Thromboprophylaxis for Coagulopathy Related to COVID-19 in Pediatrics: A Narrative Review.

In addition to harming the respiratory system, COVID-19 can affect multiple organs. Children may develop a specific complication of COVID-19 called multisystem inflammatory syndrome in children (MIS-C) which could influence the vascular system of children and cause multiple coagulopathies in the body. Information on the use of thromboprophylaxis in this condition was collected via the review of various articles. In general, different factors in immune system responses can trigger the initiation of thrombotic events. Studies have shown that starting anticoagulant prophylaxis, which contributes to decreased thrombotic events, is dependent on the patient's condition and D-dimer levels. However, further studies on pediatric populations are needed to establish the role of anticoagulants in children with this condition.

Current evidence on the use of anakinra in COVID-19.

Despite the progressing knowledge in COVID-19 management, remdesivir is the only agent that got approval to inhibit viral replication. However, there are limited data about effective immunomodulatory agents to prevent cytokine release in COVID-19. Cytokine release syndrome in COVID-19 resembles secondary hemophagocytic lymphohistiocytosis, in which interleukin-1 (IL-1) plays a key role. Anakinra is the first recombinant IL-1 receptor antagonist studied for off-label use in COVID-19 treatment. This study reviews the current clinical evidence on the role of interleukin-1 in COVID-19-related cytokine storm, therapeutic effects, significant clinical concerns, and pros and cons of anakinra administration in the management of COVID-19 patients. In this review, four items are shown to be important for achieving the optimal therapeutic effects of anakinra in COVID-19 patients. These items include duration of treatment ≥ 10 days, doses ≥ 100 mg, intravenous administration, and early initiation of therapy. Also, anakinra might be more beneficial in the early stages of the disease when higher levels of cytokines are yet to be observed, which could prevent progression to severe illness and mechanical ventilation. Further studies are required to address the SARS-CoV-2 induced cytokine release syndrome and the role of anakinra in identifying ideal treatment approaches for COVID-19 patients based on their clinical status.

Relationship of Blood Group with Level of Cooperation of Pediatric Dental Patients.

Acquaintance with the behavior of children in dental office setting is highly important in treatment success. People with different blood groups often have different behaviors. Thus, the blood group may aid in prediction of behavior of pediatric dental patients. This study is aimed at assessing the relationship of the blood group with level of cooperation of pediatric dental patients. This cross-sectional study was conducted on 130 children between 4 and 6 years of age. The blood group of children was recorded according to their identification card or by collecting an intraoral blood sample during pulpotomy and using the respective kit. To assess the level of cooperation of children, their behavior was videotaped during the procedure, and the videos were assessed by two pedodontists. The behavior of children was scored according to the Venham scale. Data were analyzed by SPSS 26 and Chi-square, Fisher's exact test, and Mann-Whitney U test. The blood group was A in 35.7%, B in 5.8%, AB in 3.2%, and O in 53.5%. Children with blood group O had maximum cooperation (52.6) while those with blood group B had minimum cooperation. Pairwise comparisons of the groups regarding the Venham scale revealed significant differences between blood groups A and B (P = 0.0001) and also B and O (P = 0.005). Pairwise comparisons of the groups regarding the level of cooperation also revealed significant differences between blood groups A and B (P = 0.0001) and B and O (P = 0.019). Blood group B may be correlated with certain behavioral traits such as dental fear and anxiety and the resultant poor cooperation.

The effects of a combination oral spray (Mucosamin®) for the prevention of oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation: a double blind randomized clinical trial.

PURPOSE: Oral mucositis (OM) is a frequent complication of conditioning regimens for hematopoietic stem cell transplantation (HSCT). Damage to the nuclear and non-nuclear materials of the mucosal cells by the production of Reactive Oxygen Species (ROS) and proinflammatory cytokines could result to development and progression of OM. Previous studies have shown the effectiveness of Mucosamin® oral spray in the management of pain and acceleration of OM healing. The aims of the current study were to evaluate prophylactic effects of Mucosamin® oral spray in reducing the incidence and severity of OM in pediatric patients undergoing allogeneic HSCT. METHOD: The current study was designed as a double-blind, placebo-controlled randomized clinical trial. Sixty patients were enrolled in the study and received placebo or Mucosamin® spray. Patients in both groups used sprays 4 times daily. Product application was begun at the time of initiation of conditioning regimen and was continued for 14 days. RESULTS: Mucosamin® significantly reduced incidence and severity of OM compared to the placebo (P values: 0.027 and 0.035, respectively). This product could also decrease OM duration and delay OM onset (P values: 0.007 and 0.006, respectively). CONCLUSION: Mucosamin® could effectively reduce incidence, severity, and duration of OM and delay OM onset in pediatric patients undergoing allogeneic HSCT. TRIAL REGISTRATION: The study protocol was registered in the Iranian Registry of Clinical Trials under the registry number IRCT20190917044805N1.

