Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis

Global prevalence of teething problems in infants and children-A systematic review and meta-analysis

BACKGROUND

Eruption of primary teeth is associated with local and systemic manifestations. Understanding the global prevalence is necessary to formulate the standard guidelines for management.

AIM

To evaluate the global prevalence of problems associated with teething in infants and children aged 0-36 months.

DESIGN

PubMed, LILACS, Web of Science, Scopus, and EMBASE were searched on May 31, 2023, and it was updated on January 31, 2024. Gray literature and reference search were performed. Cross-sectional, case-control, and cohort studies done in hospital or community settings, reporting the prevalence of signs and symptoms during the eruption of primary teeth in infants aged 0-36 months, were included. Two reviewers extracted data using a pre-piloted sheet. Data were analyzed and pooled by using random-effects meta-analyses.

RESULTS

Twenty-five studies were included. The global prevalence of teething problems was 80.0% (95% confidence interval [CI]: 67.8-89.9). The most common local symptom was increased biting (65.9%, 95% CI 37.5-89.3), and irritability (60.7%, 95% CI 50.6-70.3) was the most common general symptom.

CONCLUSION

The pooled prevalence of teething problems was estimated to be 80%. There was a variability in the prevalence of teething problems based on geographic location.

Exploring the factors driving higher interactions in false amber necklace posts on Facebook

The consumption and sharing of information on social media contribute to the circulation of false health content. In this sense, popular belief-driven posts recommending the use of amber necklaces to prevent symptoms of teething can be easily found on social media, even when they offer health risks for children. Accordingly, this study aimed to characterize posts in Portuguese by identifying message-based factors associated with higher user interactions of Facebook. A total of 500 Facebook posts published in Portuguese between August 2016 and August 2021 were retrieved by CrowdTangle, and analyzed quantitatively according to time of publication, total user interaction, and post overperforming score, and then qualitatively by two independent investigators, according to motivation, authors' profiles, and sentiment. The data were evaluated by descriptive analysis, Mann-Whitney U test, chi-square test, and multiple logistic regression models regarding interaction metrics. The posts were published predominantly by commercial profiles, with social, psychological, and financial motivations, and expressed positive sentiment. Furthermore, time of publication (OR=2.65), regular user profiles (OR=3.30), and neutral/negative sentiment (OR=2.76) were associated positively with total interactions, whereas only time of publication was associated with post overperforming scores (OR=1.65). In conclusion, Facebook posts promoting efficacy of amber necklaces in managing teething symptoms are primarily created by commercial profiles with vested interests in marketing the product. The key factors that contribute to the success of posts containing false information about amber necklaces on Facebook can be identified by considering the author's profile, sentiment, and time of publication.

Teething - filling in the gaps…

Dentists and dental care professionals may be faced with concerns from parents and carers regarding teething in infants and young children. Teething is a normal physiological and self-limiting process; however, the diverse signs and symptoms that have, over time, been attributed to teething, can make diagnosis challenging. Appropriate diagnosis is crucial in preventing the potentially life-threatening sequalae of dismissing symptoms as teething and delaying appropriate treatment of a systemically unwell child. Management of teething can be approached in a five-step process based on the National Institute for Health and Care Excellence clinical knowledge summary on teething. These include: 1) history-taking, clinical examination, diagnosis and referral of systemically unwell or severely distressed children for urgent medical review; 2) providing parental/carer reassurance, information and preventative advice; 3) simple, non-pharmacological management strategies; 4) pharmacological intervention; 5) safety-netting advice in case the child becomes systemically unwell, has prolonged symptoms, or is in severe distress. The purpose of this article is to bridge knowledge gaps regarding teething to enable appropriate diagnosis and encourage dissemination of preliminary information and ensure appropriate referral by frontline dental professionals.

Unjustified use of amber necklaces for teething symptoms alleviation: Succinic acid release underperforms compared with natural skin bacteria production

BACKGROUND

There is limited evidence of succinic acid release from amber necklace that justifies its biological plausibility.

AIM

This study aimed to evaluate the release of succinic acid from Baltic amber beads in the presence of Staphylococcus epidermidis.

