Parental Perception of Oral Health and Oral Health Status of Pediatric Patients Attending an Urban Craniofacial Center.

OBJECTIVE: The objectives of this study were to assess the oral health status and parental perception of oral health needs of pediatric patients in an urban Craniofacial Center. DESIGN: This research utilized a prospective cross-sectional matched study design. The data was collected prospectively via clinical oral examinations measuring dental caries experience and gingival health status. Parental perception of oral health was assessed through a validated questionnaire. SETTING: The study was conducted at a Pediatric Dentistry Department and Craniofacial Center (CFC) in a large urban American city. PATIENTS/PARTICIPANTS: Participants were recruited and enrolled from a CFC and Pediatric Dental Clinic. MAIN OUTCOME MEASURE(S): The outcome measures were the oral health status and parental perception thereof. RESULTS: CFC patients' caries experience in primary teeth was significantly lower than that of a healthy matched cohort, but statistically similar in permanent teeth. CFC patients had significantly higher unmet dental treatment needs. CFC patients had poor oral hygiene and were shown to have significantly higher plaque levels and worse gingival health than that of a healthy matched cohort. Parental perception of oral health did not show a statistically significantly difference between the two groups. CONCLUSIONS: Patients in our study in an urban CFC were found to have a high unmet dental and poor oral hygiene. Despite the poor oral health status, parents of children with craniofacial anomalies did perceive their oral health as different from a matched cohort of patients without these conditions.

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.

Pulp therapy for primary and immature permanent teeth: an overview.

Pulp therapy for pediatric patients aims to alleviate pulpal infection, relieve associated symptoms, and, ultimately, preserve the tooth. Primary teeth adequately retain space for their successors and have been described as "the best space maintainers." Therefore, the decision to extract a primary tooth should take into consideration occlusal growth and development as well as the potential outcome of pulp therapy. Maintaining pulpal vitality in young permanent teeth is essential for continued root formation; if vitality is lost, the root will cease growth and remain at an unfavorable length. A systematic approach to diagnosis and treatment planning is imperative, and a good history of signs and symptoms and a detailed evaluation of radiographs are prerequisites to accurate diagnosis. The purpose of this review is to aid dental professionals in correctly establishing a pulpal diagnosis and selecting the appropriate method of pulp therapy to achieve a successful outcome. The article discusses contemporary views on indications and pulp medicaments and presents step-by-step descriptions of pulp treatments for both primary and immature permanent teeth.

Premixed Mineral Trioxide Aggregate Setting Reaction in Primary Molar Pulpotomies.

Purpose: To assess the setting of premixed mineral trioxide aggregate (NuSmile NeoPUTTY) when used as a pulpotomy agent in primary molars, restored in a single visit, and to compare the effect of overlying materials, including zinc oxide eugenol (ZOE), resin-modified glass ionomer cement (RMGIC) and stainless steel crowns (SSC), on the microhardness of the NeoPUTTY.
Methods: Forty-eight extracted primary molars were prepared with the standard pulpotomy technique. Approximately three mm of NeoPUTTY were placed on the pulpal floor of each tooth. The teeth were divided into four groups according to restorative material: (1) control group-none; (2) RMGIC; (3) ZOE; and (4) ZOE and SSC. Groups 2, 3 and 4 specimens were placed in artificially simulated oral cavity conditions. After 24 hours, all teeth were sectioned mesiodistally and polished. Microhardness was then measured in Knoop scales (HK) at one mm, two mm and three mm away from the NeoPUTTY-overlying material interface following the application of a 25-gf load force for 30 seconds at each site. One-way analysis of variance was used to compare the NeoPUTTY microhardness values between groups at each depth as well as between the three different depths within each group (P <0.05).
Results: No statistically significant differences in mean HK values (57.9 to 62.3 range) were found between groups at each depth, or between depths within each group (Group 1,P =0.328; Group 2, P =0.74; Group 3, P =0.293; Group 4, P =0.788).
Conclusion: The setting reaction of NeoPUTTY, as a function of microhardness, was not affected by the presence or type of overlying material used in a single-visit pulpotomy. This in vitro study found no evidence against the immediate restoration of primary molar pulpotomies done with NeoPUTTY.

