Dental disease in children with chronic illness

Preventive dental care utilization and dental caries for Medicaid-enrolled adolescents in Oregon

OBJECTIVES

This study aimed to evaluate the relationship between preventive dental care utilization and untreated dental caries for Medicaid-enrolled adolescents and to determine if the relationship is moderated by chronic conditions (CC).

METHODS

This analysis was based on 2015-2016 Medicaid claims files and survey data collected from adolescents ages 12-18 years enrolled in Oregon Medicaid, who received a dental screening between December 2015 and December 2016 (n = 240). To assess the relationship between preventive dental care utilization and untreated dental caries (defined as decayed tooth surfaces), prevalence ratios (PR) and 95% confidence intervals (CI) were generated using log-linear regression models. We also tested for an interaction between preventive dental care utilization and CC.

RESULTS

About 60.4% of adolescents utilized preventive dental care, 21.7% had CC, and 29.6% had ≥1 decayed tooth surfaces. There were no significant differences in untreated dental caries between adolescents who did and did not utilize preventive dental care (PR: 0.73, 95% CI: 0.33-1.60; p = 0.43). There was not a significant interaction between preventive dental care utilization and CC (p = 0.65). Preventive dental care utilization was not significantly associated with untreated dental caries for adolescents with CC (PR: 0.51, 95% CI: 0.10-2.65; p = 0.42) nor among adolescents without CC (PR: 0.79, 95% CI: 0.33-1.91; p = 0.61).

CONCLUSIONS

Preventive dental care was not shown to be associated with lower untreated dental caries for Medicaid-enrolled adolescents or those with CC. Future work that is adequately powered should continue to elucidate this relationship in Medicaid enrollees.

Antibiotic Prescription for Dental Procedures in Type 1 Diabetic Children

In diabetic patients, maintaining blood glucose levels as close to normal as possible is an objective in dental management especially in pediatric ones. Patients with poorly controlled diabetes are at greater risk of developing infections. Therefore, the prescription of antibiotics may be necessary for some dental procedures.

Aim

The aim is to optimize the benefit and minimize the risk of antibiotics in dental treatments performed in diabetic children.

Materials and methods

A cross-sectional approach was conducted on 155 type 1 diabetic children (72 controlled and 83 uncontrolled). The types of dental acts held for the study were pulpotomies, pulpectomies, pediatric crowns, scaling, and extraction. For the balanced diabetic patients, no antibiotics were prescribed except for infected teeth. In the unbalanced diabetic group, for the acts causing bleeding, prophylactic antibiotics were administered. In presence of dental infection, antibiotics were administered for at least 5 days.

Results

The analysis of data was carried out using Statistical Package for the Social Sciences Computer Software (SPSS 21.0, Inc., Chicago, Illinois, USA). A probability value of <0.05 was regarded as statistically significant. Around 126 acts in the balanced group and 145 in the unbalanced ones were performed. In balanced diabetic children, 125 successes and one failure were noted. In the unbalanced group, 142 successes and three failures were recorded. The comparison between variables did not show any statistical significance (p-value = 0.382).

Conclusion

This study demonstrated that working with diabetic young patients is possible and safe as long as some measures are considered. It is crucial to identify the dental acts that necessitate antibiotics administration and to differentiate between balanced and unbalanced diabetic children for the same dental procedure.

How to cite this article

Nassif N, Noueiri B. Antibiotic Prescription for Dental Procedures in Type 1 Diabetic Children. Int J Clin Pediatr Dent 2023;16(1):60-63.

Oral Care for Children with Special Healthcare Needs in Dentistry: A Literature Review

Oral health is a very important aspect of general health, especially for vulnerable groups such as children with special healthcare needs. It is important to provide appropriate oral care in order to promote quality of life and good health for everyone, especially for children with special healthcare needs. Method: We reviewed the recent literature to collect knowledge regarding the delivery of quality oral care to children with special healthcare needs. We also explored some of the treatment management options that could address the needs of these children when attending dental clinics. Result: Unfortunately, we noted significant inequalities with issues related to oral health among those children. This situation often results in limitations to the activities of daily living for these children. There is therefore a need for much-needed advancements and refinements in oral healthcare to address the needs of children who have special healthcare needs. Conclusions: Providing children with special healthcare needs with high-quality dental care may necessitate active liaisons with healthcare facilitators and will require work across professions to make certain that these children’s oral health is also prioritized. Coordinated efforts by dental professionals are needed to provide dental health education and preventive interventions for these children.

Prevention and Treatment of Oral Complications in Hematologic Childhood Cancer Patients: An Update

Cancers have a highly negative impact on the quality of life of paediatric patients and require an individualised oral treatment program for the phases of the disease. The aim of this study was to update existing research on oral care in children diagnosed with cancer. We carried out a literature search (in English, Spanish and Portuguese) in the Pubmed, Cochrane Library, EBSCO, WOS, SciELO, Lilacs, ProQuest, and SCOPUS databases and the websites of hospitals that treat childhood cancers. We found 114 articles and two hospital protocols. After review, we describe the interventions necessary to maintain oral health in children with cancer, divided into: phase I, before initiation of cancer treatment (review of medical record and oral history, planning of preventive strategies and dental treatments); phase II, from initiation of chemo-radiotherapy to 30-45 days post-therapy (maintenance of oral hygiene, reinforcement of parent/patient education in oral care, prevention and treatment of complications derived from cancer treatment); phase III, from 1 year to lifetime (periodic check-ups, maintenance, and reinforcement of oral hygiene, dental treatments, symptomatic care of the effects of long-term cancer treatment). The use of standardised protocols can avoid or minimise oral cancer complications and the side effects of cancer therapies.

Dentoalveolar Procedures in Immune Thrombocytopenia; Systematic Review and an Institutional Guideline

Background  Dentoalveolar procedures in immune thrombocytopenia (ITP) pose a risk of bleeding due to thrombocytopenia and infection due to immunosuppressive treatments. We aimed to systematically review the safety and management of dentoalveolar procedures in ITP patients to create practical recommendations.

Methods  PubMed, Embase, Cochrane, and Cinahl were searched for original studies on dentoalveolar procedures in primary ITP patients. We recorded bleeding- and infection-related outcomes and therapeutic strategies. Clinically relevant bleeding was defined as needing medical attention.

Results  Seventeen articles were included, of which 12 case reports/series. Overall, the quality of the available evidence was poor. Outcomes and administered therapies (including hemostatic therapies and prophylactic antibiotics) were not systematically reported. At least 73 dentoalveolar procedures in 49 ITP patients were described. The range of the preoperative platelet count was 2 to 412 × 10 ⁹ /L. Two clinically relevant bleedings (2%) were reported in the same patient of which one was life-threatening. Strategies used to minimize the risk of bleeding were heterogeneous and included therapies to increase platelet count, antifibrinolytics, local measures, and minimally invasive techniques. Reports on the occurrence of bleedings due to anesthetics or infection were lacking.

