The age and primary reason for the first dental visit in children with special health care needs.

AIM: To evaluate the average age and primary reason for the first dental visit among patients with special health care needs (SHCN) as well as to examine barriers related to accessing care for children with special health care needs. METHODS: This is a cross-sectional survey that was distributed to caregivers of children with special health care needs (CSHCN).  Study data was collected through REDCap, a secure web-based survey application. RESULTS: A total of 75 caregivers participated in the survey.  Only 13% of caregivers reported that their child was less than 1 by the time of their first dental visit.  Nearly all reported seeing a pediatric dentist for their first visit (89%) and that it was for a routine exam and cleaning (83%).  About one-third of guardians reported an experience where a dentist was unable to care for their child due to their SHCN (36%). DISCUSSION: It appears that caregivers of CSHCN that participated in this survey have established routine care with a pediatric dentist at an early age. It is important to continue to educate caregivers on the importance of routine care as well as support general dentists in their role of caring for patients with SHCN.

Nonpharmacological Behavior Guidance for the Pediatric Dental Patient.

Purpose: To present evidence-based recommendations on nonpharmacological behavior guidance for the pediatric dental patient. Methods: The work group assessed eight systematic reviews for effectiveness of nonpharmacological behavior guidance techniques in children undergoing preventive care or a dental treatment visit. The key outcomes assessed included cooperative behavior, anxiety, and procedural pain. To formulate the recommendations, the work group used the GRADE framework to obtain consensus on domains such as priority of the problem, certainty of the evidence, balance between desirable and undesirable consequences, patients' values and preferences, acceptability, and feasibility. Results: Overall, the use of basic nonpharmacological behavior guidance techniques resulted in trivial-to-small effect on improvement in behavior or reduction in anxiety. However, for children and adolescents undergoing preventive care, mobile applications and modeling showed large effects in reduction of anxiety. For those undergoing dental treatment, strategies such as modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal-assisted therapy, combined tell-show-do, audiovisual distraction, and cognitive behavior therapy showed large reduction in anxiety. For children and adolescents with special health care needs, audiovisual distraction and sensory-adapted dental environment showed large reduction of anxiety. Conclusions: All the formulated recommendations were conditional and were mostly based on very low certainty of evidence. Conditional recommendations imply that different choices or combinations of behavior guidance techniques may be most appropriate for different patients. Clinicians should use techniques consistent with the parent/patient values and preferences. These recommendations are based on the best available evidence to-date and are intended to aid clinical decision making.

Child Patient with a History of Status Epilepticus Referred for Management of Grossly Decayed Primary Molar.

A patient with status epilepticus presents with a grossly carious primary molar. Medical consultation is requested from the patient's neurologist. The patient is treated in the operating room under general anesthesia for comprehensive dental care.

A Survey of Attitudes and Training of Pediatric Dentistry Residents and Faculty in the United States Regarding the LGBTQ Patient Population.

Purpose: The purpose of this study was to assess the knowledge, attitude, and training of pediatric dental residents and faculty on the management of patients who belong to the LGBTQ (lesbian, gay, bisexual, transgender, and queer) community. Methods: This cross-sectional survey included a 16-item questionnaire to assess the attitudes and training regarding the LGBTQ population, separately for pediatric dental residents and faculty across the United States. Statistical significance was set at the level of five percent, and data were analyzed using descriptive statistics, Wilcoxon rank-sum, and Fisher's exact tests. Results: In total, 132 residents and 40 faculty members completed the survey (response rates equal 14.4 percent and 16.9 percent, respectively). Residents were significantly more likely to respond that requiring LGBTQ training should be in the curriculum and that they have acquired skills to provide equal service to both LGBTQ and non-LGBTQ patients and families (faculty equals 35 percent, residents equals 57.6 percent; P<0.001). Residents were significantly more likely than faculty to respond that the American Academy of Pediatric Dentistry should publish an exclusive policy statement regarding LGBTQ oral health disparities (faculty equals 40 percent, residents equal 62.1 percent; P=0.01). Conclusions: The resident and faculty of pediatric dentistry programs in the United States have adequate awareness of managing lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients in the dental office and are willing to treat these patients, and most respondents have an interest in further education.

Reporting Quality of the Abstracts for Randomized Controlled Trials in Pediatric Dentistry.

