Digital nasoalveolar molding through presurgical orthopedics in newborns/infants with cleft lip and palate: A comprehensive review and case study.

AIMS: This study aims to provide a comprehensive review and case study about the advantages and disadvantages of the application of digital technologies in presurgical orthopedics in newborns/infants with cleft lip and palate (CLCP). Positive changes in the nasal anatomy, maxillary arch, and cleft width could be achieved. METHODS: Three representative cases of newborns/infants with CLCP were managed using the presurgical newborn/infant orthopedics (PSIO) approach. The patients were diagnosed and treated. Detailed descriptions of the impression procedures and PSIO appliance construction and placement were provided for each case. RESULTS: Case 1 utilized traditional impression techniques, Case 2 employed a semi-digitalized approach with intraoral digital scanning, and Case 3 utilized a completely digitalized method for appliance construction. Positive changes in maxillary arch dimensions and cleft width reduction were observed in all cases. CONCLUSIONS: The management of CLCP in newborns and infants poses a complex challenge with profound implications. The PSIO approach not only facilitates reconstructive surgery but also enhances overall quality of life. Digital tools, like specialized optical scanners and 3D printing, revolutionize the PSIO process, making it more efficient and patient-friendly. Clinical benefits include improved facial morphology, esthetics, feeding, speech, and optimized future surgical results. Despite ongoing efficacy debates, global adoption as the initial surgical approach underscores its value. The integration of digital technologies offers new hope for patients and families, promising a brighter future for those affected by this congenital condition.

Graphene-Based Coatings for Surface Modification and Their Applications in Fixed Orthodontics: A Scoping Review.

BACKGROUND: Surface coating technology can assist fixed appliances by reducing friction, improving antibacterial characteristics, and increasing corrosion resistance. The application of functional coatings composed of graphene onto the surfaces of orthodontic brackets and archwires has been shown to enhance their mechanical qualities. The objective of the current study was to carry out a scoping analysis of published recent evidence on the utilization of graphene as a covering material in metallic orthodontic accessories, such as brackets and archwires; Methods: A scoping review was undertaken following the PRISMA-ScR guidelines. PubMed, Embase, the Cochrane Library, Dentistry and Oral Science Source, and Google Scholar were searched between 2003 and 2023; Results: In total, 38 potential references were detected, from which 10 were selected for this review. These articles addressed the benefits of the application of graphene-oxide functional coatings onto the surface of archwires and brackets during fixed orthodontic treatment. Orthodontic graphene-oxide-based coatings provide improved surface characteristics (e.g., reduced friction and anticorrosive effects), antibacterial capabilities, and biocompatibility. These characteristics can increase the effectiveness of orthodontic therapy, improve patient comfort, and lower the likelihood of problems; Conclusion: Orthodontists should be aware of and comprehend the prerequisites for using graphene-oxide-coated archwires and brackets to fulfill needs throughout their clinical practice.

Clinical interventions for caries management through minimal intervention procedures in young children: an updated evidence-based review.

This review aimed to summarize the preventive, non-restorative and restorative minimal intervention dentistry (MID) interventions for managing dental caries during the primary dentition stage, after selecting the highest quality evidence. A comprehensive literature search for relevant studies was performed in PubMed (MEDLINE), Embase, Cochrane Library and Google Scholar, published between 2007 and 2022. Only clinical randomized controlled trials, clinical guidelines with literature review, systematic reviews and meta-analyses conducted in the primary dentition were included. One hundred fifty-three MID-associated references were found, and 63 of them were considered for the present review. Of these, 24 were clinical randomized controlled trials, 21 were systematic reviews, 3 umbrella reviews and 11 practice guidelines with a literature review. The retrieved evidence was divided into (and discussed) three general caries management strategies: (i) carious lesion diagnosis and individual risk assessment; (ii) preventive measurements and non-cavitated lesions management; and (iii) cavitated lesions management. MID is an attractive alternative management that promotes prevention rather than intervention to achieve a long-lasting oral health in young children through easy and cost-benefit preventive, non-invasive, minimally invasive or conservative invasive restorative measures. This philosophy of management is suitable for treating young children, considered friendlier and less anxiety-provoking than traditional methods.

