Paediatric dental emergencies: a retrospective study and a proposal for definition and guidelines including pain management

Risk Factors Associated with Children's Behavior in Dental Clinics: A Cross-Sectional Study

One of the most crucial tasks of pediatric dentists is to control children's negative behaviors. This study aimed to assess dental behavior and the associated risk factors among children aged 4-12. This cross-sectional study recruited healthy, unaffected children aged 4 to 12 years. Parents were interviewed regarding the sociodemographic details and characteristics of their children's dental visits. Two collaborative dentists examined the children for dental caries (DMFT/DMFT) and behavioral status (Frankl's behavior rating scale). This study included 439 children: 27.3% exhibited uncooperative behavior, and the mean DMFT/dmft was 8.46 ± 3.530. Uncooperative behavior significantly increased when the dental visit was scheduled as an emergency treatment (p = 0.134; Adjusted Odds Ratio (AOR): 1.530) and when there was an elevated DMFT/DMFT ratio (p < 0.001; AOR: 1.308). This study revealed a significant association between children's uncooperative behavior and their first dental visit, emphasizing the need for tailored strategies to address behavioral challenges when scheduling pediatric dental care. The proactive measures included controlling caries and avoiding emergencies.

Disasters in pediatric dentistry: a systematic review

BACKGROUND

Disasters can harm many people, especially children, in unpredictable and public ways. One of the neglected aspects of children's health in disasters is oral and dental hygiene, which can affect their physical and mental well-being. This systematic review explores how dentistry can help children in disasters, focusing on two aspects: providing oral health care and identifying disaster victims.

METHODS

A thorough search of databases, such as PubMed, Cochrane Library, Scopus, Embase, ProQuest, and Web of Science, was done to find English-language publications from 1930 to August 31, 2023. The screening, data collection, and quality assessment followed the PRISMA guidelines.

RESULTS

Out of 37,795 articles found in the databases, seven research articles were chosen. Five articles were retrospective, and two articles were prospective. The results showed that dentistry for children is very important in disasters by giving information about the oral and dental problems and identifying the victims. The results also showed some of the challenges and difficulties in giving dental care for children in disaster situations, such as changing control, referral systems, and parental fear of infection.

CONCLUSION

Dentistry for children can improve the health and well-being of children affected by disasters.

Dental Caries Pattern Amongst Tanzanian Children: National Oral Health Survey

BACKGROUND

Dental caries in young children and adolescents is a public oral health challenge in countries with developing economies and economic transition. This study presents a demographic pattern of dental caries in primary and permanent dentition of 5-, 12-, and 15-year-old Tanzanians based on the 2020 National Oral Health Survey findings.

METHODS

This is a cross-section study based on data from Tanzania's 5th National Oral Health Survey. Data on dental caries and basic demographics were collected employing World Health Organization Oral Health Survey protocols. Analysis was done using the SPSS computer programme version 23, and proportions and mean dental caries experiences in Decayed extracted filled teeth in primary dentition/Decayed Missing Filled Teeth in permanent dentition were summarised and chi-square statistics and binary logistic regression assessed the differences and determined the association between dental caries and the selected demographic characteristics.

RESULTS

The survey included 2187 participants; 42.4% were from rural areas and 50.7% were female. Overall caries prevalence was 17%, specifically 43.2%, 20.5%, and 25.5% amongst 5-, 12- and 15-year-olds, respectively. Decayed teeth components were 98.4%, 89.8%, and 91.4% amongst 5-, 12-, and 15-year-olds, respectively. Overall mean (SD) DMFT amongst 12- and 15-year-olds were 0.40 (0.27) and 0.59 (1.35), respectively. Urban participants had significantly lower odds of dental caries experience (odds ratio, 0.62, 95% confidence interval 0.45-0.84) compared with rural participants, whilst the 15-year-olds had higher odds of dental caries experience than the 12-year-olds.

CONCLUSION

Dental caries prevalence in primary dentition was high. The proportion of decayed teeth components of def/DMFT was the highest compared with that of missing and filled teeth components. Older adolescents and those from rural areas had higher odds of dental caries experience.

