Pediatric dentistry最新文献

Purpose: To assess the effectiveness of nonpharmacological behavior guidance interventions used for children and youth with special health care needs (CYSHCN) during preventive and dental treatment visits.

Methods: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a preventive visit (exam, fluoride application, radiographs, and prophylaxis) or a treat- ment visit (simple surgical treatment, sealants, restorative care with or with local anesthesia) with control or other interventions. The primary outcome measures for the studied interventions were reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included Randomized Controlled Trials (RCTs), performed data extraction, and assessed the risk of bias (ROB). Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done.

Results: Eleven articles qualified for analysis from 219 screened articles. Included studies evaluate the effectiveness of in office strategies such as modeling, audio-visual distraction, sensory adapted dental environment, and picture exchange communication system. The certainty of evidence ranged from Very low to Low and the magnitude of effect varied from trivial to large change in the desired outcomes.

Conclusions: Most basic non-pharmacological behavior guidance techniques showed some trivial to small reduction in self-reported anxiety and/ or improvement in behavior, with audiovisual distraction, Sensory Adapted Dental Environment, and Picture Exchange Communication System showing large reduction in anxiety based on some rating scales. Systematic Review Registration Number: PROSPERO: CRD42022314723.

Purpose: Early in the COVID-19 pandemic, restrictions from mid-March to mid-May 2020 curtailed community dental practice. The study purpose was to analyze the utilization of a pediatric hospital emergency department (ED) for dental emergencies over six months of practice disruption compared to two previous years.

Methods: Records of patients presenting to the ED were analyzed for volume, demographics, dental emergency type/acuity, and treatment. Study patients presented between March and September 2020; controls presented between March and September 2018 and March and September 2019.

Results: A total of 138 study patients (mean age equals 6.4 years) and 171 controls (mean age equals 7.0 years) were assessed. Emergency types were trauma (68 percent), caries (25 percent), and "other" (seven percent) for both periods (P=0.997). Nearly all patients triaged as "urgent." Medical radiology (P<0.001), laboratory tests (P<0.001), medication administration (P=0.016), ketamine sedation (P=0.014), and procedures by the medical team (P=0.014) increased for trauma patients in the study versus control period. Significantly more study patients with caries identified as persons of color: 69.7 percent versus 36.8 percent of controls (P=0.006).

Conclusions: The emergency department medical and dental teams served as a safety net for both public health and the private practice dental community during the early pandemic. The effect on tertiary medical facilities should be considered when closing venues for the management of routine emergencies; it is more time-efficient and cost-effective and less resource-intensive to manage patients with dental emergencies in dental clinics.

'Purpose: To assess the effectiveness of nonpharmacological behavior guidance interventions used for children undergoing dental treatment visits.

Methods: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a dental treatment visit including sealants, restorative care, dental local anesthesia, and simple surgical procedures. The primary outcome measures were reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included RCTs, performed data extraction, and assessed the risk of bias (ROB). Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommenda- tions Assessment, Development and Evaluation approach were done.

Results: Forty articles qualified for analysis from 219 screened articles. Included studies evaluated the effectiveness of pre-visit preparation and in office strategies rendered pre-/post- or during treatment such as positive imagery, direct observation/modeling, desensitization, tell-show-do and its modifications, voice control, positive reinforcement, memory restructuring, bio- feedback and breathing relaxation, animal assisted therapy, combined therapies, and cognitive behavior therapy. The certainty of evidence ranged from Very low to high and the magnitude of effect varied from trivial to large change in the desired outcomes.

Conclusions: Most of the basic non- pharmacological behavior guidance techniques showed trivial to small reduction in self-reported anxiety and/or improvement in behavior, with modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal assisted therapy, combined tell-show-do and audiovisual distraction, and cognitive behavior therapy showing large effects in reduction of anxiety based on some scales.

Purpose: The purpose of this prospective, randomized, parallel-group clinical study was to evaluate and compare the clinical outcome of preformed zirconia crowns and preformed stainless steel crowns when used to restore permanent first molars.

Methods: Patients with severely decayed, badly broken down hypomineralized or hypoplastic permanent first molars that required a full-coverage restoration were invited to parti- cipate in the study. Sixty-nine healthy, cooperative children, ages six to 12 years, were recruited for the study. Following informed consent, 36 preformed zirconia crowns and 36 stainless steel crowns were placed and assessed at one week, three months, nine months, and 12 months accord- ing to the modified United States Public Health Service Ryge criteria. The parameters evaluated were: the time required for preparation and ce- mentation; plaque accumulation; marginal integrity; fracture of the crown; retention of cement; interference with the eruption of the permanent second molar; and parental acceptance.

Results: The clinical evaluation revealed statistically comparable performance in crown retention, fracture, marginal integrity, and plaque retention at 12 months between crown types. Preformed zirconia crowns were preferred by the parents primarily because of esthetics. However, a significant difference was seen in the clinical time required for the preparation and placement of preformed zirconia crowns, which was nearly twice that for stainless steel crowns.

Conclusions: After 12 months of clinical evaluation, preformed zirconia crowns performed comparably to stainless steel crowns in their ability to restore decayed or hypomineralized permanent first molars. However, zirconia crowns took nearly twice as long to prepare, fit, and cement.

