Pediatric dentistry最新文献

Purpose: To compare oxygen saturation measurements when pulse oximeter sensors were simultaneously placed on the index finger and the second toe, and compare blood pressure recordings with non-invasive blood pressure (NIBP) cuffs simultaneously placed on the upper arm and the lower calf in children receiving general anesthesia. Methods: A total of 50 children, aged three to nine years, defined as ASA Class I or II receiving comprehensive dental treatment in the operating room with general anesthesia, were included. Pulse oximeter sensors were simultaneously placed on each subject's index finger and ipsilateral second toe. Non-invasive blood pressure cuffs were simultaneously placed on the upper arm and ipsilateral lower calf above the ankle. The same anesthesia regimen was used on all patients. Following induction of general anesthesia, measurements were simultaneously recorded every five minutes during the dental procedure. Results: Index finger oxygen saturation measurements were significantly lower than the second toe (P<0.001). Arm systolic blood pressure measurements were significantly lower than calf measurements (P<0.001). Arm diastolic blood pressure measurements were significantly lower than calf measurements (P<0.001). Conclusions: Discrepancy of vital sign measurements may be notable depending on the site from which measurements are obtained. If blood pressure is taken on the calf of a child in the Trendelenburg position, the reading will likely produce a higher systolic and diastolic measurement and should be interpreted with caution. A pulse oximeter placed on the first finger or second toe of healthy children can be regarded as interchangeable in a clinical setting.

Purpose: This study examines parental preferences for telehealth versus in-person follow-up visits after general anesthesia (GA) for children treated for dental caries. While GA is effective, it is costly and invasive, with high rates of recurrent caries and low follow-up. Telehealth may address barriers to follow-up care by improving accessibility and reducing travel burdens. Methods: A cross-sectional study was conducted with parents of children aged seven years and younger who underwent GA for dental caries at a university-based dental clinic. Participant data, collected via post-visit telephone survey, included demographics, visit modality preferences, and qualitative responses on motivators for modality preference. Quantitative and thematic analyses were performed to identify key factors associated with parental preferences. Results: Among 155 eligible children, 46 families participated. The majority (84.8 percent, n equals 39) preferred telehealth, citing flexibility, reduced transportation challenges, and ease of managing caregiver responsibilities. Those preferring in-person visits (15.2 percent, n equals seven) valued direct provider interaction and sought to avoid technology-related barriers. The mean distance to the clinic was significantly greater for the in-person group (104.2 km versus 49.6 km, P=0.017). Conclusions: The strong preference for telehealth suggests its potential to improve follow-up visit accessibility. However, implementation barriers must be addressed to ensure equitable telehealth integration.

Purpose: This systematic review and meta-analysis evaluated the clinical outcomes of prefabricated zirconia crowns (PZC) in primary teeth compared to stainless steel crowns (SSCs) and resin-based alternatives over six to 36 months. Methods: PubMed??, Google Scholar™, Web of Science®, Scopus, Embase®, and Cochrane Library® were searched for randomized clinical trials and observational studies. Cochrane risk of bias tool (RoB 2) and ROBINS-I were used for quality assessment. The pooled results were analyzed using either a fixed-effect model or a random-effects model, with the latter applied when heterogeneity was significant (I² >50%). Results: A total of 40 studies were included in the systematic review. Meta-analyses revealed comparable retention between PZCs and controls at six months (relative risk [RR] equals 1.04, 95 percent confidence interval [95% CI] equals 0.99 to 1.09, P=0.233) and 12 months (RR equals 1.03, 95% CI equals 0.98 to 1.08, P=0.11). Zirconia crowns showed non-significant improvement in gingival health (Cohen's d equals 1.85, 95% confidence interval equals -0.25 to 3.95, P=0.081) but significantly reduced plaque retention (RR equals 1.17, 95% confidence interval equals 1.02 to 1.34, P=0.025) at 12 months. Recurrent caries were equivalent (RR equals 1.02, 95% CI equals 0.98 to 1.05, P=0.26) and opposing tooth wear was insignificant (RR equals 0.96, 95% CI equals 0.91 to 1.00, P=0.091) at 12 months. Conclusion: While prefabricated zirconia crowns matched stainless steel crowns and resin-based alternatives in retention, gingival health, opposing tooth wear, and caries prevention, they provided superior outcomes in plaque resistance with moderate-certainty evidence.