Analysis of 5-Year-old children's oral health service utilization and influencing factors in Guizhou Province, China (2019-2020)

BACKGROUND

This study aimed to investigate the utilization patterns and factors related to oral health care for 5-year-old preschoolers based on Andersen's Behavioural Model in Guizhou Province, Western China.

METHOD

A cross-sectional study of 4,862 5-year-old preschoolers in 66 kindergartens was conducted in 2019 and 2020. A basic oral examination and a survey of parents and grandparents were conducted to gather data on oral health services. The results were analysed using chi-square tests and logistic regression analysis.

RESULT

The utilization rate of oral health services for children in Guizhou province was 20.5%. The dmft was 4.43, and the rate of caries was 72.2%. The average cost of a dental visit was higher in rural areas and higher for girls. Logistic regression analysis revealed that dmft ≥ 6 teeth, a history of toothache, starting toothbrushing at age ≤ 3 years and limited parental knowledge were the primary factors impacting dental visits.

CONCLUSION

Needs factors such as severe oral conditions and pain in children are the main reasons for the utilization of these services. This study underscores the urgency to actively promote the importance of oral health and expand insurance coverage for oral health services.

Non-traumatic emergency department dental visits among patients 0-25 years of age: A systematic review and meta-analysis

BACKGROUND

Nontraumatic dental conditions (NTDC) that made children attending to emergency departments (EDs) of tertiary hospitals can put significant financial and time strain on hospitals.

AIM

The aim of this systematic review and meta-analysis was to calculate the prevalence of paediatric presentations to EDs of tertiary hospitals for NTDC and describe the characteristics of these presentations.

DESIGN

A systematic search strategy using PubMed, Embase and Web of Science databases was performed to identify studies quantifying NTDC presentations to EDs of tertiary hospitals from inception through to July 2022. Eligible studies were critically appraised using the Joanna Briggs Institute checklist for studies reporting prevalence.

RESULTS

The search identified 31 099 studies, from which 14 were found to meet the inclusion criteria. A random effects model was used for meta-analysis, and the prevalence of NTDC reported through EDs of tertiary hospitals ranged from 52.3% to 77.9%.

CONCLUSIONS

Nontraumatic dental conditions, which may be preventable when caused by dental caries, made up a high proportion of dental visits to tertiary hospital EDs. Public health initiatives should be considered to reduce the burden of NTDC on EDs.

Pediatric Dental Emergencies during the COVID-19 Pandemic in Romania: A Retrospective Study

Pediatric dental emergencies can occur as a result of untreated dental caries, or can be caused by trauma or periodontal issues. The lockdown imposed during the COVID-19 pandemic reduced the number of centers authorized to deliver dental services in Romania, with only a small number of dentists delivering dental emergency treatments. The aim of this study was to investigate the demographic characteristics of children and adolescent patients who were treated in the dental emergency department of Oradea, Romania and to compare the patients who were treated in the dental emergency department in the pre-lockdown (2019), lockdown (2020) and post-lockdown year (2021). All patients who were treated in the dental emergency department were included in the study except for adults and medical files that did not contain all relevant information. Several variables were investigated (age, gender, living environment, location of affected teeth, type of emergency). In 2019, 257 children and adolescents were treated, in 2020, 198, and in 2021, 136. Most patients were aged 7-12 years in all investigated years (2019-47.9%; 2020-50.5%; 2021-43.4%), and the most affected teeth were located in the lower posterior arch (2019-53.3%; 2020-53%; 2021-48.5%). The most frequent emergencies were pulpitis (2019-40.5%; 2020-43.9%) and acute apical periodontitis (2021-42.6%). It was observed that in 2019, patients aged between 0 and 6 years were more frequently associated with trauma (p < 0.001), and in 2019 and 2020, patients aged between 7 and 12 years were more frequently associated with periodontal emergencies (p < 0.001). In 2020, patients from rural areas were more frequently associated with pulpitis (p = 0.025), and in 2021, patients from rural areas were more frequently associated with pulpitis or acute apical periodontitis, and patients from urban areas were associated more frequently with periodontal emergencies (p = 0.042). Pediatric patients with ages between 7 and 12 years old, who lived in an urban environment were most affected. Teeth located in the lower and upper posterior dental arches were most affected, and pulpitis or acute apical periodontitis were the most common pathologies.

