Evaluating malocclusion patterns in children with autism spectrum disorder using the index of complexity, outcome and need: a cross-sectional study.

BACKGROUND: The purpose of this study was to evaluate the complexity of malocclusion and existing patterns in children with autism spectrum disorders (ASD) using the index of complexity, outcome and need (ICON). METHODS: This cross-sectional study included children diagnosed with ASD, aged 9-15 years. A group of healthy children with the same demographic characteristics was randomly selected as the control group. Malocclusion was assessed according to ICON scoring protocol. The following parameters were recorded: dental aesthetics, upper arch crowding/spacing, presence of crossbite, anterior-vertical relationship (open and deep bite) and buccal segment anterior-posterior relationship. Finally, an overall ICON score was derived and reported for each patient. Descriptive analysis was performed for all investigated variables. Significance level was set at p < 0.05. RESULTS: A total of 324 children, divided into ASD (162) and control (162) groups, comprised the study population. Our results demonstrated that the average overall ICON score was significantly higher in the ASD group compared to the control group (38.77 vs. 27.43, p < 0.001). ASD children also obtained significantly higher scores regarding the dental aesthetics component (3.84 vs 2.78, p < 0.001). Study groups were significantly different in terms of the prevalence of incisor overbite and open bite (p = 0.002 and p < 0.001, respectively). Patients in the ASD group showed a higher prevalence of Class II and Class III malocclusions (p < 0.001). CONCLUSION: ASD children obtained significantly higher overall ICON scores, indicating more complex and severe malocclusions. These children also exhibited a greater tendency towards Class II and III malocclusions.

Dental caries status and related factors among 12-year-old Somali school children in Hargeisa.

OBJECTIVES: There is little data on the oral health conditions of Somali children. The aim was to assess the dental caries status and related risk factors of 12-aged children in primary schools in Hargeisa, Somaliland. METHODS: A school-based survey was conducted in Hargeisa in December 2022. Using 2-stage cluster sampling, 405 children (12-aged) were randomly selected from 16 primary schools. Data collection involved WHO structured interviewer-administered questionnaire and clinical examinations. The DMFT index was measured according to WHO criteria, and accordingly, the mean for the significant caries index (SiC) was calculated. The association between the DMFT and the relevant variables was analysed using negative binomial regression in STATA. RESULTS: The overall prevalence of dental caries was found to be 62.7%, with a mean DMFT of 1.7 and a SiC score of 3.7. Non-public school pupils showed significantly higher prevalence of dental caries and mean DMFT compared to public school counterparts (68.5% vs. 58.6%) and (1.91 vs. 1.48), respectively. Merely 14.7% of the participants utilized dental care services in the previous year. The multivariable analysis showed a significant positive association of the DMFT outcome with attending a non-public school (95% CI 1.16-2.12) and having many previous dental visits (95% CI 1.22-2.83). In the adjusted model, fathers of low education had children with better dental caries status (lower mean DMFT) than their well-educated counterparts. The mean DMFT was not significantly influenced by the factors sex, location, educational attainment (school class of the participants) and frequency of teeth cleaning. CONCLUSION: Although the overall mean DMFT of school children in Hargeisa could be regarded low, the high levels of untreated caries especially in the one-third most affected are a cause for concern. Children enrolled in non-public schools formed the high-risk group. Preventive oral public health programs targeting Somali school children are recommended.

Fissure Sealants or Fluoride Varnish? A Randomized Pragmatic Split-Mouth Trial.

This study aimed to compare the clinical effectiveness of resin-based fissure sealants (FS) and fluoride varnish (FV) in children at high caries risk. A practice-based split-mouth randomized clinical trial was conducted at 9 Public Dental Service (PDS) clinics in Norway. In total, 409 children age 6 to 10 y at high caries risk (d3mft > 0) meeting inclusion criteria were recruited by dentists and dental hygienists during routine examination. Eligibility criteria were 2 fully erupted first permanent molars (FPMs) in the same jaw, with sound occlusal surfaces or with initial caries. Participation was voluntary, caregivers and eligible children were informed about the study, and written parental consent was obtained. FS and FV were randomly applied on contralateral FPMs in the same jaw, with each participant serving as their own control. FS was applied at baseline and thereafter maintained according to clinicians' conventional procedures, whereas FV was applied at baseline, 6 mo, and 12 mo. The study outcome was success, with no need for invasive treatment (caries control), while failure was defined as dentin carious lesion or restoration. Two-level mixed-effects logistic regression analysis was used to compare FS and FV groups. Of 409 recruited children, 369 (90%) children/tooth pairs were examined after 36 mo. Intention-to-treat analysis showed 94.1% adjusted predicted probability (aPP) of success (95% confidence interval [CI] 91.7 to 96.4) in the FS group and 89.6% aPP (95% CI 86.5 to 92.7) in the FV group. In the adjusted analysis, the FV group had a lower OR for success compared with the FS group (OR 0.54, 95% CI 0.24 to 0.87). In the population studied, the clinical effectiveness of FS was statistically significantly higher compared with FV but below the estimated minimal clinically important difference of 10%.

