Prescription of panoramic radiographs in children using age-based prevalence of dental anomalies and pathologies.

BACKGROUND: Panoramic radiographs (PRs) are used in the detection and diagnosis of developmental dental anomalies and pathologies (DDAPs) in children. AIM: The primary objective of this observational cohort study was to evaluate the age-based prevalence of DDAP on PRs, whereas the secondary objective was to determine a threshold age for the detection of DDAP to provide supportive evidence for the prescription of PR in paediatric dental practice. DESIGN: The study examined diagnostic PRs from 581 subjects aged 6 to 19 years. All PRs were reviewed by experienced, calibrated, masked examiners for the identification or presence of anomalies in size, shape, position, structure, and other developmental anomalies and pathologies (ODAP) of the face-neck region in a standardized condition. The data were statistically analyzed for interpretation. RESULTS: Overall, 74% (n = 411) of the cohort had at least one anomaly (shape anomaly: 12%, number anomaly: 17%, positional anomaly: 28%, structural anomaly: 0%, and ODAP: 63%). The optimal Youden index cutoff for any anomaly was 9 years. Twelve and 15 years also showed predictive ability. CONCLUSION: The results suggest that PRs should be prescribed at ages 9, 12, and 15 years for the diagnosis of DDAP.

A comparative evaluation of video modeling and social stories for improving oral hygiene in children with autism spectrum disorder: A pilot study.

INTRODUCTION: The purpose of this pilot study was to compare video modeling (VM) to a toothbrushing social story (TSS) for improving oral hygiene in children with autism spectrum disorder (ASD). METHODS: Four to 17-year-old children and adolescents with ASD were evaluated at a pre-intervention visit for quality of oral hygiene using plaque and gingival indices. A pre-intervention survey assessed caregivers' perceptions of their children's daily oral hygiene practices. Participants were randomized into VM or TSS groups and caregivers received daily emails to access a VM or TSS presentation when completing toothbrushing for their child for 30 days. At the one-month visit, oral hygiene was re-evaluated, and post-intervention surveys were completed. RESULTS: There were significant improvements in plaque and gingival scores for VM (0.68 ± 0.20; 0.59 ± 0.15) and TSS (0.50 ± 0.11; 0.40 ± 0.10) groups at post-intervention compared to pre-intervention visits. No significant improvements in plaque or gingival scores were noted between the VM and TSS groups. Caregivers' perceptions regarding oral hygiene acceptance by their children was promising for the VM group. CONCLUSIONS: VM and TSS interventions improved oral hygiene in subjects with ASD. There was greater acceptance of daily oral hygiene in the VM compared to the TSS group.

Bifid Mandibular Canals: A Pediatric Case Series with Clinical Implications.

Aim: The aim of this case series is to provide a detailed account of pediatric cases with bifid mandibular canal (BMC) along with clinical implications. Background: The prevalence of BMC on panoramic radiographs has been reported to be 0.03-1.90% in adults. Only one study reported prevalence of BMC in children based on cone-beam computed tomography (CBCT) images. As CBCT images are not routinely prescribed in children, it is important to understand if panoramic radiographs provide a valuable tool to diagnose BMC in children. Case description: This case series provides a review of three cases of nonsyndromic, bilateral BMC, and associated radiculomegaly affecting mandibular permanent first molars in children during the mixed dentition stage. An overview of clinical implications of BMC in children is also discussed to help clinicians provide appropriate dental care and anticipatory guidance. Conclusion: Bifid mandibular canal (BMC) has never been reported in children during mixed dentition stage based on panoramic radiographs. This is the first case series reporting BMC and associated dental anomalies in children. Clinical significance: This case series will help clinicians in diagnosing BMC during mixed dentition stage and understand its clinical implications. Additionally, this case series will help define future cross-sectional studies evaluating BMC and associated dental anomalies in children. How to cite this article: Puranik CP, Chandki R, Mladenovic R, et al. Bifid Mandibular Canals: A Pediatric Case Series with Clinical Implications. Int J Clin Pediatr Dent 2023;16(3):547-549.

Evaluation of problem-based learning in dental trauma education: An observational cohort study.