Prevalence of traumatic dental injuries in emergency dental services: A systematic review and meta-analysis

OBJECTIVES

This study aimed to perform a systematic review and meta-analysis regarding the prevalence of traumatic dental injuries (TDI) in emergency dental services.

METHODS

Seven electronic and two grey literature databases were searched, up to December 2021, for studies that reported the TDI prevalence among dental emergencies. The Joanna Briggs Institute critical appraisal checklist for prevalence studies, and The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were used to assess the risk of bias and quality of evidence respectively. The R software was used to perform a proportion meta-analysis on a random-effects model to estimate the pooled prevalence and respective 95% CI.

RESULTS

From a total of 1476 studies identified after excluding duplicates, 38 met the inclusion criteria, and another five were identified through hand searching, summing 43 included observational studies with a total sample of 209099 individuals searching for emergency dental care. The overall pooled prevalence of TDI was 15.4% (95% CI: 11%-21%, I² = 100%). Paediatric dental emergency services and age group from 0 to 21 years presented the highest prevalence, 29% (95% CI: 22%-38%, I² = 99.5%) and 24% (95% CI: 15%-35%, I² = 98%) respectively.

CONCLUSIONS

The overall pooled prevalence of TDI in emergency dental services was 15.4%, and 24% in the age group under 21 years. Considering the impact of prompt and correct emergency care in the long-term prognosis of TDI, such knowledge is relevant to organize emergency healthcare and support public policies in this area.

Statistical Study on the Motivation of Patients in the Pediatric Dentistry

Our statistical study included 344 participants selected from the patients of the Pedodontics–Orthodontics Discipline of the Tîrgu-Mureş University of Medicine and Pharmacy. The patients’ age was between 6 and 18 years, with an average of 13.70 and a standard deviation of 4.62. The study participants were informed and agreed to complete two questionnaires of our conception regarding their health status, oral hygiene, and motivation for pedodontics or orthodontic treatment. The results of the two questionnaires were interpreted according to the gender and age of the patients. Data processing was performed with NCSS/PASS Dawson Edition statistical software, using the CHI2 test, considering a p of less than 0.05 as significant for comparative results. Results showed that girls were more motivated than boys in addressing pedodontic services due to dental, periodontal, and articular problems. Children, aged between 11 and 14 years, were less intrinsically motivated to solve oral health problems due to their low frequency. The intrinsic motivation for a more beautiful dentition was very strong, regardless of age and sex. Girls were more intrinsically motivated for orthodontic treatment than boys. There was a linear increase together in the age of those who wanted to improve their smile and facial appearance. Children between 11 and 14 years had the best self-perception of the appearance of their teeth, mouth, smile, and facial harmony. The strongest extrinsic motivation for orthodontic treatment came from parents or another doctor. The most important reason for orthodontics was dental malpositions, the last one was the improvement of masticatory efficiency. The extrinsic motivation from parents for orthodontics decreases linearly with age, along with the increase in motivation from the person with whom the participants relate emotionally and from the group of friends.

Impact of Pediatric Dental Resident Availability in the Pediatric Emergency Department

OBJECTIVE

The purpose of this study is to describe the impact of Delaware's first pediatric dental residency program on treatment of patients presenting to the pediatric emergency department (PED).

METHODS

Charts were reviewed for patients presenting to the PED with a dental chief complaint over a 9-month period with a comparison period. Chief complaint, diagnosis, treatment interventions, disposition, and demographic information were included. χ 2 , Fisher exact, and Student t tests with a P value less than 0.05 were regarded as significant.

RESULTS

A total of 432 patients met inclusion criteria; 197 before dental residency commencement and 235 after residency commencement. Dental consultation significantly increased (56% vs 7%, P < 0.01) between the study periods. There were no statistically significant differences in sex, race, insurance type, admissions, or proportion of presentations of trauma or infection between the study periods. Dental residents provided in-person evaluation for 40% of patients. The proportion of patients receiving dental intervention increased significantly postresidency period (57% vs 47%, P = 0.04). Pediatric emergency department extractions and splints both occurred in a significantly larger portion of patients after the start of the residency program (17% vs 1% and 5% vs 0%, P < 0.01). A higher proportion of patients with dental complaints received procedural sedation in the PED after residency (13% vs 2%, P < 0.01).

