Sugar substitutes on caries prevention in permanent teeth among children and adolescents: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to systematically review the effect of sugar substitute consumption on caries prevention in permanent teeth among children and adolescents. DATA: Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing the clinical effect of sugar substitutes (both high- and low-intensity sweeteners) in preventing caries in permanent teeth among children and adolescents aged 6-19 were included. SOURCES: A systematic search was conducted in three databases (PubMed, Web of Science and Embase) without any restrictions on publication year. STUDY SELECTION: The initial search found 1,859 items, and finally, 15 studies (11 RCTs and 4 CCTs) with a total of 6325 participants (age: 6-18 years) were included. The Cochrane risk-of-bias assessment tools were used for quality assessment. Most (80%, 12/15) were graded as having a 'moderate' or 'high' risk of bias. All trials investigated sugar alcohol, which is a low-intensity sweetener. Xylitol was the most commonly investigated (73.3%, 11/15), followed by sorbitol (46.7%, 7/15), and erythritol (13.3%, 2/15). Results of the meta-analysis showed that both xylitol (standardized mean difference [SMD]: -0.50, 95% confidence interval [CI] -0.85 to -0.16, P = 0.005) and sorbitol (SMD: -0.10, 95% CI: -0.19 to -0.01, P = 0.03) had a significant effect in preventing dental caries compared to no treatment/placebo. No clinical trials on high-intensity sweeteners such as aspartame and saccharin were found. CONCLUSION: The consumption of xylitol or sorbitol is potentially effective in preventing caries in permanent teeth among children and adolescents. No clinical evidence is available regarding the role of high-intensity sweeteners in caries prevention. CLINICAL SIGNIFICANCE: The use of xylitol or sorbitol as sugar substitutes has a beneficial effect in preventing dental caries among children and adolescents.

Assessing Pediatric Dental Resident Sedation Skills and Confidence with Simulation: A Pilot Study.

Purpose: To conduct a pilot study assessing resident performance and self-efficacy during sedation-related simulations. Methods: Residents completed one informed consent and two sedation-related emergency simulations. Performance was measured for each simulation. Self- efficacy (i. e., confidence) was measured via pre- and post-simulation questionnaires. Descriptive and nonparametric statistics were calculated. Results: Twenty-five residents completed the simulations. Second-year residents performed better than first-year residents in both informed consent and emergency simulations; however, only the informed consent simulation was significant (P<0.02). Self-efficacy significantly increased after completing the simulations (18 percent pre-simulation versus 42.7 percent post-simulation, P<0.001). Residents identified communication skills as an area of improvement after the simulations. For the emergency vignettes, residents expressed feeling inadequate knowledge, problem-solving skills, and teamwork during the simulation. Conclusions: Simulations improved resident confidence in obtaining informed consent and managing certain sedation-related emergencies, but residents felt ill-prepared to manage an emergency. Further study is warranted to understand the best-practice frequency of sedation-related emergency simulation to promote skill retention.

Traumatic dental injuries in high school athletes in the United States of America from 2005 to 2020.

BACKGROUND/AIM: Participation in sports activities is a source of dental injury. Despite recommendations for the use of mouthguards, athletes underutilize them. The aim of this study was to provide estimates of dental injuries, the mechanism of injuries and the utilization of mouthguards in high school sports. MATERIALS AND METHODS: This study was a secondary analysis of an existing dataset of a convenience sample of the National High School Sports-Related Injury Surveillance Study. Data of athletic exposures, dental injuries, mouthguard usage, and mechanism of injury from the 2005/2006 to the 2019/2020 academic years were analyzed. RESULTS: During the study period, there were 459 dental injuries in 49,987,927 athletic exposures resulting in a dental injury rate of 0.9 per 100,000 athletic exposures (AE). Slightly more than half of the traumatic dental injuries were sustained during competition (n = 256; 55.8%) and the rest (n = 200; 43.6%) were sustained during practice. The rate of dental injury in competition was 3.6 times higher than the rate in practice (RR: 3.6, 95% CI: 3.0-4.4). Dental injuries comprised 0.4% of the total 108,574 injuries sustained by athletes. Among girls' sports, field hockey had the highest rate (3.5 per 100,000 AE) and among boys' sports, basketball (2.4 per 100,000 AE) had the highest rate of dental injury. The most common mechanism of injury was contact with another player (276; 60.4%) followed by contact with apparatus (146; 31.9%). In the majority of dental injuries (308; 75.1%), the athlete was not wearing a mouthguard when the dental injury was sustained. CONCLUSIONS: Dental injuries were a small proportion of all injuries sustained by high school athletes. The majority of dental injuries were sustained when the athlete was not wearing a mouthguard.