DESIGN

The Baltic amber beads from the necklace were stratified according to their weight (average 0.05 g ± 0.067). Subsequently, the beads (n = 8) were submerged in 0.9% buffered saline (Control) or brain-heart infusion culture medium in the presence of a commercial strain of S. epidermidis, a resident skin bacterium incubated at 37°C for 24 h or 7 days. The samples were centrifuged, and the supernatants were analyzed by 1H Nuclear Magnetic Resonance. Multivariate analyses were adopted using the sparse partial least squares discriminant analysis method (p < .05).

RESULTS

The group incubated with saline solution showed small release of succinic acid only after 7 days. In the groups with S. epidermidis, the release of succinic acid was observed in the both presence and absence of amber beads, indicating that succinic acid is a product released by bacteria.

CONCLUSIONS

It was found that amber beads do not exhibit the ability to release expressive succinic acid, especially in a short period of time, which does not justify their use in infants. The most production of succinic acid is tributed to S. epidermidis.

Functional adaptation of the infant craniofacial system to mechanical loadings arising from masticatory forces

The morphology and biomechanics of infant crania undergo significant changes between the pre- and post-weaning phases due to increasing loading of the masticatory system. The aims of this study were to characterize the changes in muscle forces, bite forces and the pattern of mechanical strain and stress arising from the aforementioned forces across crania in the first 48 months of life using imaging and finite element methods. A total of 51 head computed tomography scans of normal individuals were collected and analysed from a larger database of 217 individuals. The estimated mean muscle forces of temporalis, masseter and medial pterygoid increase from 30.9 to 87.0 N, 25.6 to 69.6 N and 23.1 to 58.9 N, respectively (0-48 months). Maximum bite force increases from 90.5 to 184.2 N (3-48 months). There is a change in the pattern of strain and stress from the calvaria to the face during postnatal development. Overall, this study highlights the changes in the mechanics of the craniofacial system during normal development. It further raises questions as to how and what level of changes in the mechanical forces during the development can alter the morphology of the craniofacial system.

Unveiling deception: Characterizing false amber necklace messages on Facebook

BACKGROUND

Messages promoting the benefits of amber necklaces for children are common on social media, despite their health risks.

AIM

This study characterized Facebook posts with false content about the efficacy of amber necklaces in teething.

DESIGN

A sample of 500 English-language Facebook posts was analyzed by two investigators to determine the motivations, author's profile, and sentiments of posts. Latent Dirichlet Allocation topic modeling was used to identify salient terms and topics. An intertopic distance map was created to calculate the topic similarity. These data were analyzed using descriptive analysis, the Mann-Whitney U test, Cramer's V test, and multiple logistic regression models, regarding the time since initial posting and interaction metrics.

RESULTS

Most posts were made by business profiles and expressed positive sentiments, with social, psychological, and financial motivations. The posts were categorized into the topics "giveaway," "healing features," and "sales." Overperforming scores and total interaction increased with time since the initial posting. Posts with links had higher overperforming scores.

CONCLUSION

The findings suggest that Facebook posts about the efficacy of amber necklaces in teething are motivated by financial interests, using psychological and social mechanisms to achieve greater interaction with their target audience.

Parental beliefs in and attitudes toward teething signs and symptoms: A systematic review

BACKGROUND

Parents believe that teething is associated with signs and symptoms, which may induce them to give medications that could harm their children. Some children may require alleviation of symptoms and overall attention.

AIM

To assess parents' beliefs in and attitudes toward teething.

DESIGN

Through electronic databases and gray literature, this systematic review identified cross-sectional studies reporting parents' beliefs in, knowledge about, and attitudes toward the signs and symptoms of primary tooth eruption in children aged between 0 and 36 months. Three reviewers independently selected the studies, collected the information, assessed methodological quality, and checked for accuracy with disagreements solved by a fourth reviewer. The Agency of Research and Quality in Health questionnaire for cross-sectional studies was used for quality assessment. Descriptive analysis with median and interquartile ranges was adopted.

RESULTS

Twenty-nine studies comprising 10 524 participants from all geographic regions were included. The methodological quality of the studies was moderate. Most parents have beliefs in signs and symptoms during dentition, the most reported symptom being the desire to bite. Oral rehydration was the most exposed attitude in the studies included. Only a small proportion of parents reported no attitude.