CONCLUSIONS

Pediatric dental resident availability in the PED significantly increased dental consultation and intervention. A significantly higher percentage of PED patients received definitive treatment at point of service without requiring referral to another facility.

Dental Emergencies in an Italian Pediatric Hospital during the COVID-19 Pandemic

Emergency rooms (ER) are largely used by patients with oral complaints, who choose the ER over private or public dental offices for oral prevention and treatment. During the COVID-19 pandemic, the activity of most dental facilities was limited, and most hospitals and ERs were dedicated to the treatment of COVID-19 patients. The present study analyzed the number of and reason for visits at the emergency room (ER) of Ospedale dei Bambini “Vittore Buzzi”, the main pediatric hospital in Milano, Italy, between 2019 and 2020, with a particular focus on oral emergencies. In 2019, 25,435 children turned to the ER, compared to 16,750 in 2020. About 10% of the children were eventually admitted to the hospital in both years. The number of admissions for infectious diseases, other than COVID-19, signed an important decrease in 2020, while trauma/injuries decreased slightly in number but increased in proportion. The number and proportion of ER visits for oral complaints decreased in 2020 compared to 2019. Stomatitis was the most frequent condition, followed by traumatic injuries, which decreased in number and percentage between 2019 and 2020. Oral infections and painful caries accounted for about 15% of the cases in both 2019 and 2020. These data highlight the need to promote territorial services for the prevention and treatment of oral health complaints, including dental emergencies.

Dental caries severity and oral health-related quality-of-life in Brazilian preschool children

The impact of dental caries on oral health-related quality-of-life (OHRQoL) may be influenced by disease severity. This study evaluated the impact of caries severity on OHRQoL in preschool children. A school-based, cross-sectional study was conducted with 205 children (aged 2-5 years) in Southern Brazil. Parents answered the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and provided sociodemographic information. The Caries Assessment Spectrum and Treatment criteria were used to evaluate caries severity, and Poisson regression with robust variance estimation conducted to determine the rate ratio (RR) and 95% confidence intervals (CIs) of the mean OHRQoL scores according to severity level. Most children had at least one tooth in the morbidity (37%) or pre-morbidity (35%) stages, and the prevalence of impacts on OHRQoL was 40%. Caries severity was associated with the impact scores: after adjustments, the mean B-ECOHIS scores were 6.31 (95% CI: 4.24-9.38) higher for children in the morbidity stage, and 10.84 (95% CI: 6.51-18.05) higher in the severe morbidity stage, than for healthy children [RR = 10.84 (95% CI: 6.51-18.05)]. Children with carious lesions into dentine or with pulpally-involved or abscessed teeth had poorer OHRQoL than children without such lesions.

Clear aligner VS fixed self-ligating appliances: Orthodontic emergency during 2020 COVID-19 pandemic

Introduction

The aim was to investigate the type, incidence, and degree of orthodontic-related emergencies in orthodontic patients during the 2020 coronavirus disease 2019 pandemic and compare the different effects of clear aligner (CA) and fixed self-ligating appliances on the orthodontic emergency.

Methods

The questionnaire was based on emergencies in orthodontics. The responses of 428 patients between the ages of 12 and 38 years (20.4 ± 7.03) in orthodontic treatment during 2020 were examined.

Results

The gender, age, and the type of orthodontic appliance affect the incidence of orthodontic-related emergencies. Female or adolescent patients treated by self-ligating appliances showed a higher incidence of emergencies. The patients treated by CA exhibited a much lower incidence of emergency. Appliance detachment and mucosa injury were very common in respondents, whereas accidental ingestion and other rare emergencies were less common. The most common reason leading to appliance detachment was chewing hard food. Interestingly, the fixed self-ligating appliances group was also affected by the accidental detachment of appliances to a large extent. The CA and self-ligating groups showed an almost equal incidence of accidental ingestion. The most common foreign body was elastics in both groups. However, the self-ligating group could accidentally ingest dangerous foreign bodies, such as archwires, miniscrews, and welded attachments.