Efficacy of the HBW Ultrasonic Ring for retrieval of fragmented manual or rotatory instruments.

A study was conducted to evaluate the success rates of bypassing or removing fragments of instruments that had fractured within the roots of mandibular molars using a HBW Ultrasonic Ring. Forty extracted first permanent mandibular molars with root canal curvature were included. The teeth were distributed randomly into four groups according to the type of instrument and the root canal third where they had fractured. The success rate for removal of instrument fragments was 100% for both of two stainless steel groups, 90% for a nitinol middle third group, and 80% for a nitinol apical third group. The mean time required for instrument removal was around 40 min. The HBW Ultrasonic Ring showed acceptable experimental results for retrieval of broken instrument fragments.

Rapid maxillary expansion and its consequences on the nasal and oropharyngeal anatomy and breathing function of children and adolescents: An umbrella review.

OBJECTIVE: To identify, qualify, and summarize the evidence from different systematic reviews about the outcomes of Rapid Maxillary Expansion (RME) on upper airway dimensions and breathing function in young patients. METHODS: A literature search (from 2000 to December 2022) was conducted through PubMed (MEDLINE), the Cochrane Library, EMBASE, and Dentistry & Oral Science Source. The authors conducted the following umbrella review phases: research question, study selection criteria (systematic reviews involving randomized clinical trials and longitudinal observational designs), data extraction, and critical appraisal (bias risk assessment) of selected articles through the ROBIS tool. RESULTS: The initial search yielded 65 potential references. After screening titles and summaries, and the elimination of duplicated publications, 15 articles were eligible for the evaluation of the full-text document. Finally, 11 systematic reviews (5 combined with meta-analysis) were selected, reporting 132 single studies; 38 of them were unrepeatable. Risk-of-bias assessment showed an average global moderate/high quality among the included studies. There was high heterogeneity between the systematic reviews' (and meta-analyses') methodologies used. CONCLUSIONS: The present umbrella review concludes that significant and stable increases in the nasal and oropharyngeal space volumes and a decrease in airway resistance of growing children and adolescents, occur immediately after RME and at 3, 6- and 12-months follow-up.

2 × 4 appliance in the mixed dentition stage: a scoping review of the evidence.

A great emphasis is currently given to the early correction of malocclusions to prevent further complications if left untreated. Interceptive orthodontics not only simplifies but also eliminates the need for later procedures. The 2 × 4 appliance is an orthodontic treatment modality applied during the mixed dentition period, particularly for malpositioned permanent upper incisors. This scoping review was aimed to examine the breadth and depth of the published literature on this clinical topic, as well as knowledge gaps, about this fixed appliance during mixed dentition, for the correction of incipient anterior malocclusions (incisor crowdings, midline diastemas, or crossbites). PubMed, Cochrane Library, Google Scholar, Dentistry & Oral Sciences Source, and two grey literature databases were explored; under a structured PICO question (Patient, Intervention, Comparison, Outcome) and eligibility criteria, for relevant clinical trials, observational studies, and case reports/series (in English or Spanish), using different searching terms. Titles and abstracts were screened. Full-text articles were critically reviewed for bias risk and a data charting table was constructed. 161 references were identified, after which 115 titles remained after removing duplicates. After the abstract screening, 18 potential full-text articles were reviewed. Finally, 16 studies were included, according to the performed critical appraisal. The 2 × 4 appliance is suitable for mixed dentition patients with mild or severe malocclusions, particularly when removable appliance usage is a critical problem.

Oral management of children/adolescents with ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome: A scoping review.

