JOURNAL OF DENTISTRY FOR CHILDREN最新文献

Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. It can involve the temporomandibular joint (TMJ) at onset; however, this is frequently overlooked until later stages when pain and dysfunction occur. The purpose of this paper is to discuss the case of a 14-year-old female with malocclusion and TMJ pain who presented for orthodontic treatment. The orthodontist referred her to the orofacial pain specialist to rule out TMJ dysfunction before starting care. After a comprehensive evaluation, the patient was diagnosed with JIA. Dentists can play a key role in the initial detection of systemic diseases causing TMJ pathology. This case report outlines the main orofacial signs and symptoms a dentist needs to be familiar with for the prompt identification of JIA, further reiterating the importance of an early diagnosis for a better prognosis and quality of life of a young patient with JIA.

Transgender youth are at risk for poorer oral health and may have a more difficult time accessing health care. Pediatric dentists should be aware of risk factors that impact care in the dental office and operating room settings. Medical care avoidance is common and can be reinforced when patients feel unsupported or misunderstood when receiving care. Intentional or unintentional environmental indignities, which communicate negative attitudes toward transgender patients, may occur from unknowing providers. Identified here are best practices and opportunities for improvement when providing care for these patients. Dental care for the transgender patient requires a welcoming and inclusive environment that encourages continuous comprehensive care for these individuals.

Hypodontia is commonly associated with cleft lip and/or palate and can be managed by autotransplantation of teeth. In this case report, autotransplantation of the immature mandibular right second premolar to replace the congenitally missing maxillary right second premolar was performed successfully in an 11-year-old Chinese male. An ectopic tooth resembling a premolar tooth was subsequently noted to be developing palatal to the root apex of the transplanted tooth one month after surgery. The development of a dental tooth germ at the site of the autotransplantation post-surgery is a possibility and clinicians should be aware and monitor for such development. The development of a tooth germ post-autotransplantation of an immature tooth could provide a new perspective into tooth organogenesis in patients with agenesis of permanent teeth.

Pharmacological behavior guidance has long been a mainstay of pediatric dental care. Behavioral limitations of very young children and dental fear in adolescents and children with special health care needs have made sedation and general anesthesia important to quality care delivery for these populations. The purposes of this review are to provide a broad perspective on the historical and contemporary use of sedation in pediatric dentistry, summarize available data on the safety and efficacy of opioid and multi-drug moderate sedation protocols, and consider the growing role of minimal intervention dentistry and the importance of patient and medication selection.

Purpose: Treatment for early childhood caries may include advanced behavior management modalities, such as moderate sedation (MS) or general anesthesia (GA). The purpose of this study was to determine which factors are important to parents when considering MS or GA for their child.
Methods: Parents completed a cross-sectional survey to determine which factors they considered in their decision between MS or GA for dental treatment. The relative importance of social, financial, and patient-level factors, the importance of dentists' recommendations, and the reported knowledge levels and sources of information regarding treatment modality were also assessed.
Results: The majority of 130 parents surveyed reported at least a moderate amount of knowledge about GA and MS. Although most identified their dentist as the primary source of information (45 percent for GA, 51 percent for MS), many reported having no source of information about either (23 percent for GA, 16 percent for MS). For both groups, the dentist's recommendation for MS or GA was more influential than cost, risk profile, and the number of missed work and school days (P <0.001). Being well-informed about the treatment modality was more influential than the dentist's recommendation only for the parents who chose MS (P <0.001).
Conclusion: Parents' self-reported knowledge regarding their treatment modality was relatively low. The choice of treatment modality for pediatric dental care relied mostly on the dentist's recommendation.

Purpose: To evaluate the use of lingual frenotomy assessment tools and the anatomical features most commonly used by dentists and otolaryngologists to determine if a frenotomy was indicated.
Methods: A nine-question survey was distributed to American Academy of Pediatric Dentistry members and otolaryngologists in the American Medical Association. The survey consisted of three categories: (1) demographics; (2) use of a standardized assessment tool; and (3) assessing anatomical features for frenotomy. Three different cases of ankyloglossia were given to assess which anatomical features were used to determine if a frenotomy was needed.
Results: Subjects included 404 practitioners. The most common frenotomy assessment tool utilized was the Hazelbaker assessment tool, followed by the LATCH and Bristol tongue assessment tools. The anatomical features used by most responders in determining if a frenotomy was indicated were the appearance of the tongue when lifted, tongue protrusion, frenulum length, and frenulum type.
Conclusions: Many practitioners believe frenotomies for ankyloglossia are indicated when there is a functional impairment and an anatomical component. This study suggests that the general appearance of the tongue when lifted is the most common anatomical feature used for assessing the need for a frenotomy.

