Time delays in treating dental trauma at a children's hospital and private pediatric dental practice.

PURPOSE: The purpose of this study was to compare the time interval between a child sustaining a dental injury and the rendering of treatment in a hospital setting and a private pediatric dental practice. METHODS: Data were collected from the patient records of children treated for dental trauma at a children's hospital emergency department, a children's hospital dental clinic, and a private pediatric dental practice. Data included demographics and the time, date, type of injury, and its treatment. RESULTS: Injuries were more severe, treatment was more complex, and the time interval between injury and treatment was longer for those children treated in the hospital setting versus private practice, regardless of distance traveled. Children treated at their dental home experienced fewer treatment delays. Insurance status, medical complexity, and associated injuries were not related to treatment delays. CONCLUSIONS: Children who seek emergency care for traumatic dental injuries in a hospital setting experience greater delays in treatment compared to those seeking care in a private practice setting. These findings might not be generalizable to other hospital settings or private practices due to the inherently unique characteristics of the sites used in this study.

Premature loss of primary anterior teeth due to trauma--potential short- and long-term sequelae.

Traumatic dental injuries (TDIs) can result in the premature loss of primary anterior teeth due to an immediate avulsion, extraction later after the injury because of poor prognosis or late complications, or early exfoliation. There are a number of potential considerations or sequelae as a result of this premature loss that have been cited in the dental literature, which include esthetics, quality of life, eating, speech development, arch integrity (space loss), development and eruption of the permanent successors, and development of oral habits. This article provides a comprehensive review of the dental literature on the possible consequences of premature loss of maxillary primary incisors following TDI.

Massachusetts emergency departments' resources and physicians' knowledge of management of traumatic dental injuries.

BACKGROUND: Hospital emergency departments (ED) are confronted with triaging and managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests that there exists inadequate knowledge of the management of traumatic dental injuries (TDI) among medical professionals who must be knowledgeable and have the appropriate resources needed to triage or treat patients presenting with TDI. AIM: The aims of this study were to (i) evaluate the resources of Massachusetts emergency departments (MEDs) for TDI, (ii) determine the knowledge of management of TDI among MED physicians, and (iii) investigate potential factors that affect their knowledge. MATERIALS AND METHODS: Surveys were mailed to MED directors and their physicians. The director survey contained questions regarding institutional information for each emergency department (ED). The physician survey contained questions about physician characteristics and tested their knowledge of managing dental trauma. RESULTS: A total of 72 surveys (16 MED directors and 56 physicians) were returned and included in the analysis. Only 50% of the MEDs had on-site dental coverage, 43.8% had 24-h off-site dental coverage, and none had a formal written dental trauma protocol. MED physician's knowledge of the appropriate management of luxations and avulsions was generally good, but poor for dental fractures. The MED physician's knowledge for the emergent nature of the various injuries was generally good with that of avulsions being the best. Physicians were more likely to have a better knowledge of managing dental trauma if they were specialists in pediatric emergency medicine (P = 0.001) or their hospitals had an academic affiliation (P = 0.05). CONCLUSIONS: Based on the findings from this study, educational campaigns must be undertaken to improve both the resources available to the ED, and the knowledge of physicians regarding emergency management of TDI. In addition, efforts should be made by local dental organizations to provide ED with lists of dentists who are knowledgeable and willing to be available 24 h day⁻¹ to consult with and, if necessary, treat TDI. These efforts would enhance the long-term outcomes for patients sustaining dental trauma who present to hospital ED.

The art and science of managing traumatic injuries to primary teeth.

The selection of an appropriate treatment protocol and the rendering of treatment to children with traumatic injuries of their primary teeth are often more challenging than doing so for the permanent teeth of older individuals. This article discusses general considerations involving patient, parent, dentist, dental anatomy and occlusion that are responsible for the differences between the treatment protocols for the management of traumatic dental injuries to primary teeth and those for permanent teeth.

Personality types of pediatric dentists: comparative analysis and associated factors.

PURPOSE: The purpose of this study was to determine the personality types of pediatric dentists and associated variables. METHODS: A survey containing the Myers-Briggs Type Indicator and demographic and practice questions was mailed to 500 pediatric dentists. RESULTS: The responding 214 pediatric dentists preferred sensing over intuition, feeling over thinking and judging over perceiving. The distribution of the pediatric dentists' 16 personality types differed significantly from other dental specialists, general dentists, and pediatricians as well as the general population. Pediatric dentists were significantly more likely to prefer: sensing when compared to pediatricians; feeling when compared to dental specialists, general dentists, and pediatricians; and judging when compared to pediatricians and the general population. Pediatric dentists who preferred sensing were more likely to spend a greater portion of their time in clinical care than those who preferred intuition. Ninety-seven percent of those responding were very satisfied or satisfied with their profession. Those who were very satisfied were more likely to prefer extraversion, be over 46-years-old, and practice in a non-solo setting. CONCLUSIONS: The personalities of pediatric dentists differ from other dentists and pediatricians as well as the general population and are associated with some demographic and practice factors.

