Pediatric Dental Patients Research Articles

Herbal irrigants in primary teeth: A step toward green dentistry based on the wisdom of past

A wide plethora of chemical endodontic irrigants are used to achieve the desired results in terms of disinfection and removal of debris besides mechanical means. However, their detrimental properties such as allergic potential, cytotoxicity, antimicrobial resistance, and safety concerns have intrigued researchers over the years to look for safer options. During the past decade, the number of studies has increased utilizing herbs as irrigating solutions. This literature review was conducted to summarize the existing knowledge and provide a comprehensive review of clinical trials on herbal irrigating solutions in pediatric dental patients. An exhaustive literature search was performed in the indexed databases electronically for publications in peer reviewed scientific journals to find the relevant clinical studies evaluating efficacy of herbal root canal irrigants employed in primary teeth.

Clinical management recommendations for paediatric dental patients in times of covid-19 - a review

Objective-This article provides a short clinical overview of the epidemiology, symptoms, routes of transmission and their application in treatment strategies related to this novel infection in paediatric dental patients. Data Source-Various guidelines and recommendations dealing with patient screening, infection control preventive and minimally invasive approach leading to the prevention of cross contamination and least generation of aerosols are here to modify dental practices. Conclusion- Dental care providers for children need to be aware and prepared for tackling any impending infectious disease challenge as might be the case in the current outbreak of SARS- CoV-2 transmission according to specific geographical location.

Pain assessment during mandibular nerve block injection with the aid of dental vibe tool in pediatric dental patients: a randomized clinical trial.

This study aimed to evaluate the effectiveness of DentalVibe in pain reduction during local anesthetic injection compared to traditional injection in pediatric patients. This cross-over randomized controlled clinical trial included a sample of 60 children, aged 5 to 7 years, who were selected based on the need for local anesthesia for bilateral mandibular pulpotomy treatment. They were randomly allocated into two groups. Each group received two mandibular nerve block injections, with a 2-week interval as the washing out period. At first appointment, mandibular nerve block injection was performed either with vibration using DentalVibe at the injection site or benzocaine gel 20% applied before local anesthetic injection; the alternative technique was used at the second appointment. In each visit subjective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and objective pain was evaluated using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. Assessment using the Wong-Baker FACES Pain Rating Scale showed that the mean pain levels in DentalVibe and traditional injection groups were 0.80 ± 1.34 and 2.60 ± 3.22, respectively. The mean pain levels according to the FLACC scale were 2.20 ± 2.04 and 3.13 ± 2.30 in the DentalVibe and traditional injection groups, respectively. Both scales showed statistically significant differences between the two groups in favor of DentalVibe (P < .001). A positive significant correlation between the two scales in the two interventions was recorded, where the Spearman rho was 0.41 for the DentalVibe group, and 0.52 for traditional injection group (P < .001). Compared to the traditional approach, DentalVibe reduced pain sensation during mandibular nerve block injection in pediatric patients.

Study on the Collection of Medical and Health Information by Parents of Pediatric Dental Patients

Study on the Collection of Medical and Health Information by Parents of Pediatric Dental Patients

Safety of chloral hydrate sedation in dental practice for children: an overview.

Chloral hydrate is the oldest and most common sedative drug used in moderate sedation for pediatric dental patients. Hence, the purpose of this article is to review the safety and possible adverse events of this drug when used for pediatric dental treatment. A bibliographic search in PubMed, MEDLINE, Cochrane Library and KMbase, KISS, DBpia, KoreaMed, and RISS databases was performed. Using the keywords “dental sedation,” “chloral hydrate,” and “children or adolescent,” 512 scientific articles were found. Subsequently, 183 studies were individually assessed for their suitability for inclusion in this literature review. Altogether, 24 studies were selected. They included 12 cases of death before, during, or after chloral hydrate sedation for dental treatment, majorly due to dosing error and use of multiple sedatives. Additionally, intraoperative adverse events were mostly respiratory problems such as hypoxia and apnea, but most events were temporary. After treatment, prolonged sedation, including excessive sleep and less activity were the most common postoperative adverse events, and even death cases were reported. Despite the wide acceptance of chloral hydrate as a sedative-hypnotic agent, the risk of adverse events and adequate dose should be of great concern when using it for pediatric dental sedation.

Effectiveness of different behavior guidance techniques in managing children with negative behavior in a dental setting: A randomized control study.

