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1.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31964759

RESUMO

This set of recommendations is designed to assist the pediatrician in caring for children with Williams syndrome (WS) who were diagnosed by using clinical features and with chromosome 7 microdeletion confirmed by fluorescence in situ hybridization, chromosome microarray, or multiplex ligation-dependent probe amplification. The recommendations in this report reflect review of the current literature, including previously peer-reviewed and published management suggestions for WS, as well as the consensus of physicians and psychologists with expertise in the care of individuals with WS. These general recommendations for the syndrome do not replace individualized medical assessment and treatment.


Assuntos
Síndrome de Williams/complicações , Adolescente , Adulto , Fatores Etários , Anormalidades Cardiovasculares/etiologia , Anormalidades Cardiovasculares/terapia , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Assistência Odontológica para Crianças/métodos , Facies , Feminino , Transtornos da Audição/etiologia , Humanos , Hipercalcemia/complicações , Hipercalcemia/diagnóstico , Hipercalcemia/terapia , Hipotireoidismo/etiologia , Lactente , Masculino , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/terapia , Fotografação , Exame Físico , Comportamento Problema/psicologia , Transição para Assistência do Adulto , Sistema Urinário/anormalidades , Síndrome de Williams/genética , Síndrome de Williams/terapia , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-31311179

RESUMO

Dental care under general anaesthesia (GA) is an option when normal treatment cannot be accomplished due to un-cooperation and systemic or cognitive/intellectual disabilities. The purpose of this retrospective cohort study was to analyse the dental treatment under GA in medically compromised and healthy children. The data were collected from the medical records of children who received their dental treatment under GA. The data regarding patient age, sex, general health, and type of treatment were analysed. This clinical trial included 229 study subjects (138 males, 91 females) with an average age of 8.34 (SD 3.78). Counts and relative counts were used for description of qualitative data. The association between the variables was analysed using contingency tables. The significance of the findings was tested by the chi-square test. Most of the children were older pre-school 63 (27.51%) and young school children 102 (44.54%). Medical disability (systemic or intellectual) was diagnosed in 142 children (62.01%); the remaining 87 (37.99%) were healthy children. Dental treatment of primary teeth was more commonly performed in healthy children (65.52%) compared to medically compromised children (58.45%) (p = 0.287). The total number of medically compromised children and the total number of healthy children were both considered to be 100% for the purpose of the following calculations. In terms of permanent dentition, medically compromised children required more extractions and fillings (38.03%, 57.04%) compared to healthy children (14.94%, 17.24%, respectively). The results of this study revealed that dental treatment under GA was more commonly performed in medically compromised children in permanent teeth only in comparison to healthy children. Based on these findings, both health professionals and state authorities should focus more on preventive care in medically compromised children in order to improve their oral health.


Assuntos
Anestesia Dentária/estatística & dados numéricos , Anestesia Geral/estatística & dados numéricos , Assistência Odontológica para Crianças/métodos , Utilização de Instalações e Serviços/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Estudos de Casos e Controles , Criança , Saúde da Criança , Pré-Escolar , Doença Crônica , República Tcheca , Assistência Odontológica para Crianças/estatística & dados numéricos , Feminino , Nível de Saúde , Humanos , Masculino , Estudos Retrospectivos
3.
J Clin Pediatr Dent ; 43(3): 147-154, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964718

RESUMO

Dentinogenesis Imperfecta type II (DI2), also known as hereditary opalescent dentin, is one of the most common genetic disorders affecting the structure of dentin, not related with osteogenesis imperfecta, which involves both primary and permanent dentitions. The purpose of this article is to perform a scoping review of the published peer-reviewed literature (1986-2017) on DI2 management in children and to outline the most relevant clinical findings extracted from this review. Forty four articles were included in the present scoping review. According to the extracted data, the following are the most important tasks to be performed in clinical pediatric dentistry: to re-establish the oral mastication, esthetics, and speech, and the development of vertical growth of alveolar bone and facial muscles; to reduce the tendency to develop caries, periapical lesions and pain; to preserve vitality, form, and size of the dentition; to avoid interfering with the eruption process of permanent teeth; to decrease the risk of tooth fractures and occlusion disturbances; to return the facial profile to a more normal appearance; and to prevent or treat possible temporomandibular joint problems. Therefore, Pediatric Dentists should bear in mind that early diagnosis and treatment, together a long-term follow-up of DI2 in children, continue to be the best approaches for achieving enhanced patient psychological well-being and, in consequence, their quality of life.