BACKGROUND/AIM: Problem-based learning (PBL) allows higher thinking among dental students and has improved first-time pass-rates in predoctoral pediatric dentistry education. The aim of this retrospective observational cohort study was to evaluate the impact of PBL-based, traumatic dental injuries case discussions on predoctoral dental trauma education. MATERIALS AND METHODS: Student performance and perceptions after receiving dental trauma curriculum with or without PBL-based dental trauma case discussions were evaluated. All the students challenged their simulated patient-based assessments. Three recall-based, objective structured clinical examinations, and critical thinking competencies assessed student knowledge about management of traumatic injuries affecting primary or permanent dentition including avulsion. The scores and number of attempts for each competency were compared between the study cohorts using t-tests. Student's self-perceived learning outcomes were measured through a voluntary, five-question survey. Mantel-Haenszel ordinal Chi-square tests were used to assess for differences in rates of agreement on survey responses from the students. Linear regression was used to assess effect of training on scores adjusting for student type (predoctoral or advanced standing). Pearson's correlations were used to assess association between scores. Significance was set at 0.05. RESULTS: For the PBL cohort, there was a significant (p > 0.05) improvement in the first-time pass-rates and scores in three out of four competencies. A higher proportion of students in the PBL cohort perceived that their dental trauma education improved their radiographic and diagnostic skills compared to the cohort that did not receive PBL (p > 0.05). There was no correlation between recall-memory versus critical thinking competencies (r < 0.5). CONCLUSION: The PBL-based dental trauma case discussion had a positive impact on predoctoral student learning and perceived benefits while managing simulated traumatic dental injuries. Due to a lack of correlation between recall-memory and critical thinking assessments, evaluation of predoctoral student's dental trauma competencies should involve multi-model assessment.

Development of integrated electronic medical and dental record competencies and impact of training modalities.

BACKGROUND: The American Recovery and Reinvestment Act provided incentives for the adoption of electronic health records. The integrated electronic medical and dental records (iEMDRs) can minimize healthcare charting errors. The use of iEMDR by healthcare students requires training and competence. There are no defined student competencies to assess the effective and responsible use of iEMDR in dentistry. The goal of this study was to propose a student competency model and study the impact of training modalities on iEMDR competency. METHODS: This retrospective observational cohort study evaluated de-identified assessment scores (AS) and performance scores (PS) in predoctoral dental student (PDS) and advanced standing predoctoral (ASP) student cohorts that received remote or in-person iEMDR training. The AS and PS evaluated the knowledge and application of iEMDR, respectively. A voluntary survey evaluated students' self-perceived preparedness for iEMDR use. Linear regressions were used to determine the association between training modality and scores. Mantel-Haenszel ordinal chi-square tested differences between groups and agreement by training type. Statistical significance was set at 0.05. RESULTS: The sample size (N = 214) provided 95% power to detect differences between study groups. The knowledge of iEMDR (AS) was not impacted due to the training type (p = 0.90) in either student cohorts, whereas the application of knowledge (PS) was higher in ASP student cohort after remote training (p < 0.001) as compared to PDS student cohort. Higher proportion of students perceived preparedness after remote learning in comparison to in-person training (p < 0.001). DISCUSSION: The iEMDR competency model was useful to test the effective and responsible use of iEMDR, and remote training improved students' self-perceived preparedness.

Perception and outcomes after implementation of problem-based learning in predoctoral pediatric dentistry clinical education.

PURPOSE: Problem-based learning (PBL) has been a useful addition to health-based curricula by supporting learning with contributory discussion, research, and critical analysis of evidence in a peer-supported learning format. The aim of this study was to determine the impact of PBL on pediatric dentistry clinical education. METHODS: First-time pass-rates in clinical and objective structured clinical examinations were measured in student cohorts receiving pediatric curricular formats with (PBL+) or without a PBL (PBL-) experience. Student perceived learning outcomes were measured through a voluntary survey. The numbers of each competency attempt were compared between the study groups (PBL+ or PBL-) using Wilcoxon Rank-Sum tests or Fisher's exact tests. Mantel-Hanzel ordinal chi-square tested for differences in rates of agreement on survey responses from students in the PBL+ or PBL- groups. Significance was set at 0.05. RESULTS: There was a significant improvement in the first-time pass-rates in five of seven competencies in the PBL+ group. A significantly higher proportion of students in the PBL+ group perceived that their predoctoral pediatric dentistry rotation improved their diagnostic skills compared to the students in the PBL- group (p < 0.001). However, there was no significant difference (p > 0.05) between the perceptions on satisfaction of clinical or non-clinical staff support, perceived self-improvement in radiographic or clinical skills or overall benefits of the predoctoral pediatric dentistry rotation. CONCLUSION: The addition of a PBL component to a traditional curricular format in a pediatric dentistry clinical rotation had a positive impact on learning in a predoctoral dental program.