Conclusion  Based on alarmingly limited data, clinically relevant bleedings and infections after dentoalveolar procedures in ITP patients seem rare. Awaiting prospective and controlled studies to further evaluate these risks and the efficacy of therapeutic interventions, we provided our institutional guideline to guide the management of dentoalveolar procedures in ITP patients.

Nanotechnology-based therapies for the prevention and treatment of Streptococcus mutans-derived dental caries

BACKGROUND

Dental caries results from long-term acid production when sugar is metabolized by a bacterial biofilm, resulting in a loss of calcium and phosphate from the enamel. Streptococcus mutans is a type of acid-producing bacteria and a virulent contributor to oral biofilms. Conventional treatment options, such as cefazolin and ampicillin, have significant levels of bacterial resistance. Other topical agents, such as fluoride, tend to be washed away by saliva, resulting in low therapeutic efficacy.

HIGHLIGHT

This review aims to highlight the solubility issues that plague poorly water-soluble therapeutic agents, various novel polymeric, and lipid-based nanotechnology systems that aim to improve the retention of therapeutic agents in the oral cavity.

CONCLUSION

In this review, different formulation types demonstrated improved therapeutic outcomes by enhancing drug solubility, promoting penetration into the deep layers of the biofilm, facilitating prolonged residence time in the buccal cavity, and reducing the emergence of drug-resistant phenotypes. These formulations have a strong potential to give new life to therapeutic agents that have limited physicochemical characteristics.

Dental caries in children and adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis

Background

Optimal utilization of dental caries data is crucial in epidemiological research of individuals with juvenile idiopathic arthritis (JIA). The aims were to: explore whether caries is more prevalent among children and adolescents with JIA compared to controls; examine presence of caries according to JIA group, socio-behavioral and intraoral characteristics, and the extent to which surface-specific caries varies between and within individuals; assess whether surface-specific caries varies according to JIA group and dentition; and investigate whether disease-specific clinical features of JIA are associated with presence of caries.

Methods

In this comparative cross-sectional study, calibrated dentists examined index teeth (primary 2. molars, 1. permanent molars) of 4–16-year-olds with JIA (n = 219) and matched controls (n = 224), using a detailed caries diagnosis system (including enamel caries). JIA-specific characteristics were assessed by pediatric rheumatologists and socio-behavioral information collected by questionnaires. Multilevel mixed-effect logistic regressions reporting odds ratios (OR) with 95% confidence interval (CI) were applied (caries at surface level as outcome variable). Potential confounders were adjusted for, and the effect of dependency of surface-specific caries data was estimated by calculating intra-class correlation coefficients (ICC).

Results

At individual level, no significant difference in caries prevalence was found between individuals with JIA and controls, regardless of inclusion of enamel caries. Proportion of enamel lesions exceeded dentine lesions. JIA was not associated with presence of caries, but in both groups, low maternal educational level was associated with presence of caries (OR: 2.07, 95% CI: 1.24–3.46). Occlusal and mesial surfaces, compared to buccal surfaces, had generally higher OR according to presence of caries than distal and lingual surfaces (ICC = 0.56). Surface-specific caries in the permanent dentition differed significantly according to group affiliation. Some JIA disease-specific variables were suggested to associate with presence of caries.

Conclusions

No overall difference in caries prevalence between individuals with JIA and controls was observed, but for both groups, low maternal educational level and tooth surface associated with presence of caries. Associations between JIA disease-specific variables and presence of caries cannot be excluded. Due to predominance of enamel lesions, the potential of preventative dental strategies is considerable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01758-y.

Preventive oral health care use for children with special health care needs aged 6 through 12 years enrolled in Medicaid: A mixed methods study

BACKGROUND

The authors aimed to assess preventive oral health care (POHC) use for children with special health care needs (CSHCN) aged 6 through 12 years enrolled in Medicaid and identify intervention strategies to improve oral health.

METHODS

In this sequential mixed methods study, the authors analyzed 2012 Medicaid data for children aged 6 through 12 years in Washington state. They used eligibility and claims data to identify special health care needs status (independent variable) and POHC use (outcome variable). They ran modified Poisson regression models to generate prevalence rate ratios. They coded data from 21 key informant interviews deductively using content analytic techniques.

RESULTS

Of the 208,648 children in the study, 18% were identified as CSHCN and 140,468 used POHC (67.3%). After adjusting for confounding variables, the authors found no difference in POHC use by special health care need status (prevalence rate ratio, 1.00; 95% CI, 0.99 to 1.01; P = .91). In the qualitative analysis, the authors identified 5 themes: caries risk depends on a child's specific health condition, caries complicates overall health, having a special need creates a bigger barrier to care, legislation alone is "not going to make much of a dent," and improvements across all fronts are needed to promote the oral health of CSHCN in Medicaid.

CONCLUSIONS

CSHCN enrolled in Medicaid are just as likely as children without special health care needs to use POHC, although barriers to oral health care access persist for CSHCN.

PRACTICAL IMPLICATIONS

Future efforts should focus on comprehensive strategies that address the varying levels of dental disease risk and difficulties accessing oral health care within the diverse group of CSHCN.

Cross-sectional analysis of dental treatment under general anaesthesia in hospitalised Western Australian children in 2018-19

Objective To date, there has been little research that has comprehensively analysed dental treatment under general anaesthesia (DGA) at Perth Children's Hospital (PCH) for dental emergencies (dental pain and sepsis). This cross-sectional descriptive analysis of the PCH dental department analysed the demographic of children admitted and the type of treatment used, and assessed the cost. Methods This was a retrospective descriptive study analysing the dental records of patients ranging from 2 to 16 years of age at PCH in Western Australia. Of the 310 cases randomly selected from the 2018-19 study period, 202 were admitted for DGA. Two outcome measures were derived: cumulative count of treatment mix and cost analysis. Results The mean (±s.d.) age at the time of admission was 6.2±2.6 years and the mean (±s.d.) decayed (d/D), missing, (m/M) and filled (f/F) teeth (dmft/DMFT) was 2.1±0.8. Of the 429 teeth affected, 282 were molars. Treatments were grouped therapeutically; of the 856 treatments performed, 465 were extractions (54%). The total cost, consisting of direct and indirect costs, was A$313823, and equated to an approximate mean (±s.d.) of A$1554±109 per case. Conclusion Untreated dental caries was the most common cause for hospital admission. Most cases presenting at the emergency department were young children (<7 years old) who underwent extractions under DGA. What is known about the topic? The Child Dental Benefits Schedule (CDBS) was introduced to improve access and affordability to oral health care for children without private dental insurance. However, a significant number of children are still being admitted to hospital for emergency dental treatment. What does this paper add? Despite the availability of the CDBS, untreated dental caries remains one of the most common reasons for dental emergency in the PCH. What are the implications for practitioners? Not only are direct costs a burden on the health budget, but indirect and intangible costs also affect children and their families.

Oral health care in urban general practice: what are the support and training needs?