Dental fear is a common cause of uncooperative behavior among young children, which poses a challenge in providing effective dental treatment. With the advancements in technology, several behavior guidance techniques in the form of distraction have emerged over time for managing uncooperative pediatric dental patients. The aim of this study is to compare and evaluate the effectiveness of four different behavior guidance techniques in managing uncooperative pediatric patients by measuring pre- and post-operative dental fear/anxiety levels using physiological and nonphysiological parameters. Sixty systemically healthy children aged 5-8 years with negative behavior as per Frankl's Rating Scale, requiring restoration were included in the study and randomly divided into four equal groups (n = 15), based on the guidance techniques used: Tell-Show-Do (TSD) as a control group and audio distraction, audiovisual distraction (AVD) (virtual reality [VR]) and Mobile Phone Game Distraction as test groups. Pre- and post-intervention levels of the child's fear/anxiety were assessed using both physiological (blood pressure and pulse rate) and nonphysiological (facial image scale) parameters. The data were evaluated using t-test and one-way ANOVA test. A statistically significant difference was observed in both physiological and non-physiological parameters post-intervention in the groups with a maximum decrease in the AVD (VR) group. AVD (VR) was found to be the most effective while TSD alone as the least effective behavior guidance technique in reducing dental fear/anxiety in uncooperative pediatric dental patients.

Managing pediatric dental patients during the SARS-CoV-2 pandemic

The coronavirus disease 2019 (COVID-19) represents one of the major medical challenges that the World Health Organization (WHO) had to declare the situation as a pandemic and public health emergency. As the virus spreads very rapidly across the world through droplets and direct contact, dental professionals are at the highest risk of exposure to the infection. The emergence of COVID-19 has totally changed the way we practise dentistry. However, the true impact of COVID-19 towards pediatric dental practice is under-reported. Literature search was conducted through PubMed, CINAHL, and SCOPUS databases using the combination of terms such as “Covid19,” “coronavirus,” “pediatric dentistry,” and “paediatric dentistry” to identify relevant documents. This review was written around the impact of COVID-19 on scheduling appointments, infection control practices, and clinical settings and impact on dental care practices. With limited available sources, recommendations were summarized from included guidelines and clinical recommendations. Pediatric dentists are advised to remain vigilant to recent international and local institutional guidelines; appropriate professional clinical judgment should be considered when making decisions.

CARE AND DENTAL INTEGRALITY IN CARRIERS OF DOWN SYNDROME

Down syndrome is a chromosomal disorder caused by trisomy in chromosome 21.The oral cavity manifests many changes induced by the environment as well as alteration in immune system. The objective is to report a 12-year-old male pediatric dental patient who is attended in the dental care service for patients with special needs. He was a heart patient and a carrier of Down syndrome, presenting aggressiveness and endurance on the dental attendance. His problem was a toothache; however, the clinical examination verified mixed dentition, periodontal disease, high incidence of dental caries, malocclusion, staining on teeth, mouth breathing, narrow palate, and macroglossia. The treatment was accomplished through adequacy, prophylaxis, fluoride application, restorations, periapical radiography to exodontia, and the "hug technique." The importance of orientation about the dental health care of patients with Down syndrome to the professional teams is essential, beyond proper procedure and knowledge about the oral characteristics and how a dental surgeon could act to promote the integrality. Down syndrome is a chromosomal disorder caused by trisomy in chromosome 21.The oral cavity manifests many changes induced by the environment as well as alteration in immune system. The objective is to report a 12-year-old male pediatric dental patient who is attended in the dental care service for patients with special needs. He was a heart patient and a carrier of Down syndrome, presenting aggressiveness and endurance on the dental attendance. His problem was a toothache; however, the clinical examination verified mixed dentition, periodontal disease, high incidence of dental caries, malocclusion, staining on teeth, mouth breathing, narrow palate, and macroglossia. The treatment was accomplished through adequacy, prophylaxis, fluoride application, restorations, periapical radiography to exodontia, and the "hug technique." The importance of orientation about the dental health care of patients with Down syndrome to the professional teams is essential, beyond proper procedure and knowledge about the oral characteristics and how a dental surgeon could act to promote the integrality.

Effect of Music on Pain and Anxiety in Pediatric Dental Patients

Dental anxiety and pain management in pediatric children is always challenging,Management of Pain and anxiety are the utmost concern for a paediatrician in order to achieve patient cooperation which plays an essential role in the success of the treatment. Interventions aimed at improving the health and wellbeing of children may also cause pain and anxiety. Inadequate pain control during medical procedures can have long-term detrimental effects, especially among very young children. Hence this review article aims at determining the effect of music on pain and anxiety in pediatric dental patients.