Acrylated Hydroxyazobenzene Copolymers in Composite-Resin Matrix Inhibits Streptococcus mutans Biofilms In Vitro.

Purpose: The purpose of this study was to evaluate the effect of acrylated hydroxyazobenzene (AHA) copolymers in a composite-resin matrix on Streptococcus mutans (SM) biofilms. Methods: The AHA was synthesized and polymerized within a bisphenol A-glycidyl methacrylate and triethylene glycol dimethacrylate (bisGMA:TEGDMA) matrix while bisGMA:TEGDMA discs served as controls. The cytotoxicity of AHA was determined using a cell viability assay. Sucrose-dependent SM biofilms were grown on the AHA and control substrates. At 24 hours and after mechanical toothbrushing (equivalent to six months), the number of live SM was quantified on the substrates and in the surrounding media. Microscopic images of the substrates were captured after live-dead staining. Results: The AHA substrates were as biocompatible as bisGMA: TEGDMA substrates. The microscopic images and quantification demonstrated no live SM on the AHA substrates and in the surrounding media as compared to the controls. The inhibitory efficacy of AHA substrates on SM biofilm was intact even after mechanical toothbrushing. Conclusions: Acrylated hydroxyazobenzene in a composite-resin matrix completely inhibits SM proliferation growth and demonstrates a zone of SM inhibition. The antibacterial propertyof AHA could be harnessed for caries prevention in high caries-risk children by incorporating AHA into the restorative and sealant materials.

Association Between Autism Spectrum Disorder and Dental Anomalies of the Permanent Dentition.

Purpose: The purpose of this study was to evaluate the association between dental anomalies of the permanent dentition and autism spectrum disorder (ASD). Methods: The dental and medical records and panoramic radiographs of 200 six- to 17-year-old subjects with a diagnosis of ASD were assessed retrospectively. The controls were 200 age- and gender-matched healthy children. The individual counts of shape, number, and positional dental anomalies and the total counts of all anomalies were recorded. Medical comorbidities were defined and documented as two subgroups: ASD subjects with (ASD-C) or without (ASD-NC) comorbidities. Results: Seventy-seven percent of ASD subjects had at least one comorbidity. Sixty-five percent of ASD subjects demonstrated at least one dental anomaly in comparison to controls (53 percent). There were no significant differences for the prevalence of number, shape, positional, or total anomalies between control, ASD-C, or ASD-NC groups. The ASD-NC group had a significantly higher proportion of pyramidal molars (P=0.02) and ectopically erupting teeth (P=0.04) when compared to controls. Conclusions: There were no significant differences in prevalence for shape, number, or positional anomalies in the permanent dentition between autism spectrum disorder subjects and healthy controls. The prevalence of pyramidal teeth and ectopic eruption was significantly associated with ASD.

Oral and dental findings in emanuel syndrome.

Emanuel Syndrome (ES; OMIM# 609029) is a rare disorder caused by an unbalanced chromosomal translocation [supernumerary der(22)t(11,22)] and characterized by multiple congenital abnormalities. With limited published cases and low prevalence (1:110 000), detailed ES-associated oro-dental findings have not previously been reported. This is a case report of a 14-year-old boy with ES who presented with congenital cardiac, renal, auditory, musculoskeletal problems, and global developmental delay. The patient was managed with risperidone, melatonin, omeprazole, guanfacine, and oxcarbazepine. Anxiety-associated self-injurious behaviour was seen along with stereotypic hand movements. Consistent with previous reports, microcephaly and micrognathia were noted. Oro-facial cleft or gross asymmetry, however, was not observed. Significant oro-dental findings included delayed eruption of primary and permanent teeth, oligodontia (two erupted and five unerupted permanent teeth), and short-root anomaly of central incisors. The patient demonstrated anxiety-triggered bruxism with generalized attrition. This case report provides a comprehensive list of systemic ES findings along with oro-dental manifestations, which have previously not been reported in detail.