AIMS: EEC is a rare syndrome characterized by the triad of ectrodactyly, ectodermal dysplasia, and orofacial clefting, along with other clinical manifestations mainly in hair, skin, and teeth. The present paper aimed to perform a scoping review to collect the most relevant studies and focused on the diagnosis and oral management of EEC syndrome in the pediatric dental setting. This review also pretended to make recommendations and map the gaps in this clinical topic. METHODS: An exhaustive electronic and manual search was conducted in four databases (PubMed, EMBASE, Google Scholar, and Dentistry & Oral Sciences Source/EBSCO) according to previously established eligibility criteria, using different combinations of keywords, MeSH terms, and Boolean operators. Titles, abstracts, and full-text articles were screened and selected by precalibrated reviewers. A data charting was also accomplished for summarizing the overview of the evidence. RESULTS: A total of 37 references were identified, and 32 titles remained after removing duplicates; then, 25 potential full-text articles were carefully reviewed. Finally, 15 relevant and most informative studies were included. Most studies were single clinical case reports. Only one descriptive retrospective study was detected. None randomized clinical trials or comparative observational studies were found. A medical/dental multidisciplinary approach is needed for the management of EEC syndrome. CONCLUSIONS: Diverse dental specialists must be involved. Pediatric dentists must play a principal role in the prevention and treatment of oral diseases; particularly the preservation of the primary and mixed dentitions, trying to achieve normal orofacial growth.

Assessment of Pediatricians' Knowledge, Practices, and Attitudes on Oral Health/Care in Children in the Last Decade: A Systematic Scoping Review and Critical Reflection.

Pediatricians are primary health care professionals who supervise the growth and development and treat infants and children during the first years of life. Thus, they should possess knowledge regarding oral health care, to provide anticipatory guidance, as well as dental education to parents in order to make appropriate clinical decisions. For many years, several surveys have been performed worldwide to assess the pediatricians' knowledge, awareness, and experience regarding oral health care and prevention. This work aimed to scope the existing literature and summarize the most relevant evidence about knowledge, practices, and attitudes on oral health/care among pediatricians worldwide. PubMed, Cochrane Library, Google Scholar, and Dentistry & Oral Sciences Source were explored. Under a structured PCC question and eligibility criteria, for relevant clinical trials and observational studies, published during the last decade. Titles and abstracts were screened. Full-text articles were critically reviewed for bias risk and a data charting table was constructed. A total of 44 references were initially identified, and 37 titles remained for abstract screening after removing duplicates; then, 27 potential full-text articles were carefully reviewed. Finally, 25 relevant and most informative studies were included. The selected studies were conducted in India, Lebanon, Saudi Arabia, and Paraguay, Europe, Australia, Qatar, Iran, Turkey, United Arab Emirates, Nigeria, Brazil, Chile, Germany, Taiwan, Canada, and the USA. Through included surveys, researchers have reported different levels of knowledge, practice involvement, and attitude on children's oral health among pediatricians. In general, unsatisfactory knowledge of oral health was reported. The main impediments for a better professional involvement or practice include inappropriate education, poor auto-confidence, and lack of time. So, it has been suggested that some oral health training or clinical guidelines should be included in the current medical curricula.

Effect of tricalcium silicate cements in gene expression of COL1A1, MAPK's, and NF-kB, and cell adhesion in primary teeth' pulp fibroblasts.

