Pediatric dentistry最新文献

Purpose: The purpose of this study was to identify and analyze reports and testimonies from the U.S. Government Accountability Office (GAO) relevant to children's oral health and dental care during the calendar years 1990 through 2021. Methods: The GAO database was searched for reports and testimonies that directly or tangentially addressed children's oral health and dental care. Titles, abstracts, and texts were reviewed to determine what Congress asked of GAO and how GAO responded. Results: Among nearly 30,000 health- and health care-related GAO releases over 31 years, 35 were focused on children's oral health and/or dental care. In response to requests by key congressional committees and legislators, reports addressed coverage, access, utilization, cost, network adequacy, workforce, and safety net. Multiple reports addressed the persistence of health and health care inequities. GAO's findings have supported dental mandates for the Children's Health Insurance Program (CHIP) and Affordable Care Act, the federal pediatric Oral Health Initiative, and congressional oversight of federal agencies that administer Medicaid/CHIP and train dentists. Conclusions: Over more than a quarter century, the U. S. Government Accountability Office has contributed meaningfully to congressional understanding of pediatric oral health and dental care. Continued reliance by Congress on GAO investigations can further enhance policy-making and oversight on issues important to pediatric dentistry.

Purpose: he purpose of this study was to examine risk factors in the development of early childhood caries (ECC) at age three years in a prospective cohort study of 18- to 23-month-old children. Methods: This was a longitudinal observational study of 872 children 18 to 23 months of age in Hokkaido, Japan, with follow-up at age three years. A self-administered questionnaire was completed by parents or guardians of the children. The baseline survey contents included sex, age, the existence of smokers in the home, maternal smoking during pregnancy, nocturnal breastfeeding, snacking habits, bottle-feeding, frequency of parents brushing their child's teeth, the use of fluoride toothpaste, parents sharing of utensils with child, and socio-economic status. The number of decayed, missing, or filled teeth (dmft) was obtained from dental examinations in both the baseline and follow-up surveys. Logistic regression analysis was performed to estimate the odds ratio for the new onset of ECC in threeyear-olds. Results: The dmft at 18 to 23 months old, nocturnal breastfeeding, prolonged breastfeeding, snacking habits, parents brushing their child's teeth less frequently, and parental sharing utensils with the child were significantly associated with the incidence of ECC at age three years. Conclusions: The existence of early childhood caries in 18- to 23-month-olds may be a strong predictor of the new development of dental caries. Other lifestyles were found to be risk factors for the incidence of dental caries by age three years.

Purpose: The purpose of this in vitro study was to compare the fracture resistance and survival of various esthetic crowns for primary molars after artificial aging via chewing simulation. Methods: A typodont tooth (mandibular primary second molar) was prepared to receive five different types of crowns as follows (n equals 10): prefabricated fiberglass (PF); CAD/CAM zirconia (CZ); CAD/CAM resin-ceramic (CR); composite- strip (CS); and prefabricated zirconia (PZ) as control. All specimens were subjected to 750,000 cycles of thermomechanical loading to artificially simulate three years of clinical service. None of the crowns from the CS group survived artificial aging. Surviving crowns were evaluated via micro-CT considering microcrack formation, and a load-to-fracture test was applied. Data were analyzed using one-way analysis of variance followed by the Duncan test. Results: Group PZ (557.4±170.1 N) and CR (669.6±255.2) were found to have comparable results (P >0.05), which were lower than the other groups (P<0.05). Group CZ resulted in the highest mean load-to-fracture value (1126.2±180.6; P <0.05). At the end of three years of artificial aging, microcracks were observed for only CS and PF groups. Conclusions: These in vitro data suggest that all tested crowns, except CS crowns, survived three years of artificial aging; however, CAD/CAM zirconia crowns may provide longer service, as they showed the highest fracture resistance with no microcrack formation.

