Apprehensive Children Research Articles

Clinical Outcome Success of Silver-Modified Atraumatic Restorative Treatment (SMART) in Treating Children with Dental Caries in Primary Teeth: A Systematic Review

Abstract Objective: A novel approach called silver-modified atraumatic restorative therapy (SMART) integrates glass ionomer cement (GIC) restorations with silver diamine fluoride (SDF). This new method combines the ability of GIC to seal the tooth and sever the nutrition that bacteria require to proliferate, with the bactericidal power of SDF. The purpose of this review is to evaluate and compare the available data regarding the efficacy of the SMART approach in treating children's carious primary teeth. Materials and Methods: The earliest date accessible up until February 15, 2024, was thoroughly searched in databases including Scopus, PubMed, Cochrane, Science Direct, Lilacs, Science Direct, Web of Science, and Google Scholar. The review only comprised randomized controlled trials. The PICO strategy (P: Children with dental caries in primary teeth; I: SMART; C: Conventional drill and fill method or atraumatic restorative treatment [ART] therapy; O: Clinical success) was adopted. Risk of bias assessment and quality of evidence were assessed using the RoB-2 tool and GRADE tool, respectively. Results: Four full-text publications that met the eligibility criteria underwent additional processing for data extraction and qualitative analysis. In three studies, no difference was found in the clinical performance of SMART and conventional drill and fill/ART therapy, whereas in one study, the clinical performance of SMART was found to be better than the conventional ART therapy. Conclusion: SMART and conventional drill and fill/ART techniques have comparable clinical performance for carious primary teeth of children. SMART can be used to treat asymptomatic deep carious lesions as well as apprehensive children. However, the cost-effectiveness of SMART restorations needs to be investigated in a variety of demographics.

Short Term Effects of Inhalation Sedation on Child Dental Fear and Anxiety.

Dental procedures profoundly affect a child's dental fear and anxiety, rendering dental treatment difficult. Inhalation sedation with a mixture of nitrous oxide and oxygen (NO2/02) breathed through a nosepiece is a form of light conscious sedation widely used in apprehensive children to help them relax and accept dental treatment. This, however, can have both shortand long-term effects on child dental fear and anxiety. This study aimed to assess the short-term immediate effect of inhalation sedation on child dental fear and anxiety scores. This analytical cross-sectional study was conducted at the Department of Paediatric Dentistry at Rehman College of Dentistry, Peshawar, Pakistan, over a period of 1.9 years (January 2019- October 2020). A total of 171 children aged 6-11 years were selected with moderate to severe dental anxiety using the Child Fear Survey Schedule-Dental Subscale (CFSS-DS), requiring pulp therapy in at least one of their deciduous molars. Baseline anxiety scores were calculated using Venham Clinical Anxiety Score (VCAS) and Venham Picture test (VPT) with a dental check-up and fluoride application. VCAS and VPT scores were then assessed at the end of their scheduled second dental visit involving dental anaesthesia and inhalation sedation. VCAS and VPT scores at the end of treatment were compared with the baseline scores. Out of 171 children, 86 were male and 85 were female, with a mean age of 7.77. Females showed a higher range of VCAS and VPT scores (p ≤0.001) compared to males. The VCAS and VPT scores declined just at the end of the second dental visit following dental anaesthesia with inhalation sedation (mean difference = 1.96 and 3.39, respectively), which was statistically significant (p ≤0.001). Inhalation sedation has a significant role in reducing child dental fear and anxiety in the short term.

Silver Diamine Fluoride in Preventing Caries: A Review of Current Trends.

Aim and objectiveTo evaluate whether silver diamine fluoride (SDF) is effective in the management of dental caries.BackgroundDental caries is most common chronic disease and conventional treatment method could not tackle the problem completely. The use of silver compounds in dentistry is over a 100 years. Silver diamine fluoride has become a newer trend in handling the caries especially in young and apprehensive children. It is a noninvasive method of arresting caries which is painless, safe, and cost effective. This article describes the trends in silver diamine fluoride in arresting caries. The combined effects of remineralizing and antibacterial property make SDF an effective cariostatic agent.Review resultsArticles were searched in electronic data bases for literature. In vivo studies, in vitro studies, systematic reviews and case reports were included.ConclusionSilver diamine fluoride is effective in the management of caries in primary dentition. There is a little effect of silver diamine fluoride in permanent molars.Clinical importanceIn the current scenario of raising importance of minimal invasive dentistry and preventive dentistry, silver diamine fluoride is an efficient tool in the management of caries.How to cite this articleSurendranath P, Krishnappa S, Srinath S. Silver Diamine Fluoride in Preventing Caries: A Review of Current Trends. Int J Clin Pediatr Dent 2022;15(S-2):S247-S251.