Tricalcium silicate cements (TSCs) regulate gene expression and cell responses from dental tissues surrounding the repair site. The study aimed to evaluate the gene expression levels of Collagen Type I Alpha 1 Chain (COL1A1), Mitogen-Activated Protein Kinases (MAPK's), Nuclear Factor-Kappa B (NF-κB), cell adhesion, and morphology of human dental pulp fibroblasts (hDPFs) from primary teeth treated with eluates obtained from Mineral Trioxide Aggregate (MTA) and Biodentine. hDPFs were treated with eluates from Biodentine and MTA (2.5 mg/mL in culture medium). The control group was a culture without the eluates. Gene expressions of COL1A1, MAPK's, and NF-κB were evaluated using Polymerase Chain Reaction (PCR) and cell adhesion by immunocytochemistry for Vinculin and Integrin ß1 expression. Gene expression of MAPK's and NF-κB in hDPFs with the eluates from MTA and Biodentine showed no significant difference versus the control group (p > 0.05), but COL1A1 exhibited a significant difference (p < 0.05). The expression of COL1A1, MAPK's, and NF-κB was lower in cultures with MTA and Biodentine eluates regarding the control group, with no significant difference between MTA and Biodentine (p > 0.05). After 72 h of incubation, the hDPFs cultured with MTA and Biodentine eluates showed an elongated morphology; after 7 d, a loss or/and reduction of the cytoplasmic processes, and smaller nuclei were observed. Vinculin and Integrin ß1 were expressed in hDPFs treated with MTA and Biodentine eluates. MTA and Biodentine did not inhibit or generate a significant difference in the expression levels of COL1A1, MAPK's, and NF-κB in hDPFs.

Molar incisor hypomineralization (MIH): prevalence and degree of severity in a Mexican pediatric population living in an endemic fluorosis area.

OBJECTIVE: To estimate the prevalence and severity of molar incisor hypomineralization (MIH) in 8 years old children living in an endemic fluorosis area. METHODS: MIH prevalence rate was determined from a study sample comprising 613 participants. They were recruited from 11 urban public schools with similar socio-economic status. Oral evaluations were performed and diagnosed MIH teeth were classified under Ghanim et al.'s criteria. Statistical descriptive and comparative analyzes were carried out. RESULTS: First permanent molars were the tooth group most affected, followed by the upper central incisors, lower central incisors, lower lateral incisors, and upper lateral incisors. There was no significant statistical difference by gender and by maxillary/mandible arches (P = 0.82 and 0.26, respectively). The frequency of MIH was more in molars compared to incisors (P < 0.02). CONCLUSIONS: The MIH prevalence in this study was 12.4 percent. According to the MIH severity, degree 2 was the most frequently detected (76.4 percent).

Clinical Management of Intra-Pulp Canal Broken Endodontic Files in Primary Teeth: Literature Review / Manejo clínico de las limas endodónticas fracturadas dentro del conducto pulpar en dientes primarios: Revisión de la literatura

ABSTRACT: Fracture of an endodontic file inside a primary root canal is a rare but critical complication during the pulpectomy treatment, because the mechanical obstruction impedes the optimal cleaning and obturation of the pulp canal, compromising seriously the clinical outcome. This accidental event is mainly associated with over-use and excessive torque of intracanal files. Most clinicians opt to proceed with the extraction of the affected tooth followed by a space maintainer placement. Other practitioners attempt the non-surgical retrieval of the separated fragment through available proven techniques in permanent teeth; however, these methods may involve significant damage to the tooth and surround tissues. On the other hand, preservation of the metallic fragment might affect the treatment prognosis and interfere with the physiological root resorption.

RESUMEN: La fractura de una lima endodóntica dentro de un conducto radicular primario es una complicación rara aunque critica durante el tratamiento de pulpectomía, debido a que la obstrucción mecánica impide la limpieza y obturación óptimas del conducto pulpar, comprometiendo seriamente el resultado clínico. Este evento accidental está principalmente asociado con el sobreuso y torque excesivo de las limas dentro del conducto. La mayoría de los clínicos optan por realizar la extracción del diente afectado, seguido por la colocación de un mantenedor de espacio. Otros practicantes intentan la remoción no quirúrgica del fragmento separado a través de técnicas disponibles probadas en dientes permanentes; sin embargo, estos métodos pueden causar daños significativos al diente y tejidos circundantes. Por otra parte, la preservación del fragmento metálico puede afectar el pronóstico del tratamiento e interferir con el proceso de reabsorción radicular fisiológico.

Clinical Efficacy of Two Topical Agents for the Remineralization of Enamel White Spot Lesions in Primary Teeth.

