Pediatric dentistry最新文献

The purposes of this study were to access the prevalence of obstructive sleep apnea (OSA) in pediatric patients receiving nonotolaryngo-logic ambulatory surgery and to evaluate the probable association of OSA with the unexpected post-surgery hospital admission of these patients. As a retrospective cohort study data was gathered from the Pediatric Health Information System (PAIS) beginning January 1, 2010 and ending August 31, 2022. The patient population for the study included children less than 18 years old, who had nonotolaryngologic ambulatory surgery, with unexpected admissions which were described as equal or greater than one day of postoperative stay. Patients excluded from the study had diagnoses of sleep disordered breathing, cleft lip or palate needing repair, and snoring. Pediatric patients included in the study totaled 855,832 with 63 percent reported as male. For children diagnosed with OSA having unexpected post non-otolaryngologic surgery admissions 43.3 percent were ages six to 12 years, 35 percent were two to five years and 21.7 percent were equal or greater than 13 years. Study group findings recorded that 39,467 (4.6 percent) of the total children in the study experienced unexpected post-surgery admissions. From this total, 599 (4.0 percent) of the children had evidence of OSA, and needed unexpected post-surgery admission, while 38,828 (5.0 percent) had no evidence of OSA. Of the children with evidence of OSA, 544 (9.4 percent) had a known diagnosis of OSA. The odds risk for unexpected post-surgery admission for children with OSA was 2.56 times that of those without OSA (95%, CI 1.32-2.83; P<.001), this finding presented OSA as a significant risk factor. Also, over the time of the study there had been a less than four-fold increase of 0.4 percent in 2010 to 1.7 percent in 2022 (P trends <.001) in the number of children with OSA requiring unexpected post-surgery admissions after nonotolaryngologic ambulatory surgery. Knowledge of this information should help in patient selection for ambulatory surgery, decrease unexpected post-surgery admissions, increase family and patient satisfaction and patient safety and decrease the use and cost of healthcare resources.

Purpose: To evaluate the effectiveness of single-visit dentist-led cognitive behavioral therapy (CBT) in reducing dental fear and anxiety (DFA) and improving cooperation in children aged six to eight years undergoing dental treatment with and without local anesthesia (LA). Methods: Seventy-six children (six to eight years) with a Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) score of 38 or higher, needing dental treatment, either with LA (N equals 38) or without LA (n equals 38), were randomly divided into two groups: Group I received conventional behavior guidance techniques (control), and Group II received CBT. Dental procedures were video recorded. Anxiety and cooperation were assessed using Venham's clinical anxiety scale (VCAS) and Venham's clinical cooperation scale (VCCS), respectively. Pre-operative and post-operative pulse rate and CFSS-DS scores were recorded. Results: CBT significantly reduced CFSS-DS scores in children undergoing dental treatment with LA (P<0.001) and without LA (P=0.003). Post-operative VCAS and VCCS scores were comparatively lower in children who received CBT, irrespective of the treatment. Additionally, CBT significantly lowered VCCS scores in children undergoing treatment with LA (P=0.046). Conclusion: Cognitive behavioral therapy effectively reduced dental fear and anxiety in children undergoing dental treatment with and without local anesthesia and is a feasible behavior management strategy.

Purpose: To conduct a systematic review of artificial intelligence (AI) in aiding clinicians with the prediction and detection specifically for early childhood caries (ECC). Methods: A search was performed across PubMed^®, EMBASE^®, Scopus, Web of Science^TM, IEEE, and grey literature (Google Scholar) databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was utilized to evaluate the potential bias. Statistical analyses were performed using random effects models in STATA 17.0, with Metandi and MIDAS packages. Results: Of 350 identified studies, 21 met the inclusion criteria. Nine studies demonstrated a low risk of bias in all QUADAS-2 categories. Studies were divided into two cate- gories: detection of ECC (7 studies) and prediction of ECC (14 studies). For ECC detection, studies reported accuracy between 78 to 86 percent, sen- sitivity ranged from 67 to 96 percent, and specificity ranged from 81 to 99 percent. In prediction-focused research, accuracies varied widely from 60 to 100 percent, sensitivity from 20 to 100 percent, and specificity from 54 to 94 percent. Six studies with adequate data were selected for the meta-analysis. The combined sensitivity of these studies was calculated at 80 percent (95 percent confidence interval [95% CI] equals 0.84 to 0.95), while the combined specificity reached 81 percent (95% CI equals 0.67 to 0.90). The diagnostic odds ratios ranged from 4 to 83, with a median of 17. Conclusion: AIs diagnostic accuracy for early childhood caries matches that of experienced dentists, emphasizing AI's potential to significantly aid in the detection and prediction of ECC.

Purpose: To compare the efficacy of high-volume evacuation (HVE) with a standard tip to Isovac^® in reducing contamination. The changes in biological contamination on surfaces with distance and direction from the mouth were also examined. Methods: Children aged four to 17 years requiring an aerosol-producing restorative procedure on at least two primary and/or permanent teeth were included. For part one, 60 patients (Frankl score three or four) were randomly treated using HVE or Isovac^®. After seven minutes, the patient's napkin and operator's face mask were examined for contamination. For part two, samples were collected from 15 subjects at five locations at varying distances and directions from the mouth after 12 minutes. Surface contamination was quantified using ATP bioluminescence. Results: Isovac^® significantly reduced surface contamination versus HVE but only close to the patient. Contamination decreased rapidly with distance and was not greater than the control 18 inches from the mouth horizontally. More contamination was directed vertically than horizontally. There was no increase in contamination with longer preparation time. Conclusions: Surface contamination falls rapidly with distance. Isovac^® was only superior to standard high-volume evacuation close to the mouth, which may not be clinically important for providers.