Purpose: The purpose of this study was to evaluate pre-extraction variables associated with spontaneous space closure between the permanent second molar (PSM) and the second premolar following early extraction of the permanent first molar (PFM). Additionally, this study aimed to assess supereruption in compensated and uncompensated maxillary molars to determine if compensating extraction increases the odds of spontaneous space closure.

Methods: A total of 134 patients aged six to 12 years with extracted PFM(s) were evaluated for spontaneous man- dibular space closure. Panoramic radiographs were reviewed to assess pre-extraction variables. Bitewing radiographs of 156 patients aged six to 13 years with previous PFM extractions were used to measure supereruption in compensated and uncompensated extractions. Both compensated and uncompensated extractions were evaluated for complete mandibular space closure.

Results: Statistically significant predictors of space closure included extraction at age eight to 10 years (P=0.04; 95 percent confidence interval [95% CI] equals 0.08 to 0.91), permanent third molar presence (P=0.02; 95% CI equals 1.16 to 4.9), and follow-up time (P=0.001; 95% CI equals 1.16 to 1.69). The odds of uncompensated PFM super- eruption were greater than those of compensated PFM supereruption (P<0.001; 95% CI equals 1.86 to 6.92). Additional follow-up increased the odds of supereruption (P<0.001; 95% CI equals 1.08 to 1.30). Uncompensated extractions did not reduce the odds of spontaneous space closure (P=0.54; 95% CI equals 0.56 to 3.08).

Conclusions: Permanent first molar extraction later than age 10 years is a negative predictor for spontaneous space closure, while permanent third molar presence is a positive predictor. Uncompensated maxillary PFMs do not inhibit spontaneous per- manent mandibular second molar space closure; however, uncompensated extractions are more likely to supererupt.

Purpose: The purpose of this randomized clinical trial was to evaluate the clinical and radiographic success of the premixed bioceramic (NeoPUTTY®) as pulpotomy medicament in primary molars in comparison to NeoMTA® 2.

Methods: Seventy primary molars indicated for pulpotomy in 42 children were randomly allocated into two groups: (1) a mineral trioxide aggregate (MTA) group (NeoMTA® 2); and (2) a premixed bioceramic group (NeoPUTTY®). Clinical and radiographic examinations of the molars following pulpotomy were conducted by two independent evaluators at six and 12 months. The data were analyzed using Fishe`s exact tests.

Results: At 12 months, the clinical and radiographic success for the MTA group were 100 percent (34 out of 34) and 94.1 percent (32 out of 34), respectively. For the NeoPUTTY® group, the clinical and radiographic success were 97.1 percent (34 out of 35) and 92.8 percent (32 out of 35), respectively. No significant differences were found between the two materials.

Conclusions: NeoPUTTY® showed a comparable success to mineral trioxide aggregate in primary molar pulpotomies over 12 months. Further clinical trials with larger sample sizes and longer follow-up periods are recommended.

Purpose: To assess the effectiveness of nonpharmacological behavior guidance interventions used for a child undergoing preventive dental visits.

Methods: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a pre- ventive visit including examination, prophylaxis, fluoride application and radiographs. Workgroup (WG) identified moderate-to-high quality system- atic reviews (SRs) published on hypnosis, audiovisual distraction, and parental presence/ absence; and decided to exclude these interventions from current SR to avoid duplication. The primary outcome measures for the studied interventions included reduction in anxiety, fear, pain, and improve- ment in cooperative behavior. Eight authors determined the included RCTs, performed data extraction, and assessed the risk of bias. Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done.

Results: Fifteen articles qualified for analysis from 219 screened articles. WG found studies evaluating effectiveness of pre- visit preparation and in-office strategies rendered pre- or during treatment such as positive imagery, communication, modeling, tell-show-do, magic tricks, mobile applications, positive reinforcement, and sensory adapted dental environment. The certainty of evidence ranged from Very low to Moderate and the magnitude of effect varied from trivial to a large change in the desired outcomes.

Conclusions: Most basic nonpharmacological behavior guidance techniques showed trivial to small reduction in self-reported anxiety and/or improvement in behavior, with mobile application and modeling showing large effects in reduction of anxiety based on some rating scales. Systematic Review Registration Number: PROSPERO: CRD42022314723.

Purpose: Plush animal pacifiers (detachable weighted stuffed animals) have gained popularity. Although pacifiers have well-known benefits, they can also affect the development of the cranio-facial-respiratory complex. The purpose of this study was to study the forces gener- ated on the maxillary arch region during the use of plush animal pacifiers.

Methods: Products were tested using an Instron model 1011 machine. A fixture was developed to standardize the testing of the various brands. Each item tested was suspended on a pin eight mm from the pacifier shield, and the position of the Instron pushing apparatus was standardized throughout the testing.

Results: Generated forces from all Plush animal pacifiers tested fell in the range of 0.47 N to 0.7 N (47.9 g to 71.4 g). The force of the pacifier alone fell in the range of 0.05 N to 0.2 N (5.1 g to 20.4 g).

Conclusions: When toy plush animals are attached to a pacifier, the forces transmitted to the nipple of the pacifier can exceed the 0.4 N minimum force (100 g equals 0.98 N) required to cause orthodontic tooth movement.