Investigation on the effects of long-term antibiotic therapy in sickle cell disease associated with molar-incisor hypomineralisation-a pilot study.

The term Molar-Incisor Hypomineralisation (MIH) is used to describe hypomineralised defects of systemic origin that affect at least one of the first permanent molars and often involves the permanent incisors. Antibiotic therapy during amelogenesis may be associated with enamel hypomineralisation. By examining children with Sickle Cell Disease (SCD), who take prophylactic antibiotics daily from birth until age five, it may be possible to determine if there is an increased prevalence of MIH in this population. The aim of this study was to determine the effect of long-term antibiotic use on the prevalence and severity of MIH in children with SCD. In a prospective cohort pilot study over a period of seven months, children aged 7-17 years, with SCD at Boston Children's Hospital (n = 18) were examined for MIH. Information regarding peri-natal concerns, incidence of illness and antibiotic use were also collected. The results were compared to a group of control patients (n = 63) for prevalence and severity of MIH using Fisher's exact test. The patients with SCD, 4/18 (22%) taking daily antibiotics did not show a statistically significant greater prevalence of MIH compared to the control group, 24/63 (38%). There was no correlation between MIH and pneumonia, asthma, fever, flu, otitis media, breastfeeding, gender and birth weight. However, an association was noted between premature birth and MIH (p ≤ 0.05). No correlation was found between long-term antibiotic use and higher prevalence of MIH in the SCD group compared to the control group. However, MIH may be more severe in those with a history of long-term antibiotics.

Effectiveness of telehealth in providing preventive oral health care: A pilot evaluation of patient, carer, and clinician experience.

BACKGROUND: This pilot study aimed to characterize the experience, satisfaction, and views on feasibility of an oral health primary prevention telehealth service at a public dental hospital's department of pediatric dentistry, from the viewpoint of patients, carers, and clinicians. METHODS: Data were collected using an anonymous questionnaire for parents/guardians, a focus group for clinicians; and were summarized using descriptive statistics, chi-square tests, analysis of variance, and by thematic analysis for the qualitative data. RESULTS: Thirty-seven parents/guardians and four clinicians were included. The mean patient age was 5 years (SD = 3.3). Over half of the parents (51.4%) were aged 30-39 years. There was high satisfaction (97.3%) and acceptability (81.1%) of the telehealth service. Native English-speakers were significantly more likely to agree that telehealth was an acceptable mode of preventive care and that they would use it again (p = 0.033). Parents reporting difficulty traveling to dental appointments were significantly more likely to score favorably in categories of usefulness, technical quality, and satisfaction relating to telehealth (all p < 0.001). Important themes from the clinician focus group included specific benefits for patients with special needs or who live rurally, reduced stress on families, and an enhanced focus on prevention. CONCLUSIONS: The findings suggest ongoing benefits of providing preventive oral health services as an adjunct to face-to-face care, especially to the identified subset of patients who will benefit the most.

Early childhood caries sequelae and relapse rates in an Australian public dental hospital.

BACKGROUND: Early childhood caries (ECC) remains one of the most prevalent childhood diseases in Australia, disproportionately affecting disadvantaged populations. AIM: To investigate the ECC experience including risk factors, incidence of caries, pain and infection as well as relapse rates of caries and secondary dental general anaesthesia (GA). DESIGN: A retrospective cohort study included dental records of children with ECC, aged <72 months at an Australian public dental hospital paediatric dentistry department from 2013 to 2015 (n = 102). Dental caries, pain, infection, referral patterns, demographic and caries risk factor data were recorded for 24 months. Descriptive statistics were used for patient characteristics and clinical data, and Kaplan-Meier curves and parametric exponential survival models for time-to-event series. RESULTS: The study population demonstrated higher-than-national average dmft and disease progression at baseline. Major risk factors for the development of caries, pain and infection were daily consumption of sweetened beverages, poor oral hygiene, residing in lower socio-economic areas, older age and being male. Rates of caries relapse and new referral for secondary treatment under general anaesthesia were relatively high. CONCLUSION: A high degree of ECC progression and recurrence in this population indicates a need for a more comprehensive approach to ECC addressing multilevel root causes and systemic risk factors.

Socio-demographic and familial factors associated with hospital admissions and repeat admission for dental caries in early childhood: A population-based study.

OBJECTIVES: Dental caries remains a complex childhood condition often requiring preventable hospital admissions. There are limited population-based epidemiological studies that use large and linked data sets to quantify the clinical, socio-demographic and familial risk factors related to hospital admissions for dental caries. The aim of this study was to describe and quantify the rates, socio-demographic, clinical characteristics and familial factors including repeat admissions associated with young children admitted to hospital for dental caries. METHODS: This cohort study (n = 33,438) used longitudinally linked hospital admission data among all children aged

Paediatric dental care during and post-COVID-19 era: Changes and challenges ahead.

