Quantitative assessment of cleft volume and evaluation of cleft's impact on adjacent anatomical structures using CBCT imaging.

OBJECTIVES: To determine pre-operative cleft volume and evaluate cleft´s impact on surrounding anatomical structures in children and adolescents with orofacial clefts using cone bean computed tomography (CBCT) imaging. METHODS: The present retrospective study retrieved CBCT examinations of 68 patients from a previous study. The examinations had been exposed either before (n = 53) or after (n = 15) alveolar bone grafting. Pre-operative volume of cleft was determined, and type and location were evaluated. Morphological changes on the adjacent anatomical structures, including the incisive foramen, the nasal septum and floor, and the inferior turbinate, were assessed. RESULTS: Mean bilateral cleft volume was 0.76 cm3, while mean unilateral cleft volume was 1.08 cm3; the difference was significant (p < 0.001). Variation in cleft volume, however, was large. The incisive foramen was not visible in the majority of cases with bilateral clefts (71%); the difference was significant (p = 0.001). In cases with unilateral clefts, the nasal septum in 87% was curved towards the cleft or graft side. Also, the mean size of the widest part of the inferior turbinate was 8.8 mm on the cleft or graft side and 10.4 mm on the non-cleft side. The difference was significant (p < 0.001). CONCLUSIONS: When required, CBCT is a feasible method for quantitatively illustrating alveolar clefts and their impact on the morphological development of surrounding structures. Variation in cleft volume was large.

Do preterm-born children and adolescents have greater need for dental care as compared to full term-born controls?

BACKGROUND: Preterm birth has been shown to cause various long-term health issues. Children who were born preterm have also been observed to have more dental behaviour management problems (DBMP) during dental examinations and treatment than children born full term. It is known that dental radiographic examinations can be uncomfortable and cause anxiety in paediatric patients. Thus, our aims were to retrospectively compare dental care related examinations and treatments carried out in three different age intervals (3-6 years, 7-12 years, and 13-19 years) among preterm- and full-term born children and adolescents. METHODS: The present study included 311 patient files: 122 very preterm-born and 33 extremely preterm-born children and adolescents (< 32 gestational weeks). A matched control group of 156 full term-born children and adolescents (≥ 37 gestational weeks) was analysed for comparison. Various factors, including DBMP, missed appointments, dental caries, and radiographic examinations, were retrieved from the dental records for three age intervals: 3-6 years, 7-12 years, and 13-19 years. RESULTS: Extremely preterm-born children missed significantly more dental appointments and presented with more DBMP during dental examinations and treatment than full term-born children in the 3-6-year age group; the same was observed for the very preterm-born in the 7-12-year age group. No significant differences in DBMP during bitewing and periapical examinations or in number of bitewing, periapical and panoramic radiographs occurred between the groups in any age interval. CONCLUSION: Preterm-born children and adolescents may need more flexibility in booking and receive reminders for scheduled visits with the general dental team. Due to the non-significant differences in dental care related oral examinations and treatments, the same dental care service may be applied to the preterm- and full-term born children and adolescents.

Do preterm-born adolescents have a poorer oral health-related quality of life?

