Child dental neglect: a short review

Pain assessment, cognitive and cortical changes with full mouth rehabilitation in a group of children

BACKGROUND

A change in professionals' perspectives on the value of general anesthesia (GA) for pediatric patients, including those with disabilities, medical conditions, severe oral issues, and challenging behaviors. Full-mouth rehabilitation under GA allows for the comprehensive treatment of all oral health problems in a single visit, without requiring the child's active participation. Extensive dental problems are often associated with severe dental pain, which can impact cognitive function, including perception, attention, memory, reasoning, language, communication, and executive functions. Individuals experiencing pain tend to perform less optimally cognitively.

AIM

This study aimed to investigate changes in cognition, brain function, and cortical alterations in children who underwent extensive dental rehabilitation under GA.

PATIENTS ANDMETHODS

Thirty uncooperative, healthy children aged 6-12 with extensive dental issues were enrolled. Pain levels were assessed using the FLACC and WBFPS scales before treatment, one week after, and three months later. Cognitive assessments, including the WCST, processing speed, digit span, and Trail Making Test, as well as EEG measurements, were also performed.

RESULTS

The results showed a significant improvement in pain levels reported by the children or their caregivers after the dental procedures, both at one week and three months. All cognitive measures, such as digit span, processing speed, and WCST performance, demonstrated substantial improvements after the treatment. The Trail Making Test also exhibited statistically significant variations before and after the dental procedures. Additionally, the MOCA test revealed a notable improvement in cognitive skills following the treatment. Furthermore, the EEG power ratio, an indicator of changes in the power balance within each frequency band, showed a statistically significant difference after the dental procedures.

CONCLUSION

the findings of this study suggest that full-mouth rehabilitation under GA can lead to improved pain management, as well as enhanced cognitive and brain functions in children.

FUTURE PERSPECTIVES

More clinical studies with a longer follow-up period and a different age range of children are required to investigate the connection between brain function and oral rehabilitation involving restorations or occlusion issues.

Child dental neglect and legal protections: a compendium of briefs from policy reviews in 26 countries and a special administrative region of China

Background

Child neglect is a public health, human rights, and social problem, with potentially devastating and costly consequences. The aim of this study was to: (1) summarize the oral health profile of children across the globe; (2) provide a brief overview of legal instruments that can offer children protection from dental neglect; and (3) discuss the effectiveness of these legal instruments.

Methods

We summarized and highlighted the caries profile and status of implementation of legislation on child dental neglect for 26 countries representing the World Health Organization regions: five countries in Africa (Nigeria, South Africa, Sudan, Tanzania, Zimbabwe), eight in the Americas (Argentina, Brazil, Canada, Chile, Mexico, Peru, Unites States of America, Uruguay), six in the Eastern Mediterranean (Egypt, Iran, Libya, Jordan, Qatar, Saudi Arabia), four in Europe (Italy, Latvia, Serbia, United Kingdom), two in South-East Asia (India and Indonesia) and one country (China) with its special administrative region (Hong Kong) in the Western Pacific.

Results

Twenty-five of the 26 countries have legal instruments to address child neglect. Only two (8.0%) of these 25 countries had specific legal instruments on child dental neglect. Although child neglect laws can be interpreted to establish a case of child dental neglect, the latter may be difficult to establish in countries where governments have not addressed barriers that limit children's access to oral healthcare. Where there are specific legal instruments to address child dental neglect, a supportive social ecosystem has also been built to facilitate children's access to oral healthcare. A supportive legal environment, however, does not seem to confer extra protection against risks for untreated dental caries.

Conclusions

The institution of specific country-level legislation on child dental neglect may not significantly reduce the national prevalence of untreated caries in children. It, however, increases the prospect for building a social ecosystem that may reduce the risk of untreated caries at the individual level. Social ecosystems to mitigate child dental neglect can be built when there is specific legislation against child dental neglect. It may be more effective to combine public health and human rights-based approaches, inclusive of an efficient criminal justice system to deal with child dental neglect.

