Anxiety during the dental care of children aged 4 to 6 years over three consecutive visits.

Managing the anxiety of children during dental care is a major aspect of a pediatric dentist's work. Only a sparse body of literature is available regarding anxiety during dental care over consecutive visits. The purpose of the study was to investigate anxiety over three consecutive visits for pediatric dental treatment using an electrodermal activity (EDA) device. We also investigated how patient age, gender, the type of dental care performed and previous dental experience, exerted effect on anxiety.This was an observational cohort study. Anxiety was assessed during treatment, using an EDA device. We also recorded Frankl's behavior rating, previous dental experience, behavior guidance technique, heart rate and the type of dental care. Our cohort included 30 healthy children aged 4-6 years who needed dental care over at least three visits. Frankl scale scores, EDA values and heart rate did not differ significantly between visits. Behavior and anxiety during treatment did not differ significantly according to gender and age. At the second visit, the Frankl score was higher in children who received pulp treatments and crowns than those who received restorations (p = 0.012). At the third visit, children who received pulp treatments and crowns had higher heart rates than those who received restorations (p = 0.011). Heart rate was significantly higher in children who had negative dental experiences when compared to those with positive experiences (p = 0.030). The levels of anxiety in children aged 4-6 years did not change significantly over three consecutive dental treatments. Therefore, varied and meticulous behavior management methods should be maintained throughout consecutive visits.

Evaluation of proximal slicing in primary maxillary incisors with proximal caries- a retrospective cohort study.

BACKGROUND: Modern management of dental caries should be more conservative and include early detection of lesions and active surveillance, in order to apply preventive measures and carefully monitor for signs of arrest or progression. Proximal slicing was suggested for nonrestorative caries treatment for primary incisors. The aim of the study was to examine the success of proximal slicing in primary maxillary incisors in arresting caries progression. METHODS: A retrospective cohort study. Data were collected from medical records of patients who had undergone proximal slicing in primary maxillary incisors with a follow-up period of at least 6 months. Treatment was considered a success when no further invasive clinical intervention was required within the follow-up period of at least 6 months. Treatment was considered a failure when further invasive clinical intervention was needed during the follow-up period (restoration, crown, or extraction). Additional variables included were the patient's gender, treated tooth, treated surface, age during their first visit to the clinic, age during slicing treatment, follow-up period, number of follow-up visits, and number of fluoride applications and additional slicing during follow-up. RESULTS: Seventy-one patients were included in the study. Proximal slicing was successful in 76% of participants with a follow-up of at least 6 months. Success was associated with older age at the first dental visit (3.5yo vs. 2.5yo, p = 0.0011) and age when proximal slicing was performed (4yo vs. 3yo, p < 0.001). CONCLUSION: Proximal slicing may successfully arrest proximal caries in primary maxillary incisors.

Distraction With Virtual Reality Goggles in Paediatric Dental Treatment: A Randomised Controlled Trial.

AIM: The aim of this study was to examine whether screening content through virtual reality (VR) goggles can diminish pain perception during local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in routine paediatric dental treatment. MATERIALS AND METHODS: This is a crossover study of healthy 4- to 12-year-old children who were scheduled to receive local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in 2 visits. The participants were randomly assigned to undergo 1 treatment performed with Oculus GO VR goggles and the other treatment without. Pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Modified Behavioral Pain Scale (MBPS). RESULTS: The study group included 29 children with a mean age of 8.29 years (SD, 1.96). Whilst administering local anaesthesia, no significant difference was observed in the Wong-Baker FACES Pain Rating Scale and in MBPS movements between visits with and without the VR goggles. However, significantly lower pain perception was observed in the other parameters of MBPS when using the VR goggles: Face (P = .007) and Cry (P = .046). During placement of a rubber dam, significantly less pain was reported by the patients (P = .005) and observed by the assessor (Face [P = .005], Cry [P = .029], and Movement [P = 0.028]) when the VR goggles were used. CONCLUSIONS: VR can decrease pain perception during rubber dam placement in children, but it has limited benefit during administration of local anaesthesia.