Kovanaze Intranasal Spray vs Traditional Injected Anesthetics: a Study of Pulpal Blood Flow Utilizing Laser Doppler Flowmetry.

OBJECTIVE: An ideal local anesthetic would be effective, minimally reduce pulpal blood flow (PBF), and not require injection. This study compared the effects of 3% tetracaine plus 0.05% oxymetazoline nasal spray (Kovanaze; KNS) and injections using 2% lidocaine with 1:100,000 epinephrine (LE) or 3% mepivacaine plain (MP) on PBF, anesthetic efficacy, and participant preference. METHODS: In a double-blind cross-over design, 20 subjects randomly received a test anesthetic and placebo at each of 3 visits (KNS/mock infiltration; mock nasal spray/LE; or mock nasal spray/MP). Nasal sprays and infiltration apical to a maxillary central incisor were delivered ipsilaterally. PBF was evaluated by laser Doppler flowmetry, and local anesthetic success was assessed with electric pulp testing. Postoperative pain levels, participant preference, and adverse events were also assessed. RESULTS: LE injections demonstrated significant reductions in PBF at all time intervals compared with baseline (P < .05), whereas KNS and MP did not. Pulpal anesthesia success rates were higher for LE (85%) compared with MP (35%) and KNS (5%). Participants reported significantly higher postoperative pain levels for KNS compared with LE and MP. Additionally, KNS was the least preferred of the anesthetics administered and resulted in more reported adverse events. CONCLUSION: Although KNS showed no significant effect on PBF, it was not effective in achieving pulpal anesthesia as used in this study.

Acceptability of medical immobilization: Results from a pilot international survey.

BACKGROUND: Controversy exists on the acceptability of medical immobilization (MI). AIM: To identify regulations, professional conventions, and opinions on the acceptability of MI and to identify practice patterns through a pilot study of members of the International Association of Paediatric Dentistry (IAPD) and their colleagues. DESIGN: A 22-item questionnaire was developed and electronically distributed to 1191 members of the IAPD. RESULTS: Responses were received from 182 dentists in 45 countries. The majority (74.9%) of respondents use MI, and 29.1% use an immobilization device. MI with an immobilization device was reported as professionally acceptable (58.1%) and permitted by medicolegal regulations (70.8%) in their countries of practice. Dentists rated acceptability of MI higher than they perceived parents would overall and perceived MI to be more acceptable by parents for emergency situations and for children with special healthcare needs but 19.8% of respondents found it totally unacceptable in all scenarios. Use and opinions of acceptability varied by geographical location with respondents from North America being more accepting of MI. Most dentists felt that the use of an immobilization device could lead to lasting psychological trauma (72.3%) and violation of the rights of the child (55.4%) but that it improves access to care (58.5%). CONCLUSION: The acceptability of MI remains an area of controversy for paediatric dentists internationally.

Ohio Dentists' Perceptions on Children School Absenteeism for Dental Care Appointments.