Assuntos
Assistência Odontológica para Crianças , Dentinogênese Imperfeita , Criança , Pré-Escolar , Assistência Odontológica para Crianças/métodos , Assistência Odontológica para Crianças/psicologia , Dentinogênese Imperfeita/psicologia , Dentinogênese Imperfeita/terapia , Dentição Permanente , Estética Dentária , Humanos , Qualidade de Vida
4.
J Dent Child (Chic) ; 86(1): 3-9, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30992095

RESUMO

Purpose: To determine if caregivers' race and ethnicity impact their willingness to accept passive immobilization for their child's dental treatment and to determine if a detailed description of passive immobilization will make caregivers more likely to accept the technique.
Methods: Caregivers of one- to 11-year-old patients were recruited in a university pediatric dental clinic. They completed two surveys and reviewed a written and pictorial description of passive immobilization.
Results: A total of 266 caregivers participated. Subjects were willing to accept passive immobilization at the following percentages by race/ethnicity: Hispanic (84 percent); African American (66 percent); Asian (50 percent); and non-Hispanic Caucasian (24 percent). There was a significant association between a caregiver's race and ethnicity and the willingness to consent to passive immobilization (P =.000), and in willingness to accept passive immobilization after reviewing its detailed description (P =.000).
Conclusion: Differences in acceptance of passive immobilization were observed based upon race and ethnicity. African American and Hispanic caregivers were more willing to accept the technique than their Asian and non-Hispanic Caucasian counter- parts. Caregivers were more likely to accept the use of passive immobilization after they were given more information about the technique. (J Dent Child 2019;86(1):3-9) Received May 30, 2018; Last Revision August 3, 2018; Accepted August 7, 2018.


Assuntos
Cuidadores , Assistência Odontológica para Crianças , Imobilização , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Assistência Odontológica para Crianças/métodos , Grupos Étnicos , Feminino , Humanos , Imobilização/métodos , Lactente , Masculino , Inquéritos e Questionários
5.
Spec Care Dentist ; 39(2): 180-187, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30729554

RESUMO

AIMS: This was a pilot study assessing the impact of a sensory adapted dental environment (SADE) on children with developmental disabilities (DD) receiving routine dental care. METHODS: A crossover study of 22 children with DD, aged 6 through 21, was conducted at a University Pediatric Dental clinic. Each participant was randomized to a sequence of two dental cleanings on a 3- to 4-month recall schedule, one with a regular dental environment (RDE) and one with SADE. Outcomes included physiological measures (heart rate and oxygen saturation) and cooperation (Frankl scores). RESULTS: Study subjects completed 36 visits. None of the physiological measures differed at either time point between the two treatment settings. The Frankl scores were significantly higher with SADE setting than RDE (P = 0.0368). Forty-six percent of parents strongly agreed that they would prefer the SADE for their child's next visit. CONCLUSION: SADE may be associated with improved behavior in children with DD.


Assuntos
Ansiedade ao Tratamento Odontológico/prevenção & controle , Assistência Odontológica para Crianças/métodos , Assistência Odontológica para Pessoas com Deficiências/métodos , Deficiências do Desenvolvimento , Crianças com Deficiência , Ambiente de Instituições de Saúde , Adolescente , Criança , Estudos Cross-Over , Feminino , Humanos , Masculino , Projetos Piloto , Adulto Jovem
6.
Spec Care Dentist ; 39(2): 236-240, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30720215