Postoperative Morbidity after Dental Treatment under General Anesthesia in Children with and without Disabilities.

Background and Objectives: General anesthesia induces reversible unconsciousness, eliminating sensation and enabling painless medical procedures. Vital for dental care, it addresses patients with medical conditions, those needing extensive procedures, and those unable to cooperate due to fear. Dental care for patients with disabilities is a significant unmet need, with studies showing increased oral disease prevalence. This research aims to analyze postoperative morbidity both in healthy and disabled children undergoing dental procedures under general anesthesia. Materials and Methods: This study involved 96 children aged 3 to 15 with dental caries. Two groups were formed: the control group (CTL) (52.94%) included healthy patients requiring general anesthesia due to unsatisfactory cooperation, and the other group included children with physical or intellectual disabilities (CD) (47.96%). Postoperative complications were monitored 1 h after the procedure and 1, 3, 7, and 14 days after the procedure by contacting parents/caregivers by phone. The intensity of postoperative pain was assessed using the Wong-Baker faces pain rating scale. General anesthesia was conducted following a standardized protocol for dental procedures. Results: CTL patients complained more often about postoperative pain 1 h after the procedure (p = 0.03). One day after the procedure, oral bleeding (p = 0.04), fever (p = 0.009), and diarrhea (p = 0.037) occurred more often in CD. In the same period, sore throat appeared more often in CTL (p = 0.036). Three days after the dental treatment, there were statistically significant increases in the occurrence of agitation (p = 0.043) and constipation (p = 0.043) in CD. Seven days later, CD demonstrated a higher occurrence of agitation (p = 0.037). According to the Wong-Baker faces pain rating scale, CTL experienced more frequent and intense pain. Conclusions: CD more frequently reported complications like oral bleeding, fever, and diarrhea. In contrast, the CTL group more often reported pain-related symptoms. The conclusion underscores the need for a pain control protocol for CD and emphasizes the importance of frequent monitoring to prevent unwanted consequences during tooth restoration under general anesthesia.

Children's experiences during their first dental visit: A qualitative study.

BACKGROUND: While the child's first dental visit can shape his/her attitude towards further treatments, little consideration has been given to exploring this experience from the child's perspective. Therefore, the aim of the study was to delineate the experiences of the first dental visit of children based on self-written stories in their own words. METHODS: Qualitative study conducted as part of the oral health promoting school program in Isfahan city, Iran. Data collection was based on the responses to a question included in the programme's printed educational content. Schoolchildren were asked to explain about their experiences of their first dental visit in a story. Two researchers read the stories separately and identified concepts and themes. In a discussion panel gained consensus about the main themes. Then the researchers integrated and grouped together similar themes to new categories. Categories originating in the data provided insights into and explanations of factors that might influence the schoolchildren's experience in the dental office. Sampling continued until saturation, when no new codes appeared in the data. The childrens' stories were imported in the MAXQD software and analyzed to retrieve the main categories and themes. RESULTS: Factors that influenced experiences appeared to be idiosyncratic, but could be classified into three categories: the person accompanying the child, child and dentist-related factors. Two sub-categories of the person accompanying the child were the role of person in their treatment and the types of persons accompanying them. Dentist-related factors included three more sub-themes of applied behavioral management techniques, their role in oral health education, and organization of the office environment. The three sub-themes of children's related factors were experiencing fear, remembering the details of their experience, and type of care received. CONCLUSION: Although the method was limited to the qualitative written stories of children and there was no opportunity to explore more and consider the detailed opinions by face-to-face interviews, some noticeable elements were mentioned by children. The person accompanying the child, child and dentist-related factors were three main categories obtained from the data.