Purpose: This cross-sectional study evaluated knowledge, practices, and beliefs of Ohio dentists treating school-aged children regarding school absenteeism in relation to compliance with dental appointments.
Methods: A 26-item questionnaire was distributed to 7,274 dentists licensed in the state of Ohio in 2019. Eligible participants were pediatric dentists (PDs) and general dentists (GDs) who treated individuals younger than 16 years of age.
Results: A return rate of 13.5 percent (958 total participants) provided a sample consisting of approximately 90 percent of GDs, a mean age of 48.5 years and primarily practicing in suburban locations. Respondents felt parental attitudes had changed over the past five years, with a significantly higher proportion of PDs reporting increased parental concerns about school absences than GDs (59.5 percent versus 31.5 percent; P <0.001). Length of excused absence increased with treatment complexity. PDs were more likely to permit longer absences than GDs and to allow parents to decide the length of absence, particularly for children with special health care needs. PDs were 6.6 times more likely to report that concerns about school absences often negatively affected oral health (P <0.001).
Conclusion: Dentists acknowledged that school absences and school policy affected parental choices regarding dental visits, with PDs consistently stating a greater effect than GDs.

Adolescent Dental Fear and Anxiety: Background, Assessment, and Nonpharmacologic Behavior Guidance.

Adolescence, the period from 11 to 21 years of age, bridges the chasm between childhood and adulthood. Adolescence can be challenging as bodies, cognition, and personality go through major transformations, but it is also a time of great joy as confident adults with a clear identity develop. Dentists need to be knowledgeable about the developmental characteristics of this group because some of the cognitive and emotional changes make adolescents vulnerable to new fears. Dentists must tailor behavior guidance to this developing psyche in a way that respects independence and promotes confidence to foster lifelong positive views of dentistry.

Absorbable Hemostatic Pack Effect After Primary Incisor Extraction: A Pilot Study and Introduction of a Novel Scale to Assess Post-Operative Bleeding.

OBJECTIVES: This pilot study compared hemostatic pack (HP) application with no intervention following extraction of maxillary primary incisors in healthy children for effect on bleeding time and influence of patient or tooth variables utilizing a novel scale for assessment of bleeding following extraction. STUDY DESIGN: A novel scale was created to assess bleeding after extraction. This scale was utilized in a randomized, split mouth study of healthy children ages 2-7 years old requiring extraction of at least 2 primary maxillary incisors under general anesthesia. One extraction site was randomly assigned to receive HP and the other had no hemostatic measures. Post-operative bleeding was rated at 2, 10, and 15 minutes post-extraction. Other variables recorded included age, sex, periapical radiolucency, presence of fistula, swelling, discoloration, intraoral stabilization device used, and vital signs at two time intervals. Pre-operative radiographs were reviewed for root resorption and periapical radiolucency. RESULTS AND CONCLUSIONS: Twenty-five patients provided 50 teeth. Hemostatic pack had a significant effect on reducing bleeding at each time point and that effect did not change over time. Age, sex, tooth pain, post-extraction heart rate, blood pressure, discoloration, amount of resorption, and presence of a periapical radiolucency had no significant effect on bleeding. The proposed bleeding scale had good intra-rater reliability and could be useful in future studies, once validated.

Correlates of oral health fatalism in caregivers of children with autism spectrum disorder.

AIMS: To study correlates of oral health fatalism (OHF) in caregivers of children with autism spectrum disorder (ASD). METHODS AND RESULTS: This exploratory analysis used baseline data from 118 Medicaid-eligible families of children with ASD in a multi-site randomized clinical trial of a parent training intervention supporting home oral hygiene and dental visits. About half (46%) of caregivers agreed with the statement "most children eventually develop dental cavities," endorsing OHF. Hispanic caregivers more strongly endorsed OHF than non-Hispanics (cumulative odds ratio = 2.4, 95% confidence interval [CI]: 1.2-4.7, P = .014). Caregivers living alone with children less strongly endorsed OHF than caregivers cohabitating with other adults (cumulative odds ratio = 0.39, 95% CI 0.17-0.86, P = .019). Multivariable analysis maintained significance of ethnicity (P = .030) but not living situation (P = .052). Additional analyses included demographics, parenting beliefs, and children's oral hygiene and oral health status. CONCLUSION: About half the caregivers endorsed OHF, with Hispanic caregivers more strongly endorsing OHF. OHF was not significantly associated with oral health behaviors or status, consistent with emerging literature suggesting fatalism is not necessarily linked to health behavior. Further exploration of OHF correlates in families of children with ASD is needed; ethnicity, living situation, child age, and caries status are of interest.