BACKGROUND: COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus is transmitted through respiratory droplets and by physical contact from contaminated surfaces to the mucosa. Its route of transmission has caused a significant challenge in medical and dental healthcare. OBJECTIVE: This article aims to review the literature and information available on the provision of paediatric dental treatment during and post-pandemic and to provide specific recommendations on the safe provision of paediatric dental care. RESULTS: Children infected by SARS-CoV-2 have no or milder COVID-19 symptoms and are potential vectors in spreading the disease. Routine dental treatment is suspended in many countries because of the increased risk of cross-infection in dental practices. Only emergency dental care is provided for urgent conditions. It is necessary to gradually reinstate regular dental care to paediatric patients and maintain their good oral health. To control the disease transmission and maintain the oral health of the population, minimally intervention techniques that minimise or eliminate aerosol generation, plus comprehensive oral health preventive measures should be practised to safeguard safety at dental practices in this unprecedented time. CONCLUSIONS: Robust infection control guidelines should be implemented in dental clinics to minimise the risk of infection and to ensure the safety of patients and staff during the pandemic. Three levels of preventive care should be practised to prevent oral diseases and improve children's oral health in this COVID-19 era. Treatment should be prioritized to patients in urgent needs and aerosol-generating procedures should be minimized.

An investigation into the effect of a resin infiltrant on the micromechanical properties of hypomineralised enamel.

BACKGROUND: Resin infiltration may alter the mechanical properties of enamel hypomineralised lesions (HL); however, variable surface layer (SL) thickness may affect resin penetration. AIMS: To determine the thickness of the SL of HL and to investigate the effect of resin infiltration on the mechanical properties of HL. DESIGN: The thickness of the SL over HL was determined using polarised light microscopy. Etching time using 15% HCl gel to remove the SL of 52 samples was determined. Selected HL and control areas of 21 teeth were infiltrated with Icon® resin infiltrant, and cross-sectional Knoop microhardness (KHN) measurements were recorded before and after resin infiltration. RESULTS: Ninety-six point five per cent of HL had a detectable SL with mean thickness of 58 ± 29 µm. Application of HCl for 120 s produced a mean MIH erosion depth of 58 ± 12 µm. Eleven of 21 samples had evidence of infiltration using visual examination. The infiltrant penetrated some of the HL leading to an increase in KHN (111 ± 75 KHN) which, when compared to adjacent non-infiltrated HL (96 ± 52 KHN), was not statistically significantly different (P = 0.56). CONCLUSIONS: There was marked variation in the SL thickness of HL. Resin infiltration of HL did not increase microhardness significantly.

Management of 2 teeth diagnosed with dens invaginatus with regenerative endodontics and apexification in the same patient: a case report and review.

INTRODUCTION: This review and case report present the treatment of a 10-year-old boy with both permanent maxillary lateral incisors demonstrating Oehlers type II dens invaginatus and pulpal involvement. Treatment was complicated by dental anxiety, supraventricular tachycardia, immature tooth development, and facial cellulitis. METHODS: An infected necrotic pulp of the permanent maxillary left lateral incisor was treated by apexification and endodontic treatment with mineral trioxide aggregate. The necrotic pulp of the permanent maxillary right lateral incisor was treated with canal debridement and dressing under general anesthesia. RESULTS: Periapical healing of both teeth occurred, with the right lateral incisor showing continued root growth, thickening of the dentinal root walls, and completed apex formation. This tooth responded normally to pulp testing. Twenty-eight months after initial treatment, the right lateral incisor displayed progressive sclerosis of the canal. CONCLUSIONS: This case demonstrates possible pulpal regeneration of an infected maxillary right lateral incisor with dens invaginatus and an immature apex after minimal canal debridement.

Resin infiltration-taking the first steps to filling the holes in cheese molars.

Molar incisor hypomineralization (MIH) involves enamel hypomineralization of systemic origin affecting one or more first permanent molars (FPM) and is often associated with other teeth, particularly the incisors. A challenging condition for both the clinician and the patient, MIH affected teeth are often subjected to repeated treatments and frequently the decision to extract one or more FPM is made. At present, there are no clinical reports of available restorative materials that are able to provide consistently adequate restorations on hypomineralized teeth. The concept of resin infiltration, which involves occluding incipient enamel carious lesions with low viscosity resins to arrest or slow the development of caries has the potential to be applied to hypomineralized enamel. Successful penetration of resin infiltrant into MIH affected enamel may aid in improving its micromechanical properties.

KBG syndrome: review of the literature and findings of 5 affected patients.

KBG syndrome is a rare, multiple congenital anomaly/mental retardation (MCA/MR) syndrome characterized by neurological disturbance, short stature, a distinct craniofacial appearance, and skeletal anomalies. It is likely to be autosomal dominant in nature with a wide range of expressivity in its clinical features. Dentally, macrodontia, particularly of the maxillary permanent central incisors is a common finding. The aim of this article was to review the familiar clinical presentations of this syndrome and to highlight previously unreported findings of generalized macrodontia and shovel-shaped incisors. Dental and clinical findings of 2 affected brothers with a 3-year follow-up of their dental progress following orthodontic treatment are outlined. Additionally, dental and clinical findings of an affected mother and her daughter, and another sporadic case are also presented.