Pre-Pandemic and Recent Oral and Medical Health Care Utilization among Young American Indian Children and Their Caregivers.

Children from diverse ethnic groups are at significantly increased risk for dental caries. In particular, American Indian (AI) children have the highest incidence of detal caries of any ethnic group. The COVID-19 pandemic dramatically restricted health care access, including preventive oral health care. Given this context, it is unclear whether or not preventive oral health care for AI children has resumed since lockdown. To address this question, we surveyed adult AI caregivers (N = 152) of children aged 0-5 years, assessing recent (12-month) and pre-COVID (for caregivers of children aged 3-5 years) preventive oral and medical health services. We also examined medical health care access and utilization among caregivers. Among children aged 3-5 years old, both pre-pandemic and past year medical care utilization were generally high (80 and 90%, respectively) as was any oral health care utilization (64 & 78%, respectively). Oral health check-ups were more common over the last year (62%) compared to pre-COVID (44%). Recent health care utilization among children 1-5 years old in this sample were generally comparable to national estimates, except for higher reported preventive medical care (99% vs. 87.6%, respectively) and higher preventive oral care (96% vs. 59.6%, respectively). More caregivers reported delaying or foregoing needed health care due to COVID (28-38%) versus due to cost (8-17%). In this survey of AI caregivers, recent child preventive health care utilization was high, and changes in utilization following the lockdown phases of the pandemic were comparable for oral and medical health care.

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.

Changes in dental visits and oral health for children by race and ethnicity during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic created new barriers to oral health care, which may worsen oral health and exacerbate disparities. The authors quantified changes in children's dental care receipt and oral health outcomes during the pandemic and examined differences among racial and ethnic groups. METHODS: Using the National Survey of Children's Health (163,948 child observations from 2017-2021), the authors used weighted modified Poisson models to examine caregiver-reported receipt of a dental visit (for any reason and for preventive care) and adverse oral health outcomes (teeth in fair or poor condition; difficulty with toothaches, cavities, or bleeding gums) from 2017 through 2019 (prepandemic) compared with 2020 and 2021. The authors examined outcomes within and across racial and ethnic groups. RESULTS: Children from all racial and ethnic groups experienced declines in receipt of dental visits, but there were limited changes in adverse oral health outcomes during 2020 and 2021. Prepandemic disparities in receipt of dental visits persisted for Black children and Asian children compared with White children. Hispanic children experienced larger increases in risk of experiencing both adverse oral health outcomes compared with White children in 2020 and in having teeth in fair or poor condition in 2021. CONCLUSIONS: The pandemic did not create new disparities in receipt of dental visits or oral health outcomes, but disparities in care persisted, and the oral health of Hispanic children was affected differentially. PRACTICAL IMPLICATIONS: Continued monitoring of dental visits and adverse oral health outcomes by race and ethnicity is critical to ensuring all children have access to oral health care. This information can help develop targeted interventions to improve children's oral health, including for minoritized racial and ethnic groups.

Dental caries and oral health-related quality of life in Preschoolers - introducing the Swedish version of the early childhood oral health impact scale (ECOHIS).

Objective: Experience of caries has a clearly negative impact on the quality of life in preschool children. The instrument Early Childhood Oral Health Impact Scale (ECOHIS) measures the oral health-related quality of life in preschool children (Child Impact Section) and their families (Family Impact Section). The aims of the study were to develop a Swedish version of ECOHIS and to evaluate the instrument's reliability, validity, and internal consistency. Additionally, to analyse the oral health-related quality of life (OHRQoL) among preschool children who have experienced caries.Methods: The original ECOHIS questionnaire was translated into Swedish. Caregivers of preschool children aged 2-5 years were recruited at dental clinics in Sweden, to participate in the study and answer the Swedish version of the ECOHIS (S-ECOHIS). The internal consistency and reliability were assessed by using Cronbach's Alpha coefficient. In order to measure the consistency of the study, the questionnaire was re-tested two weeks later for 10 of the caregivers and assessed by using intra-class correlation coefficients (ICCs). The results from S-ECOHIS were described as descriptive data and independent t-test was performed. All data were calculated using SPSS (Statistical Package for the Social Sciences).Results: S-ECOHIS was developed by translating the original English version using a double-blinded technique. A total of 274 caregivers participated in the study and completed the questionnaire. Cronbach's Alpha was 0.84 for S-ECOHIS, 0.83 for CIS, and 0.66 for FIS. The ICC was 0.95 for the test-retest of S-ECOHIS. Among the respondents, 117 (43%) had children diagnosed with caries, while 157 (57%) had children without caries. The children with caries reported a higher total score of 5.97 (SD 6.16) of S-ECOHIS, compared to the score of the non-caries children 0.77 (SD 1.38) (p < 0.001).Conclusion: The Swedish version of ECOHIS that was developed demonstrates good validity, test-retest reliability, and internal consistency. The findings show that the oral health-related quality of life is adversely affected in preschool children with caries, with particular vulnerability observed among children with untreated caries. These results indicate that S-ECOHIS is suitable for use in future clinical and research endeavors.