Management and Follow-Up of Complicated Crown Fractures with Intrusive Luxation of Maxillary Incisors in an 8-Year-Old Boy.

Intrusive luxation is a severe form of dental injury which causes damage to the pulp and supporting structures of a tooth because of its dislocation into the alveolar process. This paper shows the case of the reeruption of maxillary incisors accompanied by complicated crown fractures after 3 months. An 8-year-old boy patient was referred to the Department of Pedodontic Dentistry of Tehran University of Medical Science, Tehran, Iran, 18 hours after a fall at school. Clinical and radiographic examinations revealed intrusive luxation of both incisors with complicated crown fractures. Cervical pulpotomy is the treatment of choice for traumatized immature intruded teeth with pulp exposure. Two months later, the right central incisor teeth reerupted to a normal position and the final aesthetic restorations were done. The left central incisor was spontaneously repositioned with external root resorption, and the team decided to use interim medication (calcium hydroxide) in the root canal for stopping the process of resorption, and by the 9-month follow-up, the process of resorption had been stopped. An MTA plug was placed into the canal, and the final esthetic restorations were done.

Efficacy of Three Toothpastes in Iron Stain Removal from Primary Teeth.

AIM: This study aimed to assess the iron stain removal efficacy of three toothpastes in extracted primary teeth. MATERIALS AND METHODS: In this in vitro study, 60 extracted sound primary teeth were selected, decoronated at the cementoenamel junction, and their pulp chambers were filled with a composite. The teeth were then immersed in ferrous sulfate solution and brushed 3,000 times in an automatic tooth-brushing machine using Colgate, whitening Crest, and conventional Crest dentifrices. Stain removal was done in four groups using a prophylaxis paste. Digital images were obtained from the teeth before and after brushing with dentifrices and the changes in color parameters were measured using Photoshop and iColor software programs. Changes in color parameters were statistically analyzed using one-way ANOVA while multiple comparisons were done by Tukey's test. RESULTS: The greatest change in chroma was observed in the prophylaxis group and then in the whitening Crest, Colgate, and conventional Crest (mean values of -65.2, -31.07, -21.27, and -0.73, respectively). Prophylaxis completely removed the stains. The greatest reduction in value occurred in conventional Crest, Colgate, and whitening Crest (-18.07, -12.23, and -0.4, respectively). In the L*a*b* system, the least reductions were noted in the whitening Crest, Colgate, and conventional Crest (mean values of -1.96, -3.92, and -3.37, respectively). Prophylaxis significantly improved tooth brightness (a mean increase of 4.26). CONCLUSION: None of the toothpastes in this study were capable of effectively removing iron stains. Crest whitening toothpaste was slightly effective in this regard. CLINICAL SIGNIFICANCE: Iron drops are routinely prescribed for children younger than 2 years of age to prevent iron deficiency and iron deficiency anemia. However, iron stains on teeth are a common concern for many parents. Finding toothpastes with greater efficacy for iron stain removal can help in this respect. HOW TO CITE THIS ARTICLE: Heidari A, Shahrabi M, et al. Efficacy of Three Toothpastes in Iron Stain Removal from Primary Teeth. Int J Clin Pediatr Dent 2019;12(1):10-14.

Comparison of the Level of Substance P and Neurokinin A in Gingival Crevicular Fluid of Sound and Symptomatic Carious Primary Teeth by ELISA.

OBJECTIVES: Pulpal inflammation is often associated with odontogenic pain. Dental pulp is abundantly innervated with sensory fibers encompassing neuropeptides. Neurokinin A (NKA) and substance P (SP) are important neuropeptides in the dental pulp that can cause neurogenic inflammation. Since no previous study has assessed dental pulp neuropeptides in children, this study aimed to compare the level of NKA and SP in gingival crevicular fluid (GCF) of sound and symptomatic carious primary teeth. MATERIALS AND METHODS: Samples of GCF were obtained of 20 sound and 20 painful carious primary teeth. Enzyme-linked immunosorbent assay (ELISA) was used to quantify neuropeptides in GCF. Data were analyzed using paired t-test, ANOVA, Kolmogorov-Smirnov test and correlation coefficient test. RESULTS: A significant difference was noted in the level of NKA in GCF of painful and sound teeth (2.23 pg/ml in painful, and 1.84 pg/ml in sound teeth, P<0.05). The difference between the two groups regarding SP was not significant (2.23 pg/ml in painful, and 2.02 pg/ml in sound teeth, P>0.05). CONCLUSIONS: The results showed that the level of NKA and SP was higher in GCF of painful teeth compared to that of sound teeth. This difference was statistically significant with regard to NKA. Thus, these neuropeptides can serve as indicators for pathological activities in teeth with symptomatic irreversible pulpitis.