Oral health and plaque microbial profile in juvenile idiopathic arthritis

BackgroundThe oral microbiota has been implicated in the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. This study tested for associations between oral health, microbial communities and juvenile idiopathic arthritis (JIA).MethodsA cross-sectional exploratory study of subjects aged 10–18 years with oligoarticular, extended oligoarticular and polyarticular JIA was conducted. Control groups included pediatric dental clinic patients and healthy volunteers. The primary aim was to test for an association between dental health indices and JIA; the secondary aim was to characterize the microbial profile of supragingival plaque using 16S rRNA gene sequencing.ResultsThe study included 85 patients with JIA, 62 dental patients and 11 healthy child controls. JIA patients overall had significantly more gingival inflammation compared to dental patients, as evidenced by bleeding on probing of the gingiva, the most specific sign of active inflammation (p = 0.02). Overall, however, there was a trend towards better dental hygiene in the JIA patients compared to dental patients, based on indices for plaque, decay, and periodontitis. In the JIA patients, plaque microbiota analysis revealed bacteria belonging to genera Haemophilus or Kingella elevated, and Corynebacterium underrepresented. In poly JIA, bacteria belonging to the genus Porphyromonas was overrepresented and Prevotella was underrepresented.ConclusionIncreased gingival inflammation in JIA was independent of general oral health, and thus cannot be attributed to poor dental hygiene secondary to disability. The variation of microbial profile in JIA patients could indicate a possible link between gingivitis and synovial inflammation.

A trilogy of tragedies - paediatric dental tooth whitening.

Dental tooth whitening is used throughout the United Kingdom for patients who have aesthetic concerns regarding the colour of their teeth. Up until recent months it was also frequently used for paediatric patients with enamel opacities of cosmetic concern and discoloured non-vital anterior teeth. This safe and effective treatment option is now not available to paediatric dental patients due to changes in indemnity cover, and we demonstrate three cases from our department where dental whitening was the most appropriate treatment option. By removing this treatment option for selected paediatric patients, we are concerned that more destructive and less effective treatments may be performed with short- and long-term detriment to their oral health. Furthermore, failure to provide any treatment may negatively affect children's quality of life and psychological well-being.

Prevalence and presentation patterns of enamel hypomineralisation (MIH and HSPM) among paediatric hospital dental patients in Toronto, Canada: a cross-sectional study.

The purpose of the study was to determine the prevalence and presentation patterns of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) in the Division of Paediatric Dentistry at The Hospital for Sick Children (SickKids) in Toronto, Canada. A cross-sectional study of 429 eligible participants was carried out by nine trained and calibrated examiners. The European Academy of Paediatric Dentists (EAPD) criteria for diagnosis and documentation of MIH and HSPM defects were used. Molar incisor hypomineralisation and HSPM prevalence was 12.4% and 5.2%, respectively. Regarding MIH, the affected molars and incisors attributed to 5.6% of the total prevalence, the remaining having only molars affected. Demarcated white opacities were most common in MIH (60%) and HSPM (67%), followed by yellow/brown opacities (MIH 22%, HSPM 9%), post-eruptive breakdown (MIH 8%, HSPM 24%), atypical caries (MIH 6%, HSPM 0%), and atypical restorations (MIH 4%, HSPM 0%). In both MIH and HSPM, single surface hypomineralised lesions were significantly more common than multi-surface lesions (p < 0.0001). Most lesions affected buccal enamel (MIH 55%, HSPM 47%). Lesion extension was most frequently less than 1/3 of a tooth surface (MIH 58%, HSPM 67%) and this was significantly more common in teeth affected by HSPM than MIH (p = 0.03). Individuals with HSPM were more likely to present with two affected molars than individuals with MIH (p = 0.03). Hypomineralised second primary molars were not predictive for MIH. The prevalence of MIH and HSPM was within the range of published studies. The most common MIH and HSPM lesions affected single surface of a tooth, mostly on the buccal surface and were less than 1/3 of the surface area size.

