Dentists' attitudes towards mouthguard protection.

PURPOSE: This study analyzed the attitudes of Virginia general dentists, orthodontists, and pediatric dentists towards mouthguard protection. METHODS: Questionnaires were constructed and mailed to 2500 dentists in Virginia. RESULTS: In this survey, 97% of orthodontists, 84% of pediatric dentists, and 67% of general dentists recommended mouthguard protection for their athletically active patients. The two main reasons for not recommending mouthguards were that the patient could obtain one from a less expensive source than the dental office and the dentist had not received formal training on fabrication or use of mouthguards. More recent graduates were more likely to have been taught mouthguard use and fabrication during their dental training. General dentists (59%) and pediatric dentists (56%) recommended the custom mouthguard while orthodontists recommended the prefabricated stock type (77%) as their primary choice of mouthguard. A majority of general dentists (58%), orthodontists (81%), and pediatric dentists (76%) recommended mouthguard protection for the contact sport of basketball which presently is a non-mandated mouthguard sport. CONCLUSION: Most dentists agree that athletically active patients require mouthguard protection. Many dentists, however, question whether they were the ones responsible for distributing and fabricating the mouthguards.

Pacifier use and otitis media in infants twelve months of age or younger.

PURPOSE: The purpose of this study was two fold: to determine if within a selected population of infants the prevalence of otitis media was greater in pacifier users than in non-pacifier users, and to reveal if an association existed between otitis media and pacifier use. METHODS: The study consisted of 200 children, 12 months of age or younger. Parents were surveyed regarding children's pacifier habits, day care attendance, feeding habits, thumb sucking habits, exposure to parental smoking, and parental education level. RESULTS: The prevalence of otitis media in pacifier users (36%) was larger than that of non-pacifier users (23%), P < 0.05. A logistic regression analysis determined an association existed between otitis media and pacifier use, bottle feeding, thumb sucking, and day care utilization, P < or = 0.05. No association was discovered between otitis media and breast feeding, parental smoking and parental education level. CONCLUSION: The risk of developing otitis media in an infant is two times greater if a pacifier is used and five times greater if bottle fed or attending a day care facility.

An analysis of malocclusion in children with otitis media.

PURPOSE: The purpose of this study was to examine the occlusion of children younger than 6 years with a diagnosis of otitis media. METHODS: The study consisted of 112 children diagnosed with otitis media by their pediatrician. Parents were surveyed regarding their child's history of pacifier use, thumb/finger-sucking habit, mouthbreathing habit, method of feeding, day care attendance, snoring, allergies, asthma, upper respiratory infections, otitis media in the family, and the number of people who smoke in the home. The children's occlusions were examined. RESULTS: In this study, 52% of the population presented with some type of malocclusion, with anterior open bite (17%) and an overbite measuring greater than 70% (17%) being the most prominent. This study showed that the following factors were common in children with otitis media: bottle feeding, smoking in the home, day care attendance, upper respiratory infection, history of otitis media with a sibling, pacifier habit, snoring, and mouthbreathing habit. CONCLUSION: A logistic regression analysis showed no significant association between malocclusion and factors related to otitis media.

Minimizing otitis media by manipulating the primary dental occlusion: case report.

Acrylic resin bonded to the occlusal surfaces of mandibular second primary molars was found to be an effective method to disclude the primary dentition and reduce or eliminate otitis media in young children between the ages of two to six years of age.

Comparison of oral chloral hydrate with intramuscular ketamine, meperidine, and promethazine for pediatric sedation--preliminary report.

Fifteen consecutive pediatric patients ranging from 3 to 5 years old were selected to receive one of three sedative/hypnotic techniques. Group 1 received oral chloral hydrate 50 mg/kg, and groups 2 and 3 received intramuscular ketamine 2 mg/kg and 3 mg/kg, respectively. In addition to ketamine, patients in groups 2 and 3 received transmucosal intramuscular injections of meperidine and promethazine into the masseter muscle. Sedation for the satisfactory completion of restorative dentistry was obtained for over 40 min on average in the chloral hydrate group, but completion of dental surgery longer than 40 min was achieved in groups 2 and 3 only by intravenous supplements of ketamine.

