Pediatric dentistry最新文献

Purpose: The purpose of this study was to investigate changes in 25-hydroxyvitamin D (25(OH)D) levels in children with severe early childhood caries (S-ECC) following rehabilitative surgery using general anesthesia (GA). Methods: Children with S-ECC were recruited on the day of surgery for a prospective study investigating changes in nutritional status and well-being before and after surgery. Venipunctures for 25(OH)D were performed while children were in the operating room, and parents completed a questionnaire regarding nutritional intake, oral health, quality of life, and family demographics. Participants returned at a minimum of three months for a follow-up venipuncture, questionnaire, and dental examination. Analyses included descriptive, bivariate, and multivariable regression analyses. A P-value of ≤ 0.05 was significant. Results: Overall, 150 children participated, with a mean age of 47.7±14.1 months. The mean baseline 25(OH)D concentration was 49.8±16.9 nmol/L, with 17 percent having deficient levels. Overall, 106 returned for follow-up. Paired t-tests revealed significant improvements in the mean 25(OH)D levels following rehabilitation (50.1±17.1 nmol/L versus 61.2±18.7, P<0.001). The proportion with optimal and adequate 25(OH)D levels increased from 9.2 percent to 24.1 percent and from 48.3 percent to 67.8 percent, respectively, while those classified as deficient decreased from 17.2 percent to 8.1 percent from baseline to follow-up. Conclusions: Significant improvements in vitamin D concentrations were observed following dental rehabilitation. This provides additional evidence of the association between oral health and nutritional status.

Purpose: The purpose of this study was to evaluate the effect of 38 percent silver diamine fluoride (SDF) application on the shear bond strength (SBS) of three types of bulk-fill restorative materials to dentin. Methods: Eighty recently extracted deidentified, sound, human premolar teeth were sectioned to expose the mid-coronal dentin. A composite restorative material (ACTIVA™), a giomer (Beautifil^®), and a high-viscosity glass ionomer (HVGI) cement (Equia Forte^®) were used. The specimens were randomly assigned into eight groups (N equals 10 per group) according to the type of restorative material (ACTIVA^™, Beautifil ^®, Equia Forte ^® with and without the conditioner) and pretreatment with one drop of 38 percent SDF. Both ACTIVA^™ and Beautifil ^® were bonded to dentin with a universal adhesive (Scotchbond™ Universal). The SBS was measured in a universal testing machine with a 0.5 mm per minute crosshead speed. One-way analysis of variance, Tukey's, and adjusted pairwise comparison tests were used for statistical analysis of data (α equals 0.05). Results: Pretreatment of dentin with SDF did not affect the SBS of the tested bulk-fill materials (P>0.05). The SBS of the ACTIVA^™ and Beautifil^® groups was similar (P>0.05) and significantly higher than all Equia Forte^® groups (P<0.001). Application of conditioner had no significant effect on the SBS values of Equia Forte^® (adjusted P>0.01). Conclusions: The application of silver diamine fluoride did not influence the shear bond strength of tested bulk-fill materials to dentin. Prior conditioning did not affect the SBS of the high-viscosity glass ionomer to dentin. The giomer and composite restorative materials showed significantly higher SBS than high-viscosity glass ionomer.

Purpose: The purpose of this study was to determine the risk of prolonged general anesthesia (GA) for pediatric dental patients and understand factors that contribute to prolonged GA in patients under age three years in an academic hospital. Methods: A retrospective chart review for pediatric dental patients treated using GA collected data for patient age, treatment provided, other services involved in patient management, and case GA length. Further chart analysis was completed by a multidisciplinary team for cases of prolonged general anesthesia. Results: A total of 114 cases were evaluated. The incidence of prolonged GA exposure was 21.9 percent (N equals 25). Cohort data of cases younger than three years show that cases of prolonged GA exposure were more likely to be closer to age three, require longer non-throat pack time, require more restorative procedures, require longer procedure times, and utilize additional surgical services more often (P<0.05). Four common themes for prolonged exposure were identified (significant restorative needs, provider-level training, anesthesia complications, and utilization of other services), with most cases (88 percent) experiencing multiple themes as contributing factors. Few adverse effects were noted, and none had long-lasting effects. Conclusions: Dental rehabilitation cases in very young patients are at risk for prolonged exposure to GA. Providers should be aware of total anesthesia time while completing dental rehabilitation using GA and proactively attempt to reduce the risk of prolonged exposure.