An Audit of Paediatric Dental Patient Assessment and Recall in Faculty of Dentistry UiTM Sungai Buloh

Objective: To assess if the recall appointments and the use of radiographs for paediatric dental patients at Faculty of Dentistry, UiTM comply with current guidelines. Materials and Method: A retrospective study was conducted using patients’ dental records that were registered at the Faculty of Dentistry UiTM. The sample consisted of 350 randomly chosen treatment records of paediatric patients aged between birth and 16 years of age at the time of data collection which was in the year 2016. Data collection included demographic details, whom the cases were treated by, caries risk assessment, radiographs taken and time taken for the patient’s review appointments. Results: An initial sample size of 350 records were assessed. The mean age of patients seen when they were first seen is 6.3 years old. Caries Risk Assessment was not reported in majority of the cases (58%,). Baseline radiographs were taken in 44.6% of the cases. For the assessment of recall attendance, only samples with data on CRA was analysed (n=145). The review appointments at 3 months interval was 70% whereas at 6 months was 6.2% and one year recall was 6.7%. A chi-square test showed significant difference (p=0.013) between the category of operators for the 1-year review whereby review was higher among students and specialists as compared to dental officers. Conclusion: This study shows poor adherence to the recommended recall protocol as suggested by NICE and AAPD guidelines. Further studies need to be done to assess the patients’ and clinicians awareness regarding the recall protocol and determine the problems causing poor recall attendance.

Efficacy of vibrotactile device DentalVibe in reducing injection pain and anxiety during local anaesthesia in paediatric dental patients: a study protocol for a randomised controlled clinical trial

IntroductionA current non-pharmacological mean for attaining painless local anaesthesia (LA) is presented by vibrotactile devices. Their concept is to reduce injection pain due to distraction by applying physical stimuli which...

Reducing Anxiety in Pediatric Dental Patients Through Passive Music Therapy

Reducing Anxiety in Pediatric Dental Patients Through Passive Music Therapy

Assessment of the Quality of Care at the Paediatric Dental Clinic of a Tertiary Health Institution in Nigeria

To evaluate the quality of clinical records as a measure of quality of paediatric oral health care in a tertiary health institution, in Nigeria. A 12-month retrospective review of clinical records of all paediatric dental patients seen in the dental centre of a tertiary hospital in Nigeria was carried out. The clinical records were assessed using a structured standard checklist based on the modified CRABEL Scores. The information assessed in each of the case notes included the case note identification number, patient demographic information, the history of presenting complaint, dental and medical /drug histories. Other information elicited were clinical features, diagnosis, treatment plan, procedures done and professional rank of the person who made the entries. Scores obtained per item for each case note were inputted and analyzed using the Statistical Package for Social Sciences (SPSS) Version 20.0. Three hundred and thirty four clinical records were assessed, of which, 136 (44.3%), 106 (36.8%), 65 (21.2%) and 7 (2.3%) of entries were made by students, interns, resident doctors and consultants respectively. The median CRABEL score was 95%. Written consent was the least (0.3%) documented information. There were statistically significant differences between the professional rank and extra oral examination, treatment plan and procedures done (p<0.05). However, there was no significant difference between the professional rank and CRABEL scores (p=0.4). Using the adequacy of clinical note taking as an index of the quality of care, it may be concluded that the quality of care in our paediatric dental clinic is of high standard. The only shortcoming in our experience was almost the absence of documentation of written informed consent.

An Update on Local Anesthesia for Pediatric Dental Patients

Pain control is a crucial part of dentistry, particularly in the management of children. Behavior guidance, dose, equipments and technique of administration of the local anesthetic are influential for successful treatment of a pediatric patient. Local anaesthesia is commonly employed prior to most dental procedures. its is imperative to understand the mechanism is a by which local anaesthetic work. Local anaesthesia also has major clinical implications in that it can precipitate emergencies in patients. The intention is to present review on the relevant data on topics, involved and on the current methods available in the administration of local anesthesia used for pediatric dental patients.

Effectiveness of Distraction Techniques in Managing Pediatric Dental Patients.

ABSTRACTAimChildren having dental anxiety usually hesitate to seek dental care which can result in poor oral health and may lead to expensive and complex dental treatment in the future. The aim of the present study is to compare and evaluate the effectiveness of various distraction techniques in managing pediatric dental patients.Materials and methodsEighty healthy children selected for the study were randomly divided into 4 groups with 20 children in each group. Group I was termed as the control group; in group II, the audio distraction technique was used. Group III received audio–video distraction (AVD) by means of a chair-mounted audio–video device and group IV received AVD by means of a ceiling-mounted television. Each child had four dental visits. Child's anxiety in each visit was assessed using four parameters: RMS pictorial scale (RMS-PS), Venham picture test (VPT), pulse rate, and oxygen saturation.ResultsCeiling-mounted AVD was found to be the most effective in reducing the anxiety followed by chair-mounted AVD. Audio distraction was found to be the least effective but was better than the control group.ConclusionThe AVD technique is simple, passive, and noninvasive means of behavior management and can be used alternatively in managing anxious pediatric dental patients.How to cite this articleKhandelwal M, Shetty RM, et al. Effectiveness of Distraction Techniques in Managing Pediatric Dental Patients. Int J Clin Pediatr Dent 2019;12(1):18–24.

