JOURNAL OF DENTISTRY FOR CHILDREN最新文献

The management of molar-incisor hypomineralization is challenging as the clinical appearance and individual need for treatment vary widely, with a broad spectrum of treatment modalities available. The purpose of this report is to describe the treatment of an affected, carious permanent molar using glass ionomer cement (GIC) and an occlusal replica technique. An alginate impression of the mandibular arch was done and a partial diagnostic cast was fabricated, followed by diagnostic waxing and a silicone guide. Conventional GIC was used to fill the silicone impression, which was placed on the tooth. The excess material was removed and occlusion was checked. Twelve months after the procedure, the patient did not report any symptoms, the oral hygiene was adequate and restorative material was intact.

Knowledge of microbiology-related issues in dentistry is fundamental to clinical practice and patient care. The purpose of this literature review is to comprehensively describe the roles microbes play in pediatric dental practice, with a special focus on eight continuing and emerging microbiological issues related to waterline safety, dental material contamination, effects of oral bacteria on systemic health, antibiotic resistance, continuing COVID-19 findings and risks associated with animal-assisted therapies. Key points are highlighted on each topic, with current reports demonstrating microbial impacts on human health and clinical settings. Advice and risk management strategies related to patient care and clinical practice are provided.

Vitamin C deficiency, colloquially known as scurvy, has become rare in modern times due to the widespread availability of ascorbic acid-rich foods. Despite this, it continues to be a concern in certain at-risk populations. The purpose of this report is to describe the case of a two-year-old girl who initially presented to a pediatric dental clinic with the chief complaint of hypertrophic gingiva and bleeding. Suspecting a systemic cause, the dental team referred the patient to a hematology clinic for further evaluation. Subsequent assessments and laboratory work confirmed a diagnosis of diet-related vitamin C deficiency. Management with supplements led to the resolution of the oral manifestations and normalization of laboratory values. This report details the clinical presentation and pathophysiology of vitamin C deficiency to assist healthcare providers in recognizing signs and symptoms, ensuring timely referral and facilitating appropriate treatment. Additionally, it underscores the importance of pediatric dentists as potentially the first clinicians to encounter such cases and their role in the multidisciplinary management of these pediatric patients.

The purpose of this article is to present three cases of a rare phenomenon called pre-eruptive coronal resorption (PCR), which occurs in teeth with enamel degeneration. In the first case, the enamel defects occurred due to ectodermal dysplasia, which represents the first documented case of a patient with ectodermal dysplasia who underwent PCR. In the other two cases, the enamel defects occurred due to amelogenesis imperfecta. PCR typically develops asymptomatically; therefore, it is usually incidentally identified through radiological findings, as it presents diffuse degeneration originating externally from the enamel. The precise etiology and pathogenesis of PCRs have yet to be fully elucidated. However, as PCR can spread throughout the dentin and progress to the pulp, early diagnosis is crucial for preserving the affected teeth. Therefore, pediatric dentists should be aware of this pathology.

Purpose: To investigate caretakers' understanding of midlevel providers and determine if there is theoretical acceptance of midlevel dental therapist (DT) integration into the dental workforce. Methods: Validated DT integration surveys were disseminated to caregivers of pediatric medical patients in an urban teaching hospital. Subjects completed a questionnaire regarding previous care received by a midlevel medical provider and were questioned on the acceptance of a midlevel dental provider (i.e., DTs) into the dental workforce. Results: Two hundred two questionnaires were evaluated for recalled previous medical midlevel care (ML; 71.2 percent) and those who were unaware of ML care being provided to their child (UML; 28.7 percent). MLs were significantly in agreement with DTs performing primary tooth restorations (P<0.001), permanent tooth restorations (P=0.001), primary tooth extractions (P=0.022), and emergency treatment (P<0.001). UMLs and MLs significantly agreed that procedures be completed with the supervision of a dentist (P<0.001). Conclusions: Caregivers of pediatric medical patients are receptive to the concept of DTs and largely agree with them performing dental procedures. However, the dissemination of information on DTs to the public is necessary to increase awareness of their education, scope of practice and integration into the dental field.