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.

Cone pathway dysfunction in Jalili syndrome due to a novel familial variant of CNNM4 revealed by pupillometry and electrophysiologic investigations.

PURPOSE: To evaluate retinal function in a family presenting with Jalili syndrome due to a previously unreported variant in CNNM4. METHODS: A family of three sisters with a novel CNNM4 variant, c.482 T > C p.(Leu161Pro), and ten visually normal, age-similar controls participated in this study. The subjects underwent detailed dental examinations and comprehensive ophthalmological examinations that included color vision testing, retinal imaging, and electroretinography. Full-field light- and dark-adapted luminance thresholds were obtained, in addition to light- and dark-adapted measures of the pupillary light reflex (PLR; pupil constriction elicited by a flash of light) across a range of stimulus luminance. RESULTS: Clinical findings of cone dysfunction and amelogenesis imperfecta were observed, consistent with Jalili syndrome. Light-adapted ERGs were non-detectable in CNNM4 subjects, whereas dark-adapted ERGs were generally normal. Full-field luminance thresholds were normal under dark-adapted conditions and were elevated, but measurable, under light-adapted conditions. The CNNM4 subjects had large PLRs under dark-adapted conditions and responses near the lower limit of normal, or slightly subnormal, under light-adapted conditions. CONCLUSION: CNNM4 variants can result in Jalili syndrome with cone dystrophy and generally preserved rod function. The PLR may be a useful measure for evaluating cone function in these individuals, as robust cone-mediated PLRs were recordable despite non-detectable light-adapted ERGs.

Evaluation of a Near-Infrared Light Transillumination Device for Caries Detection in Interproximal Primary Molar Surfaces.

Purpose: To evaluate the sensitivity and specificity of the near-infrared light transillumination caries detection method by using DEXIS CariVu (DCV) for imaging of interproximal primary molar surfaces (IPMS).
Methods: A retrospective evaluation of patient records at a university pediatric dentistry (PD) clinic identified 22 patients with unrestored IPMS, which had images of both bitewing radiography (BW) and DCV. A scoring system (no caries, incipient caries, dentinal caries) was developed for the study. Two investigators (pediatric dental faculty) identically scored 90 IPMS in both BW and DCV images, establishing benchmark IPMS scores. The 180 images were then compiled in a randomized order in a questionnaire, which was answered by 24 raters (PD residents and faculty) using the study caries scoring system. Data analysis included raters and experts' percent agreement, Vassar Stats for sensitivity and specificity, and Kendall's correlation coefficient for interrater reliability.
Results: The overall agreement between raters and experts for DCV images was 48 percent (54 percent for no caries, 23 percent for incipient caries, and 68 percent for dentinal caries). The DCV's sensitivity and specificity to detect any caries were, respectively, 0.72 and 0.54, 0.60 and 0.53 for incipient caries, and 0.82 and 0.53 for dentinal caries. The BW's sensitivity and specificity to detect any caries were respectively, 0.82 and 0.87, 0.98 and 0.86 for incipient caries, and 0.99 and 0.87 for dentinal caries. The overall interrater reliability was 0.48 (95 percent confidence interval equals 0.46 to 0.50).
Conclusion: The use of DCV as a stand-alone caries detection method for IPMS is limited.

A Randomized Controlled Trial Comparing the Success of Mineral Trioxide Aggregate and Ferric Sulfate as Pulpotomy Medicaments for Primary Molars.