Risk Factors Associated with Children Receiving Treatment at Emergency Dental Clinics: A Case-Control Study

(1) Background: The process of managing children at the emergency dental clinic (ER-C) is a difficult challenge. This matched case-control study assessed risk factors associated with children visiting the ER-C compared to visits at the regular dental clinic (RD-C). (2) Methods: The participants included 421 children aged three to 12 years who were recruited at the ER-C (cases) and RD-C (controls) at King Abdulaziz University Dental Hospital, with each group matched for gender and age. A data-collection form was developed and validated in both Arabic and English, containing the following four sections: DMFT/dmft index, Frankl’s behaviour rating scale, Dental Neglect Scale, and Dental Care Barriers questionnaire. (3) Results: The ER-C (vs RD-C) group showed significantly more uncooperative behaviour (p = 0.002), a higher total mean dental neglect score (p = 0.003), and a higher dental barrier score (p < 0.001). Binary regression analysis showed that those making their first visit (AOR: 2.65, p < 0.001) and with higher dental barriers (AOR: 1.121, p < 0.001) were statistically significantly more associated with ER-C visitation. (4) Conclusion: These findings suggest that children who visit the ER-C are more prone to dental care barriers, uncooperative behaviour, and dental neglect, thus highlighting the importance of encouraging and planning their attendance to ensure optimal dental care.

Dental Neglect and Its Perception in the Dental Practice

In 2020, the number of reported cases of child maltreatment in Germany has never been higher and most of them showed signs of neglect. Most of the time, dental neglect (DN) appears together with a general form of neglect, and includes, apart from caries, many other negative short- and long-term effects for the affected child. In this study, the prevalence of DN in Germany and the way dental practices are currently addressing the topic are examined. Moreover, this study explored whether the experiences of German dentists with DN are related to their work experience, their gender or further education about DN. The data was collected using an anonymous questionnaire. The hypotheses were tested using unpaired t-tests based on differences in mean values. The three most common reasons for a suspected case of child maltreatment were the interaction of children with parents, or a legal guardian, insufficient oral or general hygiene, and grave caries. Even though most of the participating dentists agree that it is the task of the dentist to report suspected cases of child maltreatment, only few of them have done so in the past themselves. Not only insecurity about recognition and whom to contact in the suspected case, but also concern about unfounded suspicion were the most common reasons not to report a suspected case of DN. The detection and communication of suspected cases should be encouraged in order to protect affected children.

Prevalence of dental neglect and associated risk factors in children and adolescents-A systematic review

BACKGROUND

Dental neglect (DN) is characterized within the wider framework of child neglect, though it is under-recognized by professionals.

AIM

To get an overview of the prevalence of DN worldwide and highlight the possible risk factors associated with it.

METHODS

A systematic review was conducted according to PRISMA guidelines. Studies on children and adolescents aged 0-19 years were included. Studies were identified by searching in the various scientific databases up to 14 January 2020.

RESULTS

Ten primary studies were included in which DN or indicators of DN were examined. The prevalence estimate range of DN reported by seven of the included studies after removing the outliers is from 34% to 56%. The prevalence of untreated caries reported by three of the included studies ranged from 38.9% to 99%. The education level and SES of parents and parental attitudes towards dental health affect children's oral health. Moreover, looked-after children and children of refugees are at higher risk of DN.

CONCLUSION

The study showed a high prevalence of DN and untreated caries. Due to the under-reporting of DN and a limited number of included studies, the results cannot be generalized worldwide. There is a need to make policies that include reporting of DN to higher authorities by dental professionals.

Evaluation of the Orofacial Features in the Victims of Abuse and Neglect of 5-16-Year-old Age Children

BACKGROUND

Oral cavity may be considered a pivotal focal point in physical assault or abuse because of its implication in communication and nutrition. Dentists trained in a child abuse curriculum can provide valuable information and assistance to physicians about oral and dental aspects of child abuse and neglect. The present study was conducted to evaluate the orofacial features of children between the age group of 5-16 years suspected to be victims of child abuse/neglect.

MATERIALS AND METHODS

This study was conducted on 250 children ranging between 5 and 16 years were enrolled in the study. All the participants were suspected to be victims of child abuse/neglect. The orofacial features were carefully examined by a well-trained dentist.