RESUMO

Ectrodactyly ectodermal dysplasia with clefting is a rare syndrome resulting from TP63 gene mutations. It is inherited in autosomal dominant manner or as a de novo transfiguration. It is characterized by a triad of ectodermal dysplasia, ectrodactyly, and facial clefts. This report represents a clinical case of 5 years and 6 months-old male child with ectrodactyly ectodermal dysplasia cleft lip and palate syndrome requiring treatment of his carious teeth. After history taking and clinical examination, the necessary treatment was provided under general anesthesia due to the definitely negative behavior of the child. The treatment outcomes had a positive impact on the behavior and acceptance to dental treatment. This was evidenced by completion of the prosthetic and space management appliances on the dental chair. The child's quality of life was consequently improved. This was evidenced by the reduced response scores of the child perception questionnaire (CPQ11-14 ) after treatment. This report highlighted the value of proper diagnosis and fulfillment of the unmet dental needs for patients with orofacial syndromes to improve their quality of life.


Assuntos
Fissura Palatina/complicações , Assistência Odontológica para Crianças/métodos , Assistência Odontológica para Doentes Crônicos/métodos , Cárie Dentária/terapia , Displasia Ectodérmica/complicações , Deficiência Intelectual/complicações , Sindactilia/complicações , Pré-Escolar , Fissura Palatina/cirurgia , Displasia Ectodérmica/cirurgia , Humanos , Deficiência Intelectual/cirurgia , Masculino , Qualidade de Vida , Sindactilia/cirurgia
7.
Spec Care Dentist ; 39(2): 108-113, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30707461

RESUMO

AIM: The aim of this study was to evaluate oral characteristics and comorbidities that may affect dental treatment of individuals with Williams syndrome (WS). METHODS AND RESULTS: Fifty-two subjects diagnosed with WS were included in this observational study. Demographic data and medical history were compiled. Facial aspects, tooth abnormalities and oral characteristics were obtained through clinical and radiographic evaluation by a researcher/dentist. Among 52 subjects, 25 were also evaluated for temporomandibular and occlusal disorders, caries and periodontal disease. From the 52 subjects, 23 (44.2%) were female and the average age was of 20 years old (range from 4 to 35 years old). Cognitive impairment and congenital heart disease were the most common medical disorders found in all 52 (100%) and in 41 (78.8%) subjects, respectively. Among the 52 subjects, 51 (98%) presented at least one dental developmental abnormality, with generalized diastemas (72.5%) and hypodontia (50.9%) being the most frequent ones. Angle class III malocclusion was observed in 52% (13/25) of the subjects. CONCLUSIONS: The dentist should be aware of the medical conditions of individuals with WS and thus offer an adequate dental treatment. The high prevalence of tooth abnormalities and occlusal disorders requires an early dental treatment planning.


Assuntos
Assistência Odontológica para Crianças/métodos , Assistência Odontológica para Doentes Crônicos/métodos , Síndrome de Williams , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino
8.
Pediatr Dent ; 41(1): 48-51, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30803477

RESUMO

Purpose: The purpose of this study was to evaluate the feasibility of social worker-delivered oral health interventions for preschoolers in foster care. Methods: We interviewed social workers in Washington state (N equals 20). Interview data were coded into three domains: (1) oral health predictors and outcomes; (2) dental care access; and (3) intervention feasibility. Results: The mean age of participants was 39.8±10.5 years, and 65 percent worked in the public sector. Participants believed preschoolers in foster care are at risk for poor oral health, secondary to neglect and suboptimal behaviors. Many children enter foster care not having seen a dentist because of financial barriers and difficulties finding dentists who accept Medicaid. Barriers to care persist after entering foster care. Social workers considered themselves ideal interventionists to lead brief oral health programs during home visits. To enhance feasibility, social workers would require education and training. Conclusion: Future research should explore interventions that could be implemented by social workers to improve the oral health of foster children.