CONCLUSIONS

The majority of parents believed in at least one sign or symptom associated with teething, and only few of them would do nothing or just wait for the signs or symptoms to pass, with no difference among countries (Protocol doi: 10.17605/OSF.IO/S2KZ3).

Worldwide prevalence of natal and neonatal teeth: Systematic review and meta-analysis

BACKGROUND

Identifying the presence of teeth in newborns is important as it may require immediate care. This study aimed to determine the worldwide prevalence of natal and neonatal teeth.

TYPE OF STUDIES REVIEWED

Six electronic databases and the gray literature were searched on February 23, 2023 to identify observational studies reporting the prevalence of natal or neonatal teeth. Studies assuming natal and neonatal teeth as identical terms or not reporting prevalence indicators were excluded. The methodological quality of the studies was assessed using the Joanna Briggs Institute checklist for studies reporting prevalence data. The worldwide prevalence of natal and neonatal teeth was estimated via proportion meta-analysis using a β-binomial model. Heterogeneity across studies was explored via subgroup analyses and meta-regression.

RESULTS

None of the 23 included studies fulfilled all items of the methodological quality checklist. The worldwide prevalence of natal teeth was 34.55 (95% CI, 20.12 to 59.26) per 10,000, and the prevalence of neonatal teeth was 4.52 (95% CI, 2.59 to 17.91) per 10,000. Subgroup analysis by continent showed that the prevalence of natal teeth ranged from 11.26 (95% CI, 7.58 to 16.61) per 10,000 in Asia through 75.32 (95% CI, 51.11 to 99.86) per 10,000 in North America, and the prevalence of neonatal teeth ranged from 3.52 (95% CI, 1.73 to 7.06) per 10,000 in Europe through 6.01 (95% CI, 2.25 to 16.60) per 10,000 in South America. Meta-regression did not find a statistically significant association between prevalence rates and year of publication or sample size.

PRACTICAL IMPLICATIONS

Approximately 1 in 289 newborns had natal teeth and 1 in 2,212 had neonatal teeth. Although this is not a high prevalence, professionals must be alert to identify these conditions, which often require immediate care.

NMR-Based Metabolomics Demonstrates a Metabolic Change during Early Developmental Stages from Healthy Infants to Young Children

The present study aims to identify the salivary metabolic profile of healthy infants and young children, and to correlate this with age, salivary gland maturation, and dentition. Forty-eight children were selected after clinical evaluation in which all intraoral structures were examined. Total unstimulated saliva was collected, and salivary metabolites were analyzed by 1H Nuclear Magnetic Resonance (NMR) at 25 °C. Partial least squares discriminant analysis (PLS-DA), orthogonal PLS-DA (O-PLS-DA), and univariate analysis were used, adopting a 95% confidence interval. The study showed a distinct salivary metabolomic profile related to age and developmental phase. The saliva of children in the pre-eruption teeth period showed a different metabolite profile than that of children after the eruption. However, more evident changes were observed in the saliva profile of children older than 30 months. Alanine, choline, ethanol, lactate, and sugar region were found in higher levels in the saliva of patients before 30 months old. Acetate, N-acetyl sugar, butyrate, caproate, creatinine, leucine, phenylalanine, propionate, valine, succinate, and valerate were found to be more abundant in the saliva of children after 30 months old. The saliva profile is a result of changes in age and dental eruption, and these findings can be useful for monitoring the physiological changes that occur in infancy.

Clinical manifestations of tooth eruption in the first year of life and related risk factors in three regions of Brazil: multicenter birth cohort study

PURPOSE

Estimate the incidence of teething symptoms and investigate risk factors at three centers in different regions of Brazil.

METHODS

A prospective cohort study enrolled children at birth in the cities of Manaus (northern region), Porto Alegre (southern region) and Salvador (northeast region). Sociodemographic and anthropometric variables were collected at baseline and 6 months. At 12 months, data were collected on the child's health through structured interviews and dental examinations, including the primary outcome: occurrence of signs and symptoms of tooth eruption reported by parents. Statistical analysis involved Poisson regression with robust variance, with calculation of relative risks (RR).