BACKGROUND: To evaluate oral health-related quality of life (OHRQoL) over a period of five years using the Oral Health Impact Profile (OHIP-14) questionnaire in a population of Swedish adolescents born preterm and full term. METHODS: In a longitudinal study of adolescents aged 12-14 and 17-19, changes over time in OHRQoL were measured by using OHIP-14. The OHIP-14 score, self-reported chronic illness, temporomandibular disorder (TMD pain) and subjective orthodontic treatment need were compared between 98 extremely and very preterm born (< 32 gestational week) and 93 full-term controls (≥ 37 gestational week) at two ages. The chi-square test was used for comparisons within the extremely-, very-, and full-term control groups, and to contrast the differences of mean scores of OHIP-14, the ANOVA test was used for comparisons within the study groups of extremely preterm, very preterm and full term-born adolescents. RESULTS: All adolescents reported a good self-perceived OHRQoL. No significant differences in the comparisons of the total mean scores were revealed between the groups, between gender or in domain-specific scores over the 5-year period. Very preterm adolescents with reported chronic illness at 12-14 years of age showed significantly higher mean scores of OHIP-14 compared with those without chronic illness (p = 0.015). At age 17-19, significantly higher mean scores of OHIP-14 were reported by very preterm adolescents with TMD pain compared to those without TMD pain (p = 0.024). Significantly higher mean scores of OHIP-14 were found among the extremely preterm (p = 0.011) and very preterm born adolescents (p = 0.031) with a subjective need of orthodontic treatment compared with those without orthodontic treatment need. CONCLUSIONS: Poor OHRQoL measured with OHIP-14 in very preterm adolescents aged 12-14 was related to chronic illness and aged 17-19 to TMD pain. In addition, extremely and very preterm-born adolescents with subjective orthodontic treatment need at 17-19 years of age also reported poor OHRQoL. To improve the dentist-patient relationship and achieve more successful treatment results, it is important for dental clinicians to understand the impact that chronic illness, TMD pain and orthodontic treatment need has on OHRQoL in preterm-born adolescents.

Understanding behavioural changes through community-based participatory research to promote oral health in socially disadvantaged neighbourhoods in Southern Sweden.

OBJECTIVES: Inequalities in oral health have been on the rise globally. In Sweden, these differences exist not between regions, but among subgroups living in vulnerable situations. This study aims at understanding behavioural change after taking part in participatory oral health promotional activity among families living in socially disadvantaged neighbourhoods in Southern Sweden. SETTING: The current study involved citizens from a socially disadvantaged neighbourhood in Malmö, together with actors from the academic, public and private sectors. These neighbourhoods were characterised by high rates of unemployment, crime, low education levels and, most importantly, poor health. PARTICIPANTS: Families with children aged 7-14 years from the neighbourhood were invited to participate in the health promotional activities by a community representative, known as a health promoter, using snowball sampling. Between 8 and 12 families participated in the multistage focus groups over 6 months. Data were analysed using qualitative content analysis. RESULTS: Three main themes emerged from the analysis, providing an understanding of the determinants for behavioural change, including meaningful social interactions, family dynamics and health trajectories. The mothers in the study valued the social aspects of their participation; however, they believed that gaining knowledge in combination with social interaction made their presence also meaningful. Further, the participants recognised the role of family dynamics primarily the interactions within the family, family structure and traditional practices as influencing oral health-related behaviour among children. Participants reported having experienced a change in general health owing to changed behaviour. They started to understand the association between general health and oral health that further motivated them to follow healthier behavioural routines. CONCLUSIONS: The results from this study show that oral health promotion through reflection and dialogue with the communities, together with other stakeholders, may have the potential to influence behavioural change and empower participants to be future ambassadors for change.

CBCT of Swedish children and adolescents at an oral and maxillofacial radiology department. A survey of requests and indications.

Objectives: This retrospective study investigated requests and indications for cone-beam computed tomography (CBCT) in children and adolescents over a 3-year period at one oral and maxillofacial radiology department. Specific aims were to determine what technical settings were used, which caregivers write the referrals, and how often and for what reasons re-exposure was necessary.Materials and methods: Patients <19 years of age who had been referred to the department and undergone a CBCT scan during 2015-2017 were included in the study.Results: CBCT were made in 617 of the 3847 eligible referrals. The most common referral was from general practice dentists (GPD) (43%). Mean age of the patients was 12.5 years (range: 6-18). Nineteen different types of requests were identified. The most common request was assessment of an ectopic canine with a question about potential resorption of adjacent teeth (38.6%). Forty (6.5%) of the CBCT needed to be re-taken due to patient motion artefacts.Conclusions: The most common request and indication for CBCT examination of children and young adults were to assess an ectopic canine and determine the presence of resorption of adjacent teeth. Referrals from GPDs were the most frequent and the largest age group was the 11- to 15-year olds. The reason for re-exposures was motion artefacts. High scanning speed to reduce motion artefacts and a half rotation (180°) to reduce the radiation dose to the patient should be preferred. The need for continuous work with quality and systematic monitoring of radiographic procedures at any radiology department should be given high priority.