Postoperative pain and other sequelae of dental rehabilitations performed on children under general anesthesia.

PURPOSE: The purpose of this study was to determine the prevalence, severity and variables influencing postoperative pain and other sequelae in children undergoing dental rehabilitation under general anesthesia. METHODS: Healthy children scheduled for dental rehabilitation having treatment on only primary teeth were included in the study. General anesthesia protocol was standardized, and patients did not receive local anesthesia intraoperatively. Pain and other postoperative sequelae were recorded for 7 days postoperatively. RESULTS: Ninety-five percent of the 90 children had postoperative pain which was moderate in intensity and highest immediately postoperatively. Children who had extractions or were at least 4 years old and had more than 12 procedures experienced increased postoperative pain. The most common postoperative symptoms other than pain were agitation, need for analgesics, and sleepiness. Longer operative times resulted in increased postoperative sleepiness. Children whose tracheal intubations were traumatic were more likely to report sore throats. Children who were at least 4 years old required more analgesics, experienced more postoperative sleepiness, and had nausea more frequently. All postoperative problems significantly decreased by postoperative day 2 and ceased by postoperative day 4 to 5. CONCLUSION: Children undergoing dental rehabilitations under general anesthesia commonly experience postoperative symptoms such as pain, agitation, need for analgesics, and sleepiness.

Hypokalemic sensory overstimulation.

This report describes 2 generations of a family with symptoms of sensory overstimulation that exhibit a potassium sensitivity similar to that seen in hypokalemic periodic paralysis. The sensory overstimulation is characterized by a subjective experience of sensory overload and a relative resistance to lidocaine local anesthesia. The sensory overload is treatable with oral potassium gluconate, with onset of the therapeutic effect in approximately 20 minutes. The effect of potassium is reminiscent of its effect in the channelopathies underlying hypokalemic periodic paralysis, and the resistance to lidocaine applied peripherally suggests a peripheral sensory localization to the abnormality. The phenotype overlaps with that of attention deficit disorder, raising the possibility of subtypes of attention deficit disorder that have a peripheral sensory cause and novel forms of therapy.

Prevalence of bruxism and associated correlates in children as reported by parents.

PURPOSE: The purpose of this study was to determine the prevalence of childhood bruxism and associated correlates, as reported by parents. METHODS: A cross-sectional survey of parents was conducted at 4 private pediatric dental offices and the Children's Hospital Boston Dental Clinic. Data were gathered via a self-administered questionnaire offered to the parents of children under age 17. Factors were evaluated for association with bruxism using chi-square tests and multivariate logistic regression. RESULTS: Based on 854 surveys analyzed, the children's mean age was 8.1 years and 52% were female. Caucasians represented 87% of the population, and 90% of the parents had attained a high school diploma. The overall prevalence of reported bruxism was 38%. Five percent of the parents reported that their children had subjective symptoms of temporomandibular disorder (TMD); however, these were not associated with reported bruxism. A child with a psychological disorder had a 3.6 times greater likelihood of bruxism. If either parent had a history of bruxism, their child was 1.8 times more likely to brux. If bedroom doors were open, parents reported bruxism 1.7 times more often. Children who drooled at night were 1.7 times more likely to brux, while sleeptalking children were 1.6 times more likely to brux. CONCLUSIONS: (1) Of the 38% of parents reporting that their children brux, familial history, open bedroom doors, drooling, sleeptalking, and psychological disorders were significantly associated with the reported bruxism. (2) While 5% of parents reported that their children had at least one TMD symptom, no TMD symptoms were associated with reported bruxism.

IgG antibody levels to Porphyromonas gingivalis and clinical measures in children.