RESULTS

The incidence of teething symptoms was 82.4% (238/289). The multivariate analysis revealed a higher occurrence of the outcome in the city of Salvador (RR = 1.39; 95% CI 1.23-1.58), when mother's education was more than 11 years (RR = 1.31; 95% CI 1.04-1.65), when a larger number of individuals resided in the home (RR = 1.15; 95% CI 1.02-1.29), when a smoker resided in the home (RR = 1.16; 95% CI 1.03-1.31) and when the child presented flu or cold in the first year of life (RR = 1.23; 95% CI 1.09-1.38). The most reported symptoms were fever (50.5%), irritability (42.6%), itching (40.8%) and diarrhea (35.3%). Most parents (82%) took some action to alleviate symptoms, including unprescribed systemic medication, such as analgesic, anti-inflammatory and anti-diarrheic agents.

CONCLUSION

Reports of teething symptoms were associated with the city investigated, socioeconomic factors of the families and characteristics of the child's health. A high rate of administering unprescribed medication was also found.

Levels and correlates of knowledge of teething among Saudi Arabian families

Background

Parental knowledge of teething has been repeatedly investigated; however, little emphasis has been made on the associated sociodemographic factors with good knowledge of the parents and whether or not good knowledge is translated into adopting proper pain-relieving practices. The present study aims to firstly assess the knowledge level and practices of Saudi parents regarding teething and then explore associated sociodemographic variables with good knowledge of teething to determine the relation between parents' knowledge of teething and their adoption of pain-relieving practices.

Methods

This cross-sectional study recruited parents from the social networking sites Facebook, Twitter, Instagram, and WhatsApp, and they were asked to answer a pretested three-part internationally accepted questionnaire. Data were examined using descriptive statistics, chi-square analysis, multivariate logistic regression analysis, and Spearman rank-order correlation coefficient analysis.

Results

One thousand four hundred ninety-nine parents responded and returned completed questionnaires. Of those, only 11.2% had good knowledge of teething. The majority of parents did not have basic knowledge of the teething period as well as believed that teething was associated with a runny nose (87.5%), diarrhea (77.9%), and sleep disturbance (72%). The results of multivariate logistic regression analysis indicated that parents with no primary school education (Odds Ratio: 0.29), or those who had an intermediate or secondary education level (OR: 0.55 and 0.78) were less likely to have good knowledge compared with parents who had a university degree. However, parents who earned intermediate monthly income (OR: 6.63) were more likely to have good knowledge of teething. With regards to practices used to relieve teething pain, inappropriate practices were observed regarding bottle feeding at night to soothe the child's pain (72%) and applying topical analgesics to rub the gum (72.4%). A significant positive correlation was found between the knowledge score and the practice score of both fathers and mothers (r = 0.22 and 0.13, p < 0.0001).

Conclusion

A very low percentage of Saudi parents, mainly those with the highest education level and intermediate monthly income, had good knowledge of teething, which translated into appropriate practices to soothe the child's pain regardless of the parent's gender. Saudi parents should receive anticipatory guidance related to teething from all health professionals to ensure an uneventful teething period for their children.

A questionnaire-based study of Paediatric Dentists' knowledge of teething signs, symptoms and management

INTRODUCTION

Signs and symptoms attributed to erupting primary teeth are commonly known as "teething". Its existence is controversial with concern that overusing this term might mask other illnesses and some treatments may be unnecessary or harmful. Parents/carers can access over-the-counter remedies and may seek professional advice. This survey-based investigation explored gaps in knowledge, training, perceptions and experiences of UK Paediatric Dentists (PDs) regarding teething in young children.

METHOD

Cross-sectional study with a convenience sample of PDs with different training levels, accessed through the British Society for Paediatric Dentistry membership lists. A 10-item questionnaire explored participants' knowledge of teething-related issues and management. Responses are presented using descriptive statistics.

RESULTS

Of 80 responding PDs (response rate 27%), 62-74% suggested drooling, irritability, oral fixation and flushed cheeks were attributed to primary tooth eruption. Fifty-eight (72%) participants were unaware of guidelines, yet 53 (66%) felt guidance was needed.