Temporomandibular pain in adolescents with a history of preterm birth.

AIM: To evaluate the frequency of temporomandibular disorder (TMD) pain among adolescents with a history of preterm birth compared to a matched control group. METHODS: A group of 192 preterm-born adolescents was followed up at the age of 17-19 years and compared to matched controls. Self-report questionnaires included screening questions about TMD pain, chronic diseases, general health, depression, anxiety, anger, antisocial behaviour and self-concept. TMD pain was defined as answering "yes" to one or both of the following questions: "Do you have pain in the temple, face, temporomandibular joint or jaws once a week or more?" and "Do you have pain when you open your mouth wide or chew once a week or more often?" Data analysis was performed using chi-square test and logistic regression model with likelihood ratio test. RESULTS: A TMD pain frequency of 23% of preterm-born adolescents and 26% among the controls was found, with no significant differences between the groups. Neither were there differences regarding anxiety, depression, anger or self-confidence. Within the preterm group, adolescents with TMD pain registered tension and pain in the body, trouble sleeping, stomach pain and feelings of hopelessness about the future. The controls with TMD pain, more reported having a bad life, feeling like a failure and having bodily pain. Among tested background variables, only TMJ locking or intermittent locking once a week or more was found to explain TMD pain in adolescents. CONCLUSION: A high frequency of TMD pain was found in both groups, one possible explanation could be TMJ dysfunction.

Effects and cost-effectiveness of postoperative oral analgesics for additional postoperative pain relief in children and adolescents undergoing dental treatment: Health technology assessment including a systematic review.

BACKGROUND: There is an uncertainty regarding how to optimally prevent and/or reduce pain after dental treatment on children and adolescents. AIM: To conduct a systematic review (SR) and health technology assessment (HTA) of oral analgesics administered after dental treatment to prevent postoperative pain in children and adolescents aged 3-19 years. DESIGN: A PICO-protocol was constructed and registered in PROSPERO (CRD42017075589). Searches were conducted in PubMed, Cochrane, Scopus, Cinahl, and EMBASE, November 2018. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria, following the PRISMA-statement. RESULTS: 3,963 scientific papers were identified, whereof 216 read in full text. None met the inclusion criteria, leading to an empty SR. Ethical issues were identified related to the recognized knowledge gap in terms of challenges to conduct studies that are well-designed from methodological as well as ethical perspectives. CONCLUSIONS: There is no scientific support for the use or rejection of oral analgesics administered after dental treatment in order to prevent or reduce postoperative pain in children and adolescents. Thus, no guidelines can be formulated on this issue based solely on scientific evidence. Well-designed studies on how to prevent pain from developing after dental treatment in children and adolescents is urgently needed.

Five years' follow-up of dental fear and anxiety, experience of dental care and oral health behaviour in Swedish preterm and full-term adolescents.

BACKGROUND: There is rising concern about how preterm birth affects long-term health later in life. The various effects that preterm birth have on developmental outcomes, cognitive profiles and medical health may also affect levels of cooperation in the dental care situation in addition to general oral health and other oral health-related habits. Oral health is an integral part of one's general health and well-being; however, less is known about how prematurity affects oral health and other related areas such as dental care, and including dental fear and anxiety (DFA) in individuals during adolescence and adulthood. This is considered of special interest to study, as preterm children during the preschool and school period were reported to have behavioural problems during dental treatments and less than favourable oral hygiene. METHODS: A questionnaire was used of self-report design and structured into behavioural aspects relating to dental treatment, oral health-related factors, and medical health. This questionnaire at 17-19 years of age was a follow-up from 12 to 14 years of age and considered a predictor for planning future dental care for this group of patients. The 145 participating adolescents were all preterm, born between 23 and 32 weeks of gestation and 140 full-term controls, born ≥37 weeks of gestation. RESULTS: Dental fear and anxiety, oral health behaviour, and intake of sweets and sugary drinks of 17-19-year old adolescents born preterm was comparable to that of the full-term control group. Medical health problems as well as the intake of sweets and sugary drinks increased from the time of early adolescence to late adolescence in both groups. CONCLUSIONS: Preterm as well as full-term adolescents between 17 and 19 years of age are satisfied with their dental care and display low prevalence of dental fear and anxiety (DFA). The findings in this study indicate that adolescents born very preterm and extremely preterm are well prepared for transition to dental care in adult life with expectations of being able to take responsibility for their oral health.