Purpose: The purpose of this study was to compare the chemical and physical properties of eight contemporary direct pulp capping materials. Methods: Materials included: calcium hydroxide-based (Dycal^®, Lime-Lite^TM, and Ultra-Blend^TM plus), bioceramic-based (MTA Angelus^®, Biodentine^®, TheraCal LC^®, Ceramir^® Protect LC), and resin ionomer-based materials (Bio-Cap^®). Calcium release and pH changes were measured after one, seven, 28, and 90 days in 36.8 degrees Celsius of deionized water. Water sorption and solubility were calculated with weight loss after 90 days. Results: Biodentine^® (965.5 ppm) and MTA Angelus^® (921.2 ppm) released significantly more cumulative calcium ions (P<0.05), followed by Ceramir^® Protect LC (450.8 ppm) and Dycal^® (268.1 ppm); Lime-Lite^TM had the least amount of calcium ions. After 90 days, Biodentine^® and MTA Angelus^® showed significantly higher pH (P<0.05), while Bio-Cap^® and Lime-Lite^TM had limited effects in raising the pH to alkaline. Dycal^® presented the most weight loss (26 percent, P<0.05) after 90 days. Conclusions: Biodentine^® and MTA Angelus^® demonstrated more favorable in vitro characteristics for clinical pulp capping purposes, while Lime-Lite^TM had no effect in releasing calcium ions and limited influence in raising pH value.

Purpose: Incorporation of patient safety and quality improvement into the educational framework of all health care trainees, including those in dentistry, is growing. The purpose of this study was to characterize the current state of patient safety training and education in US pediatric dentistry residency programs. Methods: A 19-item web-based survey was emailed to all US pediatric dentistry residency program directors in 2021. The survey collected information regarding program background, safety education, safety protocol and experience, attitudes toward safety, and potential support for safety education. Data were analyzed using descriptive statistics and Fisher's exact test. Results: Seventy-two directors (76 percent response rate) completed the survey. The majority felt safety education was somewhat (11 percent, N equals six) or extremely important (68 percent, N equals 49) for residents. Only six percent (N equals four) reported residents entered their program with an adequate understanding of safety science. Most (74 percent, N equals 53) taught safety science through both didactic seminars and clinical experience. Timeouts under general anesthesia (78 percent, N equals 56) and emergency simulations (72 percent, N equals 52) were more common modes of clinical safety training. Overall, a limited number of program directors had familiarity with many safety tools used to prevent adverse events. Program directors' experience with adverse events was not associated with opinions regarding the importance of safety education. The majority expressed interest in AAPD supporting safety education. Conclusions: Although program directors feel safety education is important, programs do not sufficiently address safety education and look for support to help integrate safety measures into education.

Purpose: This study aimed to evaluate the effects of different medicaments (sterile saline [SS]; ferric sulfate [FS]; or sodium hypochlorite [SH]) and pulp capping materials (calcium hydroxide [CH] or mineral trioxide aggregate [MTA]) on the success of direct pulp capping (DPC) in primary molars. Methods: The study was conducted with 55 children aged four to eight years. A total of 118 teeth, in which occlusal caries removal resulted in pulp exposure, were treated with DPC across six groups: SS+CH; FS+CH; SH+CH; SS+MTA; FS+MTA; and SH+MTA. Teeth were restored with Class I composite resin. Results: After two years, the overall clinical and radiographical success for DPC were 94.1 percent (111 out of 118 teeth) and 88.9 percent (105 out of 118 teeth), respectively. The clinical and radiographical success, respectively, for hemorrhage control medicaments were 92.1 percent and 89.5 percent for SS, 92.5 percent and 82.5 percent for FS, 97.5 percent, and 95.0 percent for SH (P>0.05). Internal resorption was significantly higher in the FS+CH group when compared to other groups (P<0.05). MTA had significantly higher success than CH for clinical (98.3 percent versus 89.7 percent) and radiographical success (98.3 percent versus 79.3 percent) (P<0.05, each comparison). Conclusions: For primary molars with occlusal caries and less than one-mm exposure sites, these findings suggest that direct pulp capping with MTA following hemorrhage control with the tested solutions offers a more predictable outcome compared to CH. Further, the findings of this study indicate an increased risk for internal resorption when FS and CH are used for DPC.

