International journal of paediatric dentistry最新文献

As healthcare professionals there is a legal responsibility to provide support and make reasonable adjustments for patients with additional needs, such as autism and learning disabilities. Mind, a health charity, defines reasonable adjustments as ‘changes to prevent your disability putting you at a disadvantage compared with others who are not disabled’, this ensures equal access to services [1]. The Equality Act 2010 created a legal framework that reflects on accessibility to care for children and young people with additional needs [2]. In response, NHS England developed a Reasonable Adjustment Digital Flag on the NHS Spine, this allows health professionals to record and share reasonable adjustments an individual may need [3]. Guidance released in 2019 by Public Health England under ‘Oral Care and People with Learning Disabilities’, stated the importance of being ‘anticipatory’ with reasonable adjustments [4]. The Oliver McGowan mandatory training package was formulated to enable staff to understand autism from the perspective of the patient and how to make adjustments [5]. The patient journey through the paediatric dental department at University College Hospital London (UCLH) begins with a telephone assessment followed by a face-to-face assessment. A detailed patient history taken at the telephone appointment should help identify patients who may need reasonable adjustments and the support required.

To evaluate the existing pathway for patients with additional needs and make improvements that enhance the patient experience when attending the paediatric dental department.

This was a retrospective service evaluation with the data extracted from the hospital's electronic health record system (EHRS) by the author. Patients attending telephone and face-to-face new patient clinics in November 2023 were reviewed. Patients were identified as having additional needs through the referrals and information gathered at the telephone assessment. Inclusion criteria included all patients with neurodiversity, learning difficulties, developmental delay or complex medical histories. Patient records were reviewed to assess if a digital flag alert was present, if a 60-min appointment was requested and booked, and if reasonable adjustments were identified and recorded.

A second service evaluation was completed for patients seen in July 2024 and included a survey of staff on the use of the BSPD Autism Questionnaire, which was introduced as part of the action plan for the first evaluation [6]. The survey had three open questions, which were: likes, dislikes and recommended changes. This was completed by all staff groups involved in the care of patients with additional needs.

There were 26 children identified with AN in Evaluation 1 and 30 children in Evaluation 2 (Table 1). There were improvements in all areas evaluated between the first and second evaluations, pa

Between April 2023 and March 2024, 32 514 children in England were admitted to hospital with dental decay [1], with many of these admissions necessitating a general anaesthetic (GA) for dental treatment. As demand for this service results in often lengthy waiting lists, it is important that GA lists are used to capacity and cancellations minimised. To aid this, a robust pre-assessment process beginning at initial clinical assessment is needed; all children listed for GA should have a thorough medical history taken and a nurse-led pre-assessment prior to admission. However, where a child has a complex medical history or requires significant reasonable adjustments, a pre-assessment by a consultant anaesthetist may be required [2]. These anaesthetist-led pre-assessments are usually conducted via review of clinical notes, with or without an appointment. However, according to the Association of Paediatric Anaesthetists of Great Britain and Ireland, there is significant variation in the availability of these services around the United Kingdom [3].

The paediatric dentistry department in Leeds Teaching Hospitals Trust (LTHT), UK, has two GA pathways: an ‘extraction only’ list for fit and well children or those with mild systemic disease, and a pathway for medically complex children and comprehensive care treatment delivered at the Leeds Children's Hospital (LCH). Anaesthetist input for medically complex children is often requested as part of nurse-led pre-assessment [4], however, at LCH this additional input is requested by the dental clinician at the time of GA listing via an electronic listing form. This form becomes part of the patient's electronic record and is viewable by all specialities.

Prior to this evaluation, no local protocol existed to inform the criteria for referral. Anecdotally, high variation was observed in the quality of referral and the dental clinician decision to refer for anaesthetist pre-assessment. Concern had been raised by the pre-assessment anaesthetists that the paediatric dental team were referring more patients than other surgical specialties, and that limited quality of referrals may result in preparation issues leading to cancellations at short notice or on the day of GA. A service evaluation was therefore conducted to explore the pre-assessment pathway for these patients and their GA outcomes.

To evaluate and develop the pathway for consultant anaesthetic GA pre-assessments to improve referral quality and service utilisation.

Evaluation One included a retrospective review of all patients on the waiting list for GA at LCH in October 2022. Those on the extraction only pathway and those awaiting comprehensive care who were fit and well were excluded from analysis, as these children would not require anaesthetist-led pre-assessment. All records were reviewed and evaluated for referral to the pre-assessment service. The dental notes (including medi

Background: Moderate sedation is a behavior guidance technique in pediatric dentistry, and evaluating existing regimens can improve sedation outcomes and safety.

