OPTIMAL RESTORATIVE OPTION FOR PERMANENT FIRST MOLARS AFFECTED BY HYPOMINERALIZATION REMAINS UNCERTAIN.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Restorative techniques for permanent first molars affected by hypomineralization: a systematic review. Lopes-Fatturi A, Wambier L, Rolim TZC, Reis A, Feltrin de Souza J. Pediatr Dent 2022; 44(1):17-24. SOURCE OF FUNDING: None. TYPE OF STUDY/DESIGN: Systematic review.

A simple screening tool for occupational burnout among dentists.

BACKGROUND: Nearly 40% of US physicians experience occupational burnout. The actual prevalence rate of burnout among US dentists remains unknown. The authors examined a simplified 2-item burnout screening tool based on the Maslach Burnout Inventory (MBI) to identify possible occupational burnout among dentists. METHODS: Data were obtained from a survey of pediatric dentists (n = 540) in the United States. The full MBI items from the data set were used to determine and categorize emotional exhaustion and depersonalization. Responses to 2 MBI items, 1 for emotional exhaustion and 1 for depersonalization, were analyzed separately and risk of experiencing high MBI emotional exhaustion and depersonalization was calculated using all subscale items for these 2 burnout dimensions. Spearman correlations were used to compare responses to the 2 MBI items and MBI emotional exhaustion and depersonalization. RESULTS: Based on frequency of at least once per week, 18% of respondents had positive response to MBI item "I feel burned out from my work" and had high MBI emotional exhaustion, and 9% had positive response to MBI item "I have become more callous toward people since I took this job" along with high MBI depersonalization. The risk of experiencing the burnout dimensions of high emotional exhaustion and depersonalization increased with positive frequency score for the respective MBI items. There were strong positive correlations between responses to the 2 MBI items and emotional exhaustion and depersonalization scores, respectively. CONCLUSIONS: A simple 2-item burnout screening tool can be used to identify potential occupational burnout among dentists. PRACTICAL IMPLICATIONS: Improving awareness about occupational burnout can help mitigate its detrimental consequences.

Short-term effects of fixed orthodontic appliance on concentrations of mutans streptococci and persister cells in adolescents.

INTRODUCTION: Orthodontic patients are at an increased risk for developing caries. Dental caries is a biofilm-mediated disease, with mutans streptococci (MS) as the primary etiologic bacterial group. It has been suggested that persister cells (PCs), a subset of cells within the biofilm, contribute to the chronic infectious nature of dental caries. PC formation can be induced by environmental stressors such as orthodontic treatment. The aim of this study was to quantify MS, aerobic and facultative anaerobe bacterial PC proportions from plaque samples during the initial stage of orthodontic treatment. This study is the first to analyze the role of PCs in a population of patients highly susceptible to caries, that is, patients undergoing orthodontic treatment. METHODS: Plaque samples were collected from 17 participants (11 males and 6 females; age range: 11-18 years) before and 1 month after insertion of fixed orthodontic appliances. Percentages of MS and PCs were determined with selective media and a classical persister microbial assay, respectively. RESULTS: There was a statistically significant decrease in %MS (P = 0.039) but no statistically significant difference in %PCs (P = 0.939) after 1 month of orthodontic appliance placement. CONCLUSION: Our study illustrated the technical feasibility of analysis of PCs in plaque samples of patients during orthodontic treatment and revealed that PC formation during orthodontic treatment is highly variable across individuals.

Association of Streptococcus mutans collagen binding genes with severe childhood caries.

OBJECTIVE: An important factor in the assessment of caries risk is the presence of specific oral microflora, especially Streptococcus mutans. Some S. mutans strains possess proteins capable of binding collagen, such as the Cnm and Cbm proteins. The aim is to determine the presence of S. mutans strains carrying collagen binding proteins in a group of subjects with severe early childhood caries (S-ECC). MATERIALS AND METHODS: S. mutans strains isolated from 15 S-ECC children were analyzed for collagen binding domains (cbd) of the cnm (cbd/cnm) and cbm (cbd/cbm) genes and their ability to bind to collagen. RESULTS: S. mutans strains positive for cbd/cnm or cbd/cbm were only found in 3 subjects with the most severe caries profile, with one subject having both cbd/cnm and cbd/cbm, and the other two with one of each. cnm/cbm-positive S. mutans strains bound to collagen substrate more avidly compared with negative S. mutans strains from each of the three groups. CONCLUSIONS: Our findings of an association between the presence of the collagen binding domains of the cnm/cbm genes in plaque S. mutans and the most aggressive form of caries profile in children offer a potential strategy to identify an individual's risk for caries progression. Our study should be replicated in other settings and communities in longitudinal and longer-term studies. CLINICAL RELEVANCE: Our data offer a potential tool in the caries risk management and assessment in children.

Occupational burnout and depression among paediatric dentists in the United States.

BACKGROUND: Paediatric dentists in the United States may be at greater risk for occupational burnout and/or depression because of chronic stress associated with provision of paediatric dental care and increasing prevalence of females in the workforce. AIMS: To determine the prevalence of occupational burnout and/or depression among US paediatric dentists. DESIGN: A self-administered online anonymous survey was sent to members of the American Academy of Pediatric Dentistry (n = 4735). The questionnaire consisted of seven demographic items, 22 items of Maslach Burnout Inventory (Three subscales: Emotional exhaustion, Depersonalization, and Personal accomplishment), and eight items of Patient Health Questionnaire-8. RESULTS: The survey had a response rate of 11.4% (females = 53%). Twenty-three per cent of respondents had high emotional exhaustion while fewer respondents had high depersonalization (12%) or low personal accomplishment (10%). Nine per cent fulfilled the study's definition of occupational burnout (high emotional exhaustion + high depersonalization). Seven per cent of respondents had moderate-to-severe depression and showed significant correlations (P < .05) with high emotional exhaustion, high depersonalization and low personal accomplishment. Two out of five respondents with occupational burnout also had moderate-to-severe depression. There were no gender differences in prevalence of burnout or depression. CONCLUSIONS: Few paediatric dentists had occupational burnout and/or depression.