Purpose: The purpose of this study was to evaluate whether preoperative radiographic measurements could predict the final steel crown selection size for restoration of primary molars. Methods: A retrospective chart review of children two to 10 years old receiving oral rehabbilitation between July 2019 and May 2020 was completed. Bitewing radiographs were used to obtain two linear radiographic measurements (coronal and cervical) using DEXIS™ Imaging Software (KaVo Dental). Separate models using each, along with covariates of primary first versus primary second molars, maxillary versus mandibular molars, and their interaction, were developed using linear regression analysis (N equals 225), treating the final crown size as a continuous response. Results: Final models utilizing stainless steel crown sizes of previously crowned teeth showed that predictors and all covariates were significant (P<0.001). Three cross-validation models (80 percent training sets) for each radiographic measurement showed strong agreement with the final models. Based on the final coronal model, a practitioner would achieve a correct fit using one, two, or three attempts with accuracy rates of 46 percent, 47 percent, and seven percent, respectively, with a cumulative rate through two attempts of 93 percent; for the cervical model, respective accuracy rates were 38 percent, 51 percent, 11 percent, and 89 percent. These models were used to create size fitting guides. Conclusion: This crown fitting guide has favorable clinical potential to assist providers, especially novice dentists, in selecting crown sizes, showing promise for expanded radiographic application in dentistry, specifically to education, technical efficiency, and minimization of waste.

Purpose: Desensitization is a behavior guidance technique that has been used to help improve behavior and capacity to receive dental care in patients with autism spectrum disorder (ASD). The purpose of this study was to elicit parents' perspectives regarding the effectiveness, benefits, and barriers associated with desensitization. Methods: A qualitative descriptive approach was used. Participants included parents of children with ASD who received regular dental care in a pediatric hospital. Data were collected through individual in-depth semi-structured interviews. All interviews were audio-recorded to be transcribed verbatim and analyzed using a thematic approach. Results: Thirteen parents were interviewed. The findings indicate that desensitization improved children's dental care experience, as the repetition of appointments allowed them to develop familiarity in the clinical setting, reduced their stress and anxiety, and consequently treatment acceptance. However, parents described certain barriers to desensitization, including the organization and burden of frequent appointments and structural and financial issues, as the cost associated with desensitization visits was not covered by Medicare/Medicaid. Conclusion: Desensitization is seen by parents as an important avenue for improving dental encounters for children with autism spectrum disorder.

Purpose: The purpose of this study was to examine a university-based dental electronic health records (EHR) database to identify sedation-related adverse events (AEs) and assess patients' behavioral outcomes during routine pediatric dental sedations (PDSs) in a dental school clinic. Methods: A database was screened for patients younger than 18 years old who had received dental sedation in 2019. The qualifying EHRs were then accessed and sedations were reviewed for AEs, which were categorized using a 12-point classification system and the Tracking and Reporting Outcomes of Procedural Sedation Tool. Patient behaviors were assessed using provider progress notes and categorized as presence/ absence of agitation. Results: A total of 690 sedations were reviewed, yielding 28 AEs. Emesis was the most common AE observed in 1.3 percent of sedations. Respiratory and cardiovascular AEs were observed in 0.7 percent and 0.6 percent of sedations, respectively. Agitation was identified in 47.5 percent of sedations, while 34.1 percent of agitations resulted in the documented suspension of dental treatment. Agitation was mainly observed for nitrous oxide and oral sedation resulting in one failed sedation out of five sedations for each method. Conclusions: Potentially serious adverse effects were identified during pediatric dental sedations, but their incidence was low. A significant proportion of the sedated children experienced agitation, resulting in some sedation failures. Such events need to be tracked and examined for risk assessment reduction and quality-of-care improvement.

Purpose: The purpose of this cross-sectional study was to assess the American Academy of Pediatric Dentistry (AAPD) 2019 Annual Session attendees' knowledge, recommendation behaviors, and education regarding human papillomavirus (HPV) and HPV immunization. Methods: Conference attendees were recruited to complete a paper survey assessing demographic characteristics, education resources, HPV recommendation behaviors, and knowledge. Results: A total of 188 surveys were completed. The mean knowledge score was 7.7±1.6 (range equals zero to 10). Students/residents had the highest knowledge score (8.2±1.3; P=0.02). The statement, "Dentists should make HPV immunization recommendations," had strong agreement (3.8±0.9, range equals one to five) compared to discussing patient immunization status (2.2±1.2). The most utilized information source was personal knowledge (47.9 percent), and the least utilized were American Dental Association statements (8.5 percent). Conclusions: Participants agree dentists should make human papillomavirus immunization recommendations, but they prefer not to discuss patient immunization status. Interventions are needed to increase HPV knowledge by improving the uptake of formal organization statements.