RESULTS

Two hundred and fifty children were enrolled in the study. Seventy-two children (30%) presented with laceration of various sites including lip (n = 13), frenum (n = 8), buccal mucosa (n = 26), palate (n = 16), and floor of the mouth (n = 9). Twenty-nine participants exhibited the features of avulsion (11.6%). Eighteen children revealed dento-alveolar fractures, 104 presented with dental caries (41.6%), 19 presented with missing teeth (7.6%), all the candidates presented with deposits (100%).

CONCLUSION

Careful intraoral and perioral examination of the participants victimized to abuse and/neglect is necessary as the oral cavity is a central focus for physical abuse, which may be allied to its importance in communication and nutrition. Physicians and dentists should work together to increase the prevention, detection, and treatment of these conditions.

Clinical Consequences of Dental Caries, Parents' Perception of Child's Oral Health and Attitudes towards Dental Visits in a Population of 7-Year-Old Children

This cross-sectional study aimed to assess the occurrence of the consequences of dental caries and factors affecting dental service utilization in a population of 7-year-old children. The research included oral examination of 7-year-old schoolchildren and socio-medical study of their parents/legal caregivers. It was carried out in five primary schools of two provinces, i.e., Greater Poland and Lubusz. Dental examination was performed in accordance with World Health Organization (WHO) recommendations. The socio-medical study consisted of questionnaires with close-ended questions concerning socioeconomic characteristics of the family, reasons and time of the last visit at the dental office, consequences of child’s oral health problems, parents’ attitude towards dental visits, and parental opinion about their child’s teeth. Factors affecting utilization of dental services were statistically analyzed using univariate logistic regression assuming p < 0.05. The pufa index of examined children ranged from 0 to 7 (mean 0.80 ± 1.49), while the dmf index ranged from 0 to 14 (3.86 ± 3.32). Low financial burden of oral health expenditures and university education of at least one of the parents significantly increased the chance of visiting a dentist despite lack of pain (OR = 3.0 and 2.5, respectively). In spite of the availability of free dental care for children, socioeconomic factors still determine the utilization of dental services in Poland. Poor oral health status of examined population and negligence of regular dental check-ups emphasize a need to strengthen oral health literacy of parents and children, promoting proper attitudes towards dental care.

The "Neglected" Relationship Between Child Maltreatment and Oral Health? An International Scoping Review of Research

Globally, the oral health needs of children who have, or are suspected of having, experienced abuse or neglect has become a focus of concern. It is thus valuable and timely to map the contemporary nature of the research landscape in this expanding field. This review reports the findings of a scoping review of the international empirical literature. The aim was to explore the relationship between child maltreatment and oral health and how this complex issue is addressed in contemporary dental, health, and social work practice. The review identified 68 papers, analysis of which identified three themes: (1) There is a relationship between poor oral health and child maltreatment that is well evidenced but conceptually underdeveloped. (2) There are discrepancies between the knowledge of members of the dental team about child maltreatment and their confidence and aptitude to identify and report child protection concerns. (3) There are areas of local-level policy and practice development that seek to improve working relationships between dentists and health and social work practitioners; however, there is widespread evidence that the oral health needs of this group of vulnerable children are not consistently met. To orientate critical discussion and planning for future research and practice, we present the Patterns, Advances, Gaps, Evidence for practice and Research recommendations (PAGER) framework. The review's findings are likely to be of interest to researchers, practitioners, and policy makers working across dentistry, health and social work.

Paediatric case of group A streptococcal pharyngitis, arthritis and osteomyelitis associated with dental neglect

Group A streptococcus (GAS) causes a wide variety of infections in the paediatric population, ranging from pharyngitis to rare but severe invasive diseases, such as bacterial arthritis and osteomyelitis. Dental neglect is a type of child neglect in which caregivers fail to provide adequate care and treatment for dental diseases. This results in poor oral hygiene and can lead to complications including sepsis. We report the case of a 4-year-old boy, suffering from child neglect, presenting with GAS pharyngitis and subsequent bacterial arthritis in the right ankle, osteomyelitis in the right talus and abscess in the right calcaneus. He was first treated with penicillin, which was changed to clindamycin because of a suspected drug-induced rash. He was discharged after 6 weeks of intravenous therapy when symptoms had resolved and inflammatory markers were within the normal range. The case highlights that dental neglect may present a risk for subsequent invasive infections.