Aim: To determine if behavior at consult and sedation medication dosages is associated with sedation success and the patient's behavior using diazepam, meperidine, and hydroxyzine (DMH) regimen.

Design: A retrospective chart review of 324 patients who underwent 404 oral moderate sedations with (DMH) from April 2017 to June 2022. Sedations were graded as Successful or Unsuccessful and Positive (Frankl F3 or F4) or Negative (Frankl F1 or F2) behavior. Primary variables included Frankl behavior at consult and medication dosages. Logistic regression models were used to determine if these factors were associated with sedation success and behavior while adjusting for other patient and sedation characteristics.

Results: DMH yielded mostly successful sedations (89%) and Positive Behavior (Frankl F3 or F4) (72%). Lower Frankl scores at consult (OR: 2.3, p = 0.0140) were associated with increased odds of sedation failure. Increased age (OR: 0.8, p = 0.0047) was associated with decreased odds of failure. Meperidine dose demonstrated a significant association with improved sedation while controlling for age and behavior (p < 0.0001).

Conclusion: The (DMH) is an effective moderate sedation regimen. Patient selection is a significant factor in sedation success.

Background: Evidence suggests that pediatric patients requiring endodontic treatment in the permanent dentition are often a "missed population".

Aim: This study surveyed pediatric dentists and endodontists about the frequency with which they encounter pediatric patients requiring endodontic treatment, their training, practice patterns, and decision-making considerations for the treatment of immature permanent teeth.

Design: Surveys were distributed to endodontists (n = 2457) and pediatric dentists (n = 3974) in the United States. Data were analyzed using descriptive statistics and X² analysis. The level of significance was set at 0.05.

Results: The response rate was 13.1% (n = 840). The frequency of clinicians encountering pediatric patients requiring endodontic treatment for permanent teeth did not differ significantly by specialty. Pediatric dentists and endodontists reported statistically significant differences in their practice patterns related to the performance of vital pulp therapy (p < 0.001) and procedures for necrotic immature permanent teeth (p < 0.001). Among specialists, apexification was more frequently performed than regenerative endodontic procedures (REPs) (p < 0.001). When asked to consider clinical and patient factors related to the treatment of necrotic immature permanent teeth, pediatric dentists most frequently responded that they were "unsure" of their preferred treatment.

Conclusion: Standardized clinical knowledge and management of immature permanent teeth between specialties may improve interdisciplinary care for pediatric patients.

Background: Molar incisor hypomineralization (MIH) is associated with enamel's existing qualitative developmental defects.

Aim: This study aimed to assess the cortical and trabecular mandibular bone morphology in pediatric patients with MIH using fractal analysis (FA) and digital panoramic radiography (DPR) with various radiomorphometric indices.

Design: A total of 75 patients, including 39 in the MIH group (MIHG) and 36 in the control group (CG), underwent clinical and radiographic examination. Three regions of interest (ROIs) were analyzed: ROI1 (mandibular ramus), ROI2 (mandibular angle), and ROI3 (mandibular anterior). Radiomorphometric measurements included mandibular cortical width (MCW), panoramic mandibular index (PMI), and mandibular cortical index (MCI). Statistical significance was defined as p < 0.05.

Results: The study revealed that the right and left MCW and PMI measurements in the CG were significantly higher compared with the MIHG (p = 0.002, p < 0.001; p = 0.022; p = 0.003). However, fractal dimension (FD) analysis of the trabecular bone structure showed no significant differences between the groups across all ROIs (p > 0.05).

Conclusions: MIH may be associated with bone development due to shared developmental factors, and the assessment of MCW and PMI in DPRs can contribute to a multidisciplinary diagnosis and treatment approach based on the growth and developmental dynamics of pediatric patients.

Background: The use of fluoride-free mouthwashes (FFM) can adversely affect the anticaries benefits of fluoride toothpaste.

Aim: This study investigated (i) the impact of FFM on the anticaries benefits of fluoride toothpaste and (ii) differences in enamel-lesion assessment between two TMR techniques.

Design: The study followed a 2 (technique) × 2 (toothpaste) × 4 (mouthwash) factorial design. Toothpaste (1100 ppm F) contained either NaF or SnF₂. Mouthwashes contained CPC or EOs. Control mouthwashes were DIW and not washed after toothpaste. Two TMR techniques, conventional specimens and single sections of enamel (n = 8), were utilized. During the 5-day/pH cycling, the specimens with artificial caries-like lesions were treated two times/day with toothpaste/1 min, followed by mouthwash/30s. There was a 4 h demineralization/day. Integrated mineral loss (ΔΔZ) and lesion depth (ΔL) were determined. Data were analyzed using three-way ANOVA.