Purpose: To evaluate and compare the clinical and radiographic performance of a new type of mineral trioxide aggregate (MTA, NuSmile® NeoMTA®) and ferric sulfate (FS) as pulpotomy medicaments for primary molars over 12 months.
Methods: Fifty participants (25 per group) were enrolled, according to specific inclusion criteria. Each participant received a single primary molar pulpotomy either with MTA or FS, depending on random digit table method allocation. Fifteen pediatric dental residents completed all pulpotomies, supervised by specialist faculty. Two calibrated examiners performed outcome assessments according to standardized criteria. Every six months, the study teeth were evaluated clinically and every 12 months radiographically. The inter- and intraexaminer reliability was assessed using Cohen's kappa, and the chi-square test was used for statistical analysis.
Results: At six months, 42 participants (21 in each group) returned for evaluation. The FS group showed 95.2 percent clinical success compared to 100 percent for the MTA group. At the 12-month clinical and radiographic evaluation, the return sample consisted of 29 participants (14 in the MTA group, 15 in the FS group). FS had 86.6 percent clinical success and 60 percent radiographic success, while MTA showed 100 percent clinical and radiographic success. At 12 months, MTA showed a statistically significantly higher success rate compared to FS (P = 0.008). Examiner reliability was excellent with a kappa score greater than 0.88.
Conclusion: At 12 months, MTA showed superior success as a pulpotomy medicament in primary molars compared to FS.

Factors associated with moderate sedation attendance at a university-based pediatric dental clinic.

PURPOSE/OBJECTIVES: To evaluate patient attendance for moderate sedation (MS) at a university-based pediatric dental clinic; to identify factors with negative impact on MS being completed and to assess for associations between no-show appointments and patient variables METHODS: The electronic health records of patients scheduled for MS appointments in a 22-month period were assessed by a single investigator. Demographic and clinical data related to appointment attendance and MS procedure performance were collected and statistically analyzed using chi-square, Spearman's rho correlation tests, and logistic regression (p < 0.05) RESULTS: A total of 618 scheduled MS appointments were included. The MS appointment no-show-rate was 17.1 percent. Appointment confirmation (p = 0.001) and dmft score ≥ 9 (p = 0.039) had positive correlation with attendance, while "no-shows" history (p = 0.024) and longer waiting time (p = 0.040) had negative impact on attendance. About 20% of attended MS were not completed, with main reasons of airway risk (32.3%), ongoing illness (28.4%), and violation of NPO guidelines (21.5%). Race, ethnicity, language spoken, child's behavior, and distance traveled had no significant impact on attendance CONCLUSION: Interventions to decrease non-attendance rates should target patients who are unconfirmed, have a history of no-show appointments, and are scheduled well before the sedation appointment.

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.

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.

Aggressive Fibromatosis in the Mandible of a Child: A Rare Case Report.

Aggressive fibromatosis (AF) is an uncommon, benign, collagen-forming soft tissue neoplasm that is characterized by monoclonal myofibroblast cell proliferation and derived from musculoaponeurotic structures. It has a locally invasive pathological behavior and a high potential for recurrence. Fibromatoses with onset in infancy and childhood are characterized with higher cellularity and more aggressive growth. The mainstream management of AF is surgical removal with microscopically lesion-free margins. In advanced cases, radical surgery can lead to function loss and disfigurement. Hence, early diagnosis and management can avoid complications. Although uncommon (two to four cases per million per year are reported), approximately 25 percent of AF incidents occur in children younger than 15 years of age. Pediatric dentists are likely to be the first practitioners to encounter new cases of AF in younger populations and should have knowledge and understanding of this entity. The purpose of this report is to present a rare case of AF affecting the mandible of a young patient.

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.

Dental Management Considerations in a Pediatric Patient with Moyamoya Disease.

Moyamoya disease is a rare progressive cerebral arteriopathy associated with risk of ischemic and hemorrhagic brain complications. The dental care of affected individuals should be performed in a pain- and stress-free manner to decrease the chance of occurrence of episodes of hypocapnia, hypercapnia, hypotension, hypovolemia, and hypothermia. Dental treatment may be provided in an outpatient dental setting or in a hospital setting, but both venues require interdisciplinary collaboration to ensure safe delivery of patient care. In cases of general anesthesia, the perioperative management must be well-coordinated between dental clinicians and anesthesiologists to minimize the risk of adverse events. The purposes of this paper are to present the case of an eight-year-old Asian male with Moyamoya disease, and to discuss important aspects of his dental, behavioral, and medical management.