Role of transperineal ultrasound in infective and inflammatory disorders.

AIMS: To evaluate the role of transperineal ultrasound as screening tool in infective and inflammatory diseases of perianal region. MATERIALS AND METHODS: Initially, clinical examination of the perineal region of patients (pts) for perianal external opening of tracts, swelling and tenderness is done. The perineal USG was performed using 2 -5 MHz sector probe and 7 -13 MHz linear probe on GE logiq P 5 ultrasound machine. Internal opening of any fistulous tract were described with clockwise position and tracts were traced upto their external opening and perifocal area were screened for any ramification. The Park et al. classification was used for classifying the tracts. RESULTS: Out of 492 pts, 60 pts were normal, 257 pts had fistula, 114 pts had sinuses, 44 pts had only abscess without fistula or sinus and 17 pts had other pathologies with 95% sensitivity (Sn), 100% specificity (Sp) and Positive Predictive Value (PPV) and 95% Negative Predictive Value (NPV) for fistula and 94% Sn, 97% Sp, 89% PPV and 98% NPV for active sinuses and 98% Sp, 96% ppv and 100% NPV and Sn for abscesses. CONCLUSIONS: Transperineal Ultrasound should be performed as first line imaging modality for suspicion of low perianal fistula with high sensitivity, specificity, and negative predictive value at much lower cost and less time as compared to perineal MRI.

A Predictive Model for Root Caries Incidence.

This study aimed to find the set of risk indicators best able to predict root caries (RC) incidence in caries-active adults utilizing data from the Xylitol for Adult Caries Trial (X-ACT). Five logistic regression models were compared with respect to their predictive performance for incident RC using data from placebo-control participants with exposed root surfaces at baseline and from two study centers with ancillary data collection (n = 155). Prediction performance was assessed from baseline variables and after including ancillary variables [smoking, diet, use of removable partial dentures (RPD), toothbrush use, income, education, and dental insurance]. A sensitivity analysis added treatment to the models for both the control and treatment participants (n = 301) to predict RC for the control participants. Forty-nine percent of the control participants had incident RC. The model including the number of follow-up years at risk, the number of root surfaces at risk, RC index, gender, race, age, and smoking resulted in the best prediction performance, having the highest AUC and lowest Brier score. The sensitivity analysis supported the primary analysis and gave slightly better performance summary measures. The set of risk indicators best able to predict RC incidence included an increased number of root surfaces at risk and increased RC index at baseline, followed by white race and nonsmoking, which were strong nonsignificant predictors. Gender, age, and increased number of follow-up years at risk, while included in the model, were also not statistically significant. The inclusion of health, diet, RPD use, toothbrush use, income, education, and dental insurance variables did not improve the prediction performance.

Oral phenotype and variation in focal dermal hypoplasia.

Focal dermal hypoplasia (FDH) or Goltz Syndrome (OMIM# 305600) is an X-linked dominant ectodermal dysplasia caused by mutations in the PORCN gene. This gene encodes an endoplasmic reticulum transmembrane protein that is involved in processing the embryonically critical WNT signaling proteins. Individuals diagnosed with FDH were recruited to participate in the study through the National Foundation for Ectodermal Dysplasia. Individuals were evaluated to characterize the FDH phenotype. Each participant completed a brief dental survey and oral evaluation using artificial light. To identify the oral soft and hard tissue findings 19 individuals (16 female and 3 male) participated with a median age of 10 years (range 2-56 years). Soft and hard tissue defects were present in 68% (13) and 94% (18) of the patients, respectively. Dental anomalies were highly prevalent with 68% (13) demonstrating vertical enamel grooving, 52% (10) having peg shaped tooth deformities, and 78% (15) having enamel hypoplasia with or without discoloration. Cleft lip and cleft palate presented in 15% (3) of the participants. Other findings included 57% (11) having intra-oral lipoma or papilloma with no site predilection. Dental malocclusions were common with 63% (12) having some degree of malocclusion with 15% (3) of participants having class III malocclusion with an anterior dental cross bite. Participants frequently reported speech problems or difficulty with chewing (73%; N = 14). This study shows there is marked variation in the oral phenotype of individuals with FDH and underscores the important role of WNT signaling in oro-facial development.