Parental attitudes toward mouthguards.

An 11-item, one-page questionnaire was mailed to 1800 parents chosen at random in the Henrico County, VA public school system. Parents were asked questions such as "who should be responsible for mouthguard wear?" "what sports should require mouthguards?" and "has [their] child ever sustained an oral or facial injury?" The parental responses indicate that mouthguard enforcement is the responsibility of both parents and coaches. Of the total injuries reported, 19% were sustained in basketball, 17% in baseball, and 11% in soccer. Despite these high injury rates, however, there was a lack of perceived need for mouthguard use in these sports. When asked which sports should require a mouthguard rule, the sports that generated the most responses were, in decreasing order, football, boxing, ice hockey, wrestling, field hockey, and karate. Parents were more likely to require mouthguards for their sons than daughters, and more likely to require them for their children who participated in a mandatory mouthguard sport, a contact sport, or who had been previously injured. The authors conclude that because parents view themselves as equally responsible as coaches for maintaining mouthguard use, both groups should be targeted and approached as a possible source for the recommendation of mandatory mouthguard rules in basketball, baseball, and soccer.

Retention of esthetic veneers on primary stainless steel crowns.

The purpose of this study was to ascertain the amount of shearing force necessary to fracture, dislodge or deform the esthetic veneer facings of four commercially available veneered primary incisor stainless steel crowns. The four types tested were: Cheng Crowns, [Peter Cheng Orthodontic Laboratory]; Whiter Biter Crown II, [White Bite Inc.]; Kinder Krowns, [Mayclin Dental Studio, Inc]; and NuSmile Primary Crowns, [Orthodontic Technologies, Inc]. The crowns (#4 right central incisor) from each manufacturer were obtained with the facings attached. The crowns were soaked for ninety days and thermocycled at 4 degrees C and 55 degrees C for 500 45-second cycles. The crowns were cemented to standardized chromium cobalt metal dies. Each die was placed in to a custom holder on the Instron Universal testing machine. A force was applied at the incisal edge of the veneer at 148 degrees, (the primary interincisal angle), with a crosshead speed of 0.05 inches/minute until the veneer either fractured, dislodged or deformed. The mean force (Ibs) required +/- SD to produce failure, in descending order, was as follows: Cheng (107.8 +/- 17.3); NuSmile (100.2 +/- 18.2); KinderKrown (91.3 +/- 27.4)d Whiter Biter (81.5 +/- 21.7). To test the hypothesis of no difference among the four manufacturers, an analysis of variance was performed using PROC GLM. The resultant F statistic was 2.79 (p < 0.0543), indicating a marginally statistically significant difference in the response variable "pressure" among the four groups. A posthoc test was then performed to ascertain where these differences occurred. These results, using Turkey's studentized range test for pairwise comparisons, suggested that the only difference was between the Cheng and Whiter Biter manufacturers.

Recall intervals: effect on treatment needs: a retrospective study.

The purpose of this retrospective study was to examine the effect of recall intervals on the incidence of dental caries. Data were collected from patient records of a private pediatric dental practice. Variables examined were time of the recall interval, age, race and sex of the patient, and whether the patient lived in a fluoridated area. There were 207 patients who qualified for the study. Of the 207 patients in the study, 173 did not have any teeth with dental caries at the recall visit. A significant difference between increased caries activity and recall interval was not found in this study. There was no significant difference found between the explanatory variables and caries activity.

Recall intervals: effect on treatment needs of the handicapped patient: a retrospective study.

