Pain during primary molar local anaesthesia with SleeperOne5 computerized device versus conventional syringe: A randomized, split-mouth, crossover, controlled trial.

BACKGROUND: Because of controversial results from clinical studies comparing different dental local anesthesia methods in children, the primary objective of this randomized, split-mouth, crossover, controlled trial was to compare pain intensity during local anaesthesia (LA) performed with a computer-controlled LA delivery system (C-CLADS) versus a conventional syringe (CONV). Secondary objectives included comparisons during dental treatment. METHODS: Participants (4-8 years) with tooth pair requiring similar treatment were recruited from five French hospitals. The right primary molar, which was treated at the first visit, was randomly allocated to one of the anaesthesia groups (either intraosseous with C-CLADS or infiltration with CONV), whereas the contralateral molar (treated at the second visit) was assigned to the other group. Pain intensity and behaviour outcomes, assessed with the Faces Pain and Venham revised scales, respectively, were compared between groups using Proc mixed. Stratified analyses were performed on dentition and location. RESULTS: Among 107 participants, the analysis revealed reduced pain perception during LA in the C-CLADS group compared with the CONV group (-0.72, 95% CI: -1.43, -0.006), but not during dental treatment. Stratified analyses showed that this effect was observed only in primary dentition (p = .006) and mandibular molars (p = .005). Behavioural issues were fewer in the C-CLADS group than in the CONV group (p = .05) only during injection. CONCLUSION: C-CLADS emerged as the preferable system in primary dentition.

Improving radiographic diagnosis of pulpo-periodontal complications in primary molars by training: Application in education and clinical research.

INTRODUCTION: The objective of this study was to assess an original learning intervention to train students and paediatric dentistry teachers in radiographic diagnostic accuracy of pulpo-periodontal complications in primary molars. MATERIALS AND METHODS: The learning intervention was based on 250 different randomly ordered radiographs of primary molars within three quizzes (A, B and C) for 5 sessions (S): quiz A (50 X-rays), B and C (100 X-rays) were, respectively, completed in S1 to assess the extent of agreement with 5 experts' diagnoses, in S2 and S3 (B at days 8 and 23) and in S4 and S5 (C at days 90 and 105). During S1 and at the end of S3 and S5, the participants (48 students and 16 teachers) were informed of correct diagnoses. A satisfaction questionnaire was completed by all the students. Alongside the descriptive analyses, generalised linear mixed model (GLMM) analyses assessed the odds of participants' correct diagnosis over the study duration. RESULTS: At S1, the odds of diagnostic accuracy among students were significantly lower than those among the teachers. After receiving feedback at S1, GLMM analyses showed that among all the participants, accuracy improved over time with the odds of correct diagnoses higher in S2-5 than in S1; and there were similar increases across sessions between teachers and students, except in S3, where the improvement among teachers tended to be greater than that among the students. All students were satisfied though one-third reported that quizzes with 100 radiographs felt too long. CONCLUSION: The online case-based learning was a good training format for dental education.

Oral health status in patients with inherited epidermolysis bullosa: a comparative multicenter study.

OBJECTIVE: Epidermolysis bullosa (EB) is a rare genetic mucocutaneous disorder characterized by epithelial fragility leading to blister formation on skin and mucous membranes with even minor mechanical trauma. Most EB oral health publications give fragmented information, focusing on only one oral health aspect or one EB type. The aim of this study was to expand the knowledge of the overall oral health status of individuals with dystrophic, junctional, and simplex EB. METHOD AND MATERIALS: A comparative multicenter study, including a control group, and based on questionnaires and clinical examinations, was undertaken in three EB expert centers. RESULTS: Most EB (90.2%) participants brushed their teeth at least once a day despite the pain. The prevalence of enamel defects and caries experience did not differ between the 42 EB participants and the 42 age-/sex-matched healthy controls. Gingival inflammation unrelated to dental plaque accumulation was found in EB participants. Blisters, erythema, and erosion/ulceration mainly involved gingiva, buccal mucosa, lips, and palate, with different topographic patterns according to EB type. EB patients whatever the age showed a similar lesion distribution. Simplex and dystrophic EB patients under 12 years old displayed higher lesion severity than junctional EB ones. Only dystrophic type exhibited microstomia and ankyloglossia. CONCLUSION: Oral health status seemed to benefit from a close collaboration between dental practitioner and dermatologist, and from regular dental examination, starting at a young age and with a focus on prevention. The new appreciation of oral health involvement highlighted by this study is essential for EB patients care, regarding comorbidities and quality of life.