The Evaluation of Postoperative Complications and Oral Health-Related Quality of Life Following Dental General Anesthesia for Early Childhood Caries.

Aim The study aims to evaluate the postoperative complications and oral health-related quality of life (OHRQoL) following dental general anesthesia for early childhood caries (ECC). Materials and methods Two hundred children aged between three and six requiring full-mouth rehabilitation for general anesthesia were recruited for the study. Demographic data and oral health-related quality of life using the Early Childhood Oral Health Impact Scale (ECOHIS) were collected before the surgery. Postoperative complications and oral health-related quality of life were evaluated after 24 hours and at a one-week follow-up appointment. Results All 200 children returned for the follow-up appointment after one week. Pain was found to be the most common postoperative complication after 24 hours (52%) and one week (6%). The oral health-related quality of life showed a significant improvement after one week (P < 0.001) Conclusion Children may experience a postoperative complication after full-mouth rehabilitation, which resolves within a week. Dental pain was the most common operative complication in the present study. Oral health-related quality of life showed significant improvement after full-mouth rehabilitation.

Pediatrician's perception of oral health in children - A qualitative study.

Background It is important to assess pediatrician's perception on children's oral health as they tend to meet children early on a regular basis. Quantitative research has shown that pediatricians in India have inadequate knowledge and limited awareness about oral health care in children. Hence, it is important to assess pediatrician's opinion and perception on children's oral health using qualitative interview method. AIM: The aim of the study is to assess and explore the perception of pediatricians on children's oral health in Western Tamil Nadu, India. METHODS: A grounded theory approach was employed to conduct this qualitative study. Face-to-face interviews with the pediatricians were conducted using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Collected data were written as codes, from which categories and themes were derived. RESULTS: Four themes arrived: (1) dental health and disease, (2) anticipatory guidance, (3) barriers, and (4) remedial measures. The participants felt that they were underinformed about dental home, emergency care for dental trauma, and the interceptive role of dentists on oral deleterious habits. Insufficient dental information in their curriculum and the absence of common guidelines between pediatricians and pediatric dentists in India were considered the common causes for their lack of knowledge. CONCLUSION: Pediatricians were receptive to acquire knowledge and improvising their skills. They felt that periodic lectures and formal gatherings should be planned between pediatric dentists and pediatricians. Collaborations between pediatrics and pediatric dentistry societies are warranted to provide children with better oral health care.

Children's Oral Health Initiative: workers' perspectives on its impact in First Nations communities. / Initiative en santé buccodentaire des enfants : le point de vue des intervenants quant à ses effets dans les communautés des Premières Nations.

INTRODUCTION: Since 2004, the Children's Oral Health Initiative (COHI) has been working in many First Nations and Inuit communities in Canada to address oral health disparities, specifically early childhood caries (ECC). The COHI community-based approach improves early childhood oral health (ECOH) by balancing prevention with minimally invasive dentistry. The goal is to reduce the burden of oral disease, mainly by minimizing the need for surgery. We investigated program success in First Nations communities in the province of Manitoba, from the perspective of COHI staff. METHODS: First Nations community-based dental therapists and dental worker aides participated in three focus groups and an in-depth semistructured interview. The collected data were thematically analyzed. RESULTS: Data from 22 participants yielded converging and practitioner-specific themes. Participants reported that dental therapists and dental worker aides provide access to basic oral care in their communities including oral health assessments, teeth cleaning, fluoride varnish applications and sealants. The participants agreed that education, information sharing and culturally appropriate parental engagement are crucial for continuous support and capacity building in the community programs. Low enrolment, difficulty accessing homes and getting consent, limited human resources as well as lack of educational opportunities for dental worker aides were identified challenges. CONCLUSION: Overall, the participants reported that the COHI program positively contributes to ECOH in First Nations communities. However, increased community-based training for dental workers, community awareness about the program, and engagement of parents to facilitate culturally appropriate programming and consent processes are critical to improving program outcomes.