Purpose: The purpose of this study was to compare the remineralizing clinical efficacy of fluoride plus hydroxyapatite (Remin Pro®; RP) and fluoride plus casein phosphopeptide-amorphous calcium phosphate fluoride (Mi Paste Plus®; MPP) for the treatment of white spot lesions (WSLs) in primary tooth enamel. Methods: This study was a randomized double-blind clinical trial. It included patients with at least one primary maxillary anterior tooth with a WSL on the enamel surface. They were randomly assigned to receive either the twice-daily at-home topical application of RP or MPP or fluoride (NaF) paste (Colgate Total®; CT). The remineralization degree was quantified by the change in the number of units of fluorescence (UF) measured with laser fluorescence pen device (DIAGNOdent™) from the baseline and at days 10 and 21. Results: UF decreased significantly in all groups (P<0.001). Both RP and MPP resulted in significantly higher standardized mean difference (SMD) UF than CT (P<0.05); however, the difference between RP and MPP was not statistically significant (P>0.05). Conclusions: Topical application of Colgate Total®, Mi Paste Plus®, and Remin Pro® resulted in a remineralizing effect against white spot lesions on primary tooth enamel. Both MPP and RP were statistically superior to CT.

Calcium hydroxide/iodoform nanoparticles as an intracanal filling medication: synthesis, characterization, and in vitro study using a bovine primary tooth model.

The aims of this in vitro study were to synthesize, characterize, and evaluate the efficacy of a Calcium Hydroxide/Iodoform nanoparticles (CHIN) paste compared with Ultrapex as intracanal filling medication using an experimental model of bovine primary teeth. CH nanoparticle synthesis was performed via the simple hydrolysis technique of reacting calcium nitrate with sodium hydroxide. SEM-EDS and FT-IR analyses were used to characterize the obtained product. 30% of CH nanoparticles were combined with 40% of iodoform and 30% silicone oil to prepare an intracanal filling paste (CHIN). All endodontic procedures were performed on 34 uniradicular primary bovine teeth. Every root canal was instrumented with K files (up to #35) and obturated with the nanoparticle paste (experimental) or Ultrapex® (control). Three outcome variables were studied: penetration depth through the root dentinal tubules, Ca2+ ion release, and filling paste dissolution rate. The obtained data were analyzed by Student's t test. The X-ray diffraction pattern of CH nanoparticles showed characteristic peaks at CH, as confirmed by FT-IR analyses in which an intense signal was observed at 3643 cm-1, characteristic of CH. In the morphological characterization, CH particles could be detected at the nanosize scale. When applied as intracanal filling, the CHIN paste exhibited a higher level of penetration through the root dentin tubules. The global mean penetration measures were 500 µm for the experimental paste and 380 µm for the control paste (p < 0.05). The release of Ca2+ ions (up to the seventh day) and the dissolution rate were significantly higher in the experimental paste group than in the control group. No significant differences were observed between the groups regarding pH levels. The findings of this study suggest the potential suitability of CHI nanoparticles as an alternative intracanal filling medication for infected or devitalized primary teeth.

Lesion Sterilization Tissue Repair (LSTR) Approach Of Non-Vital Primary Molars With A Chloramphenicol-Tetracycline-ZOE Antibiotic Paste: A Scoping Review.

The study aimed to perform a systematic scoping review with the need of exploring the actual clinical applications of the chloramphenicol-tetracycline-ZOE antibiotic paste (CTZ) as a lesion sterilization tissue repair (LSTR) therapy agent. Following a scoping framework suggested by Arksey and O'Malley, relevant articles (randomized controlled trials, literature reviews, observational studies, in vitro studies, and clinical case-series reports) published over the last 15 years (in English, Spanish, or Portuguese languages) were identified and retrieved from five internet databases: PubMed, Embase/Ovid, Cochrane Library, Google Scholar, and EBSCO. By title and abstract screening and after removing duplicates, 11 articles were finally included in the present scoping review: five randomized/non-randomized clinical trials, five in vitro studies, and one case-series report. According to the collected information, there were no differences between CTZ paste and conventional pulpectomy, antibiotic pastes, and intracanal filling materials, considering the clinical, radiographic, antimicrobial activity, and periapical tissue biocompatibility outcomes. CTZ has shown excellent rates of clinical success and good radiographic results, with adequate antimicrobial effects; however, its biocompatibility has been put into doubt. Contemporary pediatric dentists should carefully consider the CTZ paste as an alternative endodontic approach for pulpally involved primary molars, with the advantages of being simple and fast, and taking into account the limitations of instrumental pulpectomy such as the microbiological and morphological complexity of primary root canals.