Results: There was no statistically significant interaction between the three factors for ΔΔZ (p = 0.894) or ΔL (p = 0.410) and no difference between toothpaste for ΔΔZ (p = 0.977) or ΔL (p = 0.507). However, mouthwashes affected ΔΔZ and ΔL (both p < 0.001). The non-wash group resulted in the most remineralization. The technique did not affect ΔΔZ (p = 0.973).

Conclusion: Fluoride-free mouthwashes may decrease the remineralization potential of fluoride toothpaste, and the single-section technique is a suitable alternative in caries research. Pediatric dentists can emphasize proper hygiene and parental guidance in supervising children's brushing/rinsing.

Objective: To assess the prevalence and risk factors of chemotherapy-induced oral mucositis in 470 children with acute lymphoblastic leukemia in China, focusing on treatment-related risk factors.

Methods: This cross-sectional study included 470 children diagnosed with acute lymphoblastic leukemia in China from January 2020 to July 2022. Data were collected from electronic medical records, field investigations, and telephone follow-ups, covering sociodemographic characteristics, nutritional status, disease and treatment history, and microbiological factors. Univariate and multivariate logistic analyses were used to evaluate the association between the occurrence and severity of chemotherapy-induced oral mucositis and these variables.

Results: The prevalence of chemotherapy-induced oral mucositis was 45.1%. Significant risk factors included receiving more than five chemotherapy cycles (p < 0.001), carrying HSV-1 (p = 0.016), infection with Candida albicans (p = 0.012), undergoing chemotherapy with specific drugs containing methotrexate/daunorubicin/cytarabine (p < 0.001), having a high clinical risk stratification (p = 0.002), and being over 6 years old (p = 0.002). The severity of chemotherapy-induced oral mucositis was associated with consolidation and intensification period (p = 0.001) and B-cell immune stratification (p < 0.001).

Conclusion: The prevalence of chemotherapy-induced oral mucositis in children with acute lymphoblastic leukemia is relatively high. It emphasizes the importance of clinical medical staff paying attention to this issue and adopting targeted interventions to reduce the prevalence of oral mucositis in this patient population.

Background: Health-related outcomes in children can be associated with parental practices.

Aim: The aim of this study was to investigate if parent-child interactions and stimulation are predictive of oral health-compromising behaviors at the age of 5 years.

Design: This longitudinal study investigated oral health-compromising factors at the age of 5 years as the outcome: sugar intake between meals more than once a day, no dental appointments or appointments only for treatment, unavailability of the mother to brush her child's teeth, and the presence of dental plaque. Exposure was child stimulation at 24 months. The association was tested using ordinal logistic regression, yielding odds ratios (OR) and 95% confidence intervals (CI).

Results: A total of 1128 children were evaluated, and 46.2% had four or five positive interactions/stimulation practices. More than 80% of the mothers reported that their children had a high sugar intake and had never been to a dentist for treatment. Children with low stimulation had 1.29 greater odds of changing from no health-compromising behaviors to one or more (OR 1.29 95% CI 1.02-1.64) than those with high stimulation.

Conclusion: High parent-child interaction and stimulation were associated with lower scores of oral health-compromising practices at the age of 5 years.

Background: Breastfeeding provides essential nutrients and benefits for newborns. However, its prolonged duration has raised concerns about potential risks for early childhood caries (ECC).

Aim: To determine if prolonged breastfeeding increases the risk of dental caries in children under 71 months.

Design: Eligibility criteria included observational studies comparing ECC risk in children breastfed for over 12 months, with no language restrictions. Databases searched included PubMed, Scopus, and others, up to May 17, 2024. Risk of bias was assessed using the JBI Critical Appraisal Checklist. Meta-analyses were performed using a random-effects model.

Results: Twenty-five studies involving 19 681 participants were included. Studies showed an increased risk of ECC in children breastfed for more than 24 months (RR = 2.44; 95% CI, 1.97 to 3.02). For the 12-24 months period, no significant risk increase was found. Meta-analyses also indicated higher ECC prevalence with breastfeeding beyond 12 months (OR = 1.86; 95% CI, 1.48 to 2.35).

Conclusion: Prolonged breastfeeding beyond 24 months is associated with an increased risk of ECC. This review highlights the need for future studies to address current research limitations and better understand the relationship between prolonged breastfeeding and ECC.

Trial registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD42024509212.