Ağız, Diş ve Çene Cerrahisi Uzmanlarının Çocuk Hastalarda Uygulanan Davranış Yönlendirme Tekniklerine İlişkin Bilgi, Tutum ve Uygulamaları

Objectives:The aim of this study was to evaluate the knowledge, attitude, and practices of oral and maxillofacial surgeons regarding behavior guidance techniques that reduced fear and anxiety for children. Materials and Methods:In this cross-sectional study, the participants were oral and maxillofacial surgeons who treat pediatric dental patients in the private and public clinics in Turkey. The questionnaires were applied through an electronic form via a website. The results were evaluated using IBM SPSS Statistics 22 for statistical analysis. A p-value of &amp;lt;0.05 was accepted as statistically significant.Results:60% of the participants were specialist trainees, 9% were doctoral students, 16% were oral and maxillofacial surgeons and 15% were lecturers in the department of oral and maxillofacial surgery of various universities. 45% of the oral and maxillofacial surgeons said they could always take responsibility of working on a pediatric patient, while 33% of them stated that they frequently treated child patients, and 22% of them sometimes took this responsibility. 55% of the participants said they had been trained in behavior guidance techniques for children. The result showed that 93% of the surgeons used tell-show-do, 69% used voice control, 27% used nonverbal communication, 73% used positive reinforcement, 61% utilized distraction techniques, 59% used presence-absence of parents, 15% used hand-over-mouth, 36% used sedation, 36% used restrain/protective stabilization, 46% used general anesthesia, and 2% had used hypnosis method.Conclusions:This study showed that the oral and maxillofacial surgeons working in public and private clinics have a high awareness of behavior guidance techniques while the level of this awareness varies among surgeons according to age, gender, workplace, work experience, and training.

Behavioral management of the pediatric dental patient among clinical dental students and interns

Anaemic syndrome is a common manifestation of rheumatoid arthritis. Both anaemia of chronic disease and iron deficiency anaemia are present in patients with rheumatoid arthritis. Patients with active rheumatoid arthritis are more like to be anaemic with a high impact on the quality of life. The diagnosis of anaemia of chronic disease is made by exclusion. Treatment of the anaemia consists merely of anti-rheumatic treatment. This was a retrospective study of 34 patients diagnosed of rheumatoid arthritis between July 2013 and June 2016. These were the patients that satisfied the 1987 revised diagnostic criteria of the American College of Rheumatology for the diagnosis of rheumatoid arthritis. Anaemia was diagnosed based on the packed cell level and laboratory analysis of red blood cell morphology. Patients with rheumatoid arthritis were divided into 3 groups; rheumatoid arthritis patients without anaemia, rheumatoid arthritis patients with anaemia of chronic disease, and rheumatoid arthritis patients with iron deficiency anaemia. The laboratory results for packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC) were noted and analyzed. Erythrocyte sedimentation rate and rheumatoid factor results were documented. Five hundred and two rheumatology patients were seen over a period of three years (July 2013 –June 2016). Thirty-four rheumatoid arthritis patients were diagnosed (F-26, M-8) with a female to male ratio of 3.3:1. The age range was 18 to 65 years with a mean age of 45 ± 6yrs. The mean duration of onset at presentation was 5 ±2.6 years, and the mean early morning joint stiffness was 3 ±1.2 hours. The mean swollen and tender joint count was 14 ± 2. Erythrocyte sedimentation rate was uniformly elevated with a mean value of 78 ± 5mm/hr. Rheumatoid factor was positive in 27 patients. Anaemia was predominant in age group 41 to 50 years. The prevalence of anaemia was 70.6%, and anaemia of chronic disease was predominantly seen (70.8%). Among patients with rheumatoid arthritis, the prevalence of anaemia was found to be relatively high. Anaemia of chronic disease was the leading cause of anaemia. The degree of anaemia was closely related to the age and duration of the disease.Keywords: Haemoglobin, iron deficiency, mean corpuscular haemoglobin, anti-rheumatic drugs, rheumatoid arthritis