Pain and Anxiety Levels Using Conventional versus Computer-Controlled Local Anesthetic Systems in Pediatric Patients: A Meta-Analysis.

The objective of this systematic review and meta-analysis was to compare the pain/anxiety levels associated with the anesthetic process by conventional and computer-controlled delivery systems (CCDS) in children. Four electronic databases (PubMed, EMBASE, Scopus, Google Scholar, and Dentistry & Oral Science Source/EBSCO) were comprehensively explored for eligible studies, in English or Spanish, published from January 1995 to December 2019. A systematic literature review and meta-analysis were conducted according to the PRISMA statement, including only randomized controlled clinical trials. An exhaustive search was performed in different electronic databases under a specific PICO-posed question. Relevant studies were selected based on titles and abstracts, and the full texts were retrieved. From these articles, important information was extracted. Wand demonstrated significantly lower pain than the conventional injection did. In the subgroup by pain scale analysis, the Facial Image Scale and Wong-Baker Faces Pain Scale showed a significant difference in favor of the CCDS. In general, the reviewed evidence shows that less perceived pain and anxiety occur when the local anesthetic technique is performed with a CCDS than with the traditional technique.

Inclusive Dentistry: Integral Management of Pediatric Patients with Intellectual Disability and/or Communication Impairments. Case-Series Reports.

Dental treatment for anxious or fearful intellectually disabled children/adolescents (IDCA) may present great challenges, due to deficits in cognitive, intellectual, language, and social abilities, in conjunction with limited adaptive behavior. In many cases, it is necessary for the Dentist to implement advanced behavioral control techniques. Inclusive Dentistry (ID) considers profoundly each patient's individual interests and likes, including the social and family situations, for choosing the respective personalized plan -contemplating potential risks and benefits- for the behavior control, in order to obtain the maximal possible cooperation of the patient in the dental chair. Through ID, the Pediatric Dental Practitioner aims to alleviate the anxiety and fear of IDCA in the clinical setting, in such a way that these patients are positively motivated, on a long-term basis, for current and future oral care, both at the dental office and at home. This management approach may be a time-consuming method or require more effort by the dentist, but it reaps benefits when applied for many mild-to-moderate (and some severe) IDCA. The Practitioner must possess the knowledge, in-depth understanding, and professional training for the adequate use of ID during the behavioral management of anxious or fearful IDCA. The aim of the present report was to describe four representative clinical cases of IDCA at our Clinic, managed under the philosophical principles of ID.

Pediatric Dental Management of an Uncommon Case of Mucopolysaccharidosis Type IV A (Morquio A Syndrome): A Case Report of a Three-Year Follow-Up.

Mucopolysaccharidosis type IV A or Morquio syndrome is an uncommon inherited metabolic condition caused by the deficient intralysosomal storage of glycosaminoglycans. Diagnosis is typically based on clinical examination, skeletal radiographs, and histochemical tests in blood cells or fibroblasts. It is characterized by evident skeletal deformities, poor joint mobility, severe growth deficit, occlusal anomalies, and enamel defects. The aim of the present clinical case report is to describe the general oral management provided to a 6-year-old female patient and its corresponding evolution for more than three years.