Conclusions

Orthodontic-related emergencies were very common in patients. The CA could effectively reduce orthodontic-related emergencies. Dentists should raise patients’ awareness of proper appliance care. A proper and standard protocol should be developed.

From Lockdown to Slow Release: Pediatric Dental Services during COVID-19 Pandemic-Emergency Preparedness and Impact on Future

Introduction

The emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) has led to global pandemic raising significant challenges to the healthcare professionals due to its high transmission rate via droplet spread or direct contact. Pediatric dentists play an important role in the healthcare system by managing dental emergencies in children while taking special measures to practice universal infection control in this COVID-19 pandemic. However, data are limited pertaining to the prevalence, etiology, and treatment provided to children at pediatric dental emergency services during the COVID-19 lockdown period.

Aim and objective

To assess the effect of the COVID-19 pandemic lockdown period on Pediatric Dental Emergency Services.

Materials and methods

A retrospective study was conducted using data of patients aged 0-14 years who visited the Pediatric Dental Emergency Services, during the COVID-19 lockdown period from March 23, 2020, to August 31, 2020. Information regarding age, gender, time of presentation, chief complaint, and treatment were collected and analyzed.

Results

This study revealed that dental emergencies in the pediatric dental services were predominantly related to dental pain (54.49%) followed by an abscess (12.35%), traumatic dental injuries (8.42%), and swelling (8.42%). A 5-year-old was the most prevalent age-group who reported dental emergencies.

Conclusion

Dental pain was the most common chief complaint of patients reporting during the COVID-19 pandemic. However, the recent state of affairs obligates the need to strike a balance between the safety of the healthcare professionals and providing optimum dental care to the patients requiring emergency intervention. While dental emergencies are unforeseeable, increasing community awareness about proper at-home care routines and utilizing regular dental preventive measures can potentially reduce the number of emergency visits.

How to cite this article

Goswami M, Gogia M, Bhardwaj S. From Lockdown to Slow Release: Pediatric Dental Services during COVID-19 Pandemic-Emergency Preparedness and Impact on Future. Int J Clin Pediatr Dent 2021;14(3):398-402.

Pediatric dental emergency management and parental treatment preferences during COVID-19 pandemic as compared to 2019

Pediatric dental emergency management were temporarily suspended during the COVID-19 pandemic, which worsened urgent dental needs. This retrospective study investigated the management of pediatric emergencies during COVID-19 lockdown and the trends in parental preferences from March to July in 2019 and 2020. Pediatric dental emergencies managed during pandemic was collated, procedures were categorized (emergency, restorative, preventive, elective) and trends in parental treatment preference was compared from March-July 2019/2020. Bivariate analysis was performed using fisher-exact test and statistical significance was set at 5%. Total 1081 children were treated during COVID-19 lockdown, and 1509 procedures were performed, of which 20.8% were emergency, 42% restorative, 24.4% preventive, 12.6% elective. In 2019, 7462 children were treated; and except for emergency (10.6%), other procedures were comparable to 2020. Extractions (267) predominated in 2020 followed by sealants (195); but in 2019, pulectomy (1268), scaling (1251) were predominant. None of the residents who performed aerosol procedures got infected with COVID-19 during the lockdown. Emergency dental needs among pediatric patients were very high during the COVID-19 pandemic in South India, and there was not much change in the trend in parental treatment preference in 2019 and 2020. Further, aerosol procedures did not increase the risk of COVID-19 during the pandemic provided proper universal precautions were followed.

Racial variations in tooth pain and care-seeking in adolescents in Malaysia

Objective

Tooth pain among adolescents is a common event that impacts substantially on quality of life. The purpose of this paper is to explore the role of race in the tooth pain experience and associated care-seeking.

Design

A cross-sectional questionnaire survey was conducted on 14–18 years from four different public schools in Kuala Lumpur. Socio-demographic, pain symptoms, and social impacts data were collected as well as medication use and visiting a dentist for tooth pain.

Results

Of 1473 questionnaires distributed, 1452 (98.6%) completed questionnaires were returned, with 269 (18.5%) reported having experienced tooth pain in the past 1 month. Those who identified as Indian (26.1%) were more likely to report tooth pain compared to Chinese (16.5%) and Malay (20.9%). In regression analysis, no factors were identified as independently associated with medication use, but Chinese and Indians compared to Malays, and those expressing difficulty sleeping were more likely to report visiting a dentist for treatment.

