Generalised hypomineralisation of enamel in oculodentodigital dysplasia: comprehensive dental management of a case.

Oculodentodigital dysplasia (ODDD) is a rare congenital disorder characterised by developmental abnormalities of the eye, dentition and digits of the hands and feet, with neurological symptoms reported in 30% of individuals. Dental anomalies associated with ODDD include enamel hypoplasia and subsequent caries, microdontia, missing teeth, amelogenesis imperfecta, pulp stones and delayed tooth development. Here, we describe the comprehensive dental management of a 3-year-old girl who presented with rapid deterioration of the primary dentition due to generalised enamel hypomineralisation. Conservative, comprehensive restorative management was performed under general anaesthesia. Within 6 months, further breakdown of the remaining unrestored enamel was noted. This case documents the challenges of conservative management in dental anomalies that are not well documented due to the extreme rarity of the disorder.

Predicting the appropriate size of the uncuffed nasotracheal tube for pediatric patients: a retrospective study.

OBJECTIVES: The selection of an appropriate size of tracheal tube is important for airway management. For nasotracheal intubation, passing the nasal cavity should be taken into account for the selection of tube size. The aim of this study was to investigate the selection of appropriate size of nasotracheal tube in pediatric patients retrospectively. MATERIALS AND METHODS: The 1-12-year patients underwent dental procedures under general anesthesia intubated nasotracheally. The correlation between height, age, weight, the tracheal diameters at C6, C7, Th2 on the chest X-ray, and actually performed tube sizes were calculated. In addition, we compared the relationships between the predicted tube size and actually the intubated tube size. RESULTS: The tube sizes intubated actually were between 4.0 and 6.0-mm ID. The formula by height could be most suitable for tube size. The correspondence rates for the tube with 4.5- and 5.0-mm ID were 78% and 53%. When they were predicted as 5.5- or 6.0-mm ID, 0.5 mm smaller size tube were intubated actually; 56% and 70%. When the predicted tube size was 4.0-mm ID, 0.5 mm larger size tube was intubated actually; 66%. CONCLUSIONS: The formula by height could be most suitable for the selection of size for pediatric nasotracheal intubation. When the predicted tube size was 5.5 or 6.0-mm ID, 0.5 mm smaller size should be chosen at first. In the case of 4.0-mm ID, 0.5 mm larger size should be chosen for first trial. CLINICAL RELEVANCE: The present data indicate that the selection of nasotracheal tube using the formula by height might be useful.

Patient-reported outcomes associated with different restorative techniques in pediatric dentistry: A systematic review and MTC meta-analysis.

BACKGROUND: Despite the increasing number of studies evaluating patient reported outcome measures (PROs), there is no clearness regarding which restorative treatment offers major benefits based on the pediatric patient perspective. AIM: To compare different restorative techniques in pediatric dentistry regarding patient-reported outcomes. DESIGN: Literature searching was carried out on prospective studies indexed in PubMed, Scopus and OpenGrey. A Mixed Treatment Comparisons (MTC) meta-analysis was undertaken considering the results from reviewed studies. Anxiety, pain and quality of life were extracted as mean with standard deviation, percentage of pain, and mean difference of scores with standard deviation, respectively. For direct comparisons, data were combined using a random-effect model. Heterogeneity was assessed with the I2 statistic. For indirect comparisons, fixed and random effects were chosen through comparison of competing models based on the Deviance Information Criteria (DIC). The expected efficacy ranking based on the posterior probabilities of all treatment rankings was also calculated. RESULTS: An initial search resulted in 4,322 articles, of which 17 were finally selected. Due to unavailability of data, only pain, anxiety and oral health related quality of life (OHRQoL) were statistically analyzed. The difference in means (95% CI) of anxiety between treatments using only hand instruments with or without chemomechanical agents were -5.35 (-6.42 to -4.20) and -5.79 (-7.77 to -3.79) respectively when compared to conventional treatment using rotary instruments and/or local anesthesia. Regarding pain, there was a trend for treatments without rotary instruments and local anesthesia to be less frequently reported as painful. No statistical difference was found intragroup nor among treatments for OHRQoL. CONCLUSIONS: Anxiety and pain are directly related with more invasive restorative treatments. On the other hand, quality of life is not improved regardless of the restorative technique used. Further well-designed prospective studies regarding PROs in children are still necessary.