The purpose of the retrospective study was to examine the effect of recall intervals on incidence of dental caries in handicapped patients. Data was collected from patient records of a private pediatric dental practice. Variables examined were time of the recall interval, age, race and sex of the patient, handicap, and whether the patient lived in a fluoridated area or not. Approximately six hundred charts were reviewed which resulted in 83 patients that qualified for the study. Of the 83 patients in the study, 57 did not have dental caries at the recall visit. The relationship between increased caries activity and recall interval was not significant. However, a trend indicating an increased chance of developing caries after a twelve month recall interval was detected.

Hypnosis as an adjunct to the administration of local anesthetic in pediatric patients.

This study investigates the acceptance of local anesthetic injection, utilizing hypnosis in twenty-nine children, ages four to thirteen years. Each subject was evaluated twice, once utilizing hypnosis before injection, and once without. A double blind research design was used to avoid effects of expectancy. Subjects in the study were videotaped during the procedure. Their behavior was rated independently by two pediatric dentists, using the North Carolina Behavior Rating Scale (NBRS). Transcutaneous pulse oximetry data were also recorded for each subject. The resulting data were evaluated for statistically significant differences between the two methods and for interrater reliability. Results showed no statistically significant differences in oxygen saturation due to hypnosis condition, order of treatment, sex, race, or age. Statistically significant differences were found in pulse rate and behavior, attributable to hypnosis condition and age, but not to sex, race, or order of treatment. Pulse rate decreased with hypnosis, as did crying. The hypnosis condition seemed to be more successful with younger children (four to six years old).

Evaluation of the Eyberg Child Behavior Inventory as a predictor of disruptive behavior during an initial pediatric dental examination.

The purpose of this study was to investigate relationships between the Eyberg Child Behavior Inventory (ECBI), a parent rating scale of children's behaviors at home, and children's disruptive behaviors during an initial dental visit. Behaviors of 18 Headstart children, 40 to 55 months of age, undergoing an initial exam were observed. Four possible negative behaviors based upon the North Carolina Behavior Rating Scale (NCBRS), were recorded by two observers for each subject during five phases of an initial dental visit and statistically compared to the total ECBI score and individual answers within the ECBI questionnaire. Overall, the majority of subjects displayed clinically acceptable behavior. Four disruptive behaviors explained 92.9% of the variation in responses by the subjects to the initial visit. These were: high hand movement during the intraoral examination, crying or verbal protest during prophylaxis, oral physical resistance during prophylaxis, and oral-physical resistance during fluoride application. The following 6 questions explained 99.3% of the variation in ECBI responses by parents or guardians: (#9) refuses to obey until threatened with punishment, (#15) whines, (#18) hits parents, (#24) verbally fights with friends his own age, (#28) constantly seeks attention, and (#35) is overactive or restless. While the total number of subjects observed were too low to generate statistically significant results, the trends appear to indicate that a child's disruptive or nondisruptive behavior at home is not a reliable predictor of disruptive or nondisruptive behavior within the dental setting. These findings are independent of gender or race.

Children's behavior in emergency and non-emergency dental situations.

This study evaluated children's behavior during emergency and non-emergency visits to the dentist. Three methods were used to evaluate behavior: 1) the Palmar Sweat Index, 2) the Taylor Manifest Anxiety Scale, and 3) the Frankl Behavior Scale. Forty children, 6-12 years of age, were seen in a pediatric dental clinic. All children had no previous dental experiences. Twenty patients were seen for new patient examinations and twenty patients had emergency examinations and treatment. This study showed that children exhibit equal levels of stress whether for a screening appointment or an emergency visit. The Palmar Sweat Index has the potential of being a viable evaluation for detecting non-verbally expressed anxiety.

Evaluation of occlusion, trauma, and dental anomalies in African-American children of metropolitan Headstart programs.

493 African-American children between the ages of three and four years were examined for evaluation of molar occlusion with frequency of anterior and posterior crossbite, fractured and/or darkened teeth from trauma and dental anomalies in the primary dentition. Overall results from both age groups revealed 90% had a mesial step, 8% a flush and 2% a distal step molar occlusion. Crossbite, either anterior or posterior, occurred in 12% of all children examined. Posterior crossbite was seen in 7% and anterior crossbite in 5%. Anterior openbite was seen in 8% of the children. Trauma to the primary dentition occurred in 23% of the children, 16% as fractured and 7% as discolored teeth. The most frequently involved teeth were the maxillary primary central incisors. Fused primary teeth were observed in two children. There were no congenitally missing primary teeth and only one supernumerary maxillary primary lateral incisor was observed.