Fluoride Modulates Parathyroid Hormone Secretion in vivo and in vitro.

The study objective was to investigate the effects of fluoride on intact parathyroid hormone (iPTH) secretion. Thyro-parathyroid complexes (TPC) from C3H (n = 18) and B6 (n = 18) mice were cultured in Ca²âº-optimized medium. TPC were treated with 0, 250, or 500 µM NaF for 24 h and secreted iPTH assayed by ELISA. C3H (n = 78) and B6 (n = 78) mice were gavaged once with distilled or fluoride (0.001 mg [F⁻]/g of body weight) water. At serial time points (0.5-96 h) serum iPTH, fluoride, total calcium, phosphorus, and magnesium levels were determined. Expression of genes involved in mineral regulation via the bone-parathyroid-kidney (BPK) axis, such as parathyroid hormone (Pth), calcium-sensing receptor (Casr), vitamin D receptor (Vdr), parathyroid hormone-like hormone (Pthlh), fibroblast growth factor 23 (Fgf23), α-Klotho (αKlotho), fibroblast growth factor receptor 1c (Fgf1rc), tumor necrosis factor 11 (Tnfs11), parathyroid hormone receptor 1 (Pth1r), solute carrier family 34 member 1 (Slc34a1), solute carrier 9 member 3 regulator 1 (Slc9a3r1), chloride channel 5 (Clcn5), and PDZ domain-containing 1 (Pdzk1), was determined in TPC, humeri, and kidneys at 24 h. An in vitro decrease in iPTH was seen in C3H and B6 TPC at 500 µM (p < 0.001). In vivo levels of serum fluoride peaked at 0.5 h in both C3H (p = 0.002) and B6 (p = 0.01). In C3H, iPTH decreased at 24 h (p < 0.0001), returning to baseline at 48 h. In B6, iPTH increased at 12 h (p < 0.001), returning to baseline at 24 h. Serum total calcium, phosphorus, and magnesium levels did not change significantly. Pth, Casr,αKlotho,Fgf1rc,Vdr, and Pthlh were significantly upregulated in C3H TPC compared to B6. In conclusion, the effects of fluoride on TPC in vitro were equivalent between the 2 mouse strains. However, fluoride demonstrated an early strain-dependent effect on iPTH secretion in vivo. Both strains demonstrated differences in the expression of genes involved in the BPK axis, suggesting a possible role in the physiologic handling of fluoride.

The etiology of eruption disorders - further evidence of a 'genetic paradigm'

The clinical spectrum of tooth eruption disorders includes both syndromic and non-syndromic problems ranging from delayed eruption to a complete failure of eruption. A defect in the differential apposition/resorption mechanism in alveolar bone can cause conditions such as tooth ankylosis, primary failure of eruption, failure of eruption due to inadequate arch length and canine impaction. As our knowledge of the molecular events underlying normal tooth eruption has increased, so too has our understanding of clinical eruption disorders. The recent finding that one gene, parathyroid hormone receptor 1 (PTH1R), is causative for familial cases of primary failure of eruption (PFE) suggests that other disturbances in tooth eruption may have a genetic etiology. In this report, we evaluated the current terminology (ankylosis, PFE, secondary retention, etc.) used to describe non-syndromic eruption disorders, in light of this genetic discovery. We observed that some individuals previously diagnosed with ankylosis were subsequently found to have alterations in the PTH1R gene, indicating the initial misdiagnosis of ankylosis and the necessary re-classification of PFE. We further investigated the relationship of the PTH1R gene, using a network pathway analysis, to determine its connectivity to previously identified genes that are critical to normal tooth eruption. We found that PTH1R acts in a pathway with genes such as PTHrP that have been shown to be important in bone remodeling, hence eruption, in a rat model. Thus, recent advances in our understanding of normal and abnormal tooth eruption should allow us in the future to develop a clinical nomenclature system based more on the molecular genetic cause of the eruption failures versus the clinical appearance of the various eruption disorders.