Time and cost analysis: pediatric dental rehabilitation with general anesthesia in the office and the hospital settings.

Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board-approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36-60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P < .001). The average total time (anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance.

Oral health status and access-to-care concerns of Suffolk County Head Start children.

This study was undertaken to establish the caries prevalence in Head Start/Early Head Start children among the non-fluoridate community of Suffolk County, Long Island, and to elicit access-to-oral-health-care issues that are present for these children. Three hundred five parents completed questionnaire surveys about access-to-care issues at Suffolk County Head Start centers. Two hundred sixteen Suffolk County Head Start children ages 2 to 5 were screened for this study. The average DMFT (decayed, missing, filled teeth) across all children screened was 2.01. Fifty-four percent of parents reported that their children received dental care in the last two years. Twenty-four percent of children who received dental care reported having access-to-care issues. Of the parents who encountered such issues, the most prevalent one stated was, "We could not find a dentist to accept our insurance." The authors concluded that there is a heightened prevalence of early childhood caries in the Head Start/Early Head Start population of Suffolk County, Long Island. There are high levels of underutilized dental care in this population. The parents in this community have reported there are access-to-care issues present that may result in high levels of dental disease.

Treatment modalities for self-injurious behaviors observed in the special-needs patient: 2 case reports.

Self-injurious behavior (SIB) is comprised of deliberate self-harm involving frequent and repetitive activities of a destructive nature. It is commonly observed in patients with developmental delay and a variety of syndromes. SIB frequently involves oral and facial tissues, requiring intervention from the dental team. The purpose of this case report was to compare and contrast the dental management of 2 patients exhibiting self-injurious behavior. The cases presented in this report discuss selection and application of fixed, semiremovable, and removable appliance therapy for SIB. Appliances utilized included fixed and removable "lip bumpers" as well as a novel semifixed splint to open the patient's bite to prevent SIB. It was important in both cases that the patients received regular follow-up exams so that the appliances could be appropriately altered as the patient adjusted.

Long-term management of a child with regional odontodysplasia: a case report.

Regional odontodysplasia, or "ghost teeth," is a dental abnormality derived from both epithelial and mesenchymal components of the tooth bud. Teeth within a particular quadrant are affected. Affected teeth usually have thin enamel and dentin of poor quality with shortened roots, open apices, or enlarged pulp chambers. The permanent teeth and maxillary arch are observed to be more severely affected than primary teeth and the mandibular arch (ratio=1.6:1), respectively. Eruption of the affected teeth is delayed or may not happen. The cause of the phenomenon is unknown. Since this problem affects both dentitions and can involve multiple care disciplines, patients often require oral care over a long period of time. The purpose of this report was to present the management of a case from initial presentation at the age of 20 months to a final prosthesis completion at the age of 22 years. The long-term treatment may involve a pediatric dentist, orthodontist, oral surgeon, and prosthodontist.

Case report: Noonan-like multiple central giant cell granuloma syndrome.

The purpose of this report was to: summarize the care of a child between the ages of 12 to 16 years old born with Noonan-like central giant cell syndrome and unrelated common variable immune deficiency; provide information on the dental management of patients with Noonan's syndrome; and present a brief discussion of the recent associated genetic findings. A review of the common features of Noonan syndrome and Noonan-like central giant cell syndrome is also provided.

Home oral health practice: the foundation for desensitization and dental care for special needs.

As oral health is increasingly recognized as a foundation for health and wellness, caregivers for special needs patients are an essential component of the oral health team and must become knowledgeable and competent in home oral health practice. Education and training for caregivers should become a standard of care early in the first year of life for any child with developmental delay or any person, regardless of age, who experiences an illness or event that compromises their ability to provide self oral health care. Given the implication of poor oral health to general health and health care costs, home oral health practice is a significant factor in dental care, general health, quality of life, and controlling health care costs.

Viral coinfection in the oral cavity of HIV-infected children: relation among HIV viral load, CD4+ T lymphocyte count and detection of EBV, CMV and HSV.

Viral coinfection in the oral cavity associated to HIV infection was evaluated in 180 children from birth to 13 years of age of both sexes. The oral examinations were performed at the Pediatric AIDS Outpatient Clinic, São Lucas Hospital and Clinic Hospital, both in Porto Alegre, Brazil and at the School of Dental Medicine, University Hospital Center, State University of New York at Stony Brook, USA. The aim of this study was to identify the presence of viral infections in the oral cavity. PCR technique was used to determine opportunistic viral infections caused by CMV, EBV, and HSV in mucosal swabs. A high frequency of viral infection was detected in the oral cavity of HIV-infected children determined by the PCR technique. HIV-infected children with viruses had a favorable CD4+ T lymphocyte count and unfavorable viral load.