Conclusion

Racial variations in the tooth pain experience and care-seeking have been identified. This may be related to socio-economic status, but further research is needed on the role of culture-related care-seeking and accessibility of dental services.

Online consultation and emergency management in paediatric dentistry during the COVID-19 epidemic in Wuhan: A retrospective study

BACKGROUND

The COVID-19 pandemic posed a great challenge to paediatric dentistry, which confronted with the restriction of service and resource shortage.

AIM

To retrospectively analyse the information of children's dental online health consultation during the COVID-19 pandemic in China, and to provide methods to distinguish between dental emergencies and non-emergencies as well as their management.

DESIGN

We collected all the online consultation information in Dept. of Paediatric dentistry, School & Hospital of Stomatology, Wuhan University, from 2 February to 31 March 2020, and extracted the information of age, gender, reason for consultation, description of symptom, and preliminary diagnosis of the children.

RESULTS

A total of 474 online consultations of paediatric dentistry were included within 59 days during lockdown, and 190 (40.1%) were dental emergencies and 284 (59.9%) non-emergencies. Of 190 emergency consultations, 186 (97.9%) showed swelling, pain, and trauma with or without systemic symptoms. Among 284 non-emergency consultations, retained primary teeth (n = 126) and orthodontic consultation (n = 53) were the most common reasons for consultation.

CONCLUSION

The paediatric emergency and non-emergency problems should be clearly distinguished and sufficient instructions provided in the special period of COVID-19. Priorities also should be set to deal with urgent conditions after the release of lockdown.

Quality assessment of clinical practice guidelines for the management of paediatric dental emergencies applicable to the COVID-19 pandemic, using the AGREE II instrument. A systematic review

OBJECTIVE

To assess the quality of Clinical Practice Guidelines (CPG) related to the management of paediatric dental emergencies applicable to the COVID-19 pandemic, through the use of the measuring instrument AGREE II (Appraisal of Guidelines for Research and Evaluation in Europe).

SOURCES AND DATA COLLECTION

A rigurous online search of CPG was accomplished among the main CPG compilers: National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse, Agency for Healthcare, Research and Quality (AHRQ), Andalusian Health Technology Assessment Department (AETSA), American Academy of Family Physicians, Tripdatabase. Furthermore, because of the need to identify CPG that meet the inclusion criteria, a manual search, among the main national and international dental organizations as well as recognized web sites, was also accomplished.

SELECTION OF RESEARCH STUDIES

All of the guides focused on paediatric dental emergencies, available in the database and "gray" literature, and published between 2000 and 2020 (applicable to COVID-19 pandemic) were included without any language restrictions. The CPG that did not contain the full paper or were addressed to adults or children with special needs, were excluded from the selection. The evaluation of the CPG, independently included, were achieved by four (04) experts by using AGREE II.

RESULTS

Five (05) out of twenty-three (23) selected CPG, were classified as "acceptable" according to AGREE II. These five guides were evaluated to determine their "Recommendation degree". Only one (01) CPG "Guía Clínica AUGE de Urgencias Odontológicas Ambulatorias-Chile, 2011" reached a score of 75%, the highest among the other guides (5 domains with a score ≥ 60%, including the domain III "Rigour of Development") to be considered as a "highly recommended" CPG.

CONCLUSIONS

According to the quality assessment and recommendation degrees criteria from AGREE II, high, middle and low quality CPG were identified. Only one CPG reached a score of 75%, to be classified as "highly recommended". Therefore, it is suggested that the existing CPG updates and future CPG use the available tools and methodologies during their elaboration, in order to guarantee their quality.

CLINICAL SIGNIFICANCE

High quality CPG for the management of dental emergencies are designed to support dental health professionals in decision-making to adopt specific dental procedures in the current COVID-19 pandemic. As a matter of fact, these CPG might contribute to reduce the risk of transmission, in case of fresh outbreak of the illness. Likewise, they might help to determine which cases warrant medical attention in centres with special facilities for COVID-19.