Consideraciones básicas para el manejo del dolor en odontopediatría en la práctica diaria del cirujano dentista general y su relación de interconsulta con el anestesiólogo / Basic considerations for the management of pain in dentistry in the daily practice of the surgeon general dentist and their relationship with the anesthesiologist

El dolor es un fenómeno complejo y multidimensional mediado por procesos psicoquímicos en el sistema nervioso periférico y central, cuya percepción puede modificarse considerablemente a través de una serie de mecanismos que incluyen, entre otros, fármacos, estímulos ambientales, procesos cognoscitivos y emocionales, así como condiciones sociales y culturales. La gran parte de los agentes farmacológicos que se utiliza en odontología tiene por objeto controlar la angustia y el dolor. En términos generales, la eliminación de la sensación de dolor en el ámbito dental requiere el bloqueo de la percepción del dolor por vía periférica, mediante anestesia local o por vía central, con anestesia general (AU)

Pain is a complex and multidimensional event regulated by psycho-chemical processes in the peripheral and central nervous system; pain perception can be modified by different mechanisms that include, between others, drugs, environmental stimuli, cognoscitive and emotional processes, and cultural and social conditions. The drugs that are used in odontology try to control the pain. In general, it is necessary to stop the peripheral and central pain perception using local or general anesthesia, respectively (AU)

Extending oral health care services to underserved children through a school-based collaboration: Part 3--A cost analysis.

PURPOSE: The purpose of this manuscript was to conduct a cost analysis of the Miles of Smiles Program, a collaboration between the University of Missouri-Kansas City School of Dentistry and the Olathe School District in Kansas. This preventive program was implemented to improve the access to oral health care for low income children within the school district. METHODS: An inventory list and de-identified patient records were used to determine the costs associated with operating the program to serve 339 elementary school students during the 2008 to 2009 school term. Costs related to equipment, supplies and personnel were included. The costs were then compared to the amount of Medicaid reimbursement obtained for the services provided. Additionally, the cost of operating a similar program, if staffed by dental professionals rather than supervised dental hygiene students, was estimated. RESULTS: The cost of operating the program during the 2008 to 2009 school term was $107,515.74. The program received Medicaid reimbursement for approximately 1.5% of the total operating cost of and approximately 6.3% of the total billable services, however, challenges with submitting and billing Medicaid claims for the first time contributed to this low rate of reimbursement. If a similar program that utilized dental professionals was implemented and treated the same number of patients, the cost would be approximately $37,529.65 more due to higher expenses associated with personnel and supplies. CONCLUSION: The program is not self-sustainable based on Medicaid government-funded insurance reimbursement alone, and therefore continuous external sources of funding or a change in the program design would be necessary for long-term sustainability of the program.

The ability of pulp sensibility tests to evaluate the pulp status in primary teeth.

BACKGROUND. Accurate determination of the pulp status is the most important part of conservative pulp therapy. AIM. The aim of this study was to assess the ability of thermal and electrical pulp tests to assess the pulp status in primary teeth. DESIGN. Seventy-eight primary molar teeth in 36 children were investigated. Fifty-six teeth had unknown pulp status in need of endodontic treatment, and 22 were intact teeth with no signs of pulp disease. Cold, hot and electrical pulp testing (EPT) were performed on each tooth. The gold standard was established by direct inspection of the pulp after an access cavity had been made. The sensitivity, specificity, positive and negative predictive values for each test and different sequential combinations of pulp testing were calculated. Sequential combination test analysis was used for data analysis. RESULTS. The highest accuracy was found for EPT, followed by heat and cold tests. No significant difference was found between the accuracy of EPT and the heat test (P-values > 0.05); however, the accuracy of EPT was significantly higher than that of the cold test (P-value< 0.05). CONCLUSION. Based on this study, EPT can be used as a reliable test for diagnosing the pulp status in primary teeth.

Wear and repair of stainless steel crowns.

AIM: The purpose of this study was to determine the wear of stainless steel crowns (SSCs) in children, and compare the extent of microleakage in SSCs that had been repaired using either a cermet glass-ionomer cement (GIC) or a packable composite resin (CR). MATERIALS AND METHODS: For the first aim, the occlusal surface thickness of 31 harvested SSCs (21 primary first and 10 second molars) and 18 unused SSCs was measured, and then examined under scanning electron microscopy. For the second aim, standardised holes were prepared on the occlusal surfaces of 20 SSCs, and then repaired using either a cermet GIC or packable CR. After their repair, the extent of microleakage was determined using 0.5% basic fuchsin and stereomicroscopy. RESULTS: The thickness of all the harvested SCCs was 5.3 µm less than that of the unused SCCs (p<0.02), and there were no significant differences between the thickness and occlusal wear rates of harvested SSCs from the first and second primary molars. Although neither of the two repair materials completely prevented microleakage, the number of specimens in which microleakage occurred after repair with a cermet GIC was significantly lower than the number of specimens in which a packable CR was used (p<0.05). CONCLUSION: We concluded that the occlusal surfaces of SSCs for first and second primary molars display wear. Although perforated SSCs can be repaired using either a cermet GIC or a packable CR, less microleakage occurs in SSCs that were repaired with a cermet GIC than those with a packable CR.

