control period. Correlations were found between cytokine levels and some of the clinical symptoms of teething: IL-1beta and TNFalpha were correlated with fever and sleep disturbances; IL-beta and IL-8 were correlated with gastrointestinal disturbances; IL-1beta was correlated with appetite disturbances. CONCLUSIONS: Cytonkines appear in the GCF of erupting prmary teeth. The cytokine levels are correlated to some symptoms of teething.

Stimulated parotid salivary flow rate in patients with Down syndrome.

Saliva is essential for oral defense against infections. Decreased salivary secretion may result in increased dental caries, oral mucosal changes, an altered sense of taste, difficulty in swallowing, and oral pain. A review of the literature reveals sporadic and contradictory reports on the use of sialometry and sialochemistry to explain the role of saliva in the oral health and well-being of subjects with Down syndrome. The present study documents parotid gland saliva secretion at different ages in a group of subjects with Down syndrome. Saliva was collected from 39 patients 11 to 62 years old, by means of a parotid salivary gland cup and under standardized conditions of stimulated secretion. The rate of salivary secretion in the entire group of patients with Down syndrome was lower than that of healthy controls and lower in the older study group compared with the younger group. Institutionalized subjects or those living in hostel-like apartments had a lower secretion rate than those living at home. No difference in salivary flow was found between those patients with Down syndrome with normal thyroid output and those with hypothyroidism who were receiving replacement therapy. In a four-way ANOVA with flow as the dependent variable and Down syndrome, hypothyroidism, institutionalization, and age as factors, Down syndrome was found to be the only variable significantly related to flow (p = 0.017). Our findings indicate that stimulated parotid salivary hypofunction in Down syndrome subjects is mainly related to their genetic disorder.