Dental Neglect

Dental neglect can be an indicator of general child neglect. Inadequately treated dental disease may have significant long-term impacts on the physical and psychological well-being of children. Primary care providers play a critical role in the prevention of dental neglect, and should be aware of the manifestations of dental caries and dental trauma. When diagnosing dental neglect, health professionals should ensure the child's caregivers have demonstrated an understanding of the condition, its consequences, and the recommended treatment and then failed to comply with the treatment. Attempts should be made to eliminate any barriers preventing caretakers from complying with professional advice. Dental neglect is a form of child maltreatment and, if suspected, should be reported to the appropriate child protective agencies.

Child abuse and the role of a dentist in its identification, prevention and protection: A literature review

Child abuse, a reprehensible act, pervades all strata of society. Dentists are more likely to encounter such cases in their daily practice. However, such cases usually go unreported due to lack of adequate knowledge. Practitioners flinch from reporting these due to various reasons, and this sets up a vicious cycle which traps the victim leading to grave long-term consequences. This review aims to collect all literature available on PubMed, PubMed Central, MEDLINE, Google Scholar, and Google search engines on the role of dentists in child abuse identification and information and summarize these details. The review will shed light on the identification of abuse in dental settings, the various legal recourses and organizations related to it, and how dentists can better equip themselves to tackle such cases if they come across one. The review also makes certain recommendations by which dentists and healthcare providers in general can better prepare themselves for such contingencies.

Parents outlook on preventive dental modalities for their children in Udham Singh Nagar, India

AIM

The aim is to evaluate the knowledge, attitude, and practices of parents toward preventive dental treatment modalities.

METHODOLOGY

A convenient sample of parents was selected randomly from four schools of Udham Singh Nagar, India. The data were collected through questionnaire on dental preventive modalities. The questionnaire includes questions pertaining to knowledge and practices toward pit and fissure sealants, fluoride application, and dental visits. Questions pertaining attitude toward the same were asked after the motivational program.

RESULTS

The majority of the parents were unaware that dental caries could be prevented by preventive treatment modalities. None of their children had undergone preventive procedures. Even after visiting dentist, 70% of parents were not informed about the preventive treatments by their respective dentists. Even after our motivational program, around one-third of the parents were reluctant to accept preventive procedures for their children.

CONCLUSION

Parent's knowledge about the preventive dental procedures for their children was insufficient. Dentists are not encouraging parents about the benefits of preventive treatment modalities. Based on our findings, promotional efforts encouraged 64% of parents to embrace preventive procedures for their children. The present study emphasizes the need to educate parents and their children.

Bacterial Leakage of Mineral Trioxide Aggregate, Calcium-Enriched Mixture and Biodentine as Furcation Perforation Repair Materials in Primary Molars

Introduction:

Adequate seal of iatrogenically perforated area within the root canal system can improve the long term treatment prognosis. This in vitro study evaluated the sealing ability of mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement and Biodentine in repair of furcation perforation in primary molars.

Methods and Materials:

A total of 61 freshly extracted primary mandibular second molars were randomly divided into three groups (n=17) and 10 teeth were put in negative (without perforation, n=5) and positive (perforated without repair, n=5) control groups. Turbidity was used as the criteria of bacterial leakage, when detected in the model of dual-chamber leakage. Data were analyzed using the Chi-Square and Kaplan-Meier survival analysis in SPSS software. The level of significance was set at 0.05.

Results:

All positive samples showed turbidity, whereas none of the negative samples allowed bacterial leakage. There was no significant difference between the number of turbidity samples in repaired teeth with all test materials (P=0.13). No significant difference was also detected in the mean survival time (P>0.05).

Conclusion:

CEM cement and Biodentine showed promising results as perforation repair materials and can be recommended as suitable alternatives of MTA for repair of furcation perforation of primary molars.

Different Aspects of General Anesthesia in Pediatric Dentistry: A Review

Context

Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further.

Evidence Acquisition

A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings.

Results

Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical.

Conclusions

Besides criteria for case selection of dental GA, some degree of dental practitioner’s judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes.