Peripheral oxygen saturation, heart rate, and blood pressure during dental treatment of children with cyanotic congenital heart disease

Association between single-nucleotide polymorphisms of NKX2.5 and congenital heart disease in Chinese population: A meta-analysis

NKX2.5 is a transcription factor that plays a key role in cardiovascular growth and development. Several independent studies have been previously conducted to investigate the association between the single-nucleotide polymorphism (SNP) 606G >C (rs3729753) in the coding region of NKX2.5 and congenital heart disease (CHD). However, the results of these studies have been inconsistent. Therefore, the present study aimed to reveal the relationship between NKX2.5 SNP 606G >C and the risk of CHD as possible in the Chinese population through meta-analysis. After retrieving related articles in PubMed, MEDLINE, EMBASE, Web of science, Cochrane, China National Knowledge Infrastructure, Wanfang DATA, and VIP database until August 2021, a total of eight studies were included in the present meta-analysis. The qualified research data were then merged into allele, dominant, recessive, heterozygous, homozygous, and additive models. Overall results of the current meta-analysis showed that 606G >C was not associated with CHD of the Chinese population in any model. In addition, subgroup analysis based on CHD type gave the same negative result. Results of sensitivity analysis showed that there was no significant correlation after the deletion of each study. Furthermore, it was noted that the results were negative and the heterogeneity was not significant. In conclusion, it was evident that NKX2-5 SNP 606G >C may not lead to the risk of CHD in Chinese population.

Pain perception of children after restorative treatments: Atraumatic restorative treatment versus chemomechanical removal - A noninferiority randomized clinical trial

BACKGROUND

Atraumatic restorative treatment (ART) and chemomechanical removal of dental caries have been shown to be safe and effective restorative procedures. However, current literature lacks well-design studies comparing the pain perceived by infants using ART and chemo-mechanical removal techniques.

AIMS

To compare pain perception of children of two techniques (ART vs. chemomechanical removal) of restorative treatments for dental caries removal.

SETTINGS AND DESIGN

A randomized clinical trial with two parallels arms (1:1) was conducted in the cities of Manaus (AM) and Uberlândia (MG), Brazil.

METHODS

Children between 4 and 9 years old were selected. In both groups - ART (n = 20) and chemomechanical caries removal (Papaya^® gel) (n = 20) - oximeter measurements (heart rate and blood oxygenation) were performed before the intervention and until the complete removal of the infected caries dentin. At the end of the treatment, a Wong-Baker scale was used to assess pain perception during the procedure. An independent researcher measured, in minutes, the duration of each technique.

STATISTICAL ANALYSIS

Poisson regression analysis was used to evaluate the association between the outcome and the explicative variables.

RESULTS

No statistical difference in pain perception between the two procedures of carious tissue removal was observed. By contrast, a lower heart rate was observed when chemomechanical removal was used (P = 0.013).

CONCLUSION

Children that underwent chemomechanical caries removal presented lower heart rate compared to those who underwent ART. However, both techniques showed minimal or absent perceived pain.

Physiologic and behavioural signs during a dental appointment in children and teenagers with Cerebral Palsy: a comparative cross-sectional study

AIM

To evaluate the heart rate (HR) and behaviour of children and teenagers with Cerebral Palsy (CP) when having a dental appointment.

METHODS

A comparative cross-sectional study was carried out with 60 participants with CP, between 2 and 14 years old (study group-SG), and 60 normotypical individuals (CG). The sample was paired according to age, gender and socioeconomic status. Behaviour was evaluated during dental prophylaxis using the Frankl Scale, and HR was measured at five moments: before the appointment, when sitting in the dental chair, during the clinical examination, during prophylaxis and immediately after prophylaxis. Mann-Whitney, Friedman and Chi-square tests were applied at a significance level of 5%.

RESULTS

SG presented significantly higher HR (p < 0.001) and more participants with uncooperative behaviour (p < 0.001) than CG in all observational periods. Furthermore, SG participants with uncooperative behaviour presented higher HR values than those in SG who were cooperative in all observational periods (p ≤ 0.002).

CONCLUSIONS

Individuals with CP have a higher HR before and during the clinical session, and are frequently more uncooperative with the procedure than normotypical individuals.

Dental management of pediatric patients affected by pulmonary atresia with ventricular septal defect: A scoping review

BACKGROUND

Congenital Heart Diseases (CHD) involves a wide range of pathological conditions, such as Pulmonary Atresia with Ventricle Septal Defect (PA/VSD). This disorder leads to the systemic circulation of oxygen-poor blood (cyanosis), with associated features and consequences in the oral cavity.

MATERIAL AND METHODS

Using scoping review methodology for screening and article selection, the primary objectives of this paper were as follows: first, to pose a research question; second, to identify relevant studies in order to answer the research question; third, to select and retrieve the studies; fourth, to chart the critical data, and finally, to collate, summarize, and report the results from the most important articles on the dental management of children affected with PA/VSD. Relevant articles (Randomized Controlled Trials [RCT], reviews, observational studies, and clinical case reports) published over a 10-year period were identified and retrieved from four Internet databases: PubMed; Embase/Ovid; Cochrane Library, and Google Scholar.

RESULTS

By title and abstract screening and after removing duplicates, 24 articles were finally included in the present scoping review. According to the extracted data, the following are the most important clinical issues to be considered when treating children with PA/VSD in the dental setting: prevalence of dental caries; prevention of dental disease (oral hygiene and diet); bacteremia and infective endocarditis risk, and child behavior control and treatment under general anesthesia.

CONCLUSIONS

Pediatric Dentists should bear in mind that early diagnosis and treatment, together a long-term follow-up of children with PA/VSD, continue to be the best approaches for achieving enhanced patient psychological well-being and, in consequence, their good quality of life.

Evaluation of treatment related fear using a newly developed fear scale for children: "Fear assessment picture scale" and its association with physiological response

Introduction:

Dental treatment is usually a poignant phenomenon for children. Projective scales are preferred over psychometric scales to recognize it, and to obtain the self-report from children.

Aims:

The aims were to evaluate treatment related fear using a newly developed fear scale for children, fear assessment picture scale (FAPS), and anxiety with colored version of modified facial affective scale (MFAS) - three faces along with physiologic responses (pulse rate and oxygen saturation) obtained by pulse oximeter before and during pulpectomy procedure.

Settings and Design:

Total, 60 children of age 6–8 years who were visiting the dental hospital for the first time and needed pulpectomy treatment were selected. Children selected were of sound physical, physiological, and mental condition. Two projective scales were used; one to assess fear - FAPS and to assess anxiety – colored version of MFAS - three faces. These were co-related with the physiological responses (oxygen saturation and pulse rate) of children obtained by pulse oximeter before and during the pulpectomy procedure.

Statistical Analysis Used:

Shapiro–Wilk test, McNemar's test, Wilcoxon signed ranks test, Kruskal–Wallis test, Mann–Whitney test were applied in the study.

Results:

The physiological responses showed association with FAPS and MFAS though not significant. However, oxygen saturation with MFAS showed a significant change between “no anxiety” and “some anxiety” as quantified by Kruskal–Wallis test value 6.287, P = 0.043 (<0.05) before pulpectomy procedure.

Conclusions:

The FAPS can prove to be a pragmatic tool in spotting the fear among young children. This test is easy and fast to apply on children and reduces the chair-side time.