Oral health-related quality-of-life in Swedish children before and after dental treatment under general anesthesia.

OBJECTIVE: This study evaluated oral health-related quality-of-life (OHRQoL) in children and families before and after dental treatment under general anesthesia because of severe caries or molar-incisor hypomineralization (MIH). MATERIALS AND METHODS: A consecutive sample of the parents/caregivers of children (3-14 years) in need of treatment under general anesthesia participated in the study. The children were divided into two groups: 3-6 years and 7-14 years. The 49-item questionnaire that was administered before and after general anesthesia comprised the Child Oral Health Quality of Life-components of the Parental-Caregivers Perception Questionnaire (P-CPQ), the Family Impact Scale (FIS) and two global questions concerning oral health and general well-being. The P-CPQ domains were Oral symptoms, Functional limitations, Emotional well-being and Social well-being. The FIS items assessed impact on family life. RESULTS: In both age groups, a significant decrease (p < 0.001) occurred in overall P-CPQ and the Oral symptoms, Functional limitations and Emotional limitations domains of the P-CPQ. Mean values for the Social well-being domain decreased significantly in the older (p < 0.05) but not the younger age group. Mean values for FIS decreased significantly in the younger (p < 0.001) and the older (p < 0.05) age groups. CONCLUSIONS: Dental treatment of severe caries or MIH, performed under general anesthesia, had an immediate effect on the oral health-related quality-of-life in the children in this study and a positive impact on the family situation.

Preterm birth does not increase the risk of traumatic dental injuries or unintentional injuries.

AIM: To evaluate the prevalence of traumatic dental injuries (TDIs) and unintentional injuries (UIs) in Swedish children from 0 to 12 years of age, comparing those who were born preterm with matched full-term controls. The associations between TDI and UI and medical health problems or socio-demographic characteristics were also studied. METHODS: This cross-sectional, case-control study used dental record reviews and interviews to obtain TDI data on 187 matched pairs aged from 0 to 6 (Sample I) and a structured questionnaire to study TDI and UI among 82 matched pairs aged from 0 to 12 (Sample II). RESULTS: Reports of TDI in the primary teeth and permanent teeth from 0 to 12 years of age were significantly more common in the control than preterm born children (p = 0.032). No significant differences were seen in the 0-6 age group. When it came to UI, there were no statistical significant differences between the preterm and control groups and no correlations between TDI and UI and medical health problems or socio-demographic characteristics. CONCLUSION: The study indicates that preterm children are no more exposed to TDI or UI than matched full-term controls. In fact, the control group parents reported significantly higher prevalence of TDI in the primary and permanent teeth.

Molar-incisor hypomineralization and oral hygiene in 10- to-12-yr-old Swedish children born preterm.

Although preterm birth is associated with an increased risk of medical problems and impairments, there is limited knowledge of how this affects oral health. It was hypothesized that when 10-12 yr of age, children who were preterm at birth would present with a higher prevalence of molar-incisor hypomineralization (MIH), more dental plaque, and a higher degree of gingival inflammation than full-term control children. Eighty-two preterm children, born between 24 and 32 wk of gestation, and 82 control children, born between 37 and 43 wk of gestation, were clinically examined for developmental defects in enamel, MIH, dental plaque, and gingival health. In addition, behaviour management problems were evaluated. Information on any aetiological factors with a potential influence on MIH and oral health was collected via questionnaires. Molar-incisor hypomineralization was more common in preterm children than in controls (38% vs. 16%), as were enamel developmental defects (69.5% vs. 51%). Low gestational age and low birth weight increased the risk of MIH. Preterm children had more plaque, a higher degree of gingival inflammation, and more behaviour-management problems than controls. In conclusion, oral health problems were more common in preterm children than in control children.