Patients with oral health problems often attend GPs instead of dentists, particularly in rural areas. There has been little research exploring challenges in providing oral health care in urban general practice. A cross-sectional survey of GPs in Greater Western Sydney explored their experiences, knowledge, confidence, and their oral health educational needs. Descriptive statistics and content analysis was undertaken. Forty-nine GPs reported experience of a wide range of oral health presentations. Approximately 60% were confident to undertake oral health examinations and determine the cause of acute toothache. Although 87% were confident providing preventative oral health advice, most did not include this in routine health assessments. Only 41% were confident explaining eligibility for public dental services. Barriers to providing oral health care were time constraints, lack of equipment and limited oral health training. Our research highlights oral health support and training needs in urban Australian general practice, as well as the need for systems-wide change to oral health training in outer urban settings to tackle health inequity, similar to those advocated in rural Australia.

Prevalence of clinical signs and pain symptoms of temporomandibular disorders and associated factors in adult Finns

Objective: To assess the prevalence of clinical signs and pain symptoms of temporomandibular disorders (TMD) and associated factors in the Finnish adult population, as well as the association between self-reported TMD pain symptoms and clinical signs.Material and methods: The sample consisted of 1577 Finnish adults who participated in the Health 2011 Survey (BRIF8901). Signs of TMD were assessed using clinical examination, and TMD pain symptoms were inquired using validated questions.Results: Of the study subjects, 35% showed at least one sign of TMD, 8% reported weekly facial pain and 6% weekly pain when biting or jaw opening. According to logistic regression, female gender, poor general health and low level of education increased the risk for most TMD signs and TMD pain symptoms. Muscle or TMJ pain on palpation associated significantly with self-reported weekly facial pain or pain when biting or jaw opening.Conclusion: Over a third of the population showed clinical signs of TMD and less than one-tenth reported TMD pain symptoms. An assessment of a patient's general health needs to be a part of TMD diagnosis and treatment. The Finnish versions of the validated questions are applicable for screening of TMD pain.

<p>Parental Perception of a Dental Home for Children with Special Needs</p>

Background and Objectives

There is a major gap in the literature that addresses parental perception of acquiring a dental home for children with special healthcare needs (CSHCN). The objectives of this study are to assess parental perceptions and challenges in acquiring a dental home for their CSHCN.

Methods

Cross-sectional prospective study using a questionnaire.

Results

A total of 302 questionnaires were completed by caregivers. More than 70% of children had developmental delay, 20% had musculoskeletal disabilities, and the rest had respiratory compromise on non-invasive ventilation, learning disability, and visual and hearing disabilities; 75% of the caregivers do not believe pediatricians are qualified to contribute in oral hygiene. Moreover, 70% of children had not had a routine dentist visit in the 12 months preceding the interview. The reasons given for the lack of such visits included the long time of appointments (25%), difficulty in child’s mobility (17%), the perception that dental care is expensive (9%), and a lack of dentist experience in dealing with children with special needs (5%). When asked what factors would encourage caregivers to choose a dental home for their children, 63% mentioned quick appointments, followed by dentists specialized in children with special needs (51%), child friendly atmosphere (21%), low cost (26.6%), close to home (20%), and others (6%). Interestingly, the majority of parents (75%) believed that the primary pediatrician of the child should initiate the dental home process.

Conclusion

Despite proper resources, children with special healthcare needs lack proper oral healthcare. This could be attributed to the lack of a dental home. A pediatrician’s role is crucial in initiating the process of acquiring a dental home for this special population.

Maternal Mental Disorders before Delivery and the Risk of Dental Caries in Children

Prevention of childhood caries is an ongoing public health challenge, but the possibility of an association with maternal mental disorders has received limited attention. We estimated the extent to which maternal mental disorders are associated with an increased risk of hospitalization due to dental caries. We conducted a longitudinal cohort study of 790,758 infants born in Quebec, Canada between 2006 and 2016, with follow-up extending to 2018. We identified women with mental disorders before or during pregnancy and computed the incidence of dental caries in their children. We estimated HR and 95% CI for the association of maternal mental disorders with the risk of dental caries, adjusted for personal characteristics. Infants of women with mental disorders before or during pregnancy had a higher incidence of dental caries compared to children of women with no mental disorder (56.1 vs. 27.2 per 10,000 person-years). Maternal stress and anxiety disorders (HR = 1.73; 95% CI 1.60-1.86), depression (HR = 1.81; 95% CI 1.60-2.03), schizophrenia and delusional disorders (HR = 1.69; 95% CI 1.29-2.22), and personality disorders (HR = 1.89; 95% CI 1.70-2.11) were associated with the risk of dental caries. The associations were present throughout childhood, including after 7 years (HR = 1.65; 95% CI 1.38-1.96). Maternal mental disorders were associated with caries of the enamel, dentin, and cementum and caries that reached the dental pulp. Maternal mental disorders before or during pregnancy, especially stress and anxiety, depression, schizophrenia, and personality disorders, are associated with the risk of childhood caries. Women with a history of mental disorders may benefit from enhanced strategies for prevention of dental caries in their children.

Orofacial manifestations and dental management of systemic lupus erythematosus: A review

Systemic lupus erythematosus (SLE) is an autoimmune multisystem disease with numerous clinical manifestations. There is no consensus about the ideal oral management for this group of patients to date. This review aimed to describe the broad spectrum of orofacial and clinical manifestations and their therapeutic approaches. Studies concerning orofacial manifestations of SLE and dental treatment modalities were selected by a literature search (1978-2019) using Google Scholar, PubMed/MEDLINE electronic databases. The initial search strategy provided a total of 129 articles, and of these, 30 were included for qualitative synthesis. The reviewed studies revealed that SLE patients are more at risk of compromised oral and dental health exhibiting increased risk of periodontal diseases and temporomandibular joint disorders. The use of systemic drugs especially immunosuppressive and anticoagulants in SLE patients may also influence their oral management. Results emphasize the need to carry out, at an early stage of the disease, an appropriate oral management of these patients to improve oral health-related quality of life and to prevent the need of more invasive therapeutics. A multidisciplinary approach is needed for dental and medical management of such patients.

Prenatal Substance Use Disorders and Dental Caries in Children

Substance use is common in women of reproductive age, but limited data exist on the dental health of their children, including risk of caries. We conducted a longitudinal cohort study of 790,758 infants born between 2006 and 2016 in Quebec, Canada. We identified women with substance use disorders before or during pregnancy. The main outcome measure was hospitalization for dental caries in offspring up to 12 y after birth. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for the association of maternal substance use with pediatric dental caries, adjusted for potential confounders. Children exposed to maternal substance use had a higher incidence of hospitalization for dental caries than unexposed children (105.2 vs. 27.0 per 10,000 person-years). Maternal substance use was associated with 1.96 times the risk of childhood dental caries (95% CI, 1.80-2.14), including a greater risk of caries of enamel, dentin, or cementum (HR, 2.00; 95% CI, 1.82-2.19) and dental pulp (HR, 2.36; 95% CI, 2.07-2.70), relative to no substance use. Associations were elevated for alcohol (HR, 2.31; 95% CI, 2.03-2.64) but were also present for cocaine, cannabis, opioids, and other substances. Substance use during pregnancy was more strongly associated with dental caries hospitalization than prepregnancy substance use. Associations were stronger in early childhood. Maternal substance use is associated with the future risk of dental caries hospitalization in children. Targeting substance use early in the lives of women may contribute to dental caries prevention in offspring.