OBJECTIVES: The purpose of this study is to systematically appraise the reporting quality of abstracts for randomized controlled trials (RCT) published in pediatric dentistry using Consolidated Standards of Reporting Trials (CONSORT) for abstracts and to analyze the relationship between the characteristics of the RCT to the quality of abstracts. MATERIALS AND METHODS: RCTs published in Pediatric Dentistry were retrieved from the PubMed database from 2016 to 2021. The quality of abstracts was appraised using CONSORT for abstracts checklist by two independent reviewers. STATISTICAL ANALYSIS: In descriptive statistics, frequency and percentage analysis were used for categorical variables, whereas mean and standard deviation were used for continuous variables. To find the significant difference between the bivariate samples in independent groups, Mann-Whitney U test was employed. Multivariate analysis was performed using Kruskal-Wallis test and Mann-Whitney U tests. Probability value of p-value less than 0.05 was considered as statistically significant. RESULTS: Two hundred abstracts were included in the study. All the abstracts adequately reported the "objective" item, whereas only 2 and 4% of abstracts adequately addressed "randomization" and "harms" items, respectively. A significant relationship was observed between the continent of first author/corresponding author, number of authors, impact factor, adherence to CONSORT guidelines, word count, focus of study, and a priori protocol registration to the quality of abstracts (p < 0.05). CONCLUSION: The abstracts of the RCT included in the study did not adequately follow the CONSORT for abstract guidelines. Adherence to the reporting guidelines would improve the overall reporting quality of abstracts of RCT published in Pediatric Dentistry. The overall mean score of the abstracts was 6.80 out of 15 indicating that the abstracts did not adequately follow the CONSORT for abstract reporting guidelines.

Nonpharmacological Behavior Guidance For Children During Dental Treatment Visits: A Systematic Review and Meta-Analysis-Part 2.

'Purpose: To assess the effectiveness of nonpharmacological behavior guidance interventions used for children undergoing dental treatment visits. METHODS: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a dental treatment visit including sealants, restorative care, dental local anesthesia, and simple surgical procedures. The primary outcome measures were reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included RCTs, performed data extraction, and assessed the risk of bias (ROB). Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommenda- tions Assessment, Development and Evaluation approach were done. RESULTS: Forty articles qualified for analysis from 219 screened articles. Included studies evaluated the effectiveness of pre-visit preparation and in office strategies rendered pre-/post- or during treatment such as positive imagery, direct observation/modeling, desensitization, tell-show-do and its modifications, voice control, positive reinforcement, memory restructuring, bio- feedback and breathing relaxation, animal assisted therapy, combined therapies, and cognitive behavior therapy. The certainty of evidence ranged from Very low to high and the magnitude of effect varied from trivial to large change in the desired outcomes. CONCLUSIONS: Most of the basic non- pharmacological behavior guidance techniques showed trivial to small reduction in self-reported anxiety and/or improvement in behavior, with modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal assisted therapy, combined tell-show-do and audiovisual distraction, and cognitive behavior therapy showing large effects in reduction of anxiety based on some scales.

Nonpharmacological Behavior Guidance for Children with Special Health Care Needs During Preventive and Treatment Dental Visits: A Systematic Review-Part 3.

PURPOSE: To assess the effectiveness of nonpharmacological behavior guidance interventions used for children and youth with special health care needs (CYSHCN) during preventive and dental treatment visits. METHODS: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a preventive visit (exam, fluoride application, radiographs, and prophylaxis) or a treat- ment visit (simple surgical treatment, sealants, restorative care with or with local anesthesia) with control or other interventions. The primary outcome measures for the studied interventions were reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included Randomized Controlled Trials (RCTs), performed data extraction, and assessed the risk of bias (ROB). Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done. RESULTS: Eleven articles qualified for analysis from 219 screened articles. Included studies evaluate the effectiveness of in office strategies such as modeling, audio-visual distraction, sensory adapted dental environment, and picture exchange communication system. The certainty of evidence ranged from Very low to Low and the magnitude of effect varied from trivial to large change in the desired outcomes. CONCLUSIONS: Most basic non-pharmacological behavior guidance techniques showed some trivial to small reduction in self-reported anxiety and/ or improvement in behavior, with audiovisual distraction, Sensory Adapted Dental Environment, and Picture Exchange Communication System showing large reduction in anxiety based on some rating scales. Systematic Review Registration Number: PROSPERO: CRD42022314723.

Nonpharmacological Behavior Guidance for Children During Preventive Dental Visits: A Systematic Review-Part 1.