Assuntos
Criança Acolhida/estatística & dados numéricos , Assistência Odontológica para Crianças/métodos , Saúde Bucal , Assistentes Sociais , Adulto , Criança , Assistência Odontológica para Crianças/organização & administração , Família , Estudos de Viabilidade , Feminino , Cuidados no Lar de Adoção/métodos , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Washington
9.
Pediatr Dent ; 41(1): 52-55, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30803478

RESUMO

Purpose: Use of general anesthesia (GA) for comprehensive dental treatment of children is an essential health benefit. Pediatric dentists utilize dentist anesthesiologists to provide GA for dental rehabilitation of severe early childhood caries. Dentist anesthesiologists deliver GA using intubated or nonintubated GA. The purpose of this study was to compare the incidence of respiratory complications when intubated versus nonintubated general anesthesia was completed by dentist anesthesiologists in a pediatric dentistry setting. Methods: The Society of Ambulatory Anesthesia (SAMBA) Clinical Outcomes Registry (SCOR) database was queried for pediatric dental GA cases completed by dentist anesthesiologists from January 1, 2010 to December 31, 2016. Logistic regression compared intubated GA versus nonintubated GA for differences in the incidence of respiratory complications. Results: Within 9,333 cases, there were 30 incidents of laryngospasm (0.3 percent), 19 incidents of bronchospasm (0.2 percent), two incidents of hypoxia (less than 0.1 percent), and six incidents of difficult airway (0.1 percent). When intubated versus nonintubated GA was compared for respiratory complication incidence, no significant association was found (P=0.81, odds ratio equals 0.93). Conclusion: No significant difference was found between the incidence of respiratory complications with intubated versus nonintubated GA provided by dentist anesthesiologists.


Assuntos
Anestesia Dentária/métodos , Anestesia Geral/métodos , Assistência Odontológica para Crianças/métodos , Intubação Intratraqueal , Anestesia Dentária/efeitos adversos , Anestesia Geral/efeitos adversos , Criança , Pré-Escolar , Assistência Odontológica para Crianças/efeitos adversos , Feminino , Humanos , Incidência , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Masculino , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia
10.
Pediatr Dent ; 41(1): 4E-12E, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30803480

RESUMO

Purpose: Oral health is important to physical and psychological health. Individuals with autism spectrum disorder (ASD) experience significant oral care challenges, but little research exists that examines efficacious interventions to improve care. The purpose of this study was to qualitatively explore parental and dentist reports of successful strategies implemented during dental care with children with ASD. Methods: Focus groups were conducted with parents of children with ASD (N = two groups) and dentists treating children with ASD (N = two groups). Focus group transcripts were transcribed verbatim and analyzed using a thematic analysis approach. Results: Three key themes were identified from the parent focus groups: (1) what makes a good dentist; (2) flexibility and techniques-strategies used by the dentist; and (3) preparation-strategies for parents and caregivers of children with ASD. Four themes emerged from the dentist groups: (1) parents know best; (2) practice; (3) flexibility; and (4) a network of colleagues. Areas of overlap between the parents and dental providers included the importance of preparation, necessity of flexibility and creativity, and value of collaboration. Conclusions: Our findings provide insight into techniques perceived by parents and dental providers to facilitate successful dental encounters for children with ASD.


Assuntos
Transtorno do Espectro Autista/complicações , Assistência Odontológica para Crianças/métodos , Pais , Adolescente , Criança , Pré-Escolar , Assistência Odontológica para Crianças/normas , Feminino , Grupos Focais , Humanos , Masculino , Saúde Bucal , Pesquisa Qualitativa , Melhoria de Qualidade
11.
Spec Care Dentist ; 39(2): 125-134, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30597580

RESUMO

AIM: This study aimed to assess the effectiveness of a novel health education method-Audio Tactile Performance (ATP) technique-in maintenance of gingival health and plaque removal efficacy among institutionalized visually impaired children of Bhubaneswar city. METHODS AND RESULTS: A parallel arm, single blinded randomized controlled trial was conducted among 10- to 15-year-old visually impaired children. Clinical examinations were done by the examiner blinded to group allocations. Oral health education materials (Braille and audio) were given to control group and ATP technique was given to test group. Clinical examinations for plaque and gingival scores were assessed at baseline, 30 days interval, and 90 days interval. The trial was registered with the Clinical Trial Registry of India (CTRI/2017/05/008551). In control group, a greater plaque reduction was observed at 30 days interval (3.58 ± 1.3) when compared to baseline (2.63 ± 2.02) and 90 days interval (3.14 ± 0.88), and this difference was statistically significant. For whole mouth, in test group, a greater reduction in gingival scores was observed at 90 days interval (2.65 ± 1.64) when compared to baseline (4.58 ± 1.63) and 30 days interval (1.23 ± 2.43), and this difference was statistically significant. CONCLUSION: ATP was found to be at par with the control group (Braille and audio aids).