Oral Health-Related Quality of Life in Persian-Speaking Elementary Schoolers in Iran: A Psychometric Study of Child Perception Questionnaire.

Background and Purpose: The study aims to examine the validity and reliability of the impact of 16-item Short-Form Child Perception Questionnaire (CPQ11-14-ISF:16) in Persian-speaking elementary schoolers. Methods: From two main cities in Iran, 708 mother-child dyads were enrolled in 2018. Decayed, missing, and filled teeth (DMFT/dmft) indexes were examined for divergent validity. Two built-in indexes of overall oral health and overall impacted well-being were used for concurrent validity. Exploratory factor analysis (EFA) with Geomin rotation, Cronbach's α, and Spearman's correlation were executed. Results: The total Cronbach's α was 0.71. EFA indicated CPQ11-14-ISF:11 (α = 0.66) to compose three eligible factors (α = 0.66), including oral problems (α = 0.54), emotional problems (α = 0.66), and social problems (α = 0.41). The concurrent/divergent validity of CPQ11-14-ISF:11 and the subscales was partially confirmed. Conclusions: The use of CPQ11-14-ISF:11 to multidimensionally address dental care for children requires further investigations.

Patterns of Parental Information Seeking Behavior on Early Childhood Caries: A Qualitative Exploration.

Objectives: This study aims to explore the information-seeking behavior patterns of parents with children receiving treatment for early childhood caries (ECC). Materials and Methods: Semistructured in-depth interviews were conducted with 20 parents of children with ECC. A topic guide was developed, focusing on questions relating to (i) the timing of their seeking information on ECC, (ii) the types of EEC information they seek, and (iii) the resources used to seek information. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was performed, whereby the data were coded and categorized into themes and subthemes. Results: Four main themes were identified: the immediacy of seeking information, perceived information need, use of resources, and barriers to seeking information. Parents either sought information immediately after detecting changes to the appearance of their child's teeth, with some being aware of the changes after signs and symptoms developed. The types of information parents usually sought covered the disease, its prevention, and management. Common sources of information were friends, family, the internet, and healthcare professionals. Barriers to seeking information discussed by parents were lack of time as well as insufficiency and inaccuracy of the information they received. Conclusion: This study highlighted the need for comprehensive, tailored early education on ECC for parents using reliable information sources. There is also a need to empower other nondental healthcare professionals to provide oral healthcare education for parents.

Caries-related and Preventive Dental Care of 5-, 12-, and 15-year-old Syrians in Bursa, Türkiye.

Objectives: Türkiye has implemented an open-door policy for Syrians since the beginning of the Syrian crisis in 2011 and has been providing medical and dental services for Syrian asylum seekers. Bursa, being the 5th largest city in the Western region of the Turkish Republic, hosts 1,83,355 registered Syrians. The present study was designed to analyze the caries-related dental services and preventive applications among 5-, 12-, and 15-year-old Syrian patients admitted to a state-affiliated dental hospital in Bursa, Türkiye. Design: This study comprises retrospective data analysis. Place and duration of study: The data from 1st January 2016 to 1st September 2021 were derived from the Bursa Oral and Dental Health Training and Research Hospital. Materials and methods: The dental records of Syrian patients aged 5, 12, and 15 years were reviewed for caries-related (restorations, extractions, and root canal treatments) and preventive applications (fissure sealants and topical fluoridation); others were excluded. Results: A total of 3,388 dental records of 1,179 Syrian children aged 5 (N = 369), 12 (N = 498), and 15 (N = 312) years were analyzed. The highest percentages of dental services offered to 5-, 12-, and 15-year-old were "tooth extractions" (n = 369; 42.2%), "fissure sealants" (n = 555; 33.7%), and "restorative treatments" (n = 384; 44.4%), respectively (p < 0.001). Considering all years (2016-2021), male subjects [odds ratio (OR)-1.42, 95% confidence interval (CI) 1.09-1.85; p = 0.01] and 12-year-old (OR-1.87, 95% CI 1.31-2.66; p = 0.001) were more likely to visit a dentist more than once per year. Conclusion: Caries-related dental services, which are an indicator of poor oral health, are common in 5-, 12-, and 15-year-old Syrian patients. How to cite this article: Elbek Cubukcu C, Celik ZC, Dinc Ata G, et al. Caries-related and Preventive Dental Care of 5-, 12-, and 15-year-old Syrians in Bursa, Türkiye. Int J Clin Pediatr Dent 2023;16(1):64-67.