PURPOSE: To assess the effectiveness of nonpharmacological behavior guidance interventions used for a child undergoing preventive dental visits. METHODS: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a pre- ventive visit including examination, prophylaxis, fluoride application and radiographs. Workgroup (WG) identified moderate-to-high quality system- atic reviews (SRs) published on hypnosis, audiovisual distraction, and parental presence/ absence; and decided to exclude these interventions from current SR to avoid duplication. The primary outcome measures for the studied interventions included reduction in anxiety, fear, pain, and improve- ment in cooperative behavior. Eight authors determined the included RCTs, performed data extraction, and assessed the risk of bias. Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done. RESULTS: Fifteen articles qualified for analysis from 219 screened articles. WG found studies evaluating effectiveness of pre- visit preparation and in-office strategies rendered pre- or during treatment such as positive imagery, communication, modeling, tell-show-do, magic tricks, mobile applications, positive reinforcement, and sensory adapted dental environment. The certainty of evidence ranged from Very low to Moderate and the magnitude of effect varied from trivial to a large change in the desired outcomes. CONCLUSIONS: Most basic nonpharmacological behavior guidance techniques showed trivial to small reduction in self-reported anxiety and/or improvement in behavior, with mobile application and modeling showing large effects in reduction of anxiety based on some rating scales. Systematic Review Registration Number: PROSPERO: CRD42022314723.

A Child with Tetralogy of Fallot Presents for Extraction of Mandibular Premolars.

A 11-year-old boy was referred from an orthodontist for routine extraction of premolars. The patient's cardiac condition was thoroughly examined, and the premolars were extracted following antibiotic prophylaxis to prevent bacterial endocarditis.

An Adolescent with Poorly Managed Asthma Referred for Pulp Therapy in a Permanent Tooth.

A 13-year old male patient with uncontrolled asthma presents with a grossly decayed permanent first molar. Medical consultation was obtained from a pulmonologist to understand the type and severity of asthma, history of allergies, aggravating factors, and medications. The patient was treated in the dental setting with nitrous oxide and oral conscious sedation with benzodiazepine.

Adolescent Patient with Cystic Fibrosis Presents with Suspected Ludwig Angina.

A 15-year-old boy attended Emergency Department with a complaint of difficulty in breathing due to dental infection. A pulmonologist was consulted regarding the severity of the cystic fibrosis. The patient was admitted and intravenous (IV) fluids and antibiotics were given. The infected mandibular right first permanent molar tooth # 30 was extracted under IV ketamine dissociative anesthesia in the hospital setting.

Young Hemophilia Patient Presenting with Avulsed Maxillary Permanent Incisor.

A 7-year-old girl came to the Emergency Department following an avulsion of the maxillary central incisor. The tooth was replanted and splinted. The patient was referred to a hematologist for follow-up and maintenance of adequate levels of Factor VIII.

Comparison of Three Luting Cements for Prefabricated Zirconia Crowns in Primary Molar Teeth: a 36-month Randomized Clinical Trial.

PURPOSE: The purpose of this study was to evaluate and compare the long-term clinical retention and gingival health of prefabricated zirconia crowns (PZCs) in primary molar teeth cemented using three luting cements. METHODS: Primary molar teeth restored with PZCs (n equals 30 per group) were cemented using glass ionomer cement (GIC), resin-modified GIC (BioCem™), or adhesive resin cement (APC technique: air- particle abrasion, zirconia primer, composite resin). Crown retention, plaque accumulation, and gingival status were evaluated over three years; cumulative crown survival was assessed using Kalpan-Meier analysis. Plaque gingival scores were analyzed for within and between groups using repeated measures one-way analysis of variance. RESULTS: The survival of PZCs cemented using GIC was 76.7 percent, 70 percent for APC, and 50 percent for BioCem™ after three years. The mean survival for PZC in the GIC group (35.5 months) was significantly higher than for APC (34.7 months), and BioCem™ (33 months; P=0.019). Plaque accumulation around GIC-luted crowns was significantly lower (P<0.001; three-year follow-up); gingival outcomes were uniformly favorable between groups. No crown fracture was observed throughout the study period. CONCLUSIONS: Prefabricated zirconia crowns cemented using traditional glass ionomer cement have superior retention and lower plaque accumulation compared to BioCem™ and APC after three years. PZCs provided long-term favorable gingival health outcomes irrespective of the cement used for luting the crowns.

Questions of logic in Atlas methods of dental age estimation.

