Pediatric dentistry最新文献

Purpose: Dental rehabilitation under general anesthesia (DRGA) is performed increasingly by pediatric dentists. Follow-up visits and ongoing recall attendance are shown to be low post-DRGA. There is currently no guideline or published study on optimal DRGA follow-up timing recommendations. A quality improvement initiative was performed at Children's Dental Center of Children's Wisconsin to increase the rate of follow-up post-DRGA. The purpose of this study was to evaluate changes in follow-up compliance after implementing a two-week visit recommendation instead of a six-week interval for dental rehabilitation under general anesthesia follow-up. Methods: The DRGA follow-up visit recommendation was changed from six weeks to two weeks postsurgery. Attendance rates for recall exams were evaluated before and after implementation with 17 months follow-up (n equals 544). Attendance was then compared by age, special health care needs, foster care status, and caries recurrence. Results: The intervention improved compliance with DRGA follow-up for all ages (P<0.001) and six-month recall visits for ages zero to five (83.3 percent of cases, P=0.001). Patients were more likely to return for any visit within 17 months in the two-week follow-up group compared to the six-week group (P=0.002). There was no difference in caries recurrence requiring treatment between the two follow-up timing groups (P=0.86). Conclusion: Changing the dental rehabilitation under general anesthesia follow-up from six weeks to two weeks improved compliance through six months and decreased the overall number of patients lost to follow-up.

Purpose: The purpose of this study was to evaluate the progression of incipient approximal caries lesions in permanent teeth of children and adolescents with and without silver diamine fluoride (SDF) application. Methods: A retrospective analysis of dental records and radiographs was performed. Baseline and follow-up bitewing radiographs were evaluated and scored using International Caries Classification and Management System (ICCMS) criteria to assess lesion progression. Results: A total of 131 lesions from 68 subjects (mean age equals 9.6 years) were evaluated radiographically and followed for up to 41 months (mean time equals 13.61±6.8 months); 23.6 percent of lesions in the SDF group progressed compared to 38.1 percent in the control group (P<0.001). On average, lesions in the control group increased more per month compared to the study group (P<0.001). The odds of lesion progression in the control group were 2.76 times the odds of progression in the study group. There was a statistically significant difference in lesion progression based on application method; lesions where SDF was applied with Superfloss progressed more per month, on average, versus microbrush application. Conclusions: Silver diamine fluoride may be an effective therapy to slow caries progression of incipient approximal lesions in permanent teeth in high caries-risk populations. Future studies are needed to detect differences in application methods.

Purpose: The purpose of this study was to compare the effectiveness of intranasal dexmedetomidine (DEX), oral midazolam (MID), and oral midazolam combined with oral hydroxyzine (MIDHYD) with nitrous oxide when used for sedation during pediatric dental procedures. Methods: The charts of 146 patients who underwent dental procedures using moderate sedation with DEX, MID, or MIDHYD, all with nitrous oxide, from January 2014 to December 2019, were reviewed retrospectively. Sedations were evaluated for effectiveness based on sedation level and behavior using a modified University of Michigan Sedation Scale and behavior using the American Academy of Pediatric Dentistry sedation behavior scale. Procedures planned and completed were evaluated for each sedation regimen. Results: Overall, the effectiveness was not statistically different between sedation regimens (P=0.71). More stainless steel crowns were planned and completed with DEX, more resins were planned and completed with MIDHYD, and more extractions were planned and completed with MID. The onset of action and working time were found to be statistically significant between sedation regimens; DEX had the longest working time. Conclusions: This retrospective study found that intranasal dexmedetomidine with nitrous oxide showed no statistical difference in effectiveness, compared with oral midazolam or oral midazolam combined with oral hydroxyzine and nitrous oxide, in moderate sedation for pediatric dental procedures. The majority of stimulating time-consuming procedures were completed in the DEX sedation regimen.