Dental Treatment Characteristics of Autistic Children and Differences in Dental Procedures under General Anesthesia Relative to Healthy Counterparts.

Here, we assess the dental treatment characteristics among children with autism spectrum disorder (ASD) and compare the dental procedures delivered under general anesthesia (GA) with those of healthy-matched counterparts. In this retrospective cohort study, we collected data from medical records of ASD children (n = 82) which included demographic profile, medical status (including the severity of the ASD and associated comorbidities), and dental history (including dental visits, behavior, care approach, and dental procedures provided). For those children who received dental GA (DGA) (n = 64), we compared all procedures delivered and the number of repeat sessions with healthy children (n = 64). Our results reveal that most ASD children (78%) received DGA, mainly with one repeat session (63.4%). The dental procedures provided to the children differed significantly according to the severity of the ASD and the behavior of the children. Furthermore, increasing severity led to significantly worse behavior of the children, increased need for DGA and repeat sessions. Comparison of the dental procedures under GA with healthy children revealed a significantly lower mean of almost all dental procedures in ASD children, except fissure-sealed teeth (p < 0.05). Considering these findings, DGA is unavoidable for ASD children with moderate-to-severe conditions or negative behavior in the dental office, even when their dental needs are lower than healthy children. The severity of ASD was the most important factor affecting the behavior of the children and the care approach they received. Along with children's behavior, they most influenced the dental procedures delivered and the need for repeat DGA.

Comparison between digital and conventional impression techniques in children on preference, time and comfort: A crossover randomized controlled trial.

OBJECTIVE: To compare the conventional alginate impression and the digital impression taken with an intraoral scanner of both dental arches in children, using a randomized crossover design. TRIAL DESIGN: This is a monocentric, controlled, superiority, randomized, crossover, open study. METHODS: Twenty-four orthodontic patients between 6 and 11 years of age underwent intraoral scanning (TRIOS 3; 3Shape) and alginate impression of both dental arches with an interval of 1 week between the two procedures. Participants were recruited from September 2021 to March 2022 and the study was completed in April 2022. Impression time for the two procedures was compared. Patients were asked which one of the two impression procedures they preferred. A questionnaire including Visual Analogue Scale (VAS) for comfort, pain, gag reflex and difficulty in breathing, was administered to the patients. RESULTS: Eighteen out of 24 patients preferred digital impression (75%, 95% confidence interval [CI]: 55% to 88%; P = .014). Scanning time was significantly shorter than alginate impression time (difference -118 seconds; 95% CI: -138 to -99; P < .001). Comfort was significantly higher for digital impression (difference 1.7; 95% CI: 0.5 to 2.8; P = .007). There was no difference in pain (difference -0.2; 95% CI: -1.5 to 1.0; P = .686) while gag reflex and breathing difficulties were smaller for digital impression (gag reflex difference -2.5; 95% CI: -4.0 to -0.9; P = .004 and breathing difficulties difference -1.5; 95% CI: -2.5 to -0.5; P = -.004). CONCLUSIONS: Digital impression is preferred by children aged 6-11 years and it is significantly faster in acquisition time than conventional alginate impression. REGISTRATION: The study was registered on ClinicalTrials.gov with registration number NCT04220957 on January 7th, 2020 (https://clinicaltrials.gov/ct2/show/NCT04220957).

A Parental Behavior Scale in Pediatric Dentistry: The Development of an Observational Scale.