CONCLUSION

Signs and symptoms of teething might mask underlying conditions so it should be a diagnosis of exclusion. PDs attributed similar signs and symptoms to teething, as have been reported in the literature, although some commented that they did not think teething was a condition. There was a lack of awareness over guidelines.

Symptoms of the Eruption of Permanent Teeth

This prospective study examined a population of 520 urban and rural children aged 5 to 9 years. Every 2−4 weeks, the clinical symptoms accompanying primary tooth replacement such as a cough, a runny nose, pain, and body temperature were assessed in each child’s medical records. The authors were able to show in a statistically significant manner that the frequency, time, and type of cough were strongly related to the type of erupting teeth (p < 0.001 for each relationship). A cough dependent on the type of erupting teeth was observed in 86% to 92% of the examined children, with a morning bronchial cough being connected with an eruption of the lower teeth, and an eruption of the upper teeth producing an all-day pharyngeal cough caused by mucus secretions dripping down the back of the throat. A statistically significant relationship was also confirmed between the type of erupting teeth and the incidence of a runny nose (p < 0.001), the frequency of a runny nose (p < 0.001), and the time when runny nose symptoms occurred (p < 0.001). This study shows that the period when primary dentition is replaced with permanent teeth in children is characterized by a physiological cough and a runny nose.

Use of the amber teething necklace by the child population: risks versus benefits

Objective:

Based on scientific evidence, the objective of the present study is to report the possible risks and benefits of the amber teething necklace for children who use it.

Data source:

This is an integrative literature review, carried out based on the following guiding question: “Does the amber teething necklace have therapeutic properties that justify its usage during tooth eruption?”. The consulted databases were LILACS (Latin American and Caribbean Health Sciences Literature) and PubMed (National Center for Biotechnology Information), with the following descriptors: “Amber,” “Deciduous teeth,” “Strangulation,” and “Local symptoms.”

Data synthesis:

A total of five scientific articles were selected, which indicates an insufficient basis regarding the benefits associated with the use of the amber teething necklace. Conversely, there is a convergence regarding the possibility of health risks such as strangulation, asphyxiation, and swallowing of beads.

Conclusions:

Health professionals should discourage the use of the amber teething necklace by children insofar more studies on the topic are carried out.

Australian care givers' knowledge of and attitudes towards paediatric fever management

AIM

Non-evidence-based practice and inappropriate paediatric fever management by care givers is common. The aim of this study was to survey a large sample of Australian parents and care givers utilising a validated Fever Management Tool, to determine the current knowledge, beliefs and attitudes of Australian care givers regarding fever management.

METHODS

This study employed a cross-sectional survey conducted via a third-party market research company. Univariate analysis of demographic factors and their influence on knowledge scores were tested. A multivariate linear regression model was specified using all available independent univariate predicators to determine the demographic factors influencing care givers fever knowledge.

RESULTS

Data from 1000 questionnaires were analysed. The participants' total knowledge scores were evenly distributed with a mean score of 15.4/29 correct answers in the True/False questionnaire, a median score of 16 and a standard deviation of 4.27. It highlighted that Australian care givers had poor knowledge in questions related to 'teething', 'physical cooling methods' and 'medication dosing'. In the multivariate analysis, 28.9% of the total variance was explained (R² value = 0.289, P < 0.001) with 5 of 11 factors contributing.

CONCLUSION

Overall, this cross-sectional survey has provided a strong understanding of the current knowledge, attitude and beliefs of Australian care givers in regards to fever management in their children. Total knowledge of fever management was generally poor in Australia with many participants harbouring misconceptions and non-evidence-based practices. Future interventions improving fever management practices should be tailored to the specific weaknesses faced by Australian care givers in order to promote long term change.

Uso do colar de âmbar pela população infantil: riscos x benefícios

Resumo Objetivo: Com base em evidências científicas, a proposta do presente trabalho é relatar os prováveis riscos e benefícios do uso do colar de âmbar pela população infantil. Fontes de dados: Trata-se de uma revisão integrativa da literatura, realizada a partir da elaboração da questão norteadora: “O colar de âmbar apresenta propriedades que justifiquem seu uso durante a erupção dentária?’’. As bases de dados utilizadas foram LILACS (Literatura Latino-americana e do Caribe em Ciências da Saúde), PubMed (National Center for Biotechnology Information), por meio dos descritores: Âmbar; Dentes decíduos; Estrangulamento; Sintomas locais. Síntese dos dados: Após a busca dos dados, foram selecionados cinco artigos, os quais apontam insuficiente embasamento científico que comprove os benefícios relacionados ao uso do colar de âmbar. Em contrapartida, existe uma convergência quanto à possibilidade de riscos à saúde, como estrangulamento, asfixia e deglutição das pedras. Conclusões: Conclui-se que os profissionais da saúde devem desencorajar o seu uso por crianças até que pesquisas clínicas bem delineadas sejam disponibilizadas.

Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age

Background

Irritability and discomfort are common symptoms during teething periods in infants and toddlers. Non-pharmacological remedies to relieve teething symptoms include teethers and food for chewing. However, the efficacy of such remedies for their soothing effect has been poorly investigated.

Materials and methods

In this home-based pilot study, the soothing effect of a novel edible teether with a slowly dissolvable texture was investigated in 12 children aged 5 to 19 months old during primary dentition age. After parents observed their child getting irritable, the child received the edible teether for an exposure duration of 15 to 20 minutes. Parental ratings of children's mood states (crankiness, stress, happiness, and calmness) were collected using visual analog scales, and child cardiac measurements (heart rate and heart rate variability) were assessed using a wearable device. The soothing effect was quantified via mood ratings and physiological calming responses as a before-after comparison using Wilcoxon signed-rank tests.

Results

Parents perceived their child as significantly calmer and happier, less stressed, and marginally less cranky after edible teether exposure than before. The child cardiac variables showed no significant changes; however, exposure to the teether induced a marginal increase in HR within normal ranges, potentially indicating a stimulation effect.

Conclusion

The pilot study provides the first insight on the soothing effect of a novel edible teether on parent-reported mood states in young children during primary dentition age. Further research is needed to understand the relative contribution of the different components of an edible teether to the observed effects, such as texture and exposure duration, and to demonstrate its efficacy against a control product.

Trial registration

Swiss registry of clinical trial: CER-VD 2019-02155.

How to cite this article

Lerond C, Hudry J, Zahar S, et al. Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age. Int J Clin Pediatr Dent 2021;14(4):525–530.

Extraoral exanthem revealing Gianotti-Crosti syndrome in a young child: A case report

We reported a case of a 14-month-old girl with erythematous and papulovesicular pink to red lesions on the face, the upper and the lower limbs. The history and the morphological features confirmed the diagnosis of Gianotti-Crosti syndrome.

Orofacial features in children with microcephaly associated with Zika virus: A scoping review

OBJECTIVE

To analyze published scientific evidence about the most common orofacial disorders in children with microcephaly associated with ZIKV infection.

METHODS

Through a scoping review, we respond to the search question was formulated: "What are the orofacial alterations in children with microcephaly associated with ZIKV?" It was performed a search in PubMed, EMBASE, Scopus, and Health Virtual Library. It was selected papers wrote in English, Portuguese, or Spanish. An evidence quality analysis was performed using the Agency for Healthcare Research and Quality classification.

RESULTS

It was included 11 studies performed in the Brazilian Northeast region. The studies were carried out between 2018 and 2020. The main related alterations were delay in the tooth-eruption and deformation in the oral structures.

CONCLUSION

The results observed in our work show moderate scientific evidence regarding the association of ZIKV with orofacial alterations in children with microcephaly due to the classifications of the quality of evidence of each one of the included studies. The main changes reported were in the chronology of tooth eruption, alteration in teeth, and oral structures.

Rare Case of Unerupted Second Deciduous Molar with Congenitally Missing Second Permanent Premolar: Case Report

Background/Aim: The purpose of this report is to present an unusual case of failure of eruption of a second deciduous molar and its management.

Case Report: An 8-year-old boy presented with a complaint of a missing tooth. Radiographic examination revealed the second deciduous molar was impacted without any mechanical obstacles, like an odontoma or supernumerary teeth, being present.

Conclusions: The case presented in this report is of scientific relevance due to the rarity of this type of pathology and the interesting histopathology.