An alternative impression technique for individuals with special care needs.

Impression making may be complicated in individuals with limited ability to cooperate with caregivers. An alternative technique for obtaining full-arch casts from sectional preliminary impressions is described. The technique is a modification of the procedure advocated for impression making in subjects with limited mouth opening. A pair of partial stock trays is selected to fit the right and left side of the arch. Two sectional irreversible hydrocolloid impressions are made separately. The first cast is placed into the second impression prior to pouring, to obtain a cast of the complete arch. The procedure was used during the treatment of an uncooperative young patient with Lesch-Nyhan Syndrome and provided a simple and reliable means to obtain the diagnostic cast of the mandibular teeth. It is recommended not only for uncooperative patients, but also for patients with special needs; such as those with anatomical restrictions, functional impairment, and movement disorders.

Advanced techniques and armamentarium for dental local anesthesia.

Computer-controlled local anesthetic delivery (C-CLAD) devices and systems for intraosseous (IO) injection are important additions to the dental anesthesia armamentarium. C-CLAD using slow infusion rates can significantly reduce the discomfort of local anesthetic infusion, especially in palatal tissues, and facilitate palatal approaches to pulpal nerve block that find special use in cosmetic dentistry, periodontal therapy, and pediatric dentistry. Anesthesia of single teeth can be obtained using either C-CLAD intraligamentary injections or IO injections. Supplementary IO anesthesia is particularly suited for providing effective pain control of teeth diagnosed with irreversible pulpitis.

The practice and perception of pain assessment in US pediatric dentistry residency programs.

PURPOSE: The purpose of this study was to describe the current practice and perception of pain assessment in US accredited advanced pediatric dentistry residency programs, as reported by directors of these programs. METHODS: A questionnaire was sent out to 68 accredited US pediatric dentistry residency programs. Responses were statistically analyzed to find significant correlations between the actual practice of pain assessment and the perceived usefulness of pain assessment. RESULTS: Forty-four surveys (65% response rate) were completed and returned. Sixty-eight percent of program directors stated that pain is assessed at all types of appointments. A statistically significant correlation exists between program directors who regard pain assessment scales as useful and those who teach the use of such resources in their programs (chi-square = 3.73, P = .05). A statistically significant correlation exists between program directors who regard preoperative pain assessment as clinically beneficial and those who report a need to place more emphasis on pain assessment (chi-square = 6.22, P = .01). CONCLUSIONS: Pediatric dentistry residency program directors generally regard pain assessment as clinically beneficial in patient treatment. Implementing increased pain assessment teaching in pediatric dentistry residency programs could improve the confidence and skills of residents in assessing the pain of young children and those with special health care needs.

A comparison of pain and anxiety associated with the administration of maxillary local analgesia with Wand and conventional technique.

AIM: This was to compare the sensation of pain when injections were given using the Wand computer controlled local analgesia (LA) system and a conventional technique in children of pre-school and school age. METHODS: 38 children were randomly assigned to either a treatment or control group. The treatment (Wand) group consisted of 20 children, while the control group (conventional LA technique) consisted of 18 children. The children were aged between 39.0 and 120.0 months with a mean age of 81.9 months (SD- 23.2). One operator carried out all local analgesia administrations. Pain sensation was rated using the VAS scale by the operator, each child and their parent. Anxiety was rated using the Venham scale. RESULTS: No statistical difference in pain sensation and anxiety was found when the Wand was used, compared with the conventional technique (P=0.710, P=0.976). The results also showed no significant difference in anxiety change between males and females in the two groups (P=0.714). CONCLUSION: There was no difference in the pain or anxiety experienced by the children in the conventional and Wand group.

Pain assessment by children and adolescents during intraosseous anaesthesia using a computerized system (QuickSleeper).

BACKGROUND: Intraosseous (IO) anaesthesia has been shown to be effective in children. However, the pain associated with anaesthetic injections, and its acceptance by children, have never been studied. AIM: The aim of this study was to assess the pain associated with the IO injection of 4% articaine with 1 : 200 000 epinephrine using the computerized QuickSleeper' system in a population of children and adolescents. DESIGN: IO anaesthesia was performed on patients aged 10.4 +/- 2.6 years of age. The patients assessed their pain on a faces pain scale (FPS) and on a visual analogue scale (VAS). The operators were also asked to assess signs of patient pain/discomfort. RESULTS: No pain or mild discomfort was reported by, respectively, 81.8% (FPS) and 83.9% (VAS) of the patients. Some 58.9% of children with previous experience of dental anaesthesia reported that computerized IO anaesthesia was more comfortable than traditional infiltration methods. Operators noted signs of discomfort during penetration and injection in 18.3% and 25.3% of the patients, respectively. CONCLUSIONS: This study showed that the majority of children reported no pain or mild pain when anaesthetic was administered by computerized needle rotation and solution deposition. This technique holds promise for use by trained paediatric dentists.