Assuntos
Assistência Odontológica para Crianças/métodos , Placa Dentária/prevenção & controle , Gengivite/prevenção & controle , Educação em Saúde Bucal/métodos , Institucionalização , Pessoas com Deficiência Visual , Adolescente , Criança , Feminino , Humanos , Índia , Masculino , Avaliação de Programas e Projetos de Saúde , Método Simples-Cego
12.
BMC Oral Health ; 19(1): 6, 2019 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-30621659

RESUMO

BACKGROUND: Due to the lack of evidence to determine the best treatment for deep cavitated caries lesions in primary molars, the search for an effective restorative technique, which results in a minimal discomfort to patients, and reduce the time needed for the treatment, becomes relevant. The objective of this randomized clinical trial was to evaluate if high-viscosity glass ionomer cement (HVGIC) restorations is noninferior to restoration with calcium hydroxide cement associated with HVGIC for treatment of deep lesions in primary molars, as well as the impact of the treatments on cost and discomfort of the patient. METHODS: A non-inferiority randomized clinical trial with two parallels arms (1:1) will be conducted. Children with 4 to 8 years will be selected at Clinic of Pediatric Dentistry at Ibirapuera University. 108 teeth will be randomized into two groups: (1) Calcium hydroxide cement associated with HVGIC and (2) HVGIC restoration. Primary outcome will be considered the pulp vitality and to be evaluated after 6, 12, 18 and 24 months by two calibrated examiners. Survival of restorations will also be evaluated in the equal intervals. The duration of dentals treatment and the cost of all materials used will be considered for estimating of cost-efficacy of each treatment. Individual discomfort will be measured after each dental procedure using the Wong-Baker's Facial Scale. For the primary outcome, Kaplan-Meier survival and the long-rank test will be used to comparison between the groups. Cox regression will be performed to assess the influence of variables on the outcome. For all analyzes, the significance level is set at 5%. DISCUSSION: Based on the philosophy of ART, our hypothesis is that the HVGIC restoration is a possible approach to restore the deep caries lesion with pulp vitality without the use of rubber dam and anesthesia. TRIAL REGISTRATION: Clinicaltrials.gov registration NCT02903979 . Registered on June 9th 2016.


Assuntos
Assistência Odontológica para Crianças/métodos , Cárie Dentária/reabilitação , Restauração Dentária Permanente/métodos , Cimentos de Ionômeros de Vidro/uso terapêutico , Dente Decíduo , Resinas Acrílicas , Criança , Coroas , Cárie Dentária/prevenção & controle , Cimentos Dentários , Método Duplo-Cego , Humanos , Dente Molar , Odontopediatria , Dióxido de Silício
13.
Spec Care Dentist ; 39(2): 225-230, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30604876

RESUMO

Cerebral palsy (CP) is a condition caused by brain damage before, during, or shortly after birth. Communication can be a challenge when treating patients with CP. Some patients can communicate verbally, while others use augmentative alternative communication tools or have individualized means of communication. Therefore, professional dental treatment in individuals with CP is challenging, especially if the patient is affected by dental trauma and requires emergency treatment. This report shows how individualized communication skills assessment allowed us to successfully manage a 9-year-old patient with CP, who suffered extrusive luxation of the permanent lower incisor. In the present case, the teeth were repositioned briefly after the trauma had occurred and then stabilized with a flexible splint according to international guidelines. The teeth remained vital and periodontal repair was observed during the 4-year follow-up.


