Parents' acceptance of minimal intervention procedures for dental caries management in children: a scoping review.

PURPOSE: In recent years, minimal intervention procedures (MIPs) for treating dental caries in children have stood out as an innovative method. Nevertheless, the treatment decision should be based on scientific evidence, professional expertise, and parents' preference/acceptance. Evaluating the acceptance of MIPs by parents is an essential factor, but little information is available on what guides this preference. METHODS: This scoping review aims to synthesize the evidence on parents'/caregivers' acceptance of MIP for managing cavitated caries lesions in children. A search was performed in the PubMed, Cochrane Library, Lilacs and Google Scholar databases with no restriction on date or language. RESULTS: A total of 19 articles were selected (6 clinical trials, 1 longitudinal and 12 cross-sectional studies). The application of silver diamino fluoride (SDF) was the most commonly evaluated procedure (n = 17), followed by the atraumatic restorative technique (ART) and the Hall Technique (HT). The acceptance of MIPs ranged from 1.4% to 100%, and the application of SDF was better accepted in posterior teeth and in uncooperative children. ART had better aesthetic acceptance than HT. CONCLUSION: Application of SDF, Hall Technique and ART was well accepted by parents/caregivers. However, a gap remains in the literature regarding the acceptance of other procedures. Therefore, further studies in this area will contribute toward a better understanding of the opinion of parents/caregivers, and thus improve caries lesion management in children.

Nociception associated with pain/distress in young children sedated for dental treatment: a clinical study with objective and subjective measures.

PURPOSE: To evaluate the association between children's pain/distress levels and patient characteristics (age, sex, history of dental pain), sedation type (level of sedation, sedative regimen), nociception and pain intensity reported by the parents in sedated children undergoing minimally invasive dental treatment. METHODS: This clinical study evaluated secondary outcomes of an RCT that evaluated the efficacy of dexmedetomidine sedation with or without ketamine. Only children who had nociception levels recorded using the Analgesia Nociception Index (ANI) were included (0-100; 0 = highest nociception). FLACC scale (Face, Legs, Activity, Cry and Consolability) was used to assess children's pain/distress (0-10; 0 = no pain/distress). Parental proxy report of the child's pain intensity during the treatment was performed using the Visual Analogue Scale (VAS; 0-100; 0 = no pain). The association between ANI, children's age and sex, dental pain history, sedation level, sedative regimen, and VAS with the FLACC was verified using the generalised estimation equation analysis (alpha 0.05). RESULTS: Participants were 31 children (51.6% boys) and their parents (90.3% mothers). Median FLACC was 3.3 (25th-75th percentiles 1.7-8.2), ANI 80.9 (74.7-85.8), and VAS 10 (1-23). FLACC associated with ANI (OR 0.96; 95% CI 0.93-0.99; p = 0.02), moderate sedation (0.13; 0.03-0.50; p = 0.003), and VAS (1.05; 1.01-1.10; p = 0.01). CONCLUSION: Pain/distress was generally low and more prominent with minimal (versus moderate) sedation and higher nociception.

Paediatric dentists' stress during dental care for children under sedation: a cross-sectional study.

PURPOSE: The knowledge of the stress related to the practice of paediatric dentistry is scarce. The aim of this study was to verify the stress perceived by paediatric dentists related to young children's dental treatment under sedation and their association with child's behaviour and other independent variables. METHODS: A cross-sectional repeated measures study was performed with four paediatric dentists who treated 81 sedated preschoolers. Paediatric dentists reported their stress at the end of the session using the visual analog scale (VAS 0-100 mm). Samples of saliva were collected to measure the dentists' salivary cortisol level throughout the dental session. The sessions of dental treatment were video recorded for evaluation of the child's behaviour. Children's behaviour was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS). The association between the VAS scores and the other variables was verified using bivariate tests and generalised estimating equation (alpha 0.05). RESULTS: Paediatric dentists felt slightly stressed in most of the sessions (VAS median 7 points; minimum 0, maximum 97 points). VAS associated with the struggling behaviour of the child (B 0.53; 95%CI 0.32-0.74; p ≤ 0.001) and the time since dentist's graduation (B - 1.41, 95% CI - 1.87 to - 0.94; p ≤ 0.001) but not with dentist's salivary cortisol (rho - 0.053, p = 0.639). CONCLUSION: The more frequent the child's struggling behaviour during dental treatment and the shorter the time elapsed since the professional's graduation, the higher the level of objectively and subjectively measured stress of the paediatric dentist during the dental procedure.