Purpose: The purpose of this study was to compare the effectiveness of lesion sterilization and tissue repair (LSTR) antibiotic paste comprised of chloramphenicol, tetracycline, and zinc oxide and eugenol (CTZ) versus zinc oxide eugenol (ZOE) pulpectomy in the treatment of primary molars with pulp necrosis. Methods: A total of 70 three- to eight-year-old subjects with 88 primary mandibular molars with pulp necrosis were included. The teeth were randomized to the CTZ group or ZOE group. The time taken to perform both techniques was recorded. The parents of the children and the dentist who performed clinical evaluations were blind to the group assignment, although the radiographic evaluator could see the difference in treatments. Clinical and radiographic assessments were performed at three, six, nine, and 12 months. Results: At the 12-month evaluation, the clinical success was 86.4 percent for CTZ and 90.9 percent for ZOE (P=0.50), the radiographic success was 75.0 percent for CTZ and 72.7 percent for ZOE (P=0.81), and the overall success was 70.5 percent for CTZ and 72.7 percent for ZOE (P=0.81). The mean time taken to perform was 61.4 (±20.5 standard deviation) minutes for CTZ and 145.1 (±53.2) minutes for ZOE (P<0.001). Conclusions: At 12 months, both techniques presented no significant difference in success rates for nonvital pulp therapy in primary molars with necrosis. The lesion sterilization and tissue repair procedure time using chloramphenicol, tetracycline, zinc oxide, and eugenol was significantly shorter than for a zinc oxide eugenol pulpectomy.

Purpose: The purpose of this study was to evaluate the effect of acrylated hydroxyazobenzene (AHA) copolymers in a composite-resin matrix on Streptococcus mutans (SM) biofilms. Methods: The AHA was synthesized and polymerized within a bisphenol A-glycidyl methacrylate and triethylene glycol dimethacrylate (bisGMA:TEGDMA) matrix while bisGMA:TEGDMA discs served as controls. The cytotoxicity of AHA was determined using a cell viability assay. Sucrose-dependent SM biofilms were grown on the AHA and control substrates. At 24 hours and after mechanical toothbrushing (equivalent to six months), the number of live SM was quantified on the substrates and in the surrounding media. Microscopic images of the substrates were captured after live-dead staining. Results: The AHA substrates were as biocompatible as bisGMA: TEGDMA substrates. The microscopic images and quantification demonstrated no live SM on the AHA substrates and in the surrounding media as compared to the controls. The inhibitory efficacy of AHA substrates on SM biofilm was intact even after mechanical toothbrushing. Conclusions: Acrylated hydroxyazobenzene in a composite-resin matrix completely inhibits SM proliferation growth and demonstrates a zone of SM inhibition. The antibacterial propertyof AHA could be harnessed for caries prevention in high caries-risk children by incorporating AHA into the restorative and sealant materials.

Purpose: (1) Implementation of teledentistry in a private pediatric practice during COVID-19 pandemic, (2) Evaluate dental care that was assessed and managed during the COVID-19 pandemic. Methods: Urgent dental care provided during the recommended deferment of elective dentistry (3/16/20-5/17/20) was documented. Encounters were documented by type and management (conventional vs. teledentistry). Results were summarized using descriptive statistics. Associations were compared with Chi-squared or Fisher's exact test. Results: There were 137 emergency patient encounters during the study period. The types were: orthodontics (32 percent), caries (22 percent), eruption concerns (18 percent), trauma (16 percent), "other" (12 percent) (i.e., ankyloglossia, aphthous ulcers). Almost half (48 percent) were managed with teledentistry. The highest utilization of conventional dentistry was caries (70 percent), and for teledentistry was "Other" (75 percent) and eruption concerns (60 percent). Conclusion: Nearly half of emergency encounters in this sample were managed with teledentistry. Teledentistry was a necessary modality of care during the beginning of the COVID-19 pandemic and has uses and implications beyond the triage of acute dental emergencies.

Purpose: The purpose of this study was to describe the prevalence of radiographically identifiable developmental dental anomalies (DDA) in a university-based pediatric dental clinic and to assess for associations between DDA and health status. Methods: Retrospective data, obtained from the electronic dental records of a three-year pediatric patient cohort, were evaluated by two trained and calibrated examiners. Strict inclusion/ exclusion criteria were applied. A validated image quality grading system was used for radiograph assessment, and the physical status classification of the American Academy of Anesthesiology was utilized. A chi-square test and bivariate logistic regression were used for statistical analysis. The inter- and intraexaminer reliability was assessed using Cohen's Kappa. Results: A total of 1,478 subjects (69 percent medically healthy) were enrolled. DDA were identified in 25 percent of the subjects, with hyperdontia, hypodontia, and microdontia being more common. A statistically significant association was found between the presence of DDA and health status (P<0.001) and between DDA and asthma (P=0.035). Patients with systemic disturbances showed 2.12 times greater odds of having DDA (P<0.001, 95 percent confidence interval equals 1.7-2.7). Conclusions: The prevalence of developmental dental anomalies was high, with one in four patients affected. DDA in number were the most common. Patients with systemic disturbances had greater odds of having DDA.