BACKGROUND: Periodontopathic clinical markers are poorly understood in the pediatric population. Several studies have proposed Porphyromonas gingivalis (P. gingivalis) and an antibody response to the microorganism as factors in periodontal tissue destruction in children. The objective of this study was to examine the prevalence of P. gingivalis in dental plaque and of serum immunoglobulin G (IgG) antibody levels to P. gingivalis, and their relationship to periodontal clinical measures in children. METHODS: Thirty-one subjects, aged 20 to 163 months, participated in this study. Clinical measures examined included gingivitis, plaque, alveolar bone height, age, gender, ethnicity, medical status, caries, and IgG antibody levels to P. gingivalis. Five ml of blood was collected for serum analysis, and IgG antibody levels to P. gingivalis were determined by using enzyme-linked immunosorbent assay. Plaque samples were examined for the presence of P. gingivalis by DNA-DNA checkerboard. Data were analyzed on a person-level basis for relationships to serum IgG antibody levels to P. gingivalis and on a site-specific level for relationships to the presence of P. gingivalis in plaque. RESULTS: A majority (77%) of the subjects were systemically healthy, non-white (74%), and did not have detectable P. gingivalis in their plaque. Fifty-two percent of the subjects had positive serum IgG antibody levels to P. gingivalis. Based on univariate linear regression, factors related to IgG antibody levels to P. gingivalis (P<0.05) included age, average gingival index (GI), average probing depth, and number of teeth with alveolar bone crest to cemento-enamel junction (ABC-CEJ) distances >2 mm. When all clinical measures were considered together, only age remained statistically significantly related to serum IgG antibody levels to P. gingivalis. CONCLUSIONS: Age is one of the most important factors in the development of the immune response to putative microorganisms such as P. gingivalis in children. The role of IgG as a time-sensitive measure of periodontal health in children needs to be investigated further.

The effects of infant feeding patterns on the occlusion of the primary dentition.

The purpose of this study was to investigate the effects of different methods of infant feeding on the development of the occlusion in the primary dentition. The study included 126 children. Parents completed questionnaires regarding feeding and health history, and the primary dental occlusion was recorded for each child. The authors found that: (1) predominant bottle-feeding between 0 and 6 months of age was associated with the development of a pacifier habit; (2) children who used a pacifier were more likely to develop a nonmesial step occlusion, an overjet >3 mm, and an open bite; (3) children who sucked their thumb were more likely to develop an overjet >3 mm; and (4) in the absence ofnonnutritive oral habits, children who were predominantly bottle-fed between 0 and 6 months of age were more likely to develop an overbite >75%, although just shy of nominal statistical significance.

Failure rates of restorative procedures following dental rehabilitation under general anesthesia.

PURPOSE: The failure rates of restorative procedures for children undergoing dental rehabilitation under general anesthesia, performed by pediatric dental residents in advanced educational programs, were evaluated in order to determine treatment outcomes and best practices. METHODS: Retrospective review of 504 dental records of children receiving comprehensive dental treatment under general anesthesia at children's hospitals in Boston between 1990-1992 and in Washington, DC, between 1994-1998, were undertaken. Data regarding restoration outcomes were evaluated using chi square tests with correction for continuity. Only records of patients who returned for follow-up at least six months after their rehabilitations were evaluated. T-tests were performed on parametric data. RESULTS: Two-hundred and forty-one (48%) of the records were evaluated. Stainless steel crowns (SSCs) had significantly lower failure rates than amalgams (P<0.001, chi2=63). The highest failure rates were seen in composites (P<0.001, chi2=112) and composite strip crowns (P<0.001, chi2=121). CONCLUSIONS: SSCs are the most reliable restorations while composite restorations are the least durable. Failure of restorations appears to be related to follow-up length.

El tratamiento de los dientes anteriores traumatizados en los niños

El problema, prevalencia, etiología y clasificación. Comprobación del daño: objetivos y principios de tratamiento. Radiografías como ayuda del diagnóstico. Tratamiento de emergencia. Terapia pulpar. Tratamiento intermedio para incisivos traumatizados. Desplazamiento dentario y reimplante. Comprobación y tratamiento consecutivo a la pérdida dentaria. Restauraciones permanentes. Traumatismos a los dientes primarios. Secuelas del trauma a los dientes primarios. La prevención de los daños. Indice

El tratamiento de los dientes anteriores traumatizados en los niños

El problema, prevalencia, etiología y clasificación. Comprobación del daño: objetivos y principios de tratamiento. Radiografías como ayuda del diagnóstico. Tratamiento de emergencia. Terapia pulpar. Tratamiento intermedio para incisivos traumatizados. Desplazamiento dentario y reimplante. Comprobación y tratamiento consecutivo a la pérdida dentaria. Restauraciones permanentes. Traumatismos a los dientes primarios. Secuelas del trauma a los dientes primarios. La prevención de los daños. Indice