[The association between oral manifestations and the socioeconomic and cultural characteristics of HIV-infected children in Brazil and in the United States of America]. / Associação entre manifestações estomatológicas e características socioeconômicas e culturais de crianças brasileiras e norte-americanas infectadas pelo HIV.

OBJECTIVES: This study had two objectives: (1) to investigate the socioeconomic and cultural characteristics of HIV-infected children and their families in relation to the presence of oral manifestations of AIDS and (2) to identify the most frequent oral manifestations of AIDS in the sample of children studied. METHODS: The sample consisted of a total of 184 children - both boys and girls - from 0 to 13 years old. The children were receiving care at two hospitals in the city of Porto Alegre, Brazil (the Hospital de Clínicas de Porto Alegre and the Hospital São Lucas da Pontifícia Universidade Católica), and at Stony Brook University Hospital, which is in the state of New York, United States. Data were analyzed using the chisquare test, Student's t test, and analysis of variance. RESULTS: Of the 184 patients, 117 of them (63.59%) were receiving care at the Hospital de Clínicas de Porto Alegre, 26 (14.13%) at the Hospital São Lucas, and 41 (22.28%) at Stony Brook University Hospital. In the Brazilian sample (the two hospitals in Porto Alegre) 42.66% of the children were living with their natural parents (mostly with the mother), while in the United States 56.10% of the children were living with foster families. Concerning income, 39.86% of the Brazilian families had a monthly income ranging from US$ 180 to US$ 450, and 33.57% had no income or did not provide information. With the United States sample, we were not allowed to ask about income, but all the families were classified by the social workers as having a monthly income below US$ 1 000. HIV was acquired through vertical transmission by 97.20% of the Brazilian children and by 97.56% of the children in the United States sample. Oral manifestations were more frequent in the Brazilian children (72.73%) than in the children in the United States sample (53.66%) (P = 0.01). CONCLUSIONS: The frequency of oral manifestations in the samples in both Brazil and the United States was influenced by socioeconomic and cultural conditions, family structure and income, access to information concerning AIDS, and adherence to treatment.

Viral coinfection in the oral cavity of HIV-infected children: relation among HIV viral load, CD4+T lymphocyte count and detection of EBV, CMV and HSV / Co-infecção viral na cavidade bucal de crianças infectadas pelo HIV: relação entre carga viral, contagem de linfócitos T-CD4+ e detecção de EBV, CMV e HSV

A relação entre a infecção pelo HIV e a presença de diferentes tipos de vírus na cavidade bucal foi estudada em 180 crianças HIV-positivo, com idades entre zero e 13 anos de idade, de ambos os sexos. Os exames foram realizados nos Ambulatórios de Aids Pediátrica dos Hospitais São Lucas e de Clínicas, ambos em Porto Alegre, RS, Brasil e no Centro Hospitalar Universitário da Universidade Estadual de Nova Iorque, em Stony Brook (EUA). O objetivo desta pesquisa foi usar a técnica da PCR para detectar a presença dos vírus CMV, EBV e HSV na cavidade bucal desses pacientes, independentemente da presença ou não de manifestações estomatológicas relacionadas aos mesmos. Pode-se concluir que foi alta a freqüência de vírus detectados na cavidade bucal das crianças da amostra através da técnica da PCR e que a contagem média de linfócitos T-CD4+ das crianças com a presença dos vírus encontrava-se próxima da normalidade, enquanto a Carga Viral do HIV encontrava-se elevada.

Associaçäo entre manifestaçöes estomatológicas e características socioeconômicas e culturais de crianças brasileiras e norte-americanas infectadas pelo HIV / The association between oral manifestations and the socioeconomic and cultural characteristics of HIV-infected children in Brazil and in the United States of America