Children's treatment means a triangular relationship between the child, practitioner, and parent, with specific interactions influencing the procedure. The objective was to create and validate a hetero-rating scale of parental behavior and verify the correlation between child and parental behavior during pediatric dentistry sessions. Treatment sessions were recorded and evaluated, including 60 children representing three age groups. Two raters interpreted the resulting video clips using the modified Venham scale for children and the new hetero-rating scale for parents. They analyzed the videos twice and attributed scores at different time points of the appointment. The correlation between parental behavior upon entrance and the children's behavioral at the dental office in the treatment stage was significantly positive in both raters (Kendall Tau: 0.20-0.30). Furthermore, a panel of 20 dental practitioners scored a randomized selection of five recordings per age group. The level of agreement between the two experts was higher than that between the 20 clinicians. Venham types of scale involving multiple aspects can be used in research, but their application in dental practice requires further development. The link between parental anxiety and child anxiety is confirmed, but further research is required to incorporate specific aspects of treatment and parental behavior.

Impact of virtual supervised tooth brushing on caries experience and quality of life among primary school children: study protocol for a randomized controlled trial.

BACKGROUND: Dental caries is one of the most common diseases affecting children world widely as well as in the Kingdom of Saudi Arabia. Supervised tooth brushing programs are implemented throughout the world to provide young children's developing teeth with additional fluoride as a form of dental caries prevention. While school-based supervised tooth brushing programs have been proven to improve young children's oral health, virtual supervised teeth brushing programs have not been assessed. The purpose of this protocol is to assess the impact of virtual supervised tooth brushing on caries experience and quality of life among primary school students in Riyadh, Saudi Arabia. METHODS: This is a cluster randomized controlled trial comparing a virtual supervised tooth brushing program against no intervention applied. A total of 1192 (596 in each group) 8-9-year-old children in Riyadh primary schools, Saudi Arabia, will be recruited for the trial. Schools (cluster) will be randomly selected and allocated to either group. Clinical assessment for caries experience will be conducted in six points (baseline, + 3 months, + 6 months, + 12 months, + 24 months, + 36 months) by dental hygienists using the World Health Organization criteria. Data on sociodemographic behavioral factors and children's quality of life will be collected with every clinical assessment through a structured questionnaire. The primary outcome is the change in caries experience (the number of teeth with untreated dental caries, filled and missing teeth) in both primary and permanent teeth over 36 months. DISCUSSION: Virtual education as well as some health consultation through the pandemic period had enabled an effective IT infrastructure in Saudi Arabia. Virtual supervised tooth brushing is a proposed initiative. It is also an opportunity for targeting a large portion of the population with a high level of disease as a quarter of the Saudi population is younger than 15 years. This project should provide high level evidence on the effectiveness of virtual supervised tooth brushing. The findings should potentially inform policies related to the continuation/implementation of school-based programs in Saudi Arabia. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT05217316. Registered on 19 January 2022.

Is chewable toothbrush effective in terms of dental plaque reduction in children? A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: To systematically evaluate randomized controlled trials (RCTs) on whether a chewable toothbrush (CTB) is more effective than a manual toothbrush (MTB) in terms of full-mouth dental plaque reduction in non-orthodontic children. MATERIALS AND METHODS: Six databases were searched by two independent reviewers according to pre-specified eligibility criteria up to October 2022. No restrictions regarding language, date of publication and minimum follow-up period were imposed. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal and GRADE for assessing the certainty of evidence. Random-effects pairwise meta-analysis compared the dental plaque change scores of CTB and MTB through mean differences (MDs) and associated confidence intervals (95% CI), and sensitivity analysis determined whether an individual study significantly affected the results. RESULTS: Seven eligible RCTs were retrieved, including data of 310 children aged 8-14 years. Five RCTs present some concerns and two have high RoB. No significant difference was detected between toothbrushes in terms of Turesky modification of the Quigley-Hein plaque index reduction (MD = -0.04, 95% CI: -0.26-0.18), with overall very low certainty on evidence. The pooled estimate remains unchanged when any RCT is omitted. CONCLUSION: There is very low-certainty evidence of no significant difference on plaque removal between MTB and CTB in non-orthodontic children. Due to unexplained high heterogeneity and low methodological quality of RCTs, we cannot determine the extent to which our finding reflects a true effect or bias arising from limitations of primary studies.