Chairside repair of preveneered primary molar stainless steel crowns: a pilot study.

PURPOSE: To evaluate the success of a direct chairside method for repair of esthetic facings in NuSmile® and Kinder Krowns® pediatric crowns. METHODS: A rapid direct chairside technique was developed for repair of fractured facings of preveneered primary molar crowns using the Co-Jet system to pretreat the exposed metal subsurface and composite resin (Herculite XRV). A total of 19 posterior crowns were included in the pilot sample. The loss of veneer was categorized as less than 50 percent and over 50 percent of the surface area. All clinical repairs were completed by one operator and evaluated by one examiner after three months. RESULTS: Clinically, all patients accepted the repair process achieved within 15 minutes. The repair was either fully intact (N=5) or completely lost (N=14) by three months. No crowns showed partially lost repairs. This protocol had a low success rate of 26 percent. The two successfully repaired Kinder Krowns® had the greatest occlusal surface area rebonded, exposing more fenestrations of the metal subsurface. CONCLUSIONS: Due to poor retention of the repaired composite, this protocol cannot be recommended routinely for in vivo repair of preveneered stainless steel crowns with fractured facings. It could be considered as an interim procedure in selected cases.

A randomized clinical trial investigating the performance of two commercially available posterior pediatric preveneered stainless steel crowns: a continuation study.

PURPOSE: This study aimed to compare the clinical and radiographic success of preveneered posterior NuSmile® and Kinder Krowns® over one year and to assess the level of parental satisfaction with their esthetics. METHODS: Three trained operators placed 120 crowns in a split-mouth design with a random allocation for 36 participants (mean age: 5.8 years) who received two, four, six, or eight crowns. Blind assessment of the clinical and radiographic performance of the restorations was performed by four calibrated examiners after one year. Results were analyzed by Fisher's exact test and McNemar test. Examiner reliability was determined by Cohen's kappa score. Visual analogue scale (VAS) was used to assess the level of parental satisfaction. RESULTS: All crowns but one were retained, and the majority (83 percent) had no facing fractures. Parental satisfaction was high (9.4/10 on the VAS). Primary maxillary first molar crowns had more occlusal facing fractures than their mandibular counterparts (P=.02). Primary mandibular second molar crowns showed more facing fractures than their maxillary counterparts (P=.008). Both types showed no statistical difference in most categories, but Kinder Krowns had more facing fractures (P<.02). CONCLUSION: Posterior preveneered crowns have predictable durability at 12 months while offering natural appearance to restored teeth.

Posterior preveneered stainless steel crowns: clinical performance after three years.

PURPOSE: The purpose of this study was to evaluate the clinical performance of posterior preveneered stainless steel crowns after three years. METHODS: NuSmile crowns and Kinder Krowns were randomly allocated on paired molars using a split-mouth design. Variables such as fracture, wear, gingival health, and esthetics were recorded. (P<.05). RESULTS: Statistical analysis was completed on 34 paired crowns in 14 children. After three years, 53 percent of crowns were fracture free compared to 81 percent at one year. There was minimal esthetic impact for most fractures due to the location of the veneer fracture, but five crowns had extensive fracture. No difference was reported in the clinical performance between the two crown types. Fracture was more likely to occur where the adjacent tooth was missing. Parents reported a satisfaction rating of 8.3 out of 10. CONCLUSIONS: Clinical performance of both crown types was similar and successful for three years. Facing fracture occurred in 47 percent of crowns but had minimal impact on the esthetic value or parental satisfaction in the majority of cases. These crowns offer an esthetic alternative to the traditional stainless steel crown, but parents should be alerted to the possibility of veneer loss over time.