Pediatric dentistry最新文献

Purpose: This cross-sectional study examined parents' (parents, caregivers) perceptions of animal-assisted therapy (AAT) for pediatric dental patients with special health care needs (SHCN) and whether it would be welcomed in pediatric dental clinics. Methods: One hundred parents of patients with SHCN completed an online survey assessing their interest in and expectations of and concerns about AAT in pediatric dental clinics. Chi-square tests compared the anticipated impact based on child anxiety, fear, and prior AAT experience. Results: Parents of children who were anxious (63%) or had prior AAT experience (49%) were significantly more likely to believe that AAT would reduce anxiety (P=0.006 and P=0.004, respectively). Perceptions of improved communication and overall experience varied by these factors. Conclusion: Parents perceived animal-assisted therapy as beneficial, anticipating reduced anxiety and enhanced dental visits.

Purpose: To compare dental services delivered to Medicaid-covered children by age (0 to 21 years old), health status, and rural and nonrural settings based on the treating provider (general [GP] and pediatric dentists [PD]) in Ohio, USA. Methods: A retrospective Medicaid claims review was completed for Ohio children covered by an accountable care organization (ACO), with a dental claim from 2021 to 2022. Descriptive statistics, bivariate analysis, and logistic regression were used to answer the study questions. Results: A total of 1,004 dentists treated 157,049 children. GPs outnumbered PDs 5 to 1 in the claims data. Median (M) number of children treated per dentist was 39 (M by GPs equals 34, M by PDs equals 107; P<0.001). Dentists who treated more than 100 children (n equals 376) treated 95% of the population. The age of the children treated did not differ based on rurality (P=0.49). More children treated were urban residents (3 to 1), but overwhelmingly more children in rural areas were seen by GPs than PDs (74.2% vs 51.0%; P<0.001). PDs had 16% increased odds of treating children with a complex medical condition, but this decreased in rural areas. Children from rural areas were 69% less likely to see a PD only (P<0.001). Conclusions: Age, health status, dentist type, and rurality all influenced access and types of treatment provided in this Medicaid population. Rural general practitioners were more likely to see younger children and those with medical conditions, suggesting less access to specialist care.

Purpose: This systematic review and meta-analysis aimed to assess and compare dental caries among adolescents aged 12 to 15 years worldwide residing in rural and urban areas. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, EMBASE, and Google Scholar. Studies reporting decayed, missing, filled teeth (DMFT) and decayed, missing, filled surfaces (DMFS) for permanent teeth scores for both urban and rural adolescents aged 12 to 15 years were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using Review Manager 5.3 software using a random-effects model, with standardized mean differences (SMD) and 95 percent confidence intervals (95% CI) calculated. Heterogeneity was assessed using the I² statistic, and certainty of evidence was evaluated using GRADE. Results: Fifty-four cross-sectional studies were included. Pooled analysis revealed significantly higher DMFT/DMFS scores in urban adolescents (SMD equals 0.34, 95% CI equals 0.22 to 0.46; P<0.001), with considerable heterogeneity (I² equals 99%). Subgroup analyses were conducted by geographical region, age group, and study publication period (past decade). Adolescents residing in urban areas exhibited higher dental caries in comparison to their rural counterparts, although regional variations were evident. Conclusions: Based on these findings, there is a need for context-specific oral health policies and tailored preventive strategies to address inequalities in both urban and rural populations aged 12 to 15 years.

Purpose: To compare the effectiveness and report on oral sedation-related events using three different multiagent regimens in pediatric patients up to 24 hours post-discharge. Methods: Sixty healthy 3- to 7-year-old patients were randomly allocated to 1 of 3 groups. Group 1 received midazolam, meperidine, and hydroxyzine (MZ/M/H; n equals 20). Group 2 received meperidine and hydroxyzine (M/H; n equals 20). Group 3 received midazolam and hydroxyzine (MZ/H; n equals 20). Nitrous oxide inhalation was concurrently used in all groups. After completion of sedation, the treating dentist answered survey 1 regarding the preoperative period until discharge. Parents completed 2 phone interviews at 8 and 24 hours post-discharge (surveys 2 and 3). Data analysis included chi-square, 1-way analysis of variance, and post-hoc tests (P<0.05). Results: Over-all, the 3 regimes were effective (90%). Group 1 showed a significant increase in slurring/difficulty speaking post-operatively and up to discharge (P=0.04). Groups 1 and 3 exhibited significantly greater difficulty walking on their own at discharge (P=0.02). Groups 1 and 2 experienced significantly increased lethargy (P=0.02) within 8 hours post-discharge. Overall musculoskeletal effects were significantly less prior to discharge in Group 2 (P=0.02), while gastrointestinal upset was significantly more in Group 1 at 24 hours post-discharge (P=0.01). Conclusions: This randomized clinical trial demonstrated that oral sedation regimens containing different combinations of midazolam, meperidine, and hydroxyzine are effective and relatively safe. Postoperative monitoring remains essential up to 24 hours. Longer postoperative monitoring may be required when a 3-medication regimen is used.