Is methylmethacrylate toxic during pregnancy and breastfeeding?--- a systematic review.

INTRODUCTION: Methyl methacrylate (MMA) is commonly used in the fields of dentistry and orthopaedic surgery. However, there remain concerns for the occupational hazards of MMA, particularly during pregnancy and breastfeeding. METHODS: We performed a systematic review of studies on effects that MMA may have in pregnancy in the context of exposure during orthopaedic surgery and dentistry. Review articles, studies lacking statistical data, single case reports and other evidence level V studies were excluded. RESULTS: Nine studies were included. One basic science study demonstrated an increase in neuronal cell lysis and shrunken cell bodies when neocortical neurons were exposed to MMA monomer. Three animal studies exposed pregnant rodents to MMA via intraperitoneal injection or inhalation. Exposed fetuses in two studies had an increase in gross abnormalities such as hemangiomas, while there was no increase in teratologic effects in the third study. In dental workers exposed to MMA, two retrospective cohort studies did not find a statistically significant increase in birth defects or miscarriage. After exposure to MMA during total joint arthroplasty, two studies found that MMA levels were undetectable in the mothers' serum or breast milk. One study measuring the airborne levels of MMA during simulated joint arthroplasty found that concentrations never exceeded 1% of the recommended limit set forth by the Occupational Safety and Health Administration (OSHA). CONCLUSIONS: Potential teratologic effects of MMA cannot be excluded by existing evidence. However, the typical MMA exposure levels for dental and orthopaedic personnel appear to be substantially less than currently proposed exposure limits.

Connecting Medical Personnel to Dentists via Teledentistry in a Children's Hospital System: A Pilot Study.

Investigators evaluated feasibility, acceptability, and sustainability of a teledentistry pilot program within a children's hospital network between March, 2018, and April, 2019. The program connected dentists to medical personnel and patients being treated in urgent care clinics, a primary care clinic, and a freestanding emergency department via synchronous video consultation. Three separate but parallel questionnaires evaluated caregiver, medical personnel, and dentist perspectives on the experience. Utilization of teledentistry was very low (2%, 14/826 opportunities), but attitudes regarding this service were largely positive among all groups involved and across all survey domains. Uptake of new technology has barriers but teledentistry may be an acceptable service, especially in the case of dental trauma.

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.

Caregiver Preferences of Greetings by Dental Staff.

Purpose: To assess the attitudes and preferences of caregivers accompanying children to dental appointments toward greetings by dental staff.
Methods: English-speaking caregivers accompanying children to dental appointments completed a sex-specific survey consisting of 21 questions pertaining to the current visit, demographics, subject's relationship to the child, preference for greeting by providers, and previous uncomfortable experiences with greetings by providers.
Results: The sample included 238 subjects: 197 (82.8 percent) biological parents; 17 (7.1 percent) biological grandmothers/grandfathers; and 24 (10.0 percent) adults had a different relationship to the child. The single most preferred greeting was "mom" (70.0 percent) or "dad" (72.2 percent), with some variation in preferences among caregivers who were not biological parents. The second most preferred greeting was the first name for both males and females. African-American females preferred to be greeted by the first name compared to white females (P <.03). Older females preferred to be greeted by "grandma" compared to younger females (P <.01).
Conclusion: No single greeting was acceptable to all subjects. Using "mom" or "dad" was acceptable to most caregivers but not universally accepted. First name was acceptable to most, including caregivers who were not biological parents.

Dental Local Anesthesia-Related Pediatric Cases Reported to U.S. Poison Control Centers.