Assuntos
Paralisia Cerebral/complicações , Assistência Odontológica para Crianças/métodos , Assistência Odontológica para Doentes Crônicos/métodos , Avulsão Dentária/diagnóstico por imagem , Avulsão Dentária/terapia , Criança , Chile , Feminino , Humanos
14.
Community Dent Oral Epidemiol ; 47(1): 24-31, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30187941

RESUMO

OBJECTIVES: To evaluate the sensitivity and responsiveness of the Malay version of Early Childhood Oral Health Impact Scale (Malay-ECOHIS) to dental treatment of early childhood caries (ECC) under general anaesthesia (GA) and determine the minimally important difference (MID) for the Malay-ECOHIS. METHODS: A sample of 158 preschool children with ECC awaiting dental treatment under GA was recruited over an 8-month period. Parents self-completed the Malay-ECOHIS before and 4 weeks after their child's dental treatment. At 4 weeks follow-up, parents also responded to a global health transition judgement item. Data were analysed using independent and paired samples t tests, ANOVA and Pearson correlation coefficients. RESULTS: The response rate was 87.3%. The final sample comprised 76 male (55.1%) and 62 female (44.9%) preschool children with mean age of 4.5 (SD = 1.0) years. Following treatment, there were significant reductions in mean scores for total Malay-ECOHIS, child impact section (CIS), family impact section (FIS) and all domains, respectively (P < 0.001). The effect size (ES) for the Malay-ECOHIS was +1.0; across the domains, it ranged from +0.4 to +1.9. There was a weak, positive correlation for Malay-ECOHIS change scores (r = 0.165) and CIS change scores (r = 0.175) with the number of decayed teeth (dt), respectively. Similar correlation was also observed between Malay-ECOHIS change scores and the number of extracted teeth (r = 0.129). Based on the global health transition judgement, 62.3% of parents reported their child's oral condition to be "a little improved" while 37.7% reported it to be "much improved" following treatment, with Malay-ECOHIS mean change scores of 6.7 (ES = +1.1) and 9.6 (ES = +1.2), respectively. There was an observed gradient in the Malay-ECOHIS change scores and ES in relation to parents' perception of their child's oral health improvement after treatment, supporting the responsiveness of the measure. The Malay-ECOHIS MID was found to be 7 scale points. CONCLUSION: The Malay-ECOHIS is empirically shown to be sensitive and responsiveness to dental treatment of ECC under GA.


Assuntos
Anestesia Geral , Assistência Odontológica para Crianças/métodos , Cárie Dentária , Saúde Bucal , Pré-Escolar , Cárie Dentária/terapia , Feminino , Humanos , Malásia , Masculino , Pais , Qualidade de Vida
15.
Trials ; 19(1): 673, 2018 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-30522512

RESUMO

BACKGROUND: Currently, the number of children living with HIV is the highest ever. This has led to an increased focus on a healthy life expectancy in this population. Improving oral health status may contribute to improved immunity, which could in turn lead to greater overall health in this population. This study aims to evaluate the effectiveness of an oral health intervention in improving oral health and immune status among children living with HIV in Cambodia. METHODS: A randomized controlled trial will be conducted in Phnom Penh from May 2018 to April 2020. Among 520 dyads of children living with their respective caregivers, half will be randomly allocated to the intervention group and the other half to the control group. Children aged 3-15 years who are currently receiving antiretroviral therapy at the National Pediatric Hospital will be recruited. In addition, 260 HIV-uninfected children (age-matched to the intervention group) will be recruited from the communities. They, together with their caregivers, will comprise the second control group. The main components of the intervention will include oral health education sessions for the children, as well as daily oral self-care under the supervision of their caregivers. The primary study outcome will be the change in oral health status including the number of decayed, missing, or filled permanent teeth, and the secondary outcome will be CD4 count. The effects of the intervention will be assessed by comparing outcome indicators between the children in the intervention and those in the control groups. DISCUSSION: This trial will investigate the effects of an oral health intervention on the improvement of oral health and immune status among children living with HIV and determine the differences compared with the control groups. This intervention would encourage the promotion of oral health interventions among children living with HIV and thus contribute to delaying the onset of AIDS. TRIAL REGISTRATION: Current Controlled Trials, International Standard Randomized Controlled Trial Number Register, ISRCTN15177479 . Registered on 17 January 2018.