Oral status of HIV-infected children aged 12 years or younger who attended a Paediatric Infectious Diseases Clinic in Cape Town

BACKGROUND

Children continue to suffer from the impact of the human immunodeficiency virus-acquired immunodeficiency syndrome (HIV/AIDS) pandemic. In Cape Town, these children receive medical care including antiretroviral therapy from facilities like Tygerberg Hospital's Paediatric Infectious Diseases Clinic. HIV-infected children may experience an increased caries experience when compared with their healthy peers.

AIM

The aim of this study was to determine the oral health status of HIV-infected children younger than 12 years receiving antiviral drugs at the Paediatric Infectious Diseases Clinic.

DESIGN

A cross-sectional survey was conducted among children aged between 2 and 12 years presenting at this clinic. Caregivers were interviewed to obtain information regarding health seeking behaviour, oral hygiene practices and dietary habits. A single clinician undertook a standardized clinical intraoral examination according to the World Health Organization guidelines, with modifications.

RESULTS

Sixty-six children were recruited. A high prevalence of dental caries (78.8%) and an unmet treatment need of 90.4% were recorded among the participants. Most children had never visited the dentist, and those who did had mainly received emergency dental care.

CONCLUSION

The high prevalence of severe dental caries in this population highlights the need for oral health awareness and the inclusion of oral health care in the comprehensive care of children with HIV.

WHY THIS PAPER IS IMPORTANT TO PAEDIATRIC DENTISTS

The study highlights the importance of collaborating with health professions outside of dentistry. Doctors and nurses are often the first health professionals to come into contact with children with special needs. They should therefore be made aware of the early signs of decay so that these patients can be referred for dental treatment timeously. Holistic management of children with special healthcare needs is essential to improve their overall well-being.

Preventive dental care use for children with special health care needs in Washington's Access to Baby and Child Dentistry program

BACKGROUND

Preschool-aged children with special health care needs (CSHCN) from low-income households are at increased risk of developing poor oral health. The study goal was to assess preventive dental care use for CSHCN enrolled in Medicaid within Washington state's Access to Baby and Child Dentistry (ABCD) program.

METHODS

The authors analyzed 2012 Medicaid eligibility and claims files for children younger than 6 years in the ABCD program (N = 206,488). The authors used medical diagnosis and eligibility data to identify each child's special needs status (no or yes). The outcome was preventive dental care use (no or yes). The authors used modified Poisson regression models to estimate crude and covariate-adjusted prevalence rate ratios.

RESULTS

Of the 206,488 children in the study, 2.1% were CSHCN, and 114,570 used preventive dental care (55.5%). CSHCN used preventive care at rates similar to those of children without special health care needs (SHCN) (54.7% and 55.5%, respectively; P = .32). After adjustment for confounding variables, CSHCN were significantly less likely to use preventive dental care than were children without SHCN (prevalence rate ratio, 0.91; 95% confidence interval, 0.88 to 0.94; P < .001). Older preschool-aged children were significantly more likely to use preventive dental care than were younger preschool-aged children. A significantly higher proportion of preventive medical care users also used preventive dental care.

CONCLUSIONS

CSHCN who were enrolled in Medicaid in Washington's ABCD program were less likely to use preventive dental care than were children without SHCN who were enrolled in Medicaid.

PRACTICAL IMPLICATIONS

Future intervention research investigators should evaluate ways to improve access to preventive dental care for CSHCN. Additional strategies may be needed to improve oral health behaviors for preschool-aged CSHCN receiving Medicaid.

ORO-FACIAL FASCIAL SPACE INFECTION IN A PAEDIATRIC GAMBIAN POPULATION: A REVIEW OF 93 CASES

BACKGROUND

Oro-facial fascial space infection is known to be a clinical presentation of neglected dental care. The proportion of children with dental sepsis has also been known to increase markedly with caries experience. Such fascial space infection in the paediatric age group is known to progress rapidly within a short period and is thus potentially more fatal than in the adult population.

AIM

This study aimed to document and evaluate the pattern of oro-facial fascial space infection amongst paediatric Gambian population.

PATIENTS AND METHODS

The study was a 4-year descriptive retrospective survey of all patients with oro-facial fascial space infection seen and managed at the dental unit of the polyclinic attached to the Edward Francis Small Teaching Hospital in Banjul, The Gambia from May 2015 to April 2019. The information collated were patients' sociodemographic data as well as clinical features related to their medical and dental condition. The extracted data were analyzed using Statistical Package for Social Sciences (SPSS) version 15.0 (SPSS Inc, Chicago, IL). Absolute numbers and simple percentages were used to describe categorical variables. Quantitative variables were described using mean (with standard deviation), median and range. Categorical variables were compared using chi square test and numeric variables compared using student t-test. Differences were considered significant if p<0.05.

RESULTS

A total of 322 patients with oro-facial fascial space infection were managed within the period of the study out of whom 93 patients that met the inclusion criteria were studied. Their ages ranged from 3 months to 16 years, with a mean age of 8.5(SD2.1) years. There were 54 males and 39 females with a gender (M: F) ratio of 1.4: 1. All the patients presented with painful facial swelling and fever. Eighty-one (87.1%) had a history of toothache. The median number of fascial space involvement was 1 space; the submandibular space was involved unilaterally in 43 (46.2%) and bilaterally in 8 patients (8.6%). Eighty-one (87.1%) were odontogenic in origin and 12 (12.9%) were non-odontogenic. Seventy-two (88.89%) of odontogenic cases involved posterior teeth and 45 (62.5%) of these were the first permanent molars. Incision and decompression and teeth extraction were done for all the odontogenic cases. Staphylococci and/or streptococci were cultured from six patients. All the patients had inpatient treatment with a combination of intravenous amoxicillin, metronidazole and gentamicin treatment. Mortality rate was 5.4% (5 out of 93) and the mean age of patients who died, 3.0 (SD0.3) years, was significantly lower than that of those who survived, 8.3 (SD1.4) years, (p<0.0001).

CONCLUSION

The commonest symptoms of oro-facial fascial space infection in the Gambian paediatric population were fever, facial swelling and toothache. Most of the infections were odontogenic and affected most commonly the submandibular space. Posterior teeth were more commonly involved than the anterior, with the first permanent molar being the most commonly affected tooth. Incision and decompression were performed in all odontogenic cases, with extraction of all culprit teeth. All patients had in-patient treatment with intravenous amoxicillin, metronidazole and gentamicin. The mortality rate was 5.4%. The burden of dental caries with its complications is huge in the paediatric population of the Gambia. Training of dental surgeons and specialists and their auxiliaries with advocacy on the need for regular dental checkup for children, as well as prompt attention to dental diseases will help to reduce this scourge.