Developmental defects of enamel in children born preterm.

Introduction: To investigate manifestations of developmental defects of enamel (DDE) in children born preterm (PT), and to explore possible neonatal morbidities related to DDE manifestation and severity. Methods: A cohort study of 52 children born before gestational week 32 and treated in the neonatal intensive care unit; and 55 children born at full term (FT) as a control group. All the children had a dental examination at age 1-4 years by a professional pediatric dentist. DDE was defined as an alteration in the enamel surface. Results: DDE were observed in 23 (44%) and 6 (11%) children, in the PT and FT groups, respectively, odds ratio (OR) = 6.47. The OR for damaged anterior teeth was 12.87 times higher in the PT group. DDE of molars was diagnosed in 19% and 11% of the respective groups. In the PT group, the OR of DDE was 4.1 higher among those with than without respiratory distress. The risk for DDE was 5.7 higher in those who received surfactant than in those who did not. Ventilation length, both invasive and non-invasive, was significantly related to DEE. Conclusions: DDE was higher in children born PT than FT. The DDE rate was lower than expected based on current literature, and considering the overall increase in survival; this suggests improvement in treatments affecting DEE. Respiratory distress syndrome, surfactant administration reflecting the need for intubation, longer ventilation and local oral trauma were risk factors for DDE. We recommend routine dental examinations in follow up of children born PT, particularly those exposed to assisted ventilation.

The prevalence of dental developmental anomalies among childhood cancer survivors according to types of anticancer treatment.

Survival following childhood cancer has increased considerably. In an observational cross-sectional study, we assessed the prevalence of dental developmental anomalies (DDA) among childhood cancer survivors according to types of anticancer treatment. Permanent teeth were examined clinically and radiographically in 121 adolescents with a history of childhood malignancies, to identify DDA, namely hypomineralization or hypoplasia, microdontia, root changes and hypodontia. DDA were observed in 56/121 individuals (46%), in 309/3388 teeth (9%). Hypomineralization or hypoplasia of enamel appeared in 21 (17%) patients. Altered root development appeared in 26 patients and hypodontia affected 13 (10%). Dental anomalies were observed in 36 (43%) individuals who received chemotherapy and not radiation, in 20 (52%) who received radiotherapy, and in 15 (60%) of those who received head and neck radiotherapy. Among patients who received only chemotherapy, young age (6 years or younger) was associated with a higher number of malformed teeth. In conclusion, antineoplastic treatment that combines chemotherapy and radiotherapy appears to increase the risk of DDA. Radiation to the head and neck area was shown to particularly increase the risk of DDA. No specific chemotherapy agent was found to be associated more than the others with DDA.

Behaviour of 3-11-year-old children during dental treatment requiring multiple visits: a retrospective study.

PURPOSE: To examine children's behaviours during consecutive dental treatments, relative to gender, age, and behaviour guidance techniques. METHODS: A retrospective study of medical records of children treated by four residents in a Department of Paediatric Dentistry, during 2015-2018. Data included: age, gender, behaviour guidance technique (no medication, inhaled sedation, conscious sedation with hydroxyzine or benzodiazepines) and behaviour according to Frankl scale. RESULTS: Of 205 children, 134 were 3-6 yo (Group 1) and 71 were 6.1-11 yo (Group 2). Most presented a positive behavioural profile, with significant difference between groups (p = 0.02), no significant difference between genders (p = 0.72). A significant association between behaviour guidance techniques and behavioural profile was found (p = 0.01). Most children with positive behaviour received inhaled sedation (83%), while most children with negative behaviour received conscious sedation using benzodiazepines (8%). Negative behaviour was observed only in the younger children receiving conscious sedation with benzodiazepines (9%) or hydroxyzine (3%). CONCLUSIONS: Most 3-11 yo patients exhibited positive behaviour during four consecutive dental treatments, with different behaviour guidance techniques. Negative behaviour was more frequent among 3-6 yo children, where sedation was often required to achieve cooperation, and 4.5% could benefit from general anesthesia.

