Selecting an Esthetic Full Coverage Restorative Material for High Caries-Risk Primary Molars.

Full-coverage restorations are indicated for posterior primary teeth as definitive treatments for high caries-risk children and in patients whose treatment is being performed under general anesthesia. Advances in biomaterials and parental preferences have driven interest in esthetic full coverage treatment options for primary posterior teeth. The prefabricated resin crown offers a 'flex fit' adaptation over the anatomic cervical convexity of the primary clinical crown, similar in functionality to a stainless steel crown. A new commercial product, BioFlx, hopes to address the ductility, color stability and durability concerns that glass fiber-reinforced composite crowns have while maintaining the enticing clinical aspects, namely the flex fit, esthetic appearance and more conservative tooth preparation when compared to pediatric zirconia crowns. The purpose of this case report is to describe an alternative restorative material that can be employed to deliver an esthetic full coverage solution in a child with a potential nickel allergy.

Case report of an extra-oral cutaneous sinus tract of endodontic origin in a patient with autism spectrum disorder.

BACKGROUND AND OVERVIEW: Extraoral cutaneous sinus tracts (EOCST) are often misdiagnosed due to their unexpected appearance without history of odontogenic pain, discomfort, or cellulitis. Diagnosis can be further confounded in those with sensory processing difficulties since patients can have a hypersensitivity to sensory input, but simultaneously demonstrate hyposensitivity and indifference toward pain. EOCST misdiagnosis and resultant mismanagement can lead to multiple surgical excisions, biopsies, and elongated antibiotic regimens, with eventual lesion recurrence. CASE DESCRIPTION: A 19-year-old white male with autism spectrum disorder in the period of transitional dental care presented with a history of a chronic EOCST. The patient required sedation for evaluation, biopsy, and was initially managed by infectious disease under the impression of an actinomycosis infection. The patient completed a twelve-month course of antibiotic therapy with subsequent lesion re-occurrence. Eventually, the diagnosis of an EOCST of dental origin was confirmed. It was determined that pulpal necrosis was due to localized dental trauma of the lower left central incisor, as a result of a self-injurious behavior. Root canal treatment eventually led to the resolution of the lesion. It took three years from initial clinical presentation for the resolution of the lesion. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Collaboration between the medical and dental healthcare team in diagnosis and treatment planning for a patient with special needs is essential to ensure prompt and appropriate care for this patient group.

Brief Communication A Retrospective Evaluation of a Program's Use of Indirect Pulp Therapy for Primary Molars.

PURPOSE: The purpose of this retrospective study was to assess how procedural code trends reflect the adoption of evidence-based best-clinical-practice guidelines in a hospital-based pediatric dental residency program. METHODS: Data on frequency of indirect pulp therapy (IPT) and primary pulpotomy (P) utilization were assessed from 2008 to 2020. RESULTS: The rate of procedural change between IPT and P significantly differed (P<0.001) over 12 years. The total procedural frequency of IPT overcame P around the years 2014 to 2015. CONCLUSIONS: From 2008 to 2020, indirect pulp therapy became the vital pulp therapy of choice in a hospital-based pediatric dental residency program. This trend likely reflects guidelines from major publications on the subject matter and changing philosophies on vital pulp therapy at this hospital-based residency program. Using available data (in this case, procedural codes), dental education programs can identify shifts in care and teaching trends on capstone procedures like vital pulpotomy.

Oral Manifestations and Quality of Life in Children with Tuberous Sclerosis Complex: A Descriptive Study.

Purpose: The purpose of this descriptive study was to describe oral manifestations and oral health quality of life (QOL) in children aged six months to six years, 11 months with tuberous sclerosis complex (TSC). Methods: Parents of participants completed an oral health QOL survey. The presence of oral lesions associated with TSC was assessed. Results: Sixty-two participants enrolled between February 2015 and March 2017. Among the significant oral health findings, 11 (17.7 percent) had enamel pitting, 33 (53 percent) had no previous dental examination, eight (12.9 percent) did not brush their teeth, and eight (12.9 percent) had caries present. Per the QOL survey results, 18 (31 percent) had difficulty sleeping, 22 (37.3 percent) experienced irritability/frustration, and 15 (29.4 percent) had difficulty pronouncing words. Developmental delays were present in 40 (70.2 percent), seizures occurred within the last three months in 37 (59.7 percent), and a mammalian target of rapamycin inhibitor medication was used for 22 (35.4 percent). Conclusions: Enamel pitting was observed in 17.7 percent of children in the primary dentition. Oral health quality of life in this tuberous sclerosis complex cohort was significantly reduced.