Purpose: To examine dental general anesthesia (DGA) utilization patterns among children in Alberta, Canada, and identify factors contributing to the need for multiple DGAs (between 2010 and 2020). Methods: This retrospective population-based cohort study utilized administrative health data to investigate DGA usage among children (younger than 18 years). The study considered all children receiving DGA for oral and dentalrelated issues in publicly funded facilities, regardless of medical status. A descriptive statistic, binary logistic regression, Cox proportional regression, and Kaplan-Meier survival analysis were employed. Results: Among 30,523 children receiving DGA, the majority were younger than six years old (62.8 percent), were from low-income families (54.6 percent), and received treatment at urban hospitals. Most were medically healthy (91.2 percent) and received treatment for dental caries (77.1 percent), with restorations and extractions being the most frequent procedures. Significant predictors of multiple DGA events included younger age at first DGA, identification as having special health care needs (SHCNs), and the type of dental procedures performed during the first DGA. Conclusions: The findings of this study highlight the importance of considering patient characteristics and treatment factors when planning and delivering pediatric dental care. Special health care needs status emerged as a key factor associated with the likelihood of repeated dental general anesthesia, highlighting the need for tailored interventions and resource allocation to improve oral health equity in this population.

Purpose: To assess the current sedation practices among pediatric dentistry residents who completed their training from a children???s teaching hospital to align training methods for current residents. Methods: Using Standards for Quality Improvement Reporting Excellence guidelines, residency graduates were surveyed on current sedation practices. Information collected included demographics, year of residency completion, education experience, type of sedation medications used during residency and currently, emergency protocols, participation in continuing education courses, barriers to the provision of sedation, and clinical protocols. Descriptive statistics were completed, and information was utilized to update current sedation training protocols. Results: Fifty-four of 90 possible former residents responded, for a response of 60 percent. Thirteen respondents (24 percent) currently perform moderate sedation. Predominant sedation medication preferences have shifted from chloral hydrate to midazolam, meperidine, and hydroxyzine through the years. Conclusions: Feedback from previous learners and continual assessment of educational programs can help to align education with unsupervised practice after graduation. Changing trends in sedation practices highlight the crucial significance that residency program sedation curriculum and continuing education courses meet the needs of patients, thereby upholding a high standard of patient safety.

Purpose: This cross-sectional study investigated factors associated with attendance to general anesthesia (GA) appointments at an outpatient dental surgery center associated with a pediatric dentistry residency program. Methods: The study population included patients scheduled for dental care using GA from December 1, 2022, to December 1, 2023. Variables of interest were identified prior to initiation of the study, and data were collected from electronic health records. Results: During the 12 months of follow-up, a total of 543 patients completed their dental care with GA. Among the GA cases, 92 cancelled with at least 72 hours' notice, 105 canceled with less than 72 hours' notice, and 74 failed (noshow or late cancellation) to attend their appointment. There was no statistically significant association between attendance and sex or language. Patients aged between six and 11 years, with Medicaid, and who had the earliest check-in time (6:30 am to 9:30 am) and shortest distance (less than 20 miles) were less likely to keep their appointments. The most frequent reasons for late cancellation or no-show were illness (53 percent), fasting violation (4.4 percent), change in medical status (4.4 percent), insurance/finances (3.0 percent), and transportation (1.8 percent). Conclusions: A high percentage of patients in this study cancelled with short notice or no-showed for their appointments. This was primarily due to anesthesia-related factors such as illness and fasting violation, but logistical issues (transportation, weather, etc.) also impacted attendance.

Purpose: To develop permanent tooth vital pulp therapy (VPT) recommendations. Methods: GRADE framework recommendations developed from systematic review data of permanent tooth VPT through June 30, 2024. Results: Teeth with deep caries (extending to inner third or quarter of dentin with intact dentin barrier) diagnosed with normal pulp or reversible pulpitis (NP/RP) can be treated either with indirect pulp treatment (IPT), direct pup cap (DPC), partial pulpotomy (PP), or full pulpotomy (FP) (conditional recommendation, low certainty). Selective caries removal for IPT is strongly recommended (high certainty) for deep caries in NP/RP diagnosed teeth. In case of pulp exposure either DPC, PP, or FP using calcium silicate cement (CS) may be performed regardless of root maturation (conditional recommendation, low certainty). Using sodium hypochlorite (NaOCl) irrigation is strongly recommended for DPC hemostasis (high certainty) over saline and conditionally recommended (very low certainty) for pulpotomy. For permanent teeth with extremely deep caries (no discernible radiographic barrier) or deep carious teeth exhibiting spontaneous, nocturnal, or lingering pain but normal periapical appearance, complete (nonselective) caries removal to expose the pulp for assessment is strongly recommended (moderate certainty). If pulpotomy is indicated in these teeth, FP using CS is recommended over PP (conditional; low certainty). Also, PP and FP success will likely be higher if hemostasis occurs within six minutes (conditional; low certainty). Using magnification likely enhances pulp visualization, facilitating more accurate assessment of its status. Teeth with NP/RP having traumatic exposures, PP/FP is conditionally recommended over DPC. Using nonstaining CS is strongly recommended (high certainty) for VPT on teeth in esthetic areas. Conclusions: Selective caries removal is recommended for teeth having deep caries with NP/RP. CS utilization is recommended for DPC, PP, and FP using NaOCl for hemostasis. Complete caries removal and assessment of pulp status is recommended for teeth exhibiting spontaneous, nocturnal, or lingering pain; if pulp is diagnosed as vital and bleeding is controlled, FP is recommended.