Carers' and paediatric dentists' perceptions of children's pain during restorative treatment.

PURPOSE: Parents/carers' and dentists' evaluations are important when assessing young children's pain. However, there is little evidence on agreement regarding children's pain according to proxy reports. The aims of this cross-sectional study were to investigate the agreement among paediatric dentists and parents/carers about children's pain during treatment and the association between the reporting of pain and child behaviour. METHODS: Participants were 81 parents/carers of uncooperative children undergoing restorative treatment, and five paediatric dentists. Pain during dental treatment was assessed after dental procedures using the Visual Analogue Scale (0-4 mm: no pain; 5-44 mm: mild pain; 45-74 mm: moderate pain; 75-100 mm: severe pain). Child behaviour was assessed by calibrated researchers using the Ohio State University Behavioural Scale. The agreement between respondents about a child's pain was evaluated using the weighted kappa test. The association between the pain report and child behaviour was verified using the Kruskal-Wallis and Mann-Whitney tests. RESULTS: Parents/carers (36, 44.4%) and paediatric dentists (40, 49.4%) reported that children felt mild pain in all sessions. The parents/carers reported that the children experienced higher pain intensities compared to paediatric dentists. The agreement between respondents was slight (weighted Kappa < 0.20). Higher pain intensities were more frequent when the children's behaviour was uncooperative. CONCLUSION: Parents/carers and paediatric dentists showed slight agreement regarding the pain felt by children in dental treatment. Pain proxy reporting in children is influenced by the children's behaviour.

Is there an association between verbal school bullying and possible sleep bruxism in adolescents?

The aim of this study was to determine the association between verbal school bullying and possible sleep bruxism (SB) in adolescents. A case-control study was carried out at the population level by recruiting 13- to 15-year-old participants among the attendants of schools of Itabira, Brazil. The case group was composed of 103 adolescents with possible SB (i.e. self- or parental-reported), while the control group included 206 adolescents without possible SB. All participants answered a questionnaire on the occurrence of their involvement in verbal school bullying episodes, based on the National School of Health Research (PeNSE) as well as an evaluation of their economic class according to the criteria of the Brazilian Association of Research Companies. Pearson's chi-square, McNemar test and conditional logistic regression were performed to assess the association between possible SB, verbal school bullying and economic class. There were 134 (43·3%) participants who reported involvement in verbal school bullying episodes as a victim, bully or both. The majority of them were males (90·3%). Adolescents with possible SB were more likely to have been involved in episodes of verbal school bullying (OR: 6·20; 95% CI: 3·67-10·48). Based on these findings, it can be suggested that possible SB in young teenagers is associated with a history of episodes of verbal school bullying.

Malocclusion in preschool children: prevalence and determinant factors.

PURPOSE: To evaluate the prevalence of malocclusion and associated factors in the primary dentition of preschoolers in the city of Diamantina, Brazil. METHODS: A cross-sectional study was carried out with 381 children aged 3-5 years treated at the 10 basic health care units in the city during immunisation campaigns. The dependent variables (presence of malocclusion, open bite, crossbite and crowding) were evaluated through a clinical oral exam. The independent variables (gender, age, health problems, breastfeeding, bottle feeding, harmful oral habits, mother's schooling, household income and number of children in the home) were collected through interviews. Statistical analysis involved descriptive analysis, Chi square test and Poisson regression. RESULTS: The prevalence of malocclusion was 32.5%. Open bite was the most frequent type of malocclusion. Children with a history of bottle feeding (PR 1.74; 95% CI 1.24-2.44) and those with harmful oral habits (PR 1.49; 95% CI 1.23-1.99) had greater prevalence rates of malocclusion. Greater prevalence rates of open bite were also found in children with a history of bottle feeding (PR 5.00; 95% CI 1.99-12.5) and those with harmful oral habits (PR 2.90; 95% CI 1.59-5.29), whereas greater prevalence rates of crossbite were found in boys (PR 1.79; 95% CI 1.10-2.91) and were associated with mother's schooling (PR 1.91; 95% CI 1.20-3.06). CONCLUSION: A history of bottle feeding and the presence of harmful oral habits were identified as determinants for the occurrence of malocclusion in preschoolers.