Promoting oral and dental health in early childhood - knowledge, views and current practices among paediatricians in Israel.

Early childhood dental caries is the most prevalent disease in childhood. Paediatricians are considered by parents as the main authority on prevention and treatment of all the health requirements of their infants. Aim: The aim of this study was to evaluate the knowledge and practice of paediatricians in promoting oral and dental health among young patients (under age 36 months) and their parents. Materials and methods: 145 anonymous questionnaires were distributed among paediatricians, 130 of them were 90% or above answered and were suitable for analysis for this study.75% of the questionnaires were distributed during the national convention of the Israeli Association of Clinical Paediatrics, 10% in paediatric ambulatory clinics and 15% in paediatric departments in hospitals. Questionnaires were distributed between 2018 and 2020. The inclusion criteria were physicians specialists in paediatrics or residents in paediatrics, all have Israeli licences to practice in Israel. exclusion criteria were partially filled questionnaires. The questionnaire was validated in a pilot study during the years 2010-2012. In addition to demographic variables that included medical training, post-graduate education and clinical practice the questionnaire included 42 questions. Eleven questions on demographics and amount of dental training during academic and clinical training 31 questions belonged to several sections that referred to the participants' awareness of the AAP guidelines regarding oral and dental health and knowledge of oral health. In each section paediatricians were asked to answer or give an opinion on a specific issue, their answers were coded to scores on a scale of 0-5 and summed per section. Correlations between different variables were analysed. The t-test and Mann-Whitney U test were performed for comparing two variables. For comparing more than two variables, we used the Kruskal-Wallis one-way analysis of variance test or ANOVA. Results: The response rate was 89% (130 questionnaires out of 145). The survey showed that most paediatricians (80%) recognized their role in maintaining the oral and dental health of their young patients. Nevertheless, most admitted that they do not perform simple procedures on a regular basis, like dental examinations (64.6%), or asking parents about feeding habits (59.2%) or teeth brushing (75.4%). Only 21% of the participants expressed adequate knowledge of dental care for children younger than age 3 years. Fifty-eight percent of the participants never had any dental training during their entire paediatric medicine training, including medical school. Paediatricians in private or baby clinics received higher scores in practicing caries prevention, 24.15 ± 5.17 (SD), than paediatricians in hospitals, 2.79 ± 0.54 (SD) (p = 0.006). Caries prevention practice was not found to correlate with paediatricians' knowledge or attitudes regarding oral and dental caries prevention. Conclusion: Oral and dental knowledge should be incorporated into the paediatric medicine curriculum. With their heavy workload, paediatricians generally do not implement dental caries risk assessment and counselling.

Zinc Oxide Zinc Sulfate versus Zinc Oxide Eugenol as Pulp Chamber Filling Materials in Primary Molar Pulpotomies.

The long-term effect of Zinc oxide zinc sulfate (Coltosol®) dressing material on pulpotomy success and tooth survival has not yet been studied. This study compared the success rates of Zinc oxide zinc sulfate and zinc oxide eugenol as coronal dressing materials post radicular pulp amputation in primary teeth pulpotomies. This study included healthy two- to ten-year-old children who had pulpotomies on primary molars between 2012 and 2018 at the Pediatric Dentistry Clinic of the School of Dental Medicine. Data were analyzed at several follow-ups of up to 60 months. Kaplan-Meier survival curves were used to estimate survival probabilities of Zinc oxide zinc sulfate versus zinc oxide eugenol. In the 107 children included in this study, 54 teeth were filled with Zinc oxide zinc sulfate and 53 were filled with zinc oxide eugenol. Follow-up ranged from 12.2 to 73.3 months. Overall survival of Coltosol® vs. IRM filled teeth was 87.1% and 79.3%, respectively. Overall survival probabilities for Coltosol®-filled teeth at 15.5, 24 and 45 months were 95%, 89.8% and 79.7%, respectively, while for IRM they were 93.7%, 83% and 67.7%, respectively. Treatment failure rates and type of treated teeth did not differ between boys and girls (p-value = 0.77 and 0.87, respectively). Zinc oxide zinc sulfate and zinc oxide eugenol exhibited comparable high long-term success rates of up to five years (p = 0.16).