Pain behaviour and distress in children during two sequential dental visits: comparing a computerised anaesthesia delivery system and a traditional syringe.

OBJECTIVE: To compare the pain and distress response of children receiving a local anesthesia injection using a computerised device (Wand) or a traditional syringe over two consecutive treatment sessions and to study whether the response to the two injection techniques was different for high or low dentally anxious children. DESIGN: Randomised controlled trial. SETTING: Secondary dental care practice specialised in treating children. SUBJECTS AND METHODS: Children were selected and randomly allocated to the Wand or traditional injection condition. Parents completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-ds). Based on video recordings of the injections, for each 15 seconds, the occurrence of five pain related behaviours was registered and a score was given on the Venham distress scale. Children rated their pain after each injection. INTERVENTION: Over two consecutive treatment sessions one group received two local anaesthesia injections with the traditional syringe and the other group received two injections with the Wand. OUTCOME MEASURES: The mean number of pain related behaviours, the mean distress scores and the self-reported pain scores were compared. Based on the CFSS-ds subjects were split into highly and low dentally anxious children. RESULTS: One hundred and forty-seven subjects participated in the study: aged 4-11 years, 71 girls. Based on the behaviour displayed during the local anaesthesia injection and the self-reported pain after the injection, no difference could be found between an injection with the traditional syringe or the Wand over the first or second treatment session. However, on the first treatment session, highly anxious children reported more pain (p = 0.001), displayed more pain related behaviour (p = 0.002) and more distress (p <0.001) than low anxious children in reaction to the local anaesthesia injection. CONCLUSION: No clear difference in the response of referred children could be found between an injection with the Wand or the traditional syringe. Level of dental anxiety was found to be an important factor in the response of children to a local anaesthesia injection.

Impressions in cleft lip and palate--a novel two stage technique.

Though the field of presurgical orthopedics for the management of children with cleft Lip and Palate (CLAP) has made great advances over the past few decades, little is found in literature regarding the imressions required to fabricate these appliances. The purpose of this paper is to describe a novel two stage technique utilizing greenstick compound and addition silicone impression material to provide a safe, economical and accurate method for recording impressions in children with cleft lip and palate.

Assessment of the anesthetic effectiveness of anterior and middle superior alveolar injection using a computerized device versus traditional technique in children.

UNLABELLED: The study aims to evaluate the anesthetic effectiveness of the Anterior and Middle Superior Alveolar (AMSA) injection administered through a computer-controlled local anesthetic delivery system (CCLAD), and compare it with the traditional buccal and palatal injections used to anesthetize maxillary primary molars. MATERIALS AND METHODS: The sample included 80 primary maxillary molars, divided into 2 equal groups: Pulpotomy and extraction groups. Each group was divided equally into 4 subgroups: A. First molars anesthetized with the traditional technique, B. first molars anesthetized with the CCLAD, C. second molars anesthetized with the traditional technique, and D. second molars anesthetized with the CCLAD. The evaluation was done single blind using SEM scale. RESULTS: The AMSA injection with the CCLAD was found to be effective in anesthetizing maxillary primary molars in pulpotomy and extraction procedures. There was no significant difference between the two anesthetic techniques except in the step of gingival retraction buccally in, which the traditional injections were more effective than the CCLAD during extractions. No significant difference was found between first and second primary molars in the effectiveness of both techniques. CONCLUSION: The AMSA injection using CCLAD was found to be effective in children.

Evaluation of the Root ZX apex locator in primary teeth.

PURPOSE: The purpose of this study was to evaluate the accuracy of the Root ZX electronic apex locator in determining canal length in primary incisors. METHODS: Root ZX was utilized to measure the canal lengths of 150 primary incisors in vivo. After the teeth were extracted, a standard ruler was used to measure the canal lengths to the nearest 0.5 mm. A paired t test was used to compare the lengths obtained in vivo with Root ZX and the lengths measured in vitro. RESULTS: In 98 (65%) of the canals, the length measured by Root ZX was determined to be equal to the length measured in vitro. Root ZX measurements were found to be less than in vitro measurements by 0.5 mm in 24 canals (16%), and were greater than in vitro measurements by 0.5 mm in 21 canals (14%). Root ZX measurements exceeded in vitro measurements by 1.0 to 1.5 mm in 5 canals (3%) and were less than in vitro measurements by 1.0 mm in 2 canals (1%). Paired t test analysis indicated no significant difference between the 2 measurement methods (P=.67). CONCLUSIONS: Root ZX can accurately assess the length of canals in primary incisors.