Sweetener content and cariogenic potential of pediatric oral medications: A literature

Sweetened oral medications are widely used for children to facilitate compliance. A variety of natural and artificial sweeteners are used in these drug formulations to augment the sweetness and thereby palatability of the product. There is growing concern among dentists about the increased consumption of sugars in these medications by children, especially those who are chronically ill as it may contribute to diabetes mellitus, dental erosion, and dental caries. This literature review provides information about the sweetener content and cariogenic potential of commonly prescribed pediatric oral medications that are used for managing acute and chronic conditions in children and measures for oral health prevention.

Pattern of management of oro-facial infection in children: A retrospective

BACKGROUND

The purpose of this study was to determine the distribution and management of orofacial infection in children treated at one of the major hospitals in Jeddah City, Saudi Arabia over a 12-month period during the year 2014.

METHODS

Data from the clinical records of 94 children (33 girls, 61 boys; aged 2-14 years) who presented for treatment of orofacial infection at the emergency dental department of the military hospital in Jeddah during a 12-month period. Patients were treated with antibiotic therapy. A favorable outcome was determined based on length of hospital stay.

RESULTS

The results indicated that the most common cause of odontogenic infection in Saudi children was dental caries (88%). The primary posterior teeth (84%) were considered to be a major source of infection. The most commonly affected teeth were the primary first molars (34%), followed by the primary second molars (31%). Six children were hospitalized; four of these stayed less than 4 days, which was considered a short hospital stay. The most common treatment was antibiotics as 93% received a type of antibiotic.

CONCLUSIONS

The most common cause of odontogenic infection was dental caries which has been treated with antibiotic prescription and dental procedures.

High prevalence of dental caries among HIV-infected children in West Africa compared to uninfected siblings

INTRODUCTION

The objectives of this study were to investigate the association between HIV infection and dental caries among children in West Africa, and to identify factors associated with dental caries among HIV-infected children.

METHODS

We conducted a multi-center cross-sectional study in Mali, Senegal and Côte d'Ivoire with a random sample of HIV-infected children aged 5-15 years on antiretroviral therapy and their uninfected siblings. A standardized examination was performed by calibrated dentists. The association between the number of decayed, missing or filled permanent and primary teeth surfaces (DMFdefS) and HIV status was investigated by fitting multivariable zero-inflated negative binomial models, for each age group (<12 and ≥12 years). Factors associated with dental caries could be investigated only for HIV-infected children <12 years old.

RESULTS

The sample included 420 HIV-infected children and 418 non-infected siblings. The median DMFdefS was 7 for the HIV-infected children and 2 for the uninfected siblings. The proportion of children with DMFdefS ≥1 was significantly higher among the HIV-infected children than uninfected children (86.0 percent versus 64.4 percent, P < 0.001). The HIV-infected children were less likely to be caries-free than the uninfected siblings in both age groups. We found a higher degree of caries experience among HIV-infected children < 12 years old, in whom it was associated with sweet drink consumption, history of night bottle use, immunosuppression, and younger age at study entry.

CONCLUSIONS

Although preventable, the burden of dental disease was high in children from families affected by HIV in West Africa and was associated with HIV infection and immunosuppression.

The Special Needs of Preterm Children - An Oral Health Perspective

Preterm births are defined as those before 37 weeks of gestation. With advances in fertility medicine and neonatal medicine, the numbers of preterm children in the community have significantly increased. Developmental delays and complications among preterm children are well recognized. Much less consideration is given to the dental complications of preterm children. Manifestations include palatal deformations, enamel defects, tooth size variations and tooth shape deformities, malocclusions, and increased risks of early childhood caries and tooth wear. This article explores orodental risks and orodental needs of preterm children and suggests preventive and management strategies for optimizing the oral health of special needs children.

Comparison of Dental Caries Experience in Children Suffering From Epilepsy with and without Administration of Long Term Liquid Oral Medication

INTRODUCTION

Sucrose is added as sweetening agent in liquid oral medication (LOM) to mask the acrid taste of medicines which may be potentially cariogenic. Many children under long term LOM therapy for treatment of epilepsy may be susceptible to dental caries.

AIM

To assess and compare dental caries experience in children under long term liquid oral medication with those not under such medication among 2-12 years old children suffering from epilepsy.

MATERIALS AND METHODS

A cross-sectional study was undertaken on a total of 84 children aged 2-12 years, who were suffering from epilepsy receiving liquid oral medication for more than 3 months were selected (study group) and for comparison 106 children of similar age group and disease but on other forms of medication were included as control group. Dental caries was assessed using DMFT/DMFS (Decayed, Missing, Fillled Teeth / Surfaces), dmft/dft and dmfs/dfs indices. One-way ANOVA and t-test were used with p-value fixed at 0.05. Univariate logistic regression was applied.

RESULTS

Children on LOM were at increased risk of dental caries than those with other forms of medications (OR: 2.55, 95% CI (2.37-4.15) p=0.000, HS). Caries prevalence was high in the study group (76.1%) when compared to control group (55.6%).

CONCLUSION

Long term use of liquid medicines containing sucrose is a risk factor for dental caries among children with epilepsy.

Periodontitis and systemic lupus erythematosus

A large number of studies have shown a potential association between periodontal and autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus (SLE). Similar mechanisms of tissue destruction concerning periodontitis and other autoimmune diseases have stimulated the study of a possible relationship between these conditions. This study aims to review the literature about this potential association and their different pathogenic mechanisms. Considering that periodontal disease is a disease characterized by inflammation influenced by infectious factors, such as SLE, it is plausible to suggest that SLE would influence periodontal disease and vice versa. However, this issue is not yet fully elucidated and several mechanisms have been proposed to explain this association, as deregulation mainly in innate immune system, with action of phagocytic cells and proinflammatory cytokines such as IL-1β and IL-18 in both conditions' pathogenesis, leading to tissue destruction. However, studies assessing the relationship between these diseases are scarce, and more studies focused on common immunological mechanisms should be conducted to further understanding.

Effectiveness of Various Sensory Input Methods in Dental Health Education Among Blind Children- A Comparative Study

AIM

The aim of the study is to evaluate effectiveness of various sensory input methods in dental health education among blind children. Oral hygiene status was assessed through visible plaque index and oral hygiene knowledge was assessed through questionnaire before and after oral health education.

MATERIALS AND METHODS

The study involved of 200 blind children with the age range of 8 to 14 years of both genders from two blind schools similar in standard of teaching. The total study population (n=200) was randomized and divided into five Groups, comprising of 40 children in each Group. The first four were the experimental Groups who received dental health education through different modes, while the fifth Group served as control. Oral health related knowledge and plaque scores were assessed in all the study Groups before and after dental health education.

RESULTS

After intervention, the mean knowledge scores and plaque scores were statistically significant in all the study Groups when compared to the baseline scores.

CONCLUSION

The present study proved that blind children can maintain an acceptable level of oral hygiene when taught with special customized methods like multisensory approach with creative use of other senses which was found to be effective than unisensory method.