Imaging the pediatric retina: An overview.

Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.

Evaluation of the clinical efficacy of 38% silver diamine fluoride in arresting dental caries in primary teeth and its parental acceptance.

Early childhood caries (ECC) has been regarded as one of the most prevalent chronic diseases in children. Conventional restorative management of ECC is difficult to perform in very young and apprehensive children. Silver diamine fluoride (SDF) can be a useful tool in the management of dental caries by arresting the carious lesion in primary teeth. After SDF treatment, the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children. This study aimed to evaluate the clinical effectiveness of biannual application of 38% SDF followed by 5% sodium fluoride (NaF) varnish for arresting dental caries in children and its parental acceptance. Twenty-six children aged 2-5 years with 107 active caries lesions in primary teeth were enrolled. At the baseline examination, status of carious lesions was recorded and scored according to the International Caries Detection and Assessment System II. Lesion activity was assessed by visual inspection and tactile detection. Carious lesions with score 3, 4, 5, and 6 were treated with 38%SDF application, followed by 5% NaF varnish. Children were re-evaluated at 3 weeks, 3 months, 6 months, and 12 months. Parental acceptance of SDF treatment was evaluated. This study demonstrated that 38% SDF was 92.31% effective in arresting dental caries in primary teeth and was well accepted by parents. Chi-square test was used to assess the significant difference among the arrested lesions which was statistically significant (P < 0.05). Thirty-eight percent SDF can be effectively used in arresting caries in primary teeth in young and uncooperative children.

Comparative Evaluation of Intraoral and Extraoral Periapical Radiographic Techniques in Determination of Working Length: An In Vivo Study.

ABSTRACTObjectives/aimsThis study was designed to determine the endodontic working length (WL) of root canals using digital extraoral periapical radiography (EOPAR) technique and comparing its accuracy with the standard digital intraoral periapical radiography (IOPAR).Materials and methodsSixty single-rooted mandibular first premolars indicated for orthodontic extraction were radiographed preoperatively to ensure closed apices. After gaining endodontic access, WL was determined by IOPAR using paralleling technique, followed by EOPAR, by placing a cone at +35° from the contralateral side. Accessed tooth was then extracted to obtain the actual root canal length and was compared with the radiographic lengths. Data were subjected to statistical analysis using paired t test.ResultsThe actual length and the extraoral radiographic length showed no statistical significant difference (p = 0.326). The difference between the mean WL obtained by IOPA and EOPA was also not statistically significant (p = 0.096). The accuracy of IOPA technique was 97.87 ± 0.91% and that of EOPA technique was 94.65 ± 2.57%.ConclusionThe EOPA technique with an angulation of +35° can be used as an alternative to IOPA for mandibular premolars in apprehensive children, dental phobic patients with low pain threshold, neurological difficulties, and exaggerated gag reflex.How to cite this articleSridhara A, Konde S, Noojadi SR, et al. Comparative Evaluation of Intraoral and Extraoral Periapical Radiographic Techniques in Determination of Working Length: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(3):211–216.

The Subtleties and Nuances of Pediatric Sedation: A Disappearing Art for Managing the Apprehensive Child Patient

Pre-cooperative and severely apprehensive children have immature cognitive abilities, a restricted range of coping skills, brief or negligible attention spans, and virtually no experience coping with stress.

Academic achievement at the cost of ambition: The mixed results of a supportive, interactive environment on socially anxious teenagers

Social anxiety impacts functional impairment in several life domains; in children, the most notable effect is a decline in academic performance. Socially anxious children report that communicating with peers and teachers, as well as public speaking are their biggest fears in academic settings. Prior research has shown that these children attribute a lack of academic achievement to difficulties communicating interpersonally or publicly. For apprehensive children, many resources are devoted to interventions at the individual level, with little consideration given to their environment — the classroom. The current study examined the association between communication apprehension, social features of the classroom environment, and academic outcomes — current achievement and future ambitions. Three out of four classroom environmental factors (promoting interaction, promoting respect, and teacher support) buffered the negative effects of communication apprehension on current academic achievement. Interestingly, these same factors increased the negative effects of communication apprehension on future academic ambition (intentions to attend college). Implications for the mixed results of a classroom environment that encourages communication are discussed.