Purpose: Assess whether children with developmental defects of enamel (DDE) in primary teeth have a higher risk of having dental caries or a higher prevalence of clinical consequences due to the disease than those without DDE. Methods: Search was performed in PubMed, Scopus, Web of Science™, Cochrane Library, LILACS, BBO, Embase databases and in gray literature. Three independent reviewers were involved in study selection, data extraction, and bias assessment. Risk of bias was evaluated by the Newcastle-Ottawa scale. DDE and its subtypes (demarcated opacities, hypoplasia, hypomineralized second primary molars (HSPM), and fluorosis) were regarded as exposure. Dental caries and clinical consequences of untreated caries were also assessed. In the meta-analyses, odds ratio (OR) was used in the random effects model for dichotomous outcomes. Quality of evidence was assessed using the Grading Recommendations Assessment, Development and Evaluation (GRADE). Results: The search yielded 5,750 studies, 39 of which were included in the systematic review and 20 in the meta-analysis. The risk of bias ranged from 4 to 9 points. Children with DDE were more prone to primary tooth caries (OR=2.79; 95% CI:1.29-6.03), and so were those with demarcated opacities (OR=1.75; 95% CI:1.09-2.78), hypoplasia (OR=2.84; 95% CI:1.73-4.67), and HSPM (OR=2.89; 95% CI:1.65-5.06). Fluorosis was not associated with caries (OR=1.39; 95% CI:0.97-1.98). Regarding tooth as a unit of analysis, DDE was highly associated with caries (OR=2.34; 95% CI:1.74-3.16). As for the clinical consequences of caries, only the qualitative analysis was conducted and there was no consensus in the studies. Conclusion: DDE is associated with higher primary tooth caries experience.

Purpose: The purpose of this study was to evaluate resin infiltration (RI) technique's effects on the in vivo functional treatment of molar hypomineralization (MH)-affected permanent first molars (PFMs). Methods: Fifteen MH-affected PFMs were resin-infiltrated and evaluated for a three-month follow-up (FU). In vivo resin replicas were used for profilometric and scanning electron microscope (SEM) analysis of PFM surfaces; any variation of clinical aspect and dentin hypersensitivity was registered as: T0 equals baseline; T1 equals right after treatment; T2 equals oneweek follow-up; and T3, T4, and T5 equal one-, two-, and three-month FU. Results: At T0, MH-affected surfaces were rougher and more irregular than sound ones; at T1, resin-infiltrated surfaces were smoother while a progressive increase of superficial roughness was observed over time. Hypersensitivity improved at T1 and remained stable over time in severe MH cases. Conclusions: Resin infiltration seems to be a promising treatment, especially in managing severe molar hypomineralization cases for the evaluated follow-up.

Purpose: The purpose of this retrospective cross-sectional study was to examine protective stabilization (PS) patterns before and after the availability of weighted blankets (WBs) as a behavioral guidance approach during in-office dental moderate sedation. Methods: A retrospective chart review evaluated pediatric patient sedation records after six-pound lead-free WBs were introduced into the dental clinic and compared clinical outcomes to a time before WBs were available. Multivariable logistic regression analyses assessed variables associated with the occurrence of PS use during a sedation visit. Results: PS (PS) usage decreased from 78.7 percent before to 32.8 percent after the availability of WBs during sedation visits (chi-square, P<0.001). Increase in age (adjusted odds ratio [OR] equals 0.69, 95 percent confidence interval [95% CI] equals 0.53 to 0.90, P=0.006) and WB use reduced PS management (adjusted OR equals 0.067, 95% CI equals 0.020 to 0.22, P<0.001). Body mass index, gender, treatment amount, and sedation regimen did not predict the occurrence of PS. The number of completed teeth treated was not found to be statistically different between cases managed with PS versus those managed without restraint. Children managed with PS but without WBs had statistically higher heart rate changes (20.26±23.17) during treatment than children managed without restraint (8.12±15.15). Conclusions: An increase in age and weighted blanket use was associated with a reduction in the occurrence of protective stabilization during moderate sedation dental visits at the university pediatric dental clinic. Clinical practice sedation protocols should consider weighted blanket use as an alternative to PS.

Purpose: To evaluate decayed, missing, and filled surfaces in primary teeth (dmfs) in Down syndrome subjects (DS) compared to typically developed (TD) controls using analysis. Methods: A retrospective study of 440 matched subjects (220 DS and 220 TD) was conducted. Categorical variables were evaluated for association with dental caries, with mean dmfs as the main outcome measure. Pearson's chi-square and independent sample t-tests for unequal variances for means were employed. Results: Overall, the TD control group was found to have significantly higher mean dmfs scores than the DS group: TD Equals 17.65 (mean dmfs), 95% confidence interval (CI) equals 15.48 to 19.90; DS equals 10.30 (mean dmfs), at 95% CI equals 7.96 to 12.78, (P<0.001). However, when controlled for the variable factors African American status (P=0.11), Hispanic status (P=0.07) and income level at or below 200 percent of poverty level (P=0.24) there was no significant difference in mean dmfs. Conclusions: In the study population DS and TD exhibited dissimilar dmfs scores, while when taking into consideration social and economic factors dmfs was equivalent. Caries risk factors modulate disease experience and should be considered in all population-specific studies. Patients with multiple high-risk factors should be treated as such, regardless of DS status.