Improving oral hygiene skills among children undergoing treatment at the haemato-oncology department - an interventional programme

OBJECTIVES

The aim of this interventional programme was to educate children undergoing treatment at the haemato-oncology department in how to improve their oral hygiene skills.

METHODS

Children (and their parents) treated at the haemato-oncology department for haematological malignancies and disorders were educated and instructed in how to improve their dental oral hygiene skills. Instructions, demonstration and practice of toothbrushing techniques, as well as interproximal cleaning, were carried out in three separate sessions. In each session, toothbrushing skills were evaluated using the Ashkenazi index to assess improvement in oral hygiene skills over time. Four assessments were performed and recorded for each participant: before the initial explanation; immediately following the explanation; and 3 and 6 weeks following the first visit.

RESULTS

Overall, 52 children were enrolled in the programme. The first toothbrushing performance skill evaluation revealed a low score of 10.44 out of a total of 40; this was significantly increased, following the instruction session, to 33.02 (P < 0.001). This improvement was maintained at the follow-up visits at 3 weeks (35.09 ± 6.3) and 6 weeks (36.34 ± 8.3). Following the instructions, a significant increase was accomplished in both 'reach' and 'stay' components of the score, to 18.44 out of 20 for 'reach' and 17.9 out of 20 for 'stay' at the last visit (P < 0.01).

CONCLUSIONS

Individual supervised toothbrushing education, including a methodological toothbrushing technique, appears to be very effective. Educating medically compromised high-risk patients, such as hospitalised children, might be a good way to improve oral health and prevent future disease in this population.

Oral health concerns with sweetened medicaments: Pediatricians' acuity

BACKGROUND

Administration of sweetened medicaments poses many oral health related problems in children due to the lack of awareness among the pediatricians regarding their ill effects.

PURPOSE

To assess pediatricians' awareness and attitudes toward the use of liquid pediatric medicines and their relationship with dental caries and erosion.

MATERIALS AND METHODS

A cross-sectional descriptive study was conducted among the pediatricians residing in Nellore city. Data were obtained from 55 pediatricians using questionnaires.

RESULTS

Among the respondents, 95.6% prescribed liquid medicaments, 51.1% expressed that they may be associated with dental effects, 60% were not aware regarding the sweetness of medicaments, whereas majority of them (77.8%) opined that children complained regarding the taste, 73.3% stated that sugar substitutes were used as sweetening agents, 70.9% believed that they were not acidic, 68.9% did not recommend brushing after intake of medicines, 90% failed to deliver oral health instructions, and 54.5% believed that lack of oral hygiene was a contributing factor for development of dental caries.

CONCLUSION

Majority of the respondents prescribed liquid medicaments and were unaware regarding the sweetening agents and acidity, which cause ill effects on the dental hard tissues. Most of them neither recommended nor delivered oral hygiene instructions (OHI) after prescribing sweetened liquid medicaments. Hence, OHI should be delivered to enhance the oral health related quality of life in children.

PERCEPTION AND EXPERIENCE AND OF NIGERIAN PAEDIATRICIANS TO DENTAL REFERRAL FOR CHILDREN WITH CHRONIC ILLNESSES

BACKGROUND

Interdisciplinary collaboration in the management of patients offers several advantages especially for children with chronic illnesses who are often at risk for other health conditions. Diseases in other parts of the body can be detected by a physician and lead to subsequent referral to the appropriate managing team. This study assessed the perception and experience of dental referral among Nigerian paediatricians as well as factors that may influence their decision to refer to a dentist.

METHODS

Self administered questionnaires were used to obtain socio-demographic data, history of exposure to dental teachings as well as experience with dental referral. Two hundred and sixty nine paediatricians and paediatric practitioners were involved in the study. Descriptive statistics and measures of central tendencies generated. Associations were tested with Chi Squares and Statistical significance was set at P <0.05.

RESULTS

A total of 269 respondents participated in the study out of whom 142(52.8%) trained at institutions where there was a sister dental school, but 243(90.3%) of them had no official dentistry postings. Majority of the respondents 259(96.3%) were in favour of routine professional oral check-up for children but only 83(30.9%) endorsed the recommended bi annual oral checks. A referral rate of 0.76-1.9% was obtained.

CONCLUSION

Although paediatricians are a known source of dental referral for children globally, a lot needs to be done to equip the physicians with the necessary knowledge and skill that will enable them participate more actively in the promotion of oral health for Nigerian children.

Clinical oral and salivary parameters of children with juvenile idiopathic arthritis

OBJECTIVE

To evaluate clinical oral and salivary parameters of individuals with juvenile idiopathic arthritis (JIA).

STUDY DESIGN

Clinical parameters and whole saliva were collected from children aged 6 to 12 years with JIA (n = 36) and from a healthy, matched control group (n = 36). The clinical and salivary parameters evaluated were the dental caries (decayed, missing, or filled teeth), gingival and simplified oral hygiene indices, salivary flow rate, pH, buffer capacity, total protein, and secretory immunoglobulin A concentrations.

RESULTS

JIA individuals presented poorer oral hygiene (P ≤ .05) but no difference in the dental caries and gingival indices. JIA patients presented an increase in total protein concentration (86%) and buffer capacity in the range of pH 6.9 to 6.0 (10%) and a reduction in initial pH (6%), buffer capacity in the range of pH ≥ 7.0 (50%), and immunoglobulin A concentration (27%) (P ≤ .05).

CONCLUSIONS

JIA is associated with poor oral hygiene and salivary changes, including reductions in immune factors and an altered profile of salivary buffer capacity.

Facilitators and barriers to twice daily tooth brushing among children with special health care needs

PURPOSE

The oral hygiene routines of preschool-age children with special health care needs (CSHCN) were examined to identify caregiver behaviors and beliefs associated with twice daily tooth brushing.

METHODS

Ninety caregivers of CSHCN, ages 23 to 62 months, were interviewed to determine supports or barriers to tooth brushing.

RESULTS

Ninety-eight percent of caregivers had begun brushing their child's teeth and half reported brushing twice daily. Caregivers' brushing skills and the availability of child-friendly supplies were associated with twice daily versus less frequent brushing (p = .02).

CONCLUSIONS

This study adds insight into the challenges of establishing daily oral health care for children who must rely on others for their care. The facilitators and barriers to tooth brushing by caregivers of CSHCN are similar to those noted previously among parents of typically developing children. Efforts to improve all caregivers' oral hygiene skills are needed. For caregivers of CSHCN, oral health teaching opportunities may exist among professionals who provide ongoing medical care, special services and therapies.

Oral health care in children with haemophilia in Helsinki, Finland

BACKGROUND

The bleeding tendency and fear of bleeds may have a negative effect on preventive dental care of patients with haemophilia both at home and at dental appointments.

AIM

To describe the clinical practice of dental care in children with haemophilia in Helsinki, Finland.