Purpose: To describe the clinical needs and care rendered to children participating in a virtual dental home (VDH) program at a rural school in Tuolumne County, CA, USA, from 2021 to 2023. Methods: The VDH pilot program, operated at a public elementary school in rural northern California and provided dental care using teledentistry for students from kindergarten through eighth grade. Data collection included an exported report of all data elements from the electronic health record. A single study clinician reviewed clinical notes and procedure codes to ensure accuracy in data exports for data collected in academic years 2021 to 2023. Descriptive statistics were generated for demographic characteristics, clinical needs, referrals, and care rendered. Results: A total of 53 patients were enrolled, with the majority classified as high caries risk. The program recorded 160 visits for 35 unique patients in the first academic year and 173 visits for 46 in the second. Over 87% of procedures completed were for examinations and preventive services. The program achieved several Healthy People 2030 oral health targets, including a high incidence of preventive dental visits and sealants. However, it underperformed in reducing the prevalence of untreated caries. Conclusions: The school-based virtual dental home program effectively provided preventive dental treatment, minimized barriers to care, and improved access to services in a Dental Health Provider Shortage Area. Teledentistry proved effective for pediatric dentistry in preventive treatment, minimally invasive care, and referrals, highlighting the potential of VDH models in reducing dental care gaps in underserved areas.

Purpose: The purpose of the study was to illustrate frequencies of opioid exposure (provision of opioids) for pediatric nontraumatic dental conditions (NTDC) in a hospital emergency department. Methods: A retrospective chart review of 737 pediatric NTDC emergency room patients aged 0 to 21 years old was conducted to evaluate opioid prescription associated with the emergency room visit. Binomial logistic regression, Fisher's exact test, and unadjusted and adjusted odds ratios were utilized for statistical analysis. Results: Opioids were provided to 85 (11.5%) NTDC patients. Those who were seen by a dental provider had an increased odds of opioid exposure for the NTDC (odds ratio [OR] equals 4.85; 95 percent confidence interval [95% CI] equals 2.93, 8.03). Subjects who were 14 years of age or older had increased odds of opioid exposure compared to younger patients (OR equals 8.09; 95% CI equals 4.22, 15.52). Conclusion: Opioid medications were provided to 1 1% of patients, with adolescents and young adults for nontraumatic until conditions having the highest exposures.

Purpose: To evaluate the effect of selective caries excavation and the application silver diammine fluoride (SDF) on marginal leakage of resin composite restorations. Methods: A total of 128 samples from deidentified carious and noncarious extracted teeth were randomly divided into 4 groups: Group 1-complete caries excavation with no SDF; Group 2-complete caries excavation with SDF application (Advantage Arrest ® silver diamine fluoride 38%, Elevate Oral Care, LLC; West Palm Beach, FL, USA); Group 3-selective caries excavation with no SDF application; Group 4-selective caries excavation with SDF application. Following a period of storage in distilled water, microleakage measurements were done using a stereo-optical microscope at 40X magnification at 2 points on each sample. The independent samples t-test and Mann-Whitney U test were used for assessing statistical significance. Results: A significant difference was found when comparing Groups 1 and 3 (P<0.001) and Groups 2 and 4 (P<0.001) for microleakage. No significant difference was observed when comparing Groups 1 and 2 (P=0.37 and P=0.69, respectively) or Groups 3 and 4 (P=0.39 and P=0.80, respectively) for microleakage assessments. A general positive trend in microleakage values was noted between the complete caries excavation Groups (1 and 2) and the partial caries excavation Groups (3 and 4). Conclusions: The results indicate a significant difference in microleakage between complete and partial caries excavation groups. There was no significant difference in microleakage values within the complete caries excavation Groups (1 and 2) and the selective caries excavation Groups (3 and 4), regardless of SDF application.