Oral Health Care Delivery for Children During COVID-19 Pandemic-A Retrospective Study.

Aim: COVID-19 outbreak and the lockdown period following was a very challenging time for pediatric dentistry. We aimed to find whether the characteristics of dental care provided to children at the Department of Pediatric Dentistry at Hadassah medical center, Jerusalem, Israel, differed between the periods, before COVID-19 outbreak, during the lockdown period and during the period that followed it. Materials and Methods: We retrospectively reviewed computerized records of patients who visited the pediatric dental clinic at three different periods: pre-lockdown period, lockdown period, and post-lockdown period. Results: Nine-hundred and forty-nine children were included in the study; most of them were healthy children between 3 and 6 years old. During lockdown, all scheduled appointments except for treatments under general anesthesia and deep sedation were canceled due to the government's restrictions; the frequency of treatments with non-pharmacological behavior management, general anesthesia or deep sedation was higher than in the previous or subsequent periods and the use of inhaled/conscious sedation was significantly lower. During lockdown most of the children were diagnosed with dentoalveolar abscess (32.3%), compared to 14 and 21% at the previous or subsequent periods, respectively (P < 0.001). Treatments combination during lockdown included more extractions, pulpectomies and pulp extirpation and less permanent restorations (P < 0.001). None of the staff members was infected with COVID-19 at the clinic during these periods. We concluded that dentists should be updated about Covid-19 modes of transmission and the recommended infection control measures in dental settings. Effective management protocols can help the dental staff to continue to provide efficient treatment and prevent Covid-19 contamination.

Does preoperative paracetamol reduce pain after dental treatment? A randomized controlled double-blind study.

OBJECTIVE: The present study compared the efficacy of preoperative administration of paracetamol and placebo in reducing postoperative pain after routine dental treatment in children. The primary objective was to compare postoperative pain level between the groups. The secondary objective was to identify other factors that can influence postoperative pain. METHOD AND MATERIALS: A prospective, placebo-controlled parallel-group trial was conducted on two groups of children aged 5 to 12 years. One hundred and two children participated in the study, 51 in each group, 58 boys (56.9%) and 44 girls (43.1%). The average age was 7 ± 1.72 years, with no difference in age and sex between the groups. The study group received paracetamol (15 mg/kg) and the control group received placebo 15 minutes before dental treatment. Pretreatment baseline anxiety was recorded. Postoperative data were collected immediately at the end of the treatment, and by phone 2.5 hours after taking the remedy. RESULTS: The groups showed no difference in postoperative pain immediately after the treatment and 1.5 hours after treatment. The pain score was higher among children who received stainless steel crowns and combinations of crowns, pulpectomy, and extractions. CONCLUSION: Preoperative use of paracetamol has the same preemptive analgesic effect as placebo in pediatric patients who receive routine dental treatment. CLINICAL RELEVANCE: Postoperative pain can influence the willingness of children to receive consecutive treatments. Dental practitioners should prevent postoperative pain and recommend analgesia when necessary. Pain is expected after performing stainless steel crowns, pulpectomies, and extractions. The current study confirms that preoperative paracetamol has no beneficial effect.

Epidemiology and Clinical Management of Early Childhood Caries in Israel.

Aim: The aim of the present review is to describe the current status of early childhood caries (ECC) in Israel in aspects of epidemiology, prevention, and management. Methods: PubMed search was performed using the words caries, children, Israel. Demographic data was collected from the Israeli Central Bureau of Statistics. Results: The decayed, missing, and filled teeth index was 2.72 in 1992 and 2.56 in 2016. The proportion of restored teeth has increased. A number of preventive programs are ongoing but a general preventive program is lacking at the national level. From 2010, every child in Israel is eligible to receive free dental treatment. Conclusion: The gaps in understanding of the epidemiological profile of ECC in Israel is a call for more research conduct on ECC in the country.