Assuntos
Assistência Odontológica para Crianças/métodos , Infecções por HIV/terapia , Saúde Bucal , Higiene Bucal/educação , Educação de Pacientes como Assunto/métodos , Doenças Dentárias/prevenção & controle , Adolescente , Fatores Etários , Camboja , Cuidadores , Criança , Serviços de Saúde da Criança , Pré-Escolar , Dispositivos para o Cuidado Bucal Domiciliar , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/imunologia , Nível de Saúde , Humanos , Masculino , Higiene Bucal/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Autocuidado , Fatores de Tempo , Doenças Dentárias/diagnóstico , Doenças Dentárias/imunologia , Escovação Dentária , Cremes Dentais , Resultado do Tratamento
16.
Cochrane Database Syst Rev ; 12: CD003877, 2018 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-30566228

RESUMO

BACKGROUND: Children's fear about dental treatment may lead to behaviour management problems for the dentist, which can be a barrier to the successful dental treatment of children. Sedation can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. There is a need to determine from published research which agents, dosages and regimens are effective. This is the second update of the Cochrane Review first published in 2005 and previously updated in 2012. OBJECTIVES: To evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 22 February 2018); MEDLINE Ovid (1946 to 22 February 2018); and Embase Ovid (1980 to 22 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in children up to 16 years of age. We excluded cross-over trials. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted, in duplicate, information regarding methods, participants, interventions, outcome measures and results. Where information in trial reports was unclear or incomplete authors of trials were contacted. Trials were assessed for risk of bias. Cochrane statistical guidelines were followed. MAIN RESULTS: We included 50 studies with a total of 3704 participants. Forty studies (81%) were at high risk of bias, nine (18%) were at unclear risk of bias, with just one assessed as at low risk of bias. There were 34 different sedatives used with or without inhalational nitrous oxide. Dosages, mode of administration and time of administration varied widely. Studies were grouped into placebo-controlled, dosage and head-to-head comparisons. Meta-analysis of the available data for the primary outcome (behaviour) was possible for studies investigating oral midazolam versus placebo only. There is moderate-certainty evidence from six small clinically heterogeneous studies at high or unclear risk of bias, that the use of oral midazolam in doses between 0.25 mg/kg to 1 mg/kg is associated with more co-operative behaviour compared to placebo; standardized mean difference (SMD) favoured midazolam (SMD 1.96, 95% confidence interval (CI) 1.59 to 2.33, P < 0.0001, I2 = 90%; 6 studies; 202 participants). It was not possible to draw conclusions regarding the secondary outcomes due to inconsistent or inadequate reporting or both. AUTHORS' CONCLUSIONS: There is some moderate-certainty evidence that oral midazolam is an effective sedative agent for children undergoing dental treatment. There is a need for further well-designed and well-reported clinical trials to evaluate other potential sedation agents. Further recommendations for future research are described and it is suggested that future trials evaluate experimental regimens in comparison with oral midazolam or inhaled nitrous oxide.


Assuntos
Ansiolíticos/uso terapêutico , Ansiedade ao Tratamento Odontológico/tratamento farmacológico , Assistência Odontológica para Crianças/psicologia , Hipnóticos e Sedativos/uso terapêutico , Analgésicos não Entorpecentes/administração & dosagem , Ansiolíticos/administração & dosagem , Criança , Hidrato de Cloral/administração & dosagem , Assistência Odontológica para Crianças/métodos , Humanos , Hidroxizina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Meperidina/administração & dosagem , Midazolam/administração & dosagem , Óxido Nitroso/administração & dosagem , Medicação Pré-Anestésica/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Eur J Paediatr Dent ; 19(4): 324-332, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30567452

RESUMO

AIM: This review focuses on Computer-Controlled Local Anaesthesia Delivery systems (CCLAD), in comparison with conventional carpule anaesthesia in means of pain and anxiety. METHODS: Medline, Embase, Web of Science and Cochrane Database for Systematic Reviews were searched up to August 2018. Only cross-over split-mouth design studies aimed to clinically compare CCLAD with a conventional carpule anaesthesia are included. Data about pain and anxiety associated with anaesthesia were sought. The authors performed meta-analysis where appropriate. RESULTS: A total of 20 studies are included in the systematic review (n = 973 subjects). Quantitative synthesis (conducted on VAS scores from 8 studies) shows that pain intensity is over 9 points lower in CCLAD than in conventional anaesthesia on a scale from 0 to 100 (95% confidence interval, ?12.90 to ?5,53; P<.001). The systematic review showed no differences between the two techniques according to the physiological parameters of pain (heart rate or blood pressure), and the data about anxiety are inconsistent. CONCLUSION: CCLAD results in significantly slightly less pain perception with respect to conventional injection and is a promising device to help patients. The literature needs to be expanded, mostly regarding anxiety.