The effects of acute pain on cognitive skills in emergency department patients.

INTRODUCTION: Effective pain management results in improved patient satisfaction, reduced anxiety, and improved comfort. However, concern exists regarding the effects of pain medications on cognition and patient ability to consent for procedures, hospital admission, or to refuse recommended medical interventions. METHODS: This prospective, case-control study was conducted at a Level 1 Trauma Center. Eligible subjects included ED patients ages 18 and older with a triage pain score of 1 or higher, who received non-narcotic analgesic agents. Cognition was measured before and after non-narcotic pain medication using the Digit Symbol Substitution Test (DSST). A control group consisted of 35 healthy volunteers who completed the DSST at baseline and one hour. RESULTS: Among 46 subjects, the mean age was 33. The mean triage pain score was 7. Before medication, the average DSST score was 39.5. After medication, the average DSST score was 42.9. There was a significant within-subject average change in DSST score (pre-post) of 3.4 (95% confidence interval: 1.6, 5.2), p < 0.001. Among the control group, the mean baseline DSST score was 64.2 (SD 10.7). One hour later the mean DSST score had increased to 71.1 (SD 10.4). Overall, the mean within-subject change over time in DSST was 6.9 (SD 8.0) with 95% CI 4.2 to 9.7. There was not enough evidence to detect relationships between change in DSST scores and age, triage pain, triage HR, triage RR, change in pain scores, gender, ethnicity, mode of arrival nor insurance (all with p > 0.05). CONCLUSIONS: We found significant variation in DSST scores among ED patients with pain. Treatment of pain with nonsedating analgesic agents was not associated with improved scores on the Digit Symbol Substitution Test among ED patients with acute painful conditions, compared to control subjects.

[Conservative and simple rehabilitation to compensate posterior open bite: partial bonded restauration]. / Des solutions simples et conservatrices pour la compensation des infraclusions postérieures : les restaurations partielles collées.

Posterior open bite is a malocclusion characterized by the absence of vertical contacts between the occlusal surfaces of the posterior teeth of the opposing arches. It can be uni- or bilateral and involve one tooth or more. Several aetiologies of these posterior open bite have been described, including pathological eruptions, dento-maxillary dysmorphosis and temporo-mandibular dysfunctions. When considering a correction or compensation, there are several therapeutic options (orthodontic and/or surgical and/or prosthetic). Recent developments in adhesive dentistry (bonding biomaterials, ceramics and composites) have made possible the development of more conservative approach for restorative and prosthetic treatments. In order to understand the possible use of these restorations and the help it can provide in our treatment plan, we have selected three original clinical situations. Each one illustrated a posterior open bite aetiology and explained the rehabilitation strategies chosen (process of decision making and realization). Partial bonded restorations (direct composites, overlays, tabletops, veenerlays) can be considered to compensate open bite, in case of impossibility, failure or as a complement of orthodontic treatments. Additive equilibration is not described in the literature for the compensation of posterior open bite, despite the many functional advantages along a simple and conservative technique.

Caries removal strategies for deep carious lesions in primary teeth: Systematic review.

The study aimed to compare the efficacy of three caries removal techniques-complete caries removal (CCR), selective caries removal (SCR), and stepwise caries removal (SWR)-for deep carious lesions in vital temporary teeth by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs). Electronic databases (PubMed [MEDLINE], Cochrane Library, EMBASE) were searched for corresponding references up to 31 May 2019. Possible outcomes were pulp exposure, pulpo-periodontal complications, or restorative failures. Three reviewers independently selected studies, extracted data, and assessed the risk of bias using RoB 2. Meta-analyses for intention-to-treat and per-protocol scenarios were performed using Revman5. Of 1374 potentially eligible articles, ten relevant references corresponding to eight studies were included. Pooled results showed decreased risk of pulp exposure after SCR (OR: 0.10, 95% CI [0.04, 0.25]) or SWR (OR: 0.20, 95% CI [0.09, 0.44]), compared with CCR. There was a higher risk of composite restorative failure (OR: 2.61, 95% CI [1.05, 6.49]) using USPHS criteria, after SCR compared with CCR only in intention-to-treat analysis. Risk of clinical or radiographic failure of pulpo-periodontal complications was unchanged when compared with SCR and CCR or SWR. SCR and SWR may result in lower pulp exposure risk than CCR. RCTs with lower risk of bias, higher power, and longer follow-up are required to choose between these three caries removal techniques for deep carious lesions in vital temporary teeth.

Methodological Proposal to Assess Gingival Thickness in Children.

