Dental and Dentoalveolar Injuries in the Pediatric Patient

Dental and dentoalveolar injuries are common in the pediatric population. Management is predicated on the type of tooth injured (primary or permanent), extent of injury, the dental and behavioral age of the patient, and ability of the patient to tolerate treatment. Although many dental injuries occur in isolation, a systematic evaluation of the patient is mandatory to confirm the absence of basal bone fractures of the maxilla or mandible, traumatic brain injury, cervical spine injury, and/or facial soft tissue injury. Long-term follow-up is paramount to achieving a functional occlusion and optimal dental health following injury.

Do Standard Bibliometric Measures Correlate with Academic Rank of Full-Time Pediatric Dentistry Faculty Members?

The aim of this cross-sectional study was to assess the relationship between quantitative measures of research productivity and academic rank for full-time pediatric dentistry faculty members in accredited U.S. and Canadian residency programs. For each pediatric dentist in the study group, academic rank and bibliometric factors derived from publicly available databases were recorded. Academic ranks were lecturer/instructor, assistant professor, associate professor, and professor. Bibliometric factors were mean total number of publications, mean total number of citations, maximum number of citations for a single work, and h-index (a measure of the impact of publications, determined by total number of publications h that had at least h citations each). The study sample was comprised of 267 pediatric dentists: 4% were lecturers/instructors, 44% were assistant professors, 30% were associate professors, and 22% were professors. The mean number of publications for the sample was 15.4±27.8. The mean number of citations was 218.4±482.0. The mean h-index was 4.9±6.6. The h-index was strongly correlated with academic rank (r=0.60, p=0.001). For this sample, an h-index of ≥3 was identified as a threshold for promotion to associate professor, and an h-index of ≥6 was identified as a threshold for promotion to professor. The h-index was strongly correlated with the academic rank of these pediatric dental faculty members, suggesting that this index may be considered a measure for promotion, along with a faculty member's quality and quantity of research, teaching, service, and clinical activities.

Is Canine Eruption Velocity Affected by the Presence of Allograft Within a Repaired Alveolar Cleft?

PURPOSE

To assess the rate of canine eruption in alveolar clefts repaired with cancellous autograft versus cancellous autograft mixed with allograft.

MATERIALS AND METHODS

This was a retrospective cohort study of patients in mixed dentition who underwent primary repair of uni- or bilateral alveolar cleft defects. Patients were divided into 2 groups based on the method of bony reconstruction (group 1, iliac crest autograft; group 2, iliac crest autograft harvested through a minimal access approach and mixed 1:2 with demineralized bone allograft). Secondary predictor variables were demographic and anatomic factors potentially related to canine eruption. The outcome variable was the velocity of canine eruption, measured as the change in vertical distance from the incisal edge to the maxillary occlusal plane (millimeters per month). Descriptive, bivariate, and linear regression statistics were computed.

RESULTS

The study sample included 57 alveolar cleft defects; 19 were repaired with autograft alone and 38 were repaired with autograft plus allograft. The sample's mean age was 9.9 ± 2.3 years at the time of repair. Thirty-one clefts (54.4%) were part of a bilateral deformity. Canine root formation was 50% complete at the time of surgery in most patients (59.6%). Mean duration of follow-up was 23.7 ± 13.2 months. Mean canine eruption velocity was 0.20 ± 0.18 mm per month and was not associated with the method of bony repair (P = .58).

CONCLUSION

The use of allograft bone to augment bone graft volume results in similar rates of canine eruption compared with autograft bone alone.

Are panoramic radiographs predictive of temporomandibular joint synovitis in children with juvenile idiopathic arthritis?

PURPOSE

To identify specific panoramic radiographic findings associated with temporomandibular joint (TMJ) synovitis in children with juvenile idiopathic arthritis (JIA).

MATERIALS AND METHODS

This was a retrospective study of children with JIA evaluated at Boston Children's Hospital. Patients were included if they had a confirmed diagnosis of JIA, a panoramic radiograph, and a contemporaneous TMJ magnetic resonance imaging (MRI) study with contrast. Medical records and imaging studies were reviewed to document demographic, panoramic (accentuated antegonial notch, short ramus and condyle unit [RCU] length, and abnormal condyle morphology: decreased condyle anteroposterior or superoinferior dimension) and MRI findings. The outcome variable was the presence or absence of TMJ synovitis on MRI. Descriptive and bivariate statistics and logistic regression models were used to identify associations (significant at P ≤ .05).