Evaluación radiográfica de la presencia/agenesia de terceros molares en una población infantil Mexicana / Radiographic Evaluation of the Presence/Agenesis of Third Molars in a Mexican Child Population

RESUMEN En el ser humano, el tercer molar es el órgano dentario que más variaciones presenta durante su desarrollo embriológico, y es causa de diversas alteraciones y malestares durante su proceso de erupción. Se ha señalado que la agenesia del tercer molar tiene una prevalencia entre 9 y 37%. El objetivo del presente estudio transversal comparativo fue evaluar radiográficamente la presencia/ausencia de gérmenes de terceros molares (G3M) en pacientes pediátricos de origen mexicano. Se analizaron 513 radiografías panorámicas de pacientes que asistieron al Posgrado en Estomatología Pediátrica de la Universidad Autónoma de San Luis Potosí (México), durante los años 2011 a 2017. Se tomaron como criterios de inclusión, pacientes entre los 7 y 18 años de edad, sexo indistinto; se excluyeron pacientes con antecedentes de extracción de alguno de los terceros molares, tratamiento ortodóntico previo, enfermedades congénitas y/o síndromes asociados. Se compararon las frecuencias y prevalencias de agenesia de terceros molares, en total y por cuadrantes, comparando por sexo y grupo de edad. 245 radiografías panorámicas correspondieron al sexo femenino y 268 al masculino. La prevalencia total de agenesia del G3M fue estimada en casi 56%, y el grupo de edad de 7-8 años mostró el mayor porcentaje; sin embargo, cuando este grupo de edad se excluyó del análisis, dicha prevalencia disminuyó a 27.3%. Los cuadrantes mandibulares mostraron mayor porcentaje de agenesia. No hubo diferencia estadística significativa en la comparación por sexo. La prevalencia total de agenesia del G3M reportada en el presente estudio se encuentra muy por encima de los parámetros internacionales. Es muy posible que la falta de visualización radiográfica de agenesia de los terceros molares haya sido errónea en algunos casos debido a la ausencia frecuente de indicios de calcificación de este diente durante las edades tempranas (7-8 años). El análisis ajustado proporcionó un valor de prevalencia más acorde con los estándares reconocidos por la literatura dental.

ABSTRACT In the human being, third molar is the tooth that exhibits more variants during its embryologic development, usually causing diverse anomalies and discomfort when erupting to the oral cavity. It has been pointed out that the prevalence of third molar agenesis is between 9 to 37%. The aim of the present comparative cross- sectional study was to radiographically assess the presence/absence of third molar germs (G3M) in a sample of pediatric patients of Mexican origin. A total of 513 panoramic radiographs were analyzed from patients attending the Pediatric Dentistry Postgraduate Program ( San Luis Potosí University, México), during the years 2011 to 2017. Inclusion criteria were patients between 7 and 18 years old, any gender; children with antecedents of a third molar extraction, previous orthodontic treatment, or with an associated congenital or systemic condition were excluded. Total prevalence G3M agenesis was calculated. Then, statistical comparisons of agenesia proportions per dental quadrant, gender, and age group were performed. 245 panoramic radiographs corresponded to the female gender, while 268 belonged to the male gender. The total prevalence of G3M agenesia was estimated in nearly 56%, and the 7-8 years old group exhibited the highest proportion; however, when this age group was excluded from the analysis, such prevalence decreased to 27.3%. Both mandibular quadrants showed higher proportions of G3M agenesia. There were no significant differences between genders. The total prevalence reported in the present study was found to be well above regarding the international parameters. It is quite possible that lack of radiographic visualization of G3M had been inaccurate in some cases due to the common absence of calcification traces from those teeth during early ages (7-8 years old). The adjusted analysis provided a prevalence value more in line with the recognized standards in the dental literature.

