Impact of Pediatric Dental Resident Availability in the Pediatric Emergency Department.

OBJECTIVE: The purpose of this study is to describe the impact of Delaware's first pediatric dental residency program on treatment of patients presenting to the pediatric emergency department (PED). METHODS: Charts were reviewed for patients presenting to the PED with a dental chief complaint over a 9-month period with a comparison period. Chief complaint, diagnosis, treatment interventions, disposition, and demographic information were included. χ 2 , Fisher exact, and Student t tests with a P value less than 0.05 were regarded as significant. RESULTS: A total of 432 patients met inclusion criteria; 197 before dental residency commencement and 235 after residency commencement. Dental consultation significantly increased (56% vs 7%, P < 0.01) between the study periods. There were no statistically significant differences in sex, race, insurance type, admissions, or proportion of presentations of trauma or infection between the study periods. Dental residents provided in-person evaluation for 40% of patients. The proportion of patients receiving dental intervention increased significantly postresidency period (57% vs 47%, P = 0.04). Pediatric emergency department extractions and splints both occurred in a significantly larger portion of patients after the start of the residency program (17% vs 1% and 5% vs 0%, P < 0.01). A higher proportion of patients with dental complaints received procedural sedation in the PED after residency (13% vs 2%, P < 0.01). CONCLUSIONS: Pediatric dental resident availability in the PED significantly increased dental consultation and intervention. A significantly higher percentage of PED patients received definitive treatment at point of service without requiring referral to another facility.

Oral Complaint Visits to the Pediatric Emergency Department During the COVID-19 Pandemic.

OBJECTIVE: We aimed to describe differences in orofacial complaints presenting to a pediatric emergency department (PED) during the COVID-19 pandemic as compared to those presenting prior to the pandemic. STUDY DESIGN: A retrospective review was conducted in the PED from March 16, 2020, to August 16, 2020, and compared with the prior year. RESULTS: Despite a 41% reduction in total PED visits, oral visits as a percentage of PED volume increased (3% vs 2%) P < 0.01) during the pandemic. More children with dental complaints required intervention during the pandemic (48% vs 30%, P < 0.001) including extractions and splinting (15% vs 1%, P < 0.001). Compared with pre-pandemic, proportion of tooth infections increased (68% vs 40%, P < 0.001), while oral ulcers decreased (19% vs 47%, P < 0.001). CONCLUSION: Pediatric emergency department presentation decreased during the pandemic, but patients requiring interventions increased. This may reflect hesitation in seeking treatment, outpatient facility closures, and increased acuity at the time of PED presentation due to delays in seeking care.

Postoperative Bleeding Complications after Stainless Steel Crown Placement: A Case Series.

Stainless steel crown (SSC) placement is a common pediatric restorative treatment, generally completed with minimal complications. Discussed in this case series are two patients who presented to the emergency department (ED) with moderate oral bleeding persisting more than 12 hours after oral rehabilitation under general anesthesia. Bleeding incidence after pediatric oral rehabilitation has been found to range from 20% to 40%, with most being considered mild and significantly associated with extractions. There is limited documentation regarding moderate, persistent postoperative bleeding associated with placement of preformed metal crowns. The objective of this paper is to raise awareness of postoperative bleeding following SSC placement, discuss probable causes to minimize complications in the future, and discuss the local measures that were used to obtain hemostasis.

Subcutaneous emphysema following dental care of a patient with ventriculoperitoneal shunt: Case report.

INTRODUCTION: Pediatric dental treatment utilizing an air-driven handpiece and triplex syringe in the operating room has been common practice for many decades. Adverse effects with compressed air are rarely reported in the dental community but can cause serious complications for pediatric patients in the unlikely event they occur. CASE REPORT: We present a case of subcutaneous emphysema of a 4-year-old presenting for dental rehabilitation under general anesthesia, which was further complicated by the presence of a ventriculoperitoneal (VP) shunt and the patient's neuroatypical status. The subcutaneous emphysema was apparent at case completion with right unilateral swelling in the cervicofacial area extending from the infratemporal space to the periorbital buccal region. The most probable etiology was compressed air from a high-speed handpiece dissecting through infected tissue during a crown preparation. Subcutaneous emphysema was managed by diagnostic radiographs, antibiotics coverage, and hospital observation due to patient's multiple health factors. CONCLUSION: Subcutaneous emphysema appears to be a rare event in pediatric dental care; however, there is increased risk for complications in the unintentional occurrence. Subcutaneous emphysema is an important differential for facial swellings. Medically complex patients, such as this case, should involve a multidisciplinary team approach due to the proximity of the VP shunt.