Purpose: The purpose of this study was to use National Poison Data System (NPDS) data to identify cases of local anesthetic (LA) adverse events related to dentistry for children. Methods: NPDS data were queried for all human cases from 2004 to 2018 that identified a parenteral LA agent as the substance, in children 12 years old and younger, which led to a medical outcome classification ranging from moderate to death. For cases that met inclusion criteria, deidentified records with case notes were requested. Results: Twenty-seven dental cases that met review criteria and had available case notes were reviewed. Most subjects were female (N equals 20 out of 27, 74 percent), and the average subject age was 6.8 years. Twenty cases (74 percent) had a moderate effect, seven cases (26 percent) had a major effect, and no fatalities were reported. The most common clinical effects classification was a seizure (N equals 13, 48 percent). One case of LA overdose was identified. Conclusions: No cases of permanent damage or fatal outcomes were found. Seizure activity following the administration of local anesthetic was the most common event, suggesting intravascular administration or a toxic dose.

Effect of FDA Warning on Codeine and Alternate Opioid Prescribing After Pediatric Dental Procedures in Ohio.

Purpose: Evaluate changes in codeine and alternate opioid prescription filling after pediatric dental procedures associated with the FDA's codeine black box warning for tonsillectomy/adenoidectomy. Methods: Patients aged 0-17 years who underwent any tooth extraction or restorative procedure during August 2011-August 2016 were identified in Ohio Medicaid claims. Interrupted time series analyses were used to evaluate the impact of the FDA's warning on the rates of codeine or alternative opioid prescription fills within 14 days postprocedure. Results: In August 2011, codeine and alternative opioid prescription fills rates after a dental procedure were 2.3 percent and 3.3 percent, respectively. These rates decreased monthly by 0.02 and 0.01 percent, respectively during the study period (P<0.0001). The FDA warning was associated with an immediate drop in codeine prescription filling of 0.4 percent (P<0.001), but there was no such association with alternative opioid prescription filling. The codeine decrease was only significant among extractions with/without concurrent restorative procedures involving males, 12- to 17-year-olds, Caucasians, and small metropolitan area residents. Conclusions: Opioid prescription filling after pediatric dental procedures decreased between 2011 and 2016 among Medicaid beneficiaries. In addition, there was a significant immediate reduction in codeine prescription filling after the FDA's codeine black box warning for tonsillectomy/adenoidectomy.

Characteristics of Pediatric Dentists Who Work When Sick.

Purpose: Presenteeism, or working while sick, results in loss of productivity and risk of spreading disease. The purpose of the present study was to identify current work practices and beliefs related to presenteeism, including demographic and practice factors that may significantly relate to presenteeism among practicing dentists in the United States. Methods: A survey of American Academy of Pediatric Dentistry members assessed dentists' practices and beliefs regarding presenteeism. Data were analyzed using descriptive statistics, chi-square test, and multi-variate logistic regression. Results: Most respondents (86 percent) worked at least once while sick in the last year. Years in practice, region, and student debt level were significantly associated with presenteeism after adjusting for confounders. Reasons for presenteeism were related to practice type, gender, years in practice, region, and salary type. Conclusions: The majority of pediatric dentists treat patients while sick. Pediatric dentists are influenced to practice while sick due to perceived economic and social pressures, including meeting expectations of colleagues and patients.

Analysis of Fluoride Content in Alternative Milk Beverages.

Background: The dentist has a responsibility to provide nutritional counseling and fluoride consumption recommendations. The purpose of this study was to measure and compare the concentrations of fluoride in a large number of alternative milk beverages and bovine milk. Study design: Thirty-three milk alternatives, including 9 diverse types and 11 different brands, were analyzed using a fluoride ion-selective electrode (ISE) and an ISE meter. Fluoride concentrations were then compared among different types and between different brands. Results: Fluoride concentration ranged from 0.01 ppm (Malk® Pure Cashew Milk) to 0.80 ppm (Almond Breeze® Original Unsweetened Almond Milk) with a mean concentration of 0.32 ppm. When compared, bovine whole milk (0.03±0.00 ppm) was found to be significantly lower in fluoride than all samples analyzed except Malk Pure Cashew Milk, Soy Milk Vanilla, Rice Milk, and Pecan Milk. Major differences also existed between the same milk alternative types of different brands. Conclusion: The amount of fluoride varies among different types of milk alternatives and different brands. To ensure that the dental team can provide proper recommendations regarding fluoride use, manufacturers should consider placing fluoride concentrations on nutrition labels.