Dental fear and anxiety and oral health behaviour in 12- to 14-year-olds born preterm.

BACKGROUND: An enhanced frequency of cognitive and behavioural disturbances has been reported in preterm children. It is not known if this affects their perceptions of or behaviour in the dental care situation. HYPOTHESIS: The hypotheses were that preterm (PT) children aged 12-14 years more often exhibit dental fear and anxiety (DFA) than full-term controls (C), while no differences were expected regarding oral health behaviour. METHODS: One hundred and nine PT and 108 C children took part in the present questionnaire study. DFA was assessed using the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS). In addition the questionnaire covered items including satisfaction with received dental care, oral health behaviour and medical health. RESULTS: The children's CFSS-DS scores revealed no differences between the PT and C groups. Regarding oral health behaviour there were no differences, except that PT children more often used dental floss and extra fluoride supplements. PT children reported more medical health problems than C children. CONCLUSIONS: Preterm (PT) children 12- to 14-years-old, as well as C of same age group, seem to be satisfied with their dental care and display low prevalence of DFA. Still, a higher frequency of medical health problems in the PT children suggests that these children should be regarded as potential risk patients for oral health problems.

The preterm child in dentistry. Behavioural aspects and oral health.

BACKGROUND: Advancements in medical care have enabled more children born preterm to survive and develop as healthy individuals alongside their full-term peers. However, a higher frequency of medical health problems, cognitive and behavioural disturbances, including problems in school, has been reported. There is limited knowledge about how this affects preterm children (PT) in dentistry, and few studies have evaluated behavioural problems related to dental treatments and oral health in PT as compared with full-term control children (C). AIMS: The overall objective was to investigate behavioural problems related to dental treatments and the oral health in PT born between 23 and 32 weeks of gestation as compared with full-term C. Specific aims were to analyze behaviour management problems (BMP), dental fear and anxiety (DFA), prevalence of Molar-Incisor Hypomineralization (MIH), oral hygiene, gingival health, and dental caries in PT and full-term C. MATERIALS AND METHODS: The study group comprised all children born between 23 and 32 weeks of gestation in the catchment area of the University hospitals of Lund and Malmö in southern Sweden. The subjects in Papers I-III were PT and matched full-term C, followed from preschool years to adolescence. In Paper IV, a new group of children, living in the city of Malmö was identified, the subjects being 10-to-12-year old PT and matched full-term C. Information about dental treatment, oral health and oral health related factors were obtained from dental records, interviews, questionnaires and clinical examinations. RESULTS OF THE FOUR PAPERS: Paper I: BMP and dental caries was studied in 187 PT and 187 C, based on notes in dental records at 3 and 6 years of age, and during the preschool period (3-6 years). At age 3, but not at age 6, the prevalence of BMPat dental examinations were more common in PT than in C. At various kinds of dental treatments during the preschool period, PT presented more frequently with BMP. No differences were found regarding dental caries. Paper II: Parents of 153 PT and 153 C were interviewed on two occasions, two years apar (preschool period and early school years) regarding experience of their child's dental care, oral health behaviour and medical health. BMPwere reported more common in PT than in C during preschool period but not during the early school years. PT also reported more medical health problems than C. Paper III: AT 12-14 years of age, 109 PT and 108 C toop art in a questionnaire study, including, the Children's Fear Survey Schedule--Dental Subscale (CFSS-DS) to measure the level of DFA, oral health behaviour and medical health. Few PT and C reported DFA. PT reported more daily use of dental floss and use of extra fluorid supplements than C. Further, PT reported more medical health problems than C. Paper IV: Eighty-two PT and 82 full-term C, aged 10 to 12 years, were clinicaly examined regarding the prevalence and severity of MIH as well as their levels of oral hygiene and gingival health. In addition, BMP and dental caries were recorded. MIH was more common in PT than in C. Low gestational age and low birth weight increased the risk of MIH. PT had more plaque and gingival inflammation and presented more BMP than C. No difference in caries prevalence was found. CONCLUSIONS AND IMPLICATIONS: In 3-to-10-year old PT and matched full-term C, and based on dental records and parental reports, it was concluded that BMP were more common in PT than in C during the preschool period. The difference decreased with increasing age and during the early school years there were no differences between the groups. However, at clinical examination at the age of 10-12 years, PT presented with BMP more frequently than C. During adolescence, based on the youngsters' own viewpoints, few PT and C reported DFA. The clinical examination at 10-12 years of age showed that PT had a higher prevaleance of Molar-Incisor Hypomineralization (MIH) than C, and low gestational age and low birth weight increased the risk of MIH. At this age, PT also had less favorable oral hygiene and gingival status than C. Problems with toothbrushing were more commonly reported in PT than in C during the preschool period. During adolescence, PT reported more daily use of dental floss and extra fluoride supplements than C. Regarding caries prevalence, there were no differences between the group in either the primary or in the permanent dentition. In contrast, PT had more medical health problems, persisting from preschool period in adolescence than C. The results in this thesis indicate more behavioural problems related to dental treatment and more oral health problems in PT than in C. Therefore, PT require special attention from the dental services, with treatment planning and prevention strategies from an early age. Collaboration between medical and dental health care professionals is advocated in order to ensure good oral health in PT.