The effect of the waiting room's environment on level of anxiety experienced by children prior to dental treatment: a case control study.

BACKGROUND: In addition to visit purpose, one of the environmental factors that can cause anxiety prior to dental treatment includes the waiting room experience, specifically the amount of time spent awaiting treatment and the waiting room environment. The purpose of this study was to compare the effect of the waiting room's environment on the level of anxiety experienced by children in multisensory and traditional waiting rooms. METHODS: Case control study. Test group waited for treatment in a multisensory waiting room, which consisted of a lighting column that children could touch and climb; as well as, rhythmic music played on loudspeakers. Control group waited for treatment in a traditional waiting room. Study participants were asked to answer the "Venham Picture Test", a dental anxiety scale, while in the waiting room prior to entering the treatment room. Chi-squared, Fisher's Exact tests, and linear regression were utilized. A p-value less than 0.05 was considered statistically significant. RESULTS: No significant difference in dental anxiety scores was found between the test and control groups according to waiting room type (p > .05). Dental anxiety was significantly higher in patients who had longer waiting time prior to treatment (p = 0.019). In addition, dental anxiety was significantly associated with visit purpose (p < .001): children waiting for dental examination or those scheduled for dental treatment with conscious sedation were less anxious than children waiting for emergency treatment. CONCLUSIONS: A sensory adapted waiting room environment may be less important in reducing children's anxiety prior to dental treatment. Children's dental anxiety can be reduced by preventing emergency treatments, scheduling routine dental visits and decreasing waiting time. TRIAL REGISTRATION: TRN NCT03197129, date of registration June 20, 2017.

Oral Langerhans Cell Histiocytosis in an Infant.

Langerhans cell histiocytosis (LCH) is a rare disease characterized by abnormal proliferation of bone marrow-derived histiocytes (Langerhans cells). LCH may manifest orally with single or multiple lesions of the alveolar or basal bone. Ulcerated mucosal lesions may be accompanied by periodontal lesions that present with gingival inflammation, bleeding, recession, necrosis, toothache, dental hypermobility, tooth development abnormalities, and premature tooth loss. This paper presents the case of a five-month-old boy with very early oral manifestations of LCH and describes the combined systemic and dental treatment during a 36-month follow-up. A combined local and systemic approach may be necessary to control oral disease manifestations.

Dental pulp therapy for primary teeth in children undergoing cancer therapy.

BACKGROUND: Childhood cancer treatment negatively affects the immune system, increasing the risk for bacteremia and septicemia. As the oral cavity is a major entry portal for pathogens into the bloodstream dental care in such children tends to be radical, favouring tooth extraction over less drastic treatments such as pulpotomy, the amputation of infected dental pulp. The present study aimed to compare pulpotomy treatment success rate in children with cancer receiving immunosuppressive therapy with that of healthy children, and investigate if unsuccessful pulpotomy treatment in oncologic patients may lead to systemic complications. PROCEDURE: Twenty-six medical records of children from a paediatric oncology referral centre who had dental pulpotomy treatment (in 41 teeth) while receiving active cancer care during the years 2006-2012 were compared with records of 41 randomly selected healthy children who had undergone pulpotomy treatment (41 teeth) in the same institute during these years. Clinical and radiographic data were collected during treatments and at the end of the follow-up period (six months post dental treatment). RESULTS: No statisticaly significant difference was found between pulpotomy success rate amongst the two groups. Treatments success rates in the study and control groups were 82.9% (± 5.9) and 90.2% (± 4.7), respectively. No patient in the study group suffered from sepsis from a dental origin during follow-up period. CONCLUSIONS: Pulpotomy in paediatric cancer patients did not increase the risk for bacteremia or systemic complications from oral origin. We therefore recommend the re-evaluation of the current protocol for treating paediatric oncology patients.