Microinvasive dental treatment in pre-school children

The aim of the study was to assess the efficiency of atraumatic restorative treatment (ART) with cavity preparation by means of dental endo motor. ART method was applied in 94 children (50 females and 44 males, 301 teeth treated) aged 21-96 months. Wireless dental endo motor (Endo Mate TC2, NSK, Japan) was used for cavity preparation. The cavities (102 (33.9%) class I, 156 (51.8%) class V, 20 (6.6%) class II, 18 (6%) class III and 5 (1.7%) class IV) were then filled with glass-ionomer cement (Fuji IX, GC, Japan). Success rate was assessed 3, 6, 12 and 18 months after treatment. Overall ART procedure success rate (good marginal fit, no occlusal wearing or restoration fractures) at 18-month follow up was 88.7% (267 fillings out of 301) with the highest survival in class I (96.1%) and class V (96.2%) restoration and poorest in class II (50%), class III (44.4%) and class IV (20%) restorations. Cavity preparation with wireless dental endo motor was well tolerated even by infants (12 children were younger than 24 months), as it is noiseless and significantly faster than conventional manual preparation. ART method with the use of dental endo motor showed good success rate and proved to be highly efficient in small and apprehensive children. The method, however, should be avoided in class III and IV cavities as the success rate is poor mostly because of restoration fractures.

Book review: A handbook of expanded atraumatic techniques for the apprehensive child dental patient

Book review: A handbook of expanded atraumatic techniques for the apprehensive child dental patient

Fifteen minutes consultation: a structured approach to the child with a white red reflex

The parents of a 2 year old boy notice a difference in appearance of his two eyes in a recent flash photograph, and they alert their paediatrician. A white red...

Arresting Early Childhood Caries with Silver Diamine Fluoride-A Literature Review

Conventional restorative management of early childhood caries (ECC) is unlikely to tackle this prevalent disease, and arresting caries treatment using silver diamine fluoride (SDF) has become a pragmatic strategy, particularly for young and apprehensive children. Arrested caries is clinically characterized by its increase in hardness and a dark brown to black coloration. Subsequent restorative procedures can be carried out if necessary. This review article discusses the rationale of arresting caries treatment, mechanism of action of SDF, and safety and complications of SDF treatment. A literature search using PubMed was performed to review the clinical trials using SDF to manage ECC. Results found 6 clinical trials published in English since 1980. The studies suggested that one-off application of 12% SDF is not effective in arresting caries in children, but 38% SDF is. The main disadvantage of SDF treatment is black staining of the arrested lesion, but significant complications were not reported. In general, the studies concluded that topical application of SDF is a simple and low cost method to arrest ECC. This treatment strategy therefore increases access for children in developing countries to receive affordable dental treatment.

The Red Reflex

Eliciting the red reflex is a useful clinical test that can be easily performed in the pediatric emergency room. A direct ophthalmoscope is the only tool needed to perform this test. The test is non-invasive, making it a quick screening tool for even the most apprehensive child. A normal red reflex can rule out intraocular pathology; an abnormal reflex can indicate need for urgent ophthalmologic referral. The differential diagnoses for an absent (or black) reflex; an abnormally sized, shaped or positioned reflex; leukocoria; as well as a non-homogenous reflex are listed.

Premedication and preoperative fasting in pediatric anesthesia. Results of a survey

This study evaluates the current practice of premedication and preoperative fasting in pediatric anaesthesia in Germany. A total of 90 questionnaires were mailed to randomly selected hospitals with departments or sections of anaesthesiology and pediatric surgery. 71 questionnaires were returned and analysed (reply rate 79%). 60% of the responding hospitals start premedication between the ages of 3 and 12 months and 32% between 1 and 2 years of age. Premedication ist most often given orally (64%), followed by rectal (29%) and intranasal (3%) routes. Midazolam is used by 96% of the respondents as the primary sedative premedication. Alternatively, promethazine and chloraldhydrate are most frequently used. Anticholinergic drugs are given routinely by 21% of the respondents. For the apprehensive child intramuscular ketamine is most often used (33%), followed by intranasal midazolam (22%), rectal midazolam (19%) and rectal thiopentone or methohexitone (13%). For children less than 1 year of age 63% of the hospitals restrict clear liquids 2 hours and 34% 3 or 4 hours before anaesthesia. 64% of the respondents require abstinence from milk for 4 hours and 30% for 6 hours prior to surgery. For children older than one year of age fasting period requirements for clear liquids were 2 hours (34%), 3 hours (27%), 4 hours (30%) and 6 hours (9%). For children over 1 year of age the majority allow solid food or milk up to 6 hours prior to anaesthesia (68% and 63%, respectively). The survey shows that premedication is started during the first two years of age by nearly all responding hospitals. Oral or rectal midazolam is the most frequently used premedication regimen. Preoperative fasting guidelines vary.