Comparison of triazolam to a chloral hydrate/hydroxyzine combination in the sedation of pediatric dental patients.

The purpose of this study was to compare the effectiveness of triazolam to chloral hydrate with hydroxyzine when sedating young children for dental treatment. Twenty children, age 21 to 74 months, with a mean age of 44 months, were given triazolam. Twenty children, age 23 to 64 months, with a mean age of 42 months, were given chloral hydrate with hydroxyzine. The children were given an elixir of either .02 mg/kg triazolam or 40 mg/kg chloral hydrate with 25 mg hydroxyzine. All subjects received 50% nitrous oxide and were restrained with a Papoose Board. The sedations were videotaped and evaluated by two pediatric dentists not involved in the study. They rated the success of the sedations by degree of sleep, crying, body movements, and overall behavior. Time until onset of action of the agents given, oxygen saturation of arterial blood, and heart rate were measured. The vital signs were consistent for the two groups. There was no statistical difference in the effectiveness of sedation between the two groups.

Comparison of a chloral hydrate/hydroxyzine combination with and without meperidine in the sedation of pediatric dental patients.

The purpose of this study was to compare the effectiveness of a chloral hydrate/hydroxyzine combination with and without meperidine in the sedation of pediatric dental patients. Twenty children were given 40 mg/kg chloral hydrate and 25 mg hydroxyzine, and 20 children were given 40 mg/kg chloral hydrate and 25 mg hydroxyzine and 0.5 mg/kg meperidine. All children were between the ages of 24 and 60 months and all medications were given orally 1 hr before treatment. The children received 50% nitrous oxide for the entire procedure. All children were restrained in a Papoose Board. The patients were videotaped and their behavior was rated by two independent pediatric dentists using the Houpt Scale. The independent evaluators did not know which sedation regimen had been used. They rated success of the sedations by degree of sleep, crying, body movements, and overall behavior. Oxygen saturation of arterial blood, and heart rate also were measured. The vital signs were consistent for the two groups. There was no significant difference in the effectiveness of the two drug regimens.

Psychomotor skills and incentive as predictors in a children's toothbrushing program.

Sixty-four children, four to twelve years of age, were seen in a pediatric dental clinic for routine dental examinations. Prior to dental treatment subjects were administered tests of visual-motor development and dental knowledge. Children were randomly assigned to a toothbrushing-instruction (individual training in horizontal scrubbing) or no-instruction group. Within each group, subjects were assigned to an incentive (promise of a special prize for brushing well) or no-incentive condition. Plaque score measurements and toothbrushing skills evaluations were performed at the initial appointment and at a one-week follow-up. Brushing skills were predicted by visual-motor skills and by dental knowledge. Level of visual-motor development predicted the likelihood of missing fewer oral areas, while brushing incentive was found to affect overall improvement in plaque removal regardless of instruction. Instruction affected improvements in brushing the more difficult molar teeth and lingual surfaces specifically.

Improving children's oral hygiene through parental involvement.

This study evaluated whether preschool children's oral hygiene would improve, if the parent, after receiving professional instruction, could demonstrate proficient toothbrushing. In the experimental group, twenty-four parents received a clinical demonstration and verbal instruction in the scrub-brush technique. They were asked to demonstrate proficiency in brushing their children's teeth using this technique. In the control group, twenty-six parents received the same brushing instructions, but did not clean their children's teeth. Baseline and four-week follow-up plaque and gingival scores showed improvement only in the plaque score (p less than .05) for the experimental group. Gingival scores were unchanged. These results indicate the advantage of parental participation in their child's dental care, especially in the case of new patients.