Management of a Child with Reactive Attachment Disorder in the Dental Clinical Setting: A Case Report / Manejo de un niño con trastorno de apego reactivo en el entorno clínico dental: Reporte de un caso

ABSTRACT Reactive attachment disorder (RAD) is an early childhood mental health disease characterized by impaired social interactions and communication abilities, and neurological deficits in the child's developing brain. This disorder can significantly affect the pediatric patient's behavior in the dental setting. An uncooperative 9-year- old Mexican girl, who was residing in a temporary home, was referred by a general dental practitioner to the Postgraduate Pediatric Dental Clinic with her caretaker, requesting dental examination and treatment. The patient presented with a previous diagnosis of RAD with intellectual/social disability. With the psychiatrist's guidance, an exhaustive oral prophylaxis was carried out in the initial appointments, followed by diverse restorative treatments under the continuous application of behavioral management techniques. These restorative procedures included resin restorations and pit-fissure sealants, under local anesthesia and rubber-dam isolation, on the first four permanent molars. The entire treatment was completed in six weeks. The patient and her caretaker were provided with detailed educational and motivational strategies for improving the patient´s oral hygiene, and they also received nutritional advice. For control reviews and the reinforcement of preventive habits, future appointments were carefully scheduled. An interdisciplinary pediatric collaboration between the dentist, nurse, and psychiatrist was fundamental for improving the patient's oral health and general welfare.

RESUMEN: El trastorno de apego reactivo (RAD, por sus siglas en inglés) es una enfermedad de salud mental en la primera infancia caracterizada por interacciones sociales y capacidades de comunicación deterioradas y por déficits neurológicos en el cerebro en desarrollo del niño. Este trastorno puede afectar significativamente el comportamiento del paciente pediátrico en el entorno dental. Una niña mexicana de 9 años de edad, poco cooperadora, que residía en un hogar temporal, fue remitida a la Clínica de Odontología Pediátrica con su cuidadora, solicitando un examen y tratamiento dental. La paciente presentó un diagnóstico previo de RAD con discapacidad intelectual/ social. Con la orientación del Psiquiatra, se llevó a cabo una profilaxis oral exhaustiva en las citas iniciales, seguidas de diversos tratamientos de restauración bajo la aplicación continua de técnicas de manejo del comportamiento. Estos procedimientos de restauración incluyeron restauraciones de resina y selladores de fosas y fisuras, bajo anestesia local y aislamiento con dique de goma, en los primeros cuatro molares permanentes. Todo el tratamiento se completó en seis semanas. La paciente y su cuidadora recibieron estrategias educativas y motivacionales detalladas para mejorar la higiene oral y también recibieron asesoría nutricional. Para las revisiones de control y refuerzo de los hábitos preventivos, las citas posteriores se programaron cuidadosamente. Una colaboración pediátrica interdisciplinaria entre el dentista, la enfermera y el psiquiatra fue fundamental para mejorar la salud oral y el bienestar general del paciente.

Management of the oral hemangiomas in infants and children: Scoping review

BACKGROUND: Pediatric oral hemangiomas are benign vascular tumors that can be seen from birth, particularly in females. Hemangiomas are most frequent located in the lips and usually regress spontaneously, thus they do not require any type of treatment in most cases. The present scoping review pretended to synthesize the most relevant and currently available information from the international dental literature published in the last 25 years, regarding the management of pediatric oral hemangiomas. MATERIAL AND METHODS: An exhaustive literature search was performed in four electronic databases (PubMed, Embase, Google Scholar, and Cochrane). Initially, 241 related titles and abstracts were found. After the duplication removal, screening, and assessment processes, 37 records were included for full-text reading. Finally, 20 articles in the English language were included in the scoping review for data extraction and assessment. RESULTS: We identified and subsequently discussed three fundamental issues associated to the management of pediatric oral hemangiomas: (I) clinical characteristics, differential diagnosis, and histopathological findings; (II) evolution and complications; and (III) current available treatment modalities. CONCLUSIONS: Although these like-tumor lesions are uncommon, pediatric dentistry practitioners must be familiar with the inherent clinical characteristics, diagnosis approaches, and currently available treatment options. Nowadays, surgical removal and non-invasive medical/pharmacologic therapies are the best management modalities for pediatric oral hemangiomas

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