OBJETIVO: Investigar as características socioeconômicas e culturais de crianças infectadas pelo HIV e de suas famílias, relacionando-as com a presença de manifestaçöes estomatológicas da AIDS, e identificar as manifestaçöes estomatológicas mais freqüentes na amostra estudada. MÉTODO: A amostra foi composta por 184 crianças de ambos os sexos, com idade entre 0 e 13 anos, atendidas no Hospital de Clínicas de Porto Alegre e Hospital Säo Lucas da Pontifícia Universidade Católica, em Porto Alegre, Brasil, e no hospital universitário da Universidade do Estado de Nova Iorque em Stony Brook, Estado de Nova Iorque, Estados Unidos. Os dados foram analisados pelos testes do qui-quadrado, t de Student e análise de variância. RESULTADOS: Dos 184 pacientes, 63,59 por cento eram do Hospital de Clínicas de Porto Alegre; 22,28 por cento do hospital de Stony Brook; e 14,13 por cento do Hospital Säo Lucas. Na amostra brasileira, 42,66 por cento das crianças residiam com os pais naturais (principalmente com a mäe), enquanto que nos Estados Unidos 56,10 por cento das crianças moravam com pais adotivos. Em relaçäo à renda, 39,86 por cento das famílias no Brasil ganhavam entre 180 e 450 dólares mensais; 33,57 por cento näo tinham renda ou näo forneceram seus dados. Nos Estados Unidos, a pergunta sobre renda näo foi autorizada, mas todas as famílias foram classificadas pelos assistentes sociais do hospital como tendo renda abaixo de 1 000 dólares. O HIV foi adquirido por transmissäo vertical em 97,20 por cento dos casos no Brasil e 97,56 por cento nos Estados Unidos. A freqüência das manifestaçöes estomatológicas foi maior nas crianças brasileiras (72,73 por cento) do que nas norte-americanas (53,66 por cento) (P = 0,01). CONCLUSÖES: As condiçöes socioeconômicas e culturais, estrutura e renda familiar, acesso a informaçäo sobre AIDS e a adesäo aos esquemas terapêuticos influenciaram a freqüência das manifestaçöes estomatológicas nas duas amostras.

Objectives. This study had two objectives: (1) to investigate the socioeconomic and cultural characteristics of HIV-infected children and their families in relation to the presence of oral manifestations of AIDS and (2) to identify the most frequent oral manifestations of AIDS in the sample of children studied. Methods. The sample consisted of a total of 184 children­both boys and girls­ from 0 to 13 years old. The children were receiving care at two hospitals in the city of Porto Alegre, Brazil (the Hospital de Clínicas de Porto Alegre and the Hospital São Lucas da Pontifícia Universidade Católica), and at Stony Brook University Hospital, which is in the state of New York, United States. Data were analyzed using the chisquare test, Student's t test, and analysis of variance. Results. Of the 184 patients, 117 of them (63.59%) were receiving care at the Hospital de Clínicas de Porto Alegre, 26 (14.13%) at the Hospital São Lucas, and 41 (22.28%) at Stony Brook University Hospital. In the Brazilian sample (the two hospitals in Porto Alegre) 42.66% of the children were living with their natural parents (mostly with the mother), while in the United States 56.10% of the children were living with foster families. Concerning income, 39.86% of the Brazilian families had a monthly income ranging from US$ 180 to US$ 450, and 33.57% had no income or did not provide information. With the United States sample, we were not allowed to ask about income, but all the families were classified by the social workers as having a monthly income below US$ 1 000. HIV was acquired through vertical transmission by 97.20% of the Brazilian children and by 97.56% of the children in the United States sample. Oral manifestations were more frequent in the Brazilian children (72.73%) than in the children in the United States sample (53.66%) (P = 0.01). Conclusions. The frequency of oral manifestations in the samples in both Brazil and the United States was influenced by socioeconomic and cultural conditions, family structure and income, access to information concerning AIDS, and adherence to treatment

Freqüência da hipoplasia do esmalte em crianças infectadas pelo HIV / Enamel hypoplasia frequency in HIV infected children

A hipoplasia do esmalte é uma alteração do esmalte dental, decorrente da ação de diferentes fatores etiológicos durante o período de formação desse. Dentre os possíveis fatores etiológicos, merecem destaque as alterações sistêmicas presentes em crianças infectadas pelo HIV. O objetivo deste trabalho foi estudar a freqüência da hipoplasia do esmalte em crianças infectadas pelo HIV e a provável relação desta patologia dental com a classificação da AIDS pediátrica. A amostra foi composta por 156 crianças brasileiras e 42 crianças norte-americanas, de zero a treze anos de idade, infectadas pelo HIV. A metodologia incluiu o preechimento de uma ficha individual, o exame clínico odontológico buscando a presença de dentes com anomalia dental do tipo hipoplasia do esmalte e a revisão dos prontuários médicos das crianças. Na amostra estudada, 24 crianças (12,12%) apresentaram hipoplasia do esmalte, sendo 17 brasileiras e 7 norte-americanas. A freqüência de crianças com hipoplasia do esmalte na amostra estudada foi considerada baixa. A distribuição das 24 crianças com hipoplasia do esmalte, de acordo com a classificação da AIDS pediátrica foi: 12 (50%) na categoria clínica C, 8 (33,33%) na categoria B e 4 (16,67%) na categoria A. A maioria das crianças com hipoplasia do esmalte encontrava-se na categoria C da AIDS pediátrica, considerada a mais grave.