Purpose: The purpose of this systematic review and meta-analysis was to assess the success of pulpotomies performed on primary teeth using mineral trioxide aggregate (MTA) and other calcium-silicate-based cements (CSC). Methods: A comprehensive search was conducted in six electronic databases. The selection of studies was guided by PICOS criteria and included only randomized clinical trials that evaluated the success of pulpotomy in primary teeth using MTA, compared with other CSC materials. Risk of bias was assessed using the RoB-2 tool, and meta-analyses were conducted using RevMan ^© 5.3 software. The GRADE tool was used to determine the certainty of evidence. Results: The initial search re- trieved 662 studies, resulting in 27 included studies. Although there was significantly higher radiographic success for MTA after 12 months versus Biodentine ^TM, the 24-month follow-up showed no significant difference. Also, no significant difference was observed between MTA and Portland cement (24 months) or TheraCal^® (12 months). Seventeen studies were classified as having a high risk of bias, and the GRADE assessment revealed an overall low level of evidence. Conclusions: Pulpotomies using mineral trioxide aggregate, Biodentine ^TM, Portland cement, or TheraCal^® are highly effective for managing primary teeth. The certainty of evidence supporting these findings remains low, and future work should focus on conducting better-designed long-term studies.

Purpose: The purpose of this in vitro study was to compare the microleakage of bulk-fill restoratives to the gold standard, preformed metal crowns (PMCs), in pulpotomized primary molars. Methods: Fifty-four extracted primary molars were selected, ensuring three intact walls and at least two-thirds root length. After caries removal and pulpotomy procedures, intermediate restorative material (IRM) was placed in the pulp chambers. Teeth were then randomly divided according to the final restoration into six groups (N equals nine): Group A-Activa^™ (glass ionomer liner, etching, bonding); Group B-Tetric ^® N-Ceram Bulk-Fill composite (liner, etching, bonding); Group C-Cention^® N (liner, etching, bond- ing); Group D-Cention^® N (liner); Group E-IRM; and Group F-PMCs (control). Specimens underwent 500 thermocycles and 24-hour immersion in one percent methylene blue dye at 37 degrees Celsius. Microleakage was assessed after mesio-distal sectioning using Kruskal-Wallis and Dunn's post hoc tests (P<0.05). Results: Group A-Activa^™ (mean rank equals 18.28) and Group C-Cention^® N, (mean rank equals 20.5) showed signifi- cantly lower leakage scores than Group E-IRM (mean rank equals 41.5; P=0.012 and 0.036, respectively). Group A -Activa^™ had the highest proportion of leakage-free samples (44.4 percent). Differences between Bulk-Fill materials groups and Group F-PMCs were statistically insigni- ficant. Microleakage trends decreased in order from Group A-Activa^™ to -C Cention^® N to B-Tetric^® N-Ceram Bulk-Fill composite to D- Cention^® N (liner) to F-PMCs. Conclusions: These preliminary in vitro findings provide evidence for one aspect of restorative success, suggesting that bulk-fill restoratives, particularly Activ^a™ and Cention^® N with adhesive, may be promising alternatives to preformed metal crowns for restoring pulpotomized primary molars for microleakage resistance. However, further parameter testing and clinical research are needed to confirm these findings.

Purpose: To compare the noise generated by different types of handpieces and isolation systems. Methods: Data were collected using a sound level meter (SLM) and noise dosimeter while preparing human teeth for stainless steel crowns using a high-speed handpiece and isolation/ evacuation for five minutes. The effects of the type of handpiece (air, electric) and isolation (rubber dam with high-speed evacuation, Dryshield) on noise were analyzed using two-way analysis of variance. Results: The sound level meter data showed that the air-driven handpiece with Dry-shield was statistically the loudest (equivalent continuous sound pressure level [LAeq] equals 80.7±0.7 dBA (P<0.001). The dosimeter data showed that both the air-driven handpiece with Dryshield and the electric handpiece with Dryshield were statistically the loudest (LAeq equals 84.9±1.1 dBA and 86±0.6 dBA, respectively; P<0.001 and P<0.001, respectively). There were no differences in peak sound levels between any of the groups (P>0.05). Conclusions: None of the pediatric dental instrument combinations studied reached the LAeq equals 90 dBA limitation for eight hours set by the Occupational Safety and Health Administration standards. Although the noise levels were not above regulatory safety limitations, practitioners should consider hearing protection based on individual exposure.

Purpose: The purpose of this study was to examine trends in primary and early permanent dentition treatment patterns and the relationships between them. Methods: A secondary data analysis was performed using Medicaid claims from 2011 to 2022 for North Carolina children ages zero to 12 years. Trends and expenditures of two primary dental treatment patterns were analyzed: early childhood caries (ECC), defined as treatment to primary maxillary incisors and/or primary first molars in zero- to five-year-olds; and late childhood caries (LCC), which comprised treatment to the proximal surfaces of primary molars in six to 12-year-olds. Trends in four early permanent dentition restorative treatment pat- terns were analyzed: (1) mesial surfaces of the permanent first molars; (2) pits and fissures of the permanent first molars; (3) maxillary anterior teeth; and (4) maxillary anterior and permanent first molars. The likelihood of children who had the listed restorative treatment to their early permanent dentition also having ECC and/or LCC treatment was investigated. Data analysis relied on descriptive statistics. Results: The proportion of children with LCC treatment and the yearly treatment expenditure were consistently two times more than that associated with ECC treatment throughout the 12-year period. Children who had early permanent dentition restorative treatment were, on average, two times as likely to have had LCC treament than ECC treatment. Conclusion: Future prevention and education strategies should target late childhood caries.