Mothers' reports on systemic signs and symptoms associated with teething.

PURPOSE: The purpose of this study was to compare mothers' actual observations of signs and symptoms associated with the eruption of primary incisors in their infants with their own recollections of the same period after eruption was completed. METHODS: A comparative study was carried out with 45 non-institutionalized infants and their mothers. Oral clinical exams were performed daily for detection of tooth eruption. The mothers were also interviewed daily about signs and symptoms they thought were associated with teething in the previous 24 hours. One week after the data collection was done, the mothers answered the same questionnaire. Descriptive analysis and the McNemar test (P<.05) were performed. RESULTS: Statistically significant differences were found between the prospective and retrospective studies. Increased salivation (P<.04) and runny nose (P<.001) were reported less often and fever was reported more often (P<.001) in the retrospective evaluation. CONCLUSIONS: Mothers reported similar manifestations of sleep disturbance, diarrhea, loss of appetite, and irritability in the prospective and retrospective studies. Increased salivation and runny nose were more frequently reported in the prospective study, whereas fever was reported 5 times more often in the retrospective study.

Impact of early childhood caries on the oral health-related quality of life of preschool children and their parents.

The aim of the present population study was to evaluate the impact of early childhood caries (ECC) on the oral health-related quality of life (OHRQoL) of preschool children and their parents/caregivers. A random sample of 638 children (aged 2-5 years) underwent a clinical oral examination to assess ECC, and their parents were invited to answer two questionnaires: one on the OHRQoL of the child, the Early Childhood Oral Health Impact Scale, and another on the characteristics and sociodemographic conditions of the child. Descriptive analysis, χ(2) test, Mann-Whitney test, Kruskal-Wallis test, and hierarchically adjusted Poisson regression models were used. The prevalence of ECC was 52.2%. The number of teeth with decay ranged from 1 (n = 42; 6.6%) to 20 (n = 5; 0.8%), averaging 2.86 (SD = 4.04). There was a significant difference between the severity of ECC and OHRQoL in terms of the impact on both child and family (p < 0.001). An increase in the severity of ECC resulted in an increased negative impact on the quality of life of the child (rate ratio, RR = 5.32; 95% confidence interval, CI: 3.67-7.71). Greater age of the mother had a positive impact on the OHRQoL of preschool children (RR = 0.72; 95% CI: 0.54-0.97). Increased age resulted in an increased negative impact on the quality of life of the child (RR = 2.97; 95% CI: 1.61-5.47). ECC has a negative impact on the OHRQoL of children aged 2-5 years and their parents. Mothers aged 30 or older reported better OHRQoL, independent of the presence of ECC and the age of the child.

Esthetic-functional recovery of permanent posterior tooth using autogenous biological restoration.

Occlusal morphology and difficult access for cleaning permanent molars result in the buildup of bacterial plaque and the development of caries. One method known as biological restoration was carried out. This technique known as biological restoration, has as main restorative material a fragment obtained from a duly donated extracted human tooth. This case report describes the restoration of an extensively decayed molar through the bonding of a fragment obtained from a third molar extracted from the patient himself. Biological restoration is a low-cost option that offers satisfactory aesthetic, morphological and functional results.The morphological/functional reestablishment of posterior teeth can be obtained through biological restoration, which allows the recovery of properties inherent to the dental structure, offers satisfactory aesthetic results and low cost.

Esthetic smile rehabilitation through autogenous bonding of dental fragment: a case report.

Autogenous tooth fragment bonding offers advantages over restorations with composite resins and porcelain, including better esthetics, greater durability, reestablishment of the natural function of the dental element and short execution time. A case is presented of a 14-year-old male patient who suffered an oblique crown fracture of the permanent right maxillary central incisor (11) due to a traumatic fall. The clinical examination revealed pulp exposure with no invasion of the biological space. Due to the extension of the fracture, endodontic treatment and the placement of an intra-root esthetic pin was needed. The tooth was restored using the autogenous fragment bonding method. Excellent esthetic and functional results were observed after two years of follow up.