Pediatric dentistry最新文献

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.

Purpose: This study investigated caries recurrence in young children in China who received multiple-visit outpatient dental treatment, and explored potential risk factors. Methods: A total of 371 one-to four-year-old outpatients with caries were recruited from seven pediatric dentistry clinics in Beijing, China. Oral examinations were performed, and medical and demographic information were recorded at baseline and at three, six, nine, and 12 months. This included the number of decayed teeth (dt), decayed surfaces (ds), demographic data, plaque index, Cariostat^® index, dental behavior, and oral health practices. According to caries recurrence, the children were divided into relapse and non-relapse groups, the data from which were compared to explore the potential risk factors related to caries relapse. Results: During the 12-month follow-up, the plaque index, Cariostat^®index, and behavior score of the children significantly improved compared to the baseline (P<0.05). However, 62.26 percent of the children experienced caries recurrence. No significant differences were found in parents' education level, children's age, sex, oral health practice, plaque index, or behavior score between the relapse and non-relapse groups (P>0.05). The Cariostat^® index at baseline and 12 months, frequency of sugar intake, and dt in the relapse group were significantly higher than for the non-relapse group (P<0.05). Conclusions: Young children's awareness and effectiveness in maintaining oral hygiene significantly improved during multiple visits. However, caries recurrence remained high, indicating that treatment and long-term maintenance of dental caries in this demographic still face considerable challenges. High frequency of sugar intake was an important risk factor for recurrence of caries.

Purpose: To evaluate the bond strengths of stainless steel molar bands (SSMBs) on NuSmile^® BioFlx^® crowns (BFCs) using glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), self-adhesive resin cement (SARC), and zinc polycarboxylate cement (PXC). Methods: Eighty BFCs (size 4) and SSMBs (size 35+) were closely fit on the crowns. Four different types of luting cements (20 per group: group one-GIC; group two-RMGIC; group three-SARC; and group four-PXC) were used to cement the SSMBs onto the BFCs. The bond strength between the SSMBs and the BFCs was tested using a universal testing machine. The adhesive remnant index (ARI) was used to quantify the residual cement on the crown surface to determine the mode of bond failure. One-way analysis of variance was used to compare the mean bond strengths between the groups, and the chi-square test was used to assess the predominant site of bond failure. Results: The mean bond strength was highest (2.76±0.07 MPa) and lowest (1.38±0.2 MPa) in the SARC and PXC groups, respectively. The bond strength was significantly different be- tween the groups (P<0.05). Bond failures were observed more frequently at the crown-cement interface in the SARC, RMGIC, and GIC groups and at the band-cement interface in the PXC group. SARC had the lowest ARI score, and PXC had the highest. Conclusion: Self-adhesive resin cement significantly had the highest bond strength and the lowest adhesive remnant score after debanding, followed by resin-modified glass ionomer cement, glass ionomer cement, and zinc polycarboxylate cement, respectively.

Purpose: This study aimed to evaluate clinical outcomes of digitally and orthodontically repositioned permanent incisors following extrusive and lateral luxation injuries. Methods: In this retrospective study, patient records from 105 permanent incisors with traumatic luxation injuries that were treated by means of digital (N equals 67) or orthodontic repositioning (N equals 38) were included. The main outcome was pulpal necrosis leading to the need for endodontic therapy. Cox-proportional regression was used to estimate the association between type of treatment and the main outcome, and a Kaplan-Meier plot comparing the survival of injured teeth in each group was obtained. Results: Most participants were boys (62 percent) with a mean age of 10 years. Fewer teeth in the orthodontic group (n equals eight versus n equals 27 in the digital) developed pulp necrosis requiring endodontic therapy (P=0.04). Although not statistically significant, multivariate analyses revealed that teeth treated by means of orthodontic reduction are less likely to develop pulpal necrosis (hazard ratio equals 0.47; 95 percent confidence interval equals 0.2 to 1.0). Conclusions: Acknowledging the limitations of this study, luxated permanent incisors treated via orthodontic repositioning may exhibit more favorable outcomes. Additional studies with various injuries are needed to establish universal adoption of management guidelines.

Purpose: To conduct a systematic review of the literature relating the influence of dental caries rehabilitation (DCR) on the oral health- related quality of life (OHRQoL) of children, adolescents, and families. Methods: Six databases, grey literature, Google Scholar, and manual search were accessed. Eligibility criteria (PICO) were outlined: P (population)-children, adolescents, and family; I (intervention)-DCR; C (comparison)- OHRQoL before and after DCR; O (outcome)-OHRQoL status after DCR. Two investigators independently applied the eligibility criteria, extracted qualitative data, and assessed the risk of bias. For quantitative data, a meta-analysis was conducted using the RevMan 5.4 program. The certainty of evidence was evaluated using the GRADE system. Results: Of 2,432 records, 35 were included, totaling 3,358 participants and 11 types of instruments. A total of 25 studies exhibited good methodological quality. The meta-analysis detected improvements in OHRQoL after DCR for children aged one to nine years (P<0.001; 95 percent confidence interval [95% CI] equals 1.47 [0.90 to 2.03]), four to nine years (P<0.001; 95% CI equals 1.23 [0.99 to 1.46]), and eight to 10 years (P<0.001; 95% equals CI 0.76 [0.46 to 1.06]), adolescents aged 11 to 15 years (P=0.03; 95% CI equals 0.75 [0.07 to 1.44]), and family from children aged one to nine years (P<0.001; 95% CI equals 1.02 [0.56 to 1.49]). However, the certainty of evidence was very low. Conclusions: Dental caries rehabilitation was associated with an improved oral health-related quality of life for children and adolescents aged one to 15 years and families with children aged one to nine years. This influence highlights the potential benefits of DCR interventions in reducing the negative effects of dental issues on daily life, although further research with higher-quality evidence is needed to strengthen these findings.

Purpose: To investigate the role of behavioral, familial, and psychosocial factors in the etiology of temporomandibular disorders (TMD) in children and adolescents. Methods: A cross-sectional observational study was conducted with 139 participants (70 TMD patients, 69 healthy controls) aged nine to 18 years and their parents. TMD diagnosis was made using the Diagnostic Criteria for TMD (DC/TMD). Psychosocial, behavioral, and familial status were evaluated using Patient Health Questionnaire-4 (PHQ-4), Oral Behavior Checklist (OBC), Child Behavior Checklist/4-18 (CBCL/4-18), Family Assessment Device (FAD), and Visual Analog Scale (VAS). Statistical analyses employed the Mann-Whitney U test, Pearson's chi-square test, and Spearman's rho correlation with a significance level of P<0.05. Results: TMD patients exhibited significantly higher PHQ-4, OBC, and CBCL/4-18 scores compared to controls (P<0.001). Social withdrawal and introversion problems, such as anxiety and depression, as well as extraversion scores, such as criminal and aggressive behaviors, and diligent control scores, were higher in the TMD group. FAD scores did not differ significantly between groups (P=0.315). A statistically significant positive correlation was observed between OBC and VAS scores (r equals 0.390, P=0.001). Conclusion: These findings suggest that psychosocial and behavioral factors may play an important role in the clinical profile of temporomandibular disorders and should be considered in their assessment and management. (Pediatr Dent 2025;47(4):240-6) Received December 23, 2024.