Parental perspectives on preterm children's oral health behaviour and experience of dental care during preschool and early school years.

BACKGROUND: Children born preterm (PT) have medical conditions and impairments that may affect their oral health. Hypothesis. Our hypothesis for the study was that PT children display more dental behaviour management problems (BMPs) and less favourable oral health behaviour than controls (C). METHODS: Parents of 153 PT children and 153 C children were interviewed regarding the children's oral health behaviour and experience of dental care on two occasions, 2 years apart. The interviews concerned the preschool period and the early school years, respectively. RESULTS: BMPs were more common in PT children of preschool age, but not during the early school years. Regarding oral health behaviour, there were no differences between the groups, except that PT children had more problems with toothbrushing than C children in the preschool period, in spite of the fact that the PT group reported more medical health problems and more anxious behaviour and indications of cognitive problems than the C group. CONCLUSIONS: Children born PT exhibit several risk factors for both BMP and impaired oral health. It is essential that this group of patients is identified early and receives special attention from the dental services.

Dental behavioural management problems and dental caries prevalence in 3- to 6-year-old Swedish children born preterm.

BACKGROUND: Today, most children born preterm survive without major impairments. But high frequencies of cognitive and behavioural difficulties arise. Studies on dental behavioural management problems (DBMP) in these children are lacking. In addition, studies on caries prevalence are few and inconclusive. AIM: This study aims to compare the frequency of behavioural problems and poor compliance with dental treatment in preschool children born preterm with those born full-term. The prevalence of caries was also studied. METHODS: The study group included 187 children born between 23 and 32 weeks of gestation. The control group constituted full-term children matched by age, sex, immigrant background, and dental operator. DBMP, number of dental visits, missed appointments, and caries between ages 3 and 6 were noted. RESULTS: At age 3, but not at age 6, the prevalence of DBMP at clinical examinations was significantly higher in preterm children compared with the control group. Of the children who received dental treatments during preschool years, preterm children displayed significantly more DBMP. No significant difference in dental visits or in caries prevalence was found. Preterm children, however, missed significantly more dental appointments. CONCLUSION: Children born preterm display a higher prevalence of DBMP at dental examinations and treatments during preschool years.