Are teething gels safe or even necessary for our children? A review of the safety, efficacy and use of topical lidocaine teething gels

Lidocaine-based teething gels have been widely available in Australia for decades in both commercial preparations and those compounded by pharmacies. However, many case reports have highlighted potential risks and toxicity associated with lidocaine-based teething gels when used in infants and young children, including seizures, respiratory arrest and death. The Australian and New Zealand Society of Paediatric Dentistry and the American Academy of Paediatrics do not recommend topical agents for teething, and the US Food and Drug Administration does not recommend topical lidocaine for this purpose due to concerns of toxicity. Literature supporting the efficacy of lidocaine for teething is scant and difficult to interpret due to the flawed design of the trials conducted and varied formulations used. This opinion article aims to summarise the available literature showing the limited effectiveness and associated risks of topical lidocaine gels for use in teething. In light of these findings, the authors recommend that regulatory bodies such as the Australian Therapeutic Goods Administration review the efficacy and safety of this type of medicine and consider removing the indication for teething or limiting the age of use to older children.

Teeth: Small but Mighty and Mighty Important. A Comprehensive Review of Children's Dental Health for Primary Care Clinicians

Healthy teeth allow us to eat and stay well-nourished. Although primary care clinicians receive limited training about teeth, given the common nature of dental problems, it is important that they understand and recognize normal and abnormal dental conditions and can implement primary and secondary prevention of dental conditions in their practice. PubMed has been used to search the scientific literature for evidence on the following topics: normal dental development, dental abnormalities, malocclusion, teething, dental caries and related epidemiology and prevention, fluoride, dental injury and its management and prevention; and identification, prevention and treatment of gingivitis and periodontal disease. Literature review relied on randomized controlled trials, meta-analyses, systematic reviews, and Cochrane reviews when relevant and available. Other sources of evidence included cohort and case-control studies. Consensus statements and expert opinion were used when there was a paucity of high-quality research studies. The literature has been synthesized on these topics to make them relevant to pediatric primary care clinicians, and as available, the strength of evidence has been characterized when making clinical recommendations.

Teething symptoms in children with congenital Zika syndrome: A 2-year follow-up

BACKGROUND

The eruption of primary teeth represents a stage of many challenges for parents.

AIM

To investigate the occurrence of signs and symptoms related to the eruption of the primary dentition in children with congenital Zika syndrome.

DESIGN

Longitudinal study developed with 79 children followed up for a period of 24 months. Data on sex, gestational age, low birthweight, microcephaly, signs and symptoms related to the dental eruption phase, and use and type of medication were collected. Data were presented by descriptive and inferential statistics (chi-square test).

RESULTS

The majority (94.9%) exhibited simultaneously two or more signs and symptoms related to dental eruption. Increased salivation (91.1%), irritability (86.1%), and gingival itching (83.5%) were the most commonly reported signs and symptoms. Bivariate analysis showed association between elevation of body temperature and sex (P < 0.05). Almost two-thirds of mothers (63.3%) reported using medication to relieve symptoms presented by the child; however, the use of topical medication prevailed (57.1%).

CONCLUSION

All children with congenital Zika syndrome presented manifestations related to the eruption of primary teeth, with increased salivation, irritability, and gingival pruritus. The use of ointments and gels was the option of mothers in the treatment of the oral discomfort presented by infants.

Teething

Misconceptions about the teething process has led to high infant morbidity and mortality, which was recently experienced in Nigeria due to consumption of an adulterated drug used in the prevention and treatment of teething-related illnesses in infants. It is however, unknown if these misconceptions still persist in a rural town in Nigeria despite oral health awareness campaigns targeted at this. The aim of this study is to assess the beliefs and practices of residents in Igbo Ora, a rural township in Nigeria, regarding the teething process. A descriptive cross-sectional study was conducted among 393 adults in Igbo Ora using a 33-item, semistructured questionnaire. Symptoms such as diarrhea (80.7%), fever (69.2%), and boils (64.4%) were still considered as a must to accompany teething. Teething powder, teething syrup, and traditional concoctions were commonly recommended by (42.0%), (31.6%), and (48.1%) of the respondents, respectively, to treat and prevent teething symptoms. This study revealed that misconceptions about teething are still highly prevalent among the populace in Igbo Ora, and a structured oral health education intervention at the community level is urgently needed.