Purpose: To evaluate body mass index (BMI) - early childhood caries (ECC) relationships with various BMI expressions.
Methods: Healthy eight- to 18-month children with unerupted molar(s) were conveniently sampled from Uniontown, Ala., USA, a high caries risk community (i. e., rural, poor, racial minority). Staff measured height/weight, dentists conducted oral exams, and parents completed questionnaires annually (from 2008 to 2014) for BMI, ECC (decayed, missing due to caries, filled primary tooth surfaces [dmfs] score), and sociodemographic values, respectively. Nationally recognized standard (underweight-normal-overweight-obese), crude (overweight/obese-not), and continuous BMI variables were evaluated. Logistic regressions (with restricted cubic splines) assessed BMI-ECC relationships, producing odds ratios (ORs) and 95 percent confidence intervals (95% CIs).
Results: Male and female ECC ORs supported positive and negative parabolic functions, respectively, for increasing standard BMI categories; underweight males were associated with ECC (OR=4.59; 95% CI=1.06 to 19.85). Crudely expressed, overweight/obese males and females had lower and slightly increased odds of ECC, respectively. A continuous BMI produced a similar OR across sexes, while spline models suggested nonlinearity for each.
Conclusion: BMI-ECC associations might be nonlinear; being underweight could be a male ECC risk factor. Studies should include extreme BMI values without collapsing BMI categories.

Purpose: To evaluate reasons pediatric dental patients missed appointments associated with general anesthesia (GA) or monitored anesthesia care (MAC).
Methods: Data were collected using a retrospective review of 518 charts of patients with appointments at a university pediatric dental clinic between January 1, 2018 and April 30, 2019. The information obtained included patient demographics and reasons for failing appointments. Statistical analyses included descriptive and bivariate analyses (alpha=0.05).
Results: A total of 518 patients were included in the study. There were 86 failed appointments (age=7.6±5.8 [standard deviation; {SD}] years; 64 percent males) and 432 kept appointments (age=8.4±7.0 [SD] years; 61.6 percent males), were included in the study. Among those patients who failed appointments, 82.6 percent had public aid (Medicaid) coverage and 47.7 percent had special health care needs (SHCN). For those who kept appointments, 80.8 percent had Medicaid coverage and 55.8 percent had SHCN. The most common reason for failed appointments was "child illness." Patients seen for emergency care between consultation and the surgery visit were more likely to fail appointments than those who were not seen for emergency care (33.3 percent versus 12.7 percent; P =0.001). Additionally, the mean/median days, respectively, between consultation and surgery for patients who missed appointments were significantly higher than for patients who kept appointments (107.5/91 days versus 75.6/58 days; P <0.001).
Conclusion: Significant differences were found between patients who failed their appointments and those who kept them.

Alpha-thalassemia X-linked intellectual disability (ATR-X) syndrome affects males and is associated with profound developmental delay, facial dysmorphism, genital abnormalities, and alpha thalassemia. Appropriate oral health management for affected patients is important. The purposes of this report are to describe a case involving six years of oral health management, including training in eating, drinking and swallowing, for a patient with ATR-X syndrome, and to discuss the morphological and functional oral characteristics of this disorder. The patient's oral dysfunctions were incompetent lip-closing, inappropriate tongue protrusion, deviation of chewing acquisition, and incompetent oral and pharyngeal bolus propulsion. Other problems included inappropriate ingestion posture, low interest in meals, and poor oral hygiene. A stable oral intake and an improved eating posture were achieved through an intervention; however, the patient's inappropriate tongue protrusion, deviation of chewing acquisition, and incompetent bolus propulsion remained unchanged.

Purpose: To evaluate the prevalence of periodontal disease and alveolar bone loss in overweight/obese Brazilian adolescents.
Methods: Participants included 12- to 18-year-old adolescents who were allocated into two groups: (1) normal weight; or (2) overweight/obese. Body mass index (BMI) and waist circumference (WC) were evaluated to classify overweight/obesity. Clinical measurements included the visible plaque index (VPI) and community periodontal index (CPI). Alveolar bone loss (ABL) was also evaluated by bitewing radiographs.
Results: There were 109 subjects. There were no significant differences between the groups for VPI and CPI code two (P >0.05). CPI code zero was more prevalent in normal weight subjects than in overweight/obese subjects (P <0.05). CPI codes one and three were significantly more frequent in the overweight/obese group (P <0.05). The normal weight subjects revealed a higher percentage of sites with no ABL (P <0.05), while the overweight/obese group had a higher prevalence of incipient ABL with the number of sites greater than one and less than three (P <0.05).
Conclusion: Overweight/obesity may affect the progression of early periodontitis in the presence of poor biofilm control in adolescents, as this group presents more bleeding on probing and pathological periodontal pockets greater than four mm as well as a higher prevalence of sites with incipient alveolar bone loss.