Purpose: To investigate the effect of full-mouth rehabilitation on the levels of Streptococcus mutans and Streptococcus sobrinus in plaque samples of children suffering from severe early childhood caries using the quantitative reverse transcription polymerase chain reaction method.<br/> Methods: A dental examination was performed to determine the decayed, missing, and filled primary teeth and surfaces (dmft and dmfs, respectively) in three- to five-year-old children using the World Health Organization's caries diagnostic criteria. Supragingival plaque samples were collected from all tooth surfaces with a sterile universal scaler at baseline and six months after full-mouth rehabilitation. The Wilcoxon signed-rank test was used to compare the mean values of dmft and dmfs scores and the mean values of S. mutans and S. sobrinus levels between the pre- and post-treatment period.<br/> Results: At six months, the mean relative quantification values of S. mutans and S. sobrinus showed significant reductions (P > 0.05) in the post-treatment samples but the mean dmft scores remained the same.<br/> Conclusion: Full-mouth rehabilitation is effective in reducing levels of S. mutans and S. sobrinus, thus diminishing the cariogenic challenge in the oral cavity.

Purpose: To determine the prevalence and types of percutaneous exposure incidents (PEIs) among staff and students at a dental school, compare the prevalence of PEIs sustained in pediatric dentistry with other specialties, and evaluate the compliance to post-exposure protocols.<br/> Methods: First, a retrospective data analysis of PEIs between January 2012 and December 2017 was done. Following that, a cross-sectional study of dental students, dentists, and dental clinical assistants (DCA), using a self-administered questionnaire to collect information regarding PEIs, was conducted between January 2016 and December 2017; post-exposure management data was also collected.<br/> Results: From the archival data, 94 PEIs were recorded, with most exposures occurring among dental students (62.8 percent), followed by dentists (12.3 percent) and DCAs (10.6 percent). Needlesticks (experienced by 35.1 percent) were the most common type of injury. Only three injuries were during a pediatric dental procedure. For the cross-sectional study, there were 223 participants, with 17.5 percent reporting a PEI. The most common type, site, and cause of PEIs were bur use, fingers, and a lapse in concentration, respectively. Almost 40 percent of PEIs were not reported, with the most common reason being "it was only minor".<br/> Conclusion: PEIs are not more likely to occur in pediatric dentistry compared to other disciplines. Improvements are required in the compliance of PEI postexposure management.

Congenital insensitivity to pain with anhidrosis (CIPA), also known as hereditary sensory and autonomic neuropathy type IV, is a rare autosomal recessive condition. CIPA is caused by mutations in the NTRK1 gene, leading to the inability to feel pain and decreased or absent sweating (anhidrosis). The signs and symptoms of CIPA may not be easily diagnosed at birth, but repeated severe injuries or unintentional self-injurious behavior during infancy may prompt further investigation leading to a CIPA diagnosis. We present the case of an 18-month old child who was diagnosed with CIPA, after repeated visits to a hopsital's emergency department for serious tongue and finger biting, which prompted further investigation.

Purpose: To investigate knowledge of emergency department physicians and residents (ED-Drs) about management of traumatic dental injuries (TDI) in the United Arab Emirates (UAE).<br/> Methods: A cross sectional study of ED-Drs was conducted using a questionnaire and a score of TDI knowledge (TDI-K) was created (maximum of six). Statistical analysis was performed using chi-square, Fisher's exact, Mann-Whitney U, and Kruskal-Wallis tests, and significance was set as P <0.05.<br/> Results: One hundred fifty-five physicians participated, with one-third reporting they encountered TDI more than once a week. Sixty percent of ED-Drs had received TDI education, of which a significantly higher proportion (84.4 percent) were Western-trained (P =0.007). Consultants and specialists had the highest knowledge scores (P =0.001). ED-Drs with five to 10 years' experience scored significantly lower (3.07±1.65) than those with less than five years of experience (3.86±1.36) and those with more than 10 years of experience (3.83±1.36, P=0.034). Only 38.2 percent of general practitioners (GPs) were confident placing sutures intraorally, compared to 80.6 percent of the consultants and specialists and 57.1 percent of the residents.<br/> Conclusion: Overall knowledge of TDI and their management among ED-Drs across the UAE is inadequate. GPs had the lowest knowledge and confidence to manage TDI. (J Dent Child 2019;86(1):24-31)<br/> Received December 11, 2018; Last Revision January 11, 2019; Accepted January 11, 2019.