Pediatric elbow trauma

Acute pediatric elbow trauma is commonly seen in the emergency department (ED). Reports confirm that, compared to other fractures, children's elbow fractures are commonly misdiagnosed in the ED. In addition, missed orthopedic injuries are one of the leading causes of malpractice claims in emergency medicine. Radiologic diagnosis of these injuries is challenging, as a large portion of the pediatric elbow is composed of radiolucent cartilage. Knowledge of the normal anatomy and ossification centers around the elbow is essential for correct diagnosis. Acute neurovascular injury is frequently associated with these injuries, but is often difficult to assess in an apprehensive child. Immediate orthopedic consultation is indicated for any child with an elbow injury in whom neurologic or vascular compromise is suspected. Consultation should be strongly considered for children with displaced supracondylar fractures and/or significant echymosis and swelling about the cubital fossa.

Determinants of success and failure of EMLA

Although EMLA is known to be an effective topical anesthetic, its rate of success is unknown. Indeed, researchers have suggested that EMLA may fail with young and apprehensive children. Therefore, the objectives of this study were to assess EMLA's rate of success as well as factors which predict success. A double-blind, placebo-controlled design was utilized. The sample included 258 children and adolescents aged 5–18 years who were having venipuncture or intravenous (i.v.) cannulation. After having their anxiety assessed, subjects were randomly assigned to have EMLA or placebo applied over the procedure site for 90 min. The visual analogue scale was used to assess pain caused by removal of the semi-permeable dressing and by the procedure. Other information that was collected included: duration of drug application, interval between drug removal and procedure, skin changes at bandage and drug sites and rated difficulty of the procedure. EMLA was successful 84% of the time for venipuncture and 51% of the time for i.v. cannulation. Factors which predicted success of EMLA included type of procedure, duration of drug application and anxiety. EMLA was less successful for i.v. cannulation compared to venipuncture even with duration of drug application controlled. Those who had a poor outcome were more anxious than those with a good outcome. Age of child was not a factor. Strategies for improving efficient use of EMLA were recommended.

The use of Entonox as a sedation agent for children who have refused operative dentistry.

Abstract A study was carried out on 82 very apprehensive children who had previously refused operative dental treatment. Inhalation sedation with Entonox was offered to each child and 53 children had their treatment completed with the use of sedation and local angalgesia. Nineteen children elected to have their treatment carried out without sedation and 10 patients refused all conscious techniques. The possible role of Entonox as a safe inhalation sedation agent in the dental management of some frightened young patients is discussed.

Comparison of the calming and sedative effects of nalbuphine and pentazocine for paediatric premedication

Nalbuphine (EN2234A) is an agonist-antagonist analgesic. It is structurally related to the narcotic analgesic oxymorphone and to the narcotic antagonist naloxone. A double blind study was carried out in 400 children in ASA classification I, ranging from 10 months to 14 years of age, to compare nalbuphine, pentazocine and placebo for paediatric premedication. Our results showed that nalbuphine is comparable to pentazocine as a premedicating agent and superior to placebo, in the doses used, and that premedication is an important adjunct to anaesthesia in children. Following premedication with nalbuphine or pentazocine, there were fewer apprehensive children at the time of induction of anaesthesia and in the recovery room when compared to those receiving placebo injections.

Optimum Conditions for Examining Children

The need for optometrists to have the respect and co-operation of their child patients in order to obtain reliable and valid test results is explained. Procedures that may be used with apprehensive children to ‘break the ice’ at the start of an examination are described. These procedures have been organized to allow for perceptual development in order to facilitate their application in a busy consulting room schedule. The desirability of explaining fully the requirements for particular tests is described including a recommendation for the use of test demonstrators for this purpose.

TEACHERS' EXPECTATIONS OF THE COMMUNICATION APPREHENSIVE CHILD IN THE ELEMENTARY SCHOOL

Two studies are reported indicating that teachers form negative expectations of children who are high communication apprehensives. These expectations are discussed in terms of their probable effect on learning and the need to provide intervention programs for both children and teachers to overcome the potential negative impact of teachers' expectations on the learning of high communication apprehensive children.