Streptococcus mutans isolated from children with severe-early childhood caries form higher levels of persisters.

OBJECTIVES: Dental caries is the most common chronic infectious disease in children. Streptococcus mutans, the main cariogenic bacterial species, produces persisters, nongrowing dormant variants of regular cells associated with chronicity of diseases. We hypothesized that the recurrent nature of caries, particularly within populations with high-caries risk, is due partly to specific phenotypic features of S. mutans such as its ability to form persisters. We aimed to investigate the genotypic and phenotypic differences between the S. mutans from children with severe early-childhood caries (S-ECC) and those without caries. METHODS: S. mutans from plaque samples of caries-free (CF) and S-ECC children were tested for their ability to adapt to a lethal pH in an acid tolerance response assay. The persister levels of S. mutans isolates was quantified in both groups. RESULTS: S. mutanswas identified in all 23 S-ECC but only 6 of the 21 CF subjects. In most subjects, only one dominant S. mutans genotype was detected. No statistically significant differences in the mean survival percentage of S. mutans were observed between the two groups at a lethal pH of 3.5. However, the dominant genotype within a particular S-ECC subject exhibited a higher percentage of cell survival compared to those in the CF group. In S-ECC patients, S. mutans isolates displayed a ∼15-fold higher persistence phenotype than S. mutans isolates from CF patients. CONCLUSIONS: The ability of S. mutans to produce high levels of persisters may contribute to part of an individual's ability to control caries disease activity and recurrent lesions.

Adverse Events During Dental Care for Children: Implications for Practitioner Health and Wellness.

Adverse events during dental care for children inevitably happen, despite precautionary procedures. Remedial measures have primarily focused upon affected children and their parents/caregivers. The purpose of this paper was to summarize the effects of adverse events upon practitioners involved in the incident who have been termed second victims. Affected practitioners may suffer negative emotions impinging upon their professional performance as well as deleterious personal health consequences, including substance abuse and depression/suicidal ideation. Peer support has been identified as an important mechanism to foster recovery in second victims. Practitioners need supportive efforts following their inadvertent involvement in adverse events to facilitate their recovery and maintenance of personal health and wellness.

Evidence-based Dental Care: Perspective on Levels of Evidence.

The objective of this review was to consider compilation of evidence from literature and its interpretation. Evidence-based dentistry during its implementation has sometimes emphasized randomized clinical trials with exclusion of all other evidence. Systematic reviews must compile evidence from all study types, with the collected evidence processed through the Grading of Recommendations Assessment, Development and Evaluation system prior to their application in clinical decision-making. Evidence-based clinical practice should be based upon transparently reported evidence from all study types.

Is it Ethical to Withhold Restorative Dental Care From a Child with Occlusoproximal Caries Lesions Into Dentin of Primary Molars?

Non-restorative caries treatment (NRCT) has been mentioned as a treatment option for occluso-proximal caries lesions into dentin of primary molars. The NRCT approach for occluso-proximal caries lesions in primary molars was considered from an ethical perspective. In summary, it is not ethical to withhold restorative dental care from a child with occluso-proximal caries lesions into dentin of primary molars.

State-based Distribution of U.S. Pediatric Dentists in Private Practice.

PURPOSE: To determine state-based and regional ratios of U.S. pediatric dentists to children in 2010 and determine changes since 2000. METHODS: State-based enumeration of pediatric dentists in private practice (PDP) was determined from the American Academy of Pediatric Dentistry's 2010 Membership Directory. Number of children in each state was obtained from U.S. Census 2010 data. PDP ratio for each state was computed per 100,000 children. Changes in state-based PDP number and ratio to children were compared with 2000 data. RESULTS: There were 4,453 pediatric dentists in private practice across the United States, with a ratio of 6.00 per 100,000 children. California (583), Texas (378), New York (310), and Florida (231) had the largest PDP numbers. The Southern region (1,609) had the largest PDP number, while the Midwest (706) had the lowest number. PDP ratio to children was highest in the Northeast (7.61) and lowest in the Midwest (4.38). With the exceptions of Alaska, Vermont, and Wyoming, the PDP number and its ratio to children increased in all states between 2000 and 2010. CONCLUSIONS: Despite a generalized increase in practitioner number since 2000, noticeable differences persisted in 2010 among states in their pediatric dentist to children ratios.

Cervical lymphadenopathy in young children: case report of nontuberculous mycobacterial infection.

A four-year-old male presented with right-sided facial swelling near the angle of the mandible. Despite the presence of multiple dental carious lesions, the cervical lymphadenopathy did not appear to be of dental origin. Otolaryngology referral with subsequent excision of the affected lymph nodes confirmed the cervical lymphadenopathy to be due to a Mycobacterium avium intracellulare infection. A two-year follow-up showed successful resolution of the condition. The purpose of the present report was to describe a case with multiple dental carious lesions and cervical lymphadenopathy, with the latter attributed to a nondental etiology. A differential diagnosis of nondental etiologies of cervical lymphadenopathy in young children is described.

The evidence is lacking to support resin infiltration for primary molar proximal lesions.

Literature review found only one longitudinal clinical study on the use of resin infiltration technique for proximal carious lesions in primary molars. The findings were compared with literature regarding both conventional molar restorations and remineralization. It was concluded that based on the limited available evidence, resin infiltration technique should be used with caution for managing proximal carious lesions in primary molars.