METHODS

This study evaluated retrospectively the medical records of 28 paediatric patients with haemophilia (aged 5.3-17.4 years) from dental visits during 2009-2010. Decayed, missing and filled teeth in the primary (dmft) and permanent dentition (DMFT), Community Periodontal Index (CPI), signs of developmental dental defects in enamel and the number of preventive and restorative procedures were gathered. Dmft + DMFT scores were compared with those of 17,079 non-haemophiliac boys. The Mann-Whitney U-test was used to compare the data between the groups of different severity of haemophilia.

RESULTS

The median number of dental visits per patient was three (range 1-11). Twenty-two patients (79 %) had dmft + DMFT-scores within the 95 % reference range for age. None of the children had a CPI >2. Twelve (43 %) patients had developmental enamel defects. Half had received restorative dental care and three out of four preventive procedures.

CONCLUSIONS

Dental care during hospital visits in children with haemophilia may enhance confidence in the preventive dental care and help minimise bleeding during dental procedures.

A case-control study of nutritional factors associated with chronic suppurative otitis media in Yemeni children

BACKGROUND/OBJECTIVES

Undernutrition and chronic suppurative otitis media (CSOM) in children are common in low resource settings, but there are few studies of their interactions. The aim is to evaluate nutritional factors associated with CSOM in Yemeni children.

SUBJECTS/METHODS

A case-control study of 75 children with CSOM and 74 healthy controls. Assessment included dietary history, anthropometry, haemoglobin (Hb) and serum analytes zinc (Zn), copper (Cu), selenium (Se), iron, calcium, phosphate (PO(4)) and total 25-hydroxy vitamin D (25(OH)D).

RESULTS

Cases had lower mean Z-scores for weight-for-age, weight-for-height, body mass index and mid-upper arm circumference (MUAC) (all P<0.05), and lower mean concentrations of serum Zn (P=0.032), Se (P<0.001) and calcium adjusted for albumin (P=0.026). Age-adjusted Hb and iron biomarkers did not differ between cases and controls. There was high prevalence of low serum Zn concentration (≥ 90%) and vitamin D deficiency in both cases (80%) and controls (96%). Duration of ear discharge was negatively correlated with total 25(OH)D (P=0.028), calcium adjusted for albumin (P<0.001), PO(4) (P=0.002), transferrin receptor/log ferritin ratio (P<0.001) and Cu (P<0.001), and positively correlated with child age and MUAC (both P<0.001).

CONCLUSIONS

Children with CSOM were more undernourished than controls with lower mean serum Zn, Se and calcium concentrations. Vitamin D-deficient and iron-replete children had longer duration of infection, although this association was lost with age adjustment. Trials evaluating specific micronutrients are required in order to investigate specific nutrient-infection interactions in CSOM.

Oral health care in CSHCN: state Medicaid policy considerations

OBJECTIVE

Low dental care service utilization among Medicaid-enrolled children has often been attributed to low Medicaid reimbursement levels. The purpose of this study was to provide estimates of preventive dental care utilization by Medicaid-enrolled children with special health care needs (CSHCN) and investigate the association of Medicaid preventive dental care reimbursement levels with the receipt of preventive dental care.

METHODS

We analyzed data for 40256 CSHCN (1-17 years of age). Unadjusted estimates of not needing, needing and receiving, and needing but not receiving preventive dental care are presented. Multilevel logistic regression models were fitted to examine associations between state Medicaid dental-procedure reimbursement and receipt of preventive dental care.

RESULTS

Some significant associations were found between state-level Medicaid dental-procedure reimbursements and receipt of preventive dental care. The strongest individual-level factor associated with not receiving needed preventive dental care was not receiving needed preventive medical care. Parents of Medicaid-enrolled CSHCN were less likely to report receiving needed preventive dental care and more likely to report not needing or not receiving preventive dental care than non-Medicaid-enrolled CSHCN.

CONCLUSIONS

Medicaid-enrolled CSHCN received less needed preventive dental care than non-Medicaid-enrolled CSHCN. An important link to receiving appropriate dental care may be the primary care provider. Raising the level of preventive dental care reimbursement along with other policy changes should increase the frequency of CSHCN receiving preventive dental services. State Medicaid agencies must develop models of medical-dental care management for CSHCN in their programs to ensure the most appropriate care.

Parental perspectives on preterm children's oral health behaviour and experience of dental care during preschool and early school years

BACKGROUND

Children born preterm (PT) have medical conditions and impairments that may affect their oral health. Hypothesis. Our hypothesis for the study was that PT children display more dental behaviour management problems (BMPs) and less favourable oral health behaviour than controls (C).

METHODS

Parents of 153 PT children and 153 C children were interviewed regarding the children's oral health behaviour and experience of dental care on two occasions, 2 years apart. The interviews concerned the preschool period and the early school years, respectively.

RESULTS

BMPs were more common in PT children of preschool age, but not during the early school years. Regarding oral health behaviour, there were no differences between the groups, except that PT children had more problems with toothbrushing than C children in the preschool period, in spite of the fact that the PT group reported more medical health problems and more anxious behaviour and indications of cognitive problems than the C group.

CONCLUSIONS

Children born PT exhibit several risk factors for both BMP and impaired oral health. It is essential that this group of patients is identified early and receives special attention from the dental services.

Preventive care utilization among children with and without special health care needs: associations with unmet need

OBJECTIVE

To compare attendance at preventive medical and dental visits for children with special health care needs (CSHCN) and children without special health care needs, and associations between attending visits and unmet need.

METHODS

We analyzed data on 102 353 children aged 0 to 17 years from the National Survey of Children's Health. We examined associations between attending preventive medical or dental visits and CSHCN status, and unmet need for medical or preventive dental care and attending preventive medical or dental visits.

RESULTS

Medical care-CSHCN were more likely than other children to attend a well-child visit (odds ratio [95% confidence interval], 1.45 [1.12-1.93] for 0 to 5 years, 1.99 [1.74-2.28] for 6 to 11 years, 1.84 [1.64-2.06] for 12 to 17 years). CSHCN aged 12 to 17 years attending a well-child visit had lower odds of unmet medical need (0.48 [0.27-0.85]) than CSHCN not attending visits; well-child visits and unmet need were not associated for younger age groups. Dental care-CSHCN aged 3 to 5 years were more likely than other children of similar ages to attend a preventive dental visit (1.26 [1.04-1.52]). CSHCN attending a preventive dental visit had lower odds of unmet preventive dental needs than CSHCN not attending visits (0.52 [0.28-0.93] for 3 to 5 years, 0.18 [0.12-0.28] for 6 to 11 years, 0.12 [0.08-0.17] for 12 to 17 years).

CONCLUSIONS

CSHCN attend preventive medical and dental visits at similar or higher rates than other children. CSHCN who attend visits are less likely to have unmet needs. Further research should examine differences in visit content for CSHCN and mechanisms whereby preventive care may reduce unmet need.

Parental perceptions of dental/oral health among children with and without special health care needs

OBJECTIVES

The aims of this study were to determine the prevalence of parent-reported preventive dental care and better dental health in children with special health care needs (CSHCN) and to identify parent-reported dental problems, reasons for lack of preventive dental care, and factors associated with receiving preventive care and having better perceived dental health in CSHCN. A comparison group of children without special needs (CWOSN) was included.