RESULTS

Thirty patients (21 girls) with a mean age of 11.1 years (range, 5 to 16 yr) met the inclusion criteria. Of these, 15 patients had MRI scans positive for synovitis (bilateral in 18 joints in 9 patients and unilateral in 6 joints in 6 patients). The remaining 15 patients did not have evidence of synovitis on MRI. In the synovitis group, 18 of 24 joints (75%) showed abnormal panoramic findings (abnormal condyle morphology in 18 joints, accentuated antegonial notch in 9 joints, or short RCU length in 5 joints). In the nonsynovitis group, 15 of 36 joints (42%) showed abnormal panoramic findings (abnormal condyle morphology in 12 joints, accentuated antegonial notch in 6 joints, or short RCU length in 4 joints). Abnormal condyle morphology and accentuated antegonial notching on panoramic radiographs were found to be significantly correlated with synovitis (P = .0005 and .044, respectively). In a logistic regression model, abnormal condyle morphology was significantly associated with an increase in likelihood of TMJ synovitis versus those joints with normal condyle morphology (P = .007). Joints with abnormal condyle morphology and accentuated antegonial notching were 7.5 times as likely to have synovitis (P = .009) versus those joints without abnormal panoramic findings.

CONCLUSION

Results of this preliminary study indicate that in this sample of children with JIA, the combination of abnormal condyle morphology and accentuated antegonial notching on a panoramic radiograph correlates with TMJ synovitis on MRI.

Differentiating arthritic from myofascial pain in children with juvenile idiopathic arthritis: preliminary report

PURPOSE

To differentiate between temporomandibular joint (TMJ) inflammation and myofascial pain (MPD) in children with juvenile idiopathic arthritis (JIA).

PATIENTS AND METHODS

We performed a retrospective study of children with JIA evaluated at Boston Children's Hospital, Boston, Massachusetts. Patients, aged 16 years or younger at the time of diagnosis, were included if they had confirmed JIA with jaw signs or symptoms. Medical records and imaging studies were reviewed to document demographic, clinical, and radiographic findings. Patients with clinical evidence (joint pain/tenderness, asymmetry, limited motion) and radiographic evidence (condylar asymmetry, flattening, accentuated antegonial notch) of TMJ inflammation but without muscle pain were diagnosed with arthritis. Those with only muscle tenderness and/or limited jaw motion were diagnosed with MPD. Patients with TMJ inflammation and muscle pain/tenderness were considered to have co-existing arthritis and MPD. Outcome variables were the presence of TMJ arthritis and/or MPD. Descriptive statistics were computed.

RESULTS

There were 61 patients (44 girls) with a mean age of 12.7 years (range, 3 to 16 years) who met the inclusion criteria. The most common clinical findings were limited mouth opening (n = 24), malocclusion/asymmetry (n = 23), and/or tenderness to palpation (n = 18). Twenty-one patients had multiple signs and symptoms. Panoramic radiographs showed condylar abnormalities in 32 patients. Overall, 21 patients (34.4%) were diagnosed with active TMJ arthritis, 21 (34.4%) with MPD, and 11 (18%) with both arthritis and MPD. Of the patients, 8 (13.1%) were in remission.

CONCLUSIONS

The results of this study indicate that in patients with JIA and jaw signs/symptoms, there is an overlap in diagnoses between arthritis and MPD. This has considerable implications for patient management.

Does a case completion curriculum influence dental students' clinical productivity?

The purpose of this study was to evaluate the effects of a new clinical curriculum on dental student productivity as measured by number of procedures performed in the student teaching practice. Harvard School of Dental Medicine adopted a new clinical education model for the predoctoral program in summer 2009 based upon a Case Completion Curriculum (CCC) rather than a discipline-based numeric threshold system. The two study groups (threshold group and case completion group) consisted of students who graduated in 2009 and 2010. Clinical performance was assessed by clinical productivity across five major discipline areas: periodontics, operative dentistry, removable prosthodontics, fixed prosthodontics, and endodontics. The relationships between the two study groups with regard to number of procedures performed by category revealed that the case completion group performed a significantly higher number of operative and removable prosthodontic procedures, but fewer periodontal and endodontic procedures (p≤0.03). No statistically significant difference in number of procedures was observed with fixed prosthodontic procedures between the two groups. Clinical productivity as a result of redesigning the clinical component of the curriculum varied in selected disciplines. The CCC, in which the comprehensive management of the patient was the priority, contributed to achieving a patient-based comprehensive care practice.