PURPOSE: To review aspects of the underlying methodological procedures in Atlas Methods of Dental Age Estimation (DAE) research publications. Attention is paid to issues of Reference Data supporting the Atlases, details of analytic procedures in the development of the Atlases, the statistical reporting of results of Age Estimation (AE), the problems of expressing uncertainty, and the viability of conclusions in the reporting of DAE studies. METHODS: Research reports utilizing Dental Panoramic Tomographs for creating Reference Data Sets (RDS) were studied to unravel the processes of creating Atlases with a view to determining the appropriate procedures for developing numerical RDS and compiling them into an Atlas format to enable DAE of child subjects without birth records. RESULTS: The five different Atlases reviewed gave several different results in terms of AE. The possible causes of this were discussed - namely inadequate representation of Reference Data (RD) and lack of clarity in expressing uncertainty. It is suggested that the method of compiling Atlases needs to be more clearly defined. The yearly intervals described by some of the Atlases fails to take account of the Uncertainty of Estimates which is usually slightly greater than ±2½ years. CONCLUSION: The review of published Atlas design papers in the field of DAE shows a number of different study designs, statistical procedures, and presentational styles, particularly with regard to the statistical procedures and findings. These show that Atlas methods can only be accurate to what amounts to at best a year. RECOMMENDATIONS: Atlas methods lack the accuracy and precision of other methods of AE an example of which is the Simple Average Method (SAM).1 This inherent lack of accuracy must be taken into account when using Atlas methods for AE.

PROBE 2023 guidelines for reporting observational studies in endodontics: Explanation and elaboration.

Observational studies play a critical role in evaluating the prevalence and incidence of conditions or diseases in populations as well as in defining the benefits and potential hazards of health-related interventions. There are currently no reporting guidelines for observational studies in the field of Endodontics. The Preferred Reporting Items for study Designs in Endodontology (PRIDE) team has developed and published new reporting guidelines for observational-based studies called the 'Preferred Reporting items for OBservational studies in Endodontics (PROBE) 2023' guidelines. The PROBE 2023 guidelines were developed exclusively for the speciality of Endodontics by integrating and adapting the 'STrengthening the Reporting of OBservational studies in Epidemiology (STROBE)' checklist and the 'Clinical and Laboratory Images in Publications (CLIP)' principles. The recommendations of the Guidance for Developers of Health Research Reporting Guidelines were adhered to throughout the process of developing the guidelines. The purpose of this document is to serve as a guide for authors by providing an explanation for each of the items in the PROBE 2023 checklist along with relevant examples from the literature. The document also offers advice to authors on how they can address each item in their manuscript before submission to a journal. The PROBE 2023 checklist is freely accessible and downloadable from the PRIDE website (http://pride-endodonticguidelines.org/probe/).

PROBE 2023 guidelines for reporting observational studies in Endodontics: A consensus-based development study.

Observational studies are non-interventional studies that establish the prevalence and incidence of conditions or diseases in populations or analyse the relationship between health status and other variables. They also facilitate the development of specific research questions for future randomized trials or to answer important scientific questions when trials are not possible to carry out. This article outlines the previously documented consensus-based approach by which the Preferred Reporting items for Observational studies in Endodontics (PROBE) 2023 guidelines were developed. A steering committee of nine members was formed, including the project leaders (PD, VN). The steering committee developed an initial checklist by combining and adapting items from the STrengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist and the Clinical and Laboratory Images in Publications (CLIP) principles, as well as adding several new items specifically for the specialty of Endodontics. The steering committee then established a PROBE Delphi Group (PDG) and a PROBE Online Meeting Group (POMG) to obtain expert input and feedback on the preliminary draft checklist. The PDG members participated in an online Delphi process to reach consensus on the clarity and suitability of the items present in the PROBE checklist. The POMG then held detailed discussions on the PROBE checklist generated through the online Delphi process. This online meeting was held via the Zoom platform on 7th October 2022. Following this meeting, the steering committee revised the PROBE checklist, which was piloted by several authors when preparing a manuscript describing an observational study for publication. The PROBE 2023 checklist consists of 11 sections and 58 items. Authors are now encouraged to adopt the PROBE 2023 guidelines, which will improve the overall reporting quality of observational studies in Endodontics. The PROBE 2023 checklist is freely available and can be downloaded from the PRIDE website (https://pride-endodonticguidelines.org/probe/).

COMPARING THE CLINICAL AND RADIOGRAPHIC OUTCOMES OF PULPOTOMIES IN PRIMARY MOLARS USING BIOACTIVE ENDODONTIC MATERIALS AND FERRIC SULFATE - A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS.

OBJECTIVE: To compare the clinical and radiographic outcomes of pulpotomies in primary molars using bioactive endodontic materials and ferric sulfate. DESIGN: The search was conducted in PubMed, Ebscohost, ProQuest, and Scopus databases till June 2021. Children undergoing pulpotomy therapy in primary molars treated with ferric sulfate (FS) and bioactive endodontic materials were evaluated for clinical and radiographic success. Meta-analysis was performed on a random-effects model to assess the success at 6,12,18, and 24 months. The quality of studies was evaluated using the Cochrane risk of bias tool for randomized trials RESULTS: No significant difference was observed between Mineral trioxide aggregate (MTA) and FS at 24 months for both clinical [RR0.98 (95%CI 0.15,6.34), I2 = 0%] and radiographic [RR0.74 (95%CI: 0.23,2.43), I2 = 0%] success. At 6 months [RR1.36 (95%CI: 0.10,19.34), I2 = 33%], no difference was observed in the clinical [RR1.00 (95%CI: 0.95,1.05), I2 = 0%] and radiographic success [RR0.99 (95%CI: 0.88,1.11), I2 = 51%] between Biodentine (BD), FS and radiographic success of calcium enriched cement and FS [RR0.25 (95%CI: 0.03, 2.22), I2 = 0%]. CONCLUSION: Amongst bioactive materials, MTA and FS demonstrated equal success rates in both clinical and radiographic outcomes with follow-up periods of up to 24 months. Future, high-quality trials are required to verify the result of the current review.

Reliability of aspartic acid racemization rate for chronological age estimation-a systematic review and meta-analysis.

OBJECTIVE: The biochemical approach of dental age using aspartic acid racemization has been widely reported. The aim of this systematic review was to determine the reliability and accuracy of dental age estimation using aspartic acid racemization rate analysis. DESIGN: Eight research databases (PubMed, Google Scholar, Embase, Cochrane, MEDLINE, TRIP, Web of Science, and Scopus) were utilised to gather and assess published literatures in compliance with the PRISMA 2020 guidelines and reported in PROSPERO (CRD42020208877). This systematic review and meta-analysis focused solely on cross-sectional studies. The quality evaluation was performed using the GRADE system. The standardized mean difference between estimated and chronological age was meta-analyzed using the random effects model. RESULT: The literature review yielded 213 studies, of which 26 were considered acceptable for inclusion in this report. Out of 26 studies, 19 presented sufficient evidence for meta-analysis and the remaining 7 were used to construct a qualitative review. According to the meta-analysis, premolar-related studies had the least variability (Tau2 = 0.23; I2 = 72%) among other tooth groups. CONCLUSION: A substantial degree of heterogeneity was found in every type of tooth. Only the premolar teeth had lower degree variability; thus, it is safe to believe that the premolar tooth is the best for this type of age estimation. It is recommended to develop population-specific mathematical equations to improve the accuracy of this age estimation approach.

Age estimation of Hispanic children in the United States: Development and validation of dental reference dataset based on two staging systems.

Dental tissues follow a systematic pattern of development and several radiological methods have been developed and validated. This study aims to develop and validate a reference data set (RDS) for dental development of Hispanic children and to compare the mean age using the Demirjian and Moorrees tooth developmental stage (TDS) systems. A total of 600 Dental Panoramic Tomographs (DPTs) of Hispanic children aged 6 to 17 years were obtained and reference datasets (RDS) were developed by scoring all the maxillary and mandibular teeth in the left side of the arch according to the Demirjian (8 stage) and Moorrees (14 stage) scoring systems. To validate the RDS, 120 (DPTs) separate from the RDS were randomly selected, and dental ages were calculated from the RDS using unweighted and five weighted mean average methods. Statistical significance was set at p < 0.05, and a paired t-test was conducted to compare the difference between Chronological Age (CA) and Dental Age (DA) for each weighting method. For the 8-stage system, the mean (sd, se) difference between CA and DA for the unweighted method was 0.04 (0.51, 0.065) years for males, and 0.07 (0.41, 0.053) years for females. The difference was not statistically significant for all five weighting methods (p > 0.05). For the 14-stage system, CA-DA for the unweighted method was 0.17 (0.33, 0.042) years for males, and 0.13 (0.41, 0.053) years for females. The difference was statistically significant for most of the Moorrees methods (p < 0.05). Dental age derived from the unweighted average method using the reference dataset derived from Demirjian's 8-stage system is recommended for dental age estimation in Hispanic children and adolescents.