Purpose: To investigate the association between suboptimal serum vitamin D and early childhood caries (ECC) among children who received care at Seattle Children's Hospital (SCH) between 1999 and 2014.Methods: This cross-sectional study examined one- to six-year-old children in their primary dentition, with an American Society of Anesthesiologists (ASA) health status of II to IV, serum vitamin D, and dental data. Serum vitamin D was categorized as optimal (at least 75 nanomoles per liter) or suboptimal (less than 75 nanomoles per liter). Associations between serum vitamin D and caries were assessed using bivariate and multivariable (modified) Poisson regression models. Multivariable models were adjusted for age, race, ASA classification, season of vitamin D collection, and gastrostomy tube (G-tube) feeding status.Results: The mean age of 276 subjects was 3.4±1.5 years; 50.4 percent was female, 48.9 percent was Caucasian, 81.5 percent was ASA III status, 36.2 percent was G-tube fed, and 33.3 percent had ECC. Children with suboptimal 25-hydroxy vitamin D status were twice as likely to have ECC than children with optimal levels (relative risk = 2.14; 95 percent confidence interval = 1.45 to 3.16). The association between serum vitamin D and ECC was observed among children with neurologic (P<0.001) and genetic (P<0.001) conditions.Conclusions: Suboptimal 25-hydroxy vitamin D status was associated with increased risk for ECC in children with special health care needs. Interventions beyond the realm of the mouth are relevant for this highly vulnerable population and awareness of their vitamin D status should be considered.

Purpose: The purpose of this study was to determine the position of the mandibular lingula in a sample of cone beam computed tomography (CBCT) images taken on pediatric patients.Methods: A sample of 280 outpatient CBCT (i-CAT) scans (153 males and 127 females) were divided into three age groups: six to nine years (n=103), 10 to 13 years (n=103), and 14 to 18 years (n=74). The position of the lingula was determined relative to the anterior and posterior border of the ramus, mandibular notch, inferior border of the mandible, and mandibular plane. The mandibular angle was also recorded. In Vivo5 software was used to assess the images.Results: The average distance for all positional measurements was significantly greater in 14- to 18-year-old adolescents when compared with six- to nine-year-old children. In the oldest age group, the mandibular angle was significantly more acute. Significant differences in distances were noted bilaterally across all age groups in boys and girls for distance from lingula to mandibular notch, to inferior border mandible and to occlusal plane, while for distance lingula to posterior border of ramus it was only for boys.Conclusions: As children age, the mandible increases in all dimensions, except for the distance from the anterior border to the lingula. Small differences in the position of the mandibular lingula exist between boys and girls. These findings have implications for administering an inferior alveolar nerve block in children.

Proliferative periostitis is a rare condition that can affect children and adolescents. It is characterized by the successive deposition of layers of bone caused by low-virulence infection or chronic inflammatory stimulation. The purpose of this paper is to report a case of proliferative periostitis in a pediatric patient, emphasizing the clinical and radiographic aspects as well as the therapeutic management.

The purposes of this study were to: (1) assess children's preferences for their pediatric dentist's attire; (2) assess guardians' preferences for their child's pediatric dentist's attire; and (3) determine which attributes are associated with different types of attire. This was a cross-sectional descriptive study using survey methodology with patients and parents who attended the pediatric dental clinic at Virginia Commonwealth University, Richmond, Va., USA. A total sample of 100 guardians and 97 pediatric patients completed the computer-based questionnaire. Four subjects posed for photographs wearing various combinations of attire (professional, casual, white coat, scrubs). Among guardians, 56 percent reported preferring a provider in scrubs, with white coat the second most preferred attire (39 percent) for their children. For pediatric patients, scrubs were still most often selected, but at a lower rate (43 percent), and the white coat remained the second most preferred (37 percent). Children and parents have strong perceptions and preferences regarding their dentists' attire.

The purpose of this study was to assess body weight and periodontal disease development in obese and normal weight children. Eighty-eight 5- to 10-year-old children participated in this study. Periodontal measurements included the visible plaque index (VPI), community periodontal index (CPI), and bleeding on probing (BOP). Complete periodontal examinations were performed in some children with CPI codes three and four. Anthropometric examination consisted of body mass index (BMI, kg/m2), which was adjusted by age according to percentiles. The groups were divided into children of normal weight (<small>N</small>=43, BMI less than 85 per age) and obese children (<small>N</small>=45, BMI greater than 97 per age). The results showed that the obesity group showed significant proportions of CPI codes one (44.2%) and three (7.4%), when compared with normal weight subjects (P<0.05). VPI was similar between both groups (P>0.05). BOP was higher in obese patients than in children with normal weight (P<0.05). CPI zero was more prevalent in normal weight subjects (62.6%, P<0.05). Obese children seem to be more susceptible to periodontal disease.

The purpose of this study was to determine variables associated with adverse outcomes among traumatized permanent teeth in a university pediatric dental clinic. Electronic charts of children treated at a university-based dental clinic for trauma in permanent teeth were analyzed. Variables evaluated included demographics (age, sex, American Society of Anesthesiologists classification, and insurance type), affected tooth location, trauma characteristics, type of dental trauma, elapsed time between trauma and initial treatment, elapsed time between the initial and final treatment, initial treatment type, and initial and final restoration type. Adverse outcomes were defined as root canal treatment, decoronation, and extraction. Associations between adverse outcomes and each variable of interest were calculated using chi-square and Fisher's exact test and logistic regression. The significance level was set at five percent. Adverse outcomes were significantly associated with the type of dental trauma (P=0.001), presence of luxation injury (P=0.048), initial dental treatment (P<0.001), and initial dental restoration type (P=0.019). Treating dental trauma in permanent teeth in a timely manner can strongly impact their prognosis.