PURPOSE: Inadequate gingival thickness (GT) may lead to gingival recession. Thus, early identification of patients/teeth at risk would be advantageous. In adults, the probe's visibility through the marginal gingiva (reference test) has been considered a reliable criterion to describe a thin gingiva. This study aimed to evaluate in children two more convenient methods: the whitening of the attached gingiva with coronal labial traction (GW test) and the visibility of the gingival blood supply (BS test). MATERIALS AND METHODS: In 69 children, the GT of primary and/or permanent central and lateral incisors, first primary molars and/or first premolars was assessed with the three tests. The sensitivity and specificity of the GW and BS tests and their odds ratio with probing were calculated. RESULTS: According to probing, 39% of children in the studied population had thin gingiva. The GW and BS tests reported different percentages of GT compared to probing, except for primary teeth, maxillary permanent incisors and mandibular first premolars, where the GW test exhibited a comparable percentage. The sensitivity of GW and BS tests was 37% and 19%, respectively, when compared to probing, while the specificity was 84% and 96%, respectively. CONCLUSION: The GW and BS tests could be used for first-line diagnosis of thin gingiva; if the results are negative, probing should be implemented.

A targeted next-generation sequencing assay for the molecular diagnosis of genetic disorders with orodental involvement.

BACKGROUND: Orodental diseases include several clinically and genetically heterogeneous disorders that can present in isolation or as part of a genetic syndrome. Due to the vast number of genes implicated in these disorders, establishing a molecular diagnosis can be challenging. We aimed to develop a targeted next-generation sequencing (NGS) assay to diagnose mutations and potentially identify novel genes mutated in this group of disorders. METHODS: We designed an NGS gene panel that targets 585 known and candidate genes in orodental disease. We screened a cohort of 101 unrelated patients without a molecular diagnosis referred to the Reference Centre for Oro-Dental Manifestations of Rare Diseases, Strasbourg, France, for a variety of orodental disorders including isolated and syndromic amelogenesis imperfecta (AI), isolated and syndromic selective tooth agenesis (STHAG), isolated and syndromic dentinogenesis imperfecta, isolated dentin dysplasia, otodental dysplasia and primary failure of tooth eruption. RESULTS: We discovered 21 novel pathogenic variants and identified the causative mutation in 39 unrelated patients in known genes (overall diagnostic rate: 39%). Among the largest subcohorts of patients with isolated AI (50 unrelated patients) and isolated STHAG (21 unrelated patients), we had a definitive diagnosis in 14 (27%) and 15 cases (71%), respectively. Surprisingly, COL17A1 mutations accounted for the majority of autosomal-dominant AI cases. CONCLUSIONS: We have developed a novel targeted NGS assay for the efficient molecular diagnosis of a wide variety of orodental diseases. Furthermore, our panel will contribute to better understanding the contribution of these genes to orodental disease. TRIAL REGISTRATION NUMBERS: NCT01746121 and NCT02397824.

Familial hypophosphatemic vitamin D-resistant rickets--prevention of spontaneous dental abscesses on primary teeth: a case report.

Familial hypophosphatemic vitamin D-resistant rickets is a hereditary disease generally transmitted as an X-linked dominant trait and characterized by distinctive general clinical signs. Dental features include spontaneous dental abscesses that occur in the absence of a history of trauma or dental decay. The challenge for the dentist is to prevent and treat these lesions. This report describes the case of a young hypophosphatemic boy with abscesses. In this case, the application of fluid resin composites with a self-etching primer bonding system to all primary teeth prevented abscess formation for more than 1 year and thus avoided endodontic treatment or extraction. This constitutes a new approach to the prevention of spontaneous abscesses on primary teeth in children with familial hypophosphatemic rickets.

Bisphosphonates, osteonecrosis, osteogenesis imperfecta and dental extractions: a case series.

Over the past 4 years, numerous cases of osteonecrosis of the jaw in patients treated with bisphosphonates have been reported. Since 1998, children and adolescents with osteogenesis imperfecta have received bisphosphonates to increase their bone density and reduce the incidence of bone fractures. The results have been convincing, but recent reports of osteonecrosis of the jaw have caused great concern when these patients require dental extractions. The dental records of 15 children and adolescents with osteogenesis imperfecta, involving 60 dental extractions, mostly of primary teeth, done between 2001 and 2006, were reviewed. All patients but one had had or were having bisphosphonate treatment at the time of the extractions. No patient developed osteonecrosis. Further studies and data that allow clinicians to design adequate and safe treatment plans for this unique population are needed.