METHODS

We analyzed the 2003 National Survey of Children's Health by using a sample of 17,001 CSHCN and a comparison group of CWOSN. Descriptive and between-group chi-square statistics were used to analyze child characteristics, parent-perceived dental problems, and reasons for lack of preventive dental care. Factors associated with receipt of preventive dental care and better reported dental health were examined using logistic regression.

RESULTS

Approximately 80% of CSHCN and 72% of CWOSN received preventive dental care. CSHCN parents reported more dental problems and fewer described their children as having good to excellent dental health compared to CWOSN, despite greater odds of having dental coverage and receiving preventive dental care. Disparities were evident in preventive dental care and dental health based on income, education, and insurance coverage.

CONCLUSIONS

Most parents of CSHCN and CWOSN report that their children receive preventive dental care and have good to excellent dental health; however, disparities in dental health and receipt of preventive dental care exist. Accessing care coordination by using the medical/dental home model, particularly for CSHCN, may alleviate the situation in which some of the most vulnerable children are experiencing the worst dental health.

Ex vivo study of manual and rotary instrumentation techniques in human primary teeth

OBJECTIVE

This study aimed to evaluate, ex vivo, time and dentin removal by manual and rotary instrumentation in human primary teeth.

STUDY DESIGN

Eighty primary teeth were divided into 2 groups, embedded in resin, and sectioned for evaluation before and after instrumentation. For manual technique, teeth were prepared using K-type files and rotary preparation was performed with Hero 642. All root canals were prepared up to size 40, and the instrumentation time was recorded. Dentin removal was calculated using digital image software. Data was statistically analyzed using chi-squared, Mann-Whitney, and t tests.

RESULTS

Manual instrumentation removed more dentin in all groups compared with rotary instrumentation (P < .05). In some specimens, root perforations were observed in areas coinciding with largest root resorption. Rotary technique showed the shortest instrumentation time (P < .05).

CONCLUSIONS

Deciduous teeth, without significant root resorption, have enough root structure for instrumentation up to size 40. Rotary technique required less time and generated less dentin removal.

Oral health and the masticatory system in juvenile systemic lupus erythematosus

Our objectives were to evaluate the oral health and the masticatory system of 48 juvenile systemic lupus erythematosus (JSLE) patients and to compare them with 48 healthy children and adolescents. Demographic data, clinical manifestations and therapies of JSLE were reviewed. The DMFT index (DMFTI), the plaque (PI) and the gingival bleeding (GI) indices, dental relationship, facial profile, clinical dysfunction and mandibular mobility indices were evaluated. The two groups were homogeneous regarding age, gender, Brazilian social-economic class and dental decay index (P > 0.05). Of note, the medians of the PI and the GI were higher in JSLE patients than in controls (61.5 versus 38.10, P = 0.003 and 26.0 versus 15.95, P = 0.014; respectively). Likewise, a linear statistical correlation was evidenced between the JSLE duration and the GI (P = 0.017, r = 0.11), cumulative dose of prednisone and the PI (P = 0.01, r = 0.385) and cumulative dose of prednisone and the GI ( P = 0.001, r = 0.471). The clinical dysfunction and mandibular mobility indices were higher in JSLE patients versus controls (P = 0.002, P = 0.025). Moreover, the median of the mandibular mobility index was higher in JSLE patients who used at least one immunosuppressive than on those who did not use this medication (P = 0.0001). These results suggest that JSLE patients had an inadequate oral hygiene, higher incidence of gingivitis and temporomandibular joint dysfunction.

Strategic partnerships between academic dental institutions and communities

BACKGROUND

A landmark report from the U.S. surgeon general identified disparities in oral health care as an urgent and high-priority problem. A parallel development in the dental education community is the growing consensus that significant curriculum reform is long overdue.

METHODS

The authors performed a literature review and conducted a series of structured interviews with key institutional and community stakeholders from seven geographical regions of the United States. They investigated a wide range of partnerships between community-based dental clinics and academic dental institutions.

RESULTS

On the basis of their interviews and literature review, the authors identified common themes and made recommendations to the dental community to improve access to care while enhancing the dental curriculum.

CONCLUSIONS

Reducing disparities in access to oral health care and the need for reform of the dental curriculum may be addressed, in part, by a common solution: strategic partnerships between academic dental institutions and communities. Practice Implications. Organized dentistry and individual practitioners, along with other major stakeholders, can play a significant role in supporting reform of the dental curriculum and improving access to care.

Periodontal status and IOTN interventions among young hemophiliacs

Fifty-two young individuals suffering from severe haemophilia A and B volunteered to be compared with school- and college-going students for oral health status description and subsequent management. A total of 244 students (84.42% boys and 15.58% girls) with the age group of 13-23 years were divided into two groups, A and B (controls). The purpose of this study was to increase awareness about evidence-based dental practices by oral examinations followed by comparisons of periodontal health and prevalence of malocclusions among medically compromised students and healthy controls. Results described the oral health in severe haemophilic population to be compromised with combined simplified health index score of 0.50 and Decayed/Modified/Filled Teeth (DMFT) index score of 2.07 when compared with 0.42 and 0.95, respectively, among group B. Although prevalence of malocclusion and orthodontic treatment needs among group A were higher, yet it was not confirmed as a reason for degraded dental and periodontal status. However, spontaneous and/or toothbrush (trauma)-induced gingival bleeding episodes among group A could be explained as factors discouraging oral hygiene maintenance, particularly self-administered measures. Four haemophiliacs presented with symptoms of Temporomandibular Joint Dysfunction Syndrome (TMPDS). Evidence-based oral medicine and clinical practices need to be encouraged and applied to enhance the quality of life among haemophiliacs, particularly in developing world. Dental treatment needs of haemophilic population appear to be greater and maybe incorporated in routine dental practices, at institutional and individual levels.

Caries-related saliva properties in individuals with 22q11 deletion syndrome

OBJECTIVES

The aims were to compare saliva secretion rate, buffer capacity, cariogenic bacteria, total protein, IgA, and electrolytes between patients with 22q11 deletion syndrome (22q11DS) and control subjects and to study correlations between saliva and serum levels of IgA and electrolytes in 22q11DS patients.

STUDY DESIGN

Twenty-nine consecutive 22q11DS patients (mean age 12.6 years) and matched healthy control subjects were clinically examined, and stimulated saliva samples were collected.

RESULTS

Patients with 22q11DS had impaired salivary secretion rate (P < .01) and buffer capacity (P < .05), higher numbers of cariogenic bacteria (P < .01), increased saliva protein concentrations (P < .001), and reduced output of electrolytes (P < .001-.05) compared with control subjects. A correlation between concentration in serum and saliva was found only for IgA (r = .622; P < .01).

CONCLUSIONS

Different salivary components were affected in patients with 22q11DS, which may explain the increased caries risk seen in these patients.