Agenesis of the temporomandibular condyle is a congenital/developmental disorder that can present with the absence of the condyle and an incomplete development of the articular fossa and eminence, resulting in facial asymmetry as well as masticatory dysfunction. The purpose of this report is to present the case of a three-year-old girl with absence of the left temporomandibular condyle. The patient presented with pain and dysfunction in the left masseter muscle, pre-auricular area and ear as well as mild chin deviation to the left. The most common treatment modality is to wait and treat this condition with surgical intervention once the patient is grown. However, oral orthopedic appliances can be considered to promote bone formation prior to surgery. Prompt recognition and early treatment is advisable to take advantage of the child's growth and avoid further facial asymmetry, pain and dysfunction.

The purpose of this report is to discuss the case of a four-year-old African-American girl who presented with clinical and radiographic evidence of localized stage III grade C periodontitis. She had no history of systemic disease or caries. Treatment consisted of oral hygiene instructions, extraction of unsalvageable teeth, full-mouth debridement with the use of systemic antibiotics and subsequent periodontal maintenance care. The patient underwent a two-year follow-up, during which the disease was stabilized and no space loss was detected. Although this condition is uncommon, the pediatric dentist must be able to diagnose and treat periodontitis in the primary dentition early, together with a multidisciplinary team, to prevent a recurrence of this disease in the permanent dentition.

Purpose: To investigate opioid prescription fills following pediatric/adolescent dental procedures in central/southeastern Ohio. Methods: This population-based, retrospective cohort study utilized health insurance claims from a pediatric public accountable care organization (???Medicaid???) in central/southeastern Ohio. Patients aged 18 years and younger who had a dental procedure between January 2012 and February 2019 were identified, and claims were searched for opioid prescription fills within 14 days post-procedure. Trends in prescription fill percentages, types of opioid, procedure classification and patient characteristics were examined. Results: A total of 512,922 encounters among 212,813 patients were included. The overall opioid prescription fill was 4.9 percent. Percentages decreased throughout the study period from 6.1 percent (95 percent confidence interval [95% CI]=5.9 to 6.3) in 2012 to 3.4 percent (95% CI=3.1 to 3.8) in early 2019. When limited to extractions and endodontic procedures, the overall prescription fill percentage fell from 15.7 percent (95% CI=15.2 to 16.1) in 2012 to 9.5 percent (95% CI=8.5 to 10.4) in early 2019. The most common opioids were hydrocodone (68.6 percent) and codeine (24.7 percent), with marked annual reductions in codeine prescription fills among children younger than 14 years. From 2017 to 2018, surgical extractions compared to endodontics-only procedures (risk difference [RD]=40.7; 95% CI=38.6 to 42.9) and older patient age (RD for 18-year-olds versus 13-year-olds=21.9; 95% CI=19.8 to 24.0) were strong risk factors for filling an opioid prescription. Conclusion: Post-procedure opioid prescription fill percentages have decreased since 2012 among pediatric/adolescent Medicaid enrollees undergoing dental procedures in central/southeastern Ohio. Substantial differences in the likelihood of filling a prescription remained by procedural and demographic variables. There were marked trends in the types of opioid for which prescriptions were filled, which varied by patient age.

Purpose: To evaluate the efficacy of the American Academy of Pediatric Dentistry (AAPD) best practice recommendations for the diagnosis and management of deep carious lesions in primary teeth. Methods: Primary molars from four to eight-year-old children were selected for diagnosis and treatment planning independently by a pediatric dental resident using the AAPD recommendations and a pediatric dentist using his clinical expertise and experience. The analysis of the two evaluators was performed for sensitivity, specificity, positive predictive value, negative predictive values, and agreement scores. Results: A total of 365 primary molars from 185 children were used. Diagnosis and treatment planning by the resident demonstrated a higher sensitivity score of 92.7 percent (95 percent confidence interval [95% CI]=80.1 to 98.5) and specificity score of 96.6 percent (95% CI=94 to 98.3) for treatment planning compared to a diagnosis having sensitivity and specificity scores of 74 percent (95% CI=59.7 to 85.4) and 89.8 percent (95% CI=86 to 92.9), respectively. Lower agreement scores between the resident and the pediatric dentist were found for the diagnosis of asymptomatic irreversible pulpitis and the use of lesion sterilization and tissue repair as a treatment modality. Conclusions: The AAPD best practice recommendations showed a better consistency for treatment planning than the diagnosis of carious primary molars.