Assuntos
Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Ansiedade ao Tratamento Odontológico/prevenção & controle , Assistência Odontológica para Crianças/métodos , Manejo da Dor/métodos , Terapia Assistida por Computador/métodos , Criança , Estudos Cross-Over , Humanos , Injeções , Medição da Dor
18.
PLoS One ; 13(12): e0208437, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30521577

RESUMO

BACKGROUND: Despite the increasing number of studies evaluating patient reported outcome measures (PROs), there is no clearness regarding which restorative treatment offers major benefits based on the pediatric patient perspective. AIM: To compare different restorative techniques in pediatric dentistry regarding patient-reported outcomes. DESIGN: Literature searching was carried out on prospective studies indexed in PubMed, Scopus and OpenGrey. A Mixed Treatment Comparisons (MTC) meta-analysis was undertaken considering the results from reviewed studies. Anxiety, pain and quality of life were extracted as mean with standard deviation, percentage of pain, and mean difference of scores with standard deviation, respectively. For direct comparisons, data were combined using a random-effect model. Heterogeneity was assessed with the I2 statistic. For indirect comparisons, fixed and random effects were chosen through comparison of competing models based on the Deviance Information Criteria (DIC). The expected efficacy ranking based on the posterior probabilities of all treatment rankings was also calculated. RESULTS: An initial search resulted in 4,322 articles, of which 17 were finally selected. Due to unavailability of data, only pain, anxiety and oral health related quality of life (OHRQoL) were statistically analyzed. The difference in means (95% CI) of anxiety between treatments using only hand instruments with or without chemomechanical agents were -5.35 (-6.42 to -4.20) and -5.79 (-7.77 to -3.79) respectively when compared to conventional treatment using rotary instruments and/or local anesthesia. Regarding pain, there was a trend for treatments without rotary instruments and local anesthesia to be less frequently reported as painful. No statistical difference was found intragroup nor among treatments for OHRQoL. CONCLUSIONS: Anxiety and pain are directly related with more invasive restorative treatments. On the other hand, quality of life is not improved regardless of the restorative technique used. Further well-designed prospective studies regarding PROs in children are still necessary.


Assuntos
Ansiedade/epidemiologia , Assistência Odontológica para Crianças/métodos , Assistência Odontológica/psicologia , Dor/epidemiologia , Ansiedade/etiologia , Criança , Assistência Odontológica/instrumentação , Assistência Odontológica para Crianças/instrumentação , Humanos , Metanálise em Rede , Dor/etiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida
20.
Gen Dent ; 66(6): 19-22, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30444702

RESUMO

Most children are able to cooperate during conventional, in-office dental treatment using traditional, communicative behavior guidance techniques that are carefully selected and applied to the developmental needs of a particular child. Children who are unable to cooperate during conventional treatment due to a lack of psychological or emotional maturity and/or the existence of a mental, physical, or medical disability may require pharmacologic techniques such as procedural sedation or general anesthesia to complete rehabilitative dental treatment. Patient safety dictates that careful preparation and robust case selection processes guide clinical decision-making related to pharmacologic behavior guidance. Before using these techniques, the sedation provider must demonstrate an adequate understanding of these techniques, from definitions and best practices to case selection and patient safety. This article presents essential information-with an emphasis on best practices and patient safety-for dentists who are considering pharmacologic behavior guidance for the children they treat.


Assuntos
Sedação Consciente , Assistência Odontológica para Crianças/métodos , Anestesia Dentária/métodos , Criança , Sedação Consciente/efeitos adversos , Sedação Consciente/métodos , Assistência Odontológica para Crianças/psicologia , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Segurança do Paciente , Guias de Prática Clínica como Assunto
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