Purpose: To evaluate the prevalence of teething problems throughout the period of primary tooth eruption. Methods: This birth cohort study was conducted in two phases: Phase one (evaluation of teething symptoms among newly recruited infants) and Phase two (evaluation of teething symptoms among newly recruited infants and follow-up evaluation among infants recruited in Phase one). The study included an evaluation of infants born in a tertiary health care hospital using a hybrid design of telephonic conversation/video calling and clinical examination. The data were collected by one trained and calibrated evaluator and recorded in a self-designed form with validated measures of teething problems. Results: A total of 525 infants and parents participated. Teething problems were most prevalent at nine months of age (67.1 percent), followed by 12 months (50.1 percent) and 15 months (43.6 percent). Finger-sucking was the most common teething problem at six months (14 percent), nine months (81 percent), and 12 months (61.1 percent) of age. Incisor eruption was most associated with teething problems (72.5 percent), followed by canines (39.4 percent), first molars (36.9 percent) and second molars (24.9 percent). A significant correlation was seen between maternal education and maternal occupation and the parent-reported prevalence of teething problems (P<0.05). Conclusions: Almost two-thirds of the parents reported one or more teething problems at nine months coinciding with incisor eruption, whereas half also reported teething problems at 12 months. A significant correlation was seen between maternal education, maternal occupation and the prevalence of teething problems.
Purpose: To assess the fracture resistance of prefabricated esthetic crowns for primary molars. Methods: Seventy-two human mandibular second primary molars were divided into three groups: preveneered stainless steel crowns (VSS), prefabricated zirconia crowns (PZ) and BioFlx crowns (BF). Crowns were cemented with glass ionomer cement; for each group, 12 samples were tested for fracture resistance and 12 samples underwent 5,000 thermocycles before testing. The fracture mode was assessed for all the samples. Differences in the fracture resistance values between the groups were tested using analysis of variance (ANOVA), followed by Tukey's post hoc test, while the distribution of fracture modes was tested using Fisher's exact test. Statistical significance was set at P =0.05 and analyses were conducted using SPSS version 25.0 software. Results: ANOVA tests indicated a significant difference in fracture resistance among the test groups (P <0.001). The groups were ranked as follows: before thermocycling- (1) PZ group (3,327±1497), (2) BF group (1,694±163) and (3) VSS group (536±12); and after thermocycling-(1) PZ group (3,308±162), (2) BF group (1,579±77) and (3) VSS group (413±16). Tukey's post hoc analysis indicated that the PZ group exhibited a significantly higher fracture resistance than the BF and VSS groups (P <0.001). The VSS group showed a predominance of minimal cracks (5.6 percent) and loss of less than half of the crown (11.1 percent). Conclusions: PZ yielded the highest resistance, followed by BF crowns. VSS may require caution in high-stress areas due to their susceptibility to esthetic component failure, although the underlying crown remains functional.
Purpose: To understand mandatory educational requirements for child abuse and neglect (CAN) recognition and mandated reporting for dentists to obtain and renew dental licensure in the United States (US).Methods: Publicly available state websites, dental board documents and the American Academy of Pediatric Dentistry's website outlining requirements for dental licensure in the US were reviewed for specifically designated mandated reporting or CAN educational requirements as prerequisites to obtain either initial or renewal of licensure to practice dentistry within the jurisdiction. For inclusion in the study, CAN education had to be listed as a requirement specific to obtaining and renewing dental licensure, not just a general mandated reporting education suggested or required by the state.Results: Four of 50 states (Illinois, Iowa, New York and Pennsylvania) and the District of Columbia require a mandatory educational course on CAN and reporting to obtain a dental license. Four states (Illinois, Iowa, Maryland and Pennsylvania) and the District of Columbia require a mandatory educational course on CAN to renew a license.Conclusions: This study suggests that more US states should implement a requirement for dental professionals to take a mandatory educational course on CAN recognition and reporting to obtain and renew dental licensure. This education should be specific to dentistry and dental practice settings to best prepare professionals to report suspected abuse and/or neglect.
Purpose: To measure the fluoride release and enamel fluoride uptake from a new dimethicone-based fluoride varnish (Profisil) and Duraphat fluoride varnish, and determine if the varnishes occlude dentin tubules. Methods: The fluoride release of both varnishes was measured from specimens with a constant surface area to volume ratio in a water bath. The fluoride uptake of demineralized enamel cores treated with both varnishes was studied over 24 hours using ion-specific electrodes to determine fluoride content and atomic absorption spectroscopy to determine calcium content. Scanning electron microscopy (SEM) was used to examine the occlusion of dentin tubules and the surface of enamel after treatment with varnish. Results: Duraphat varnish released 68±7.1 ppm of fluoride per gram of varnish after 24 hours. Profisil varnish released 65±6.3 ppm of fluoride per gram of varnish after 24 hours. Duraphat varnish specimens had a fluoride content of 2.5±1.8 mg F/g enamel before application of the varnish, which increased to 285±62 mg F/g enamel after 24 hours. Profisil varnish specimens had a fluoride content of 2.4±2.1 mg F/genamel before application of the varnish, which increased to 272±74 mg F/g enamel after 24 hours. SEM images depicted that both varnishes occluded open dentin tubules and left mineral deposits on the surface of the enamel. Conclusions: Both varnishes released significant amounts of fluoride and significantly increased the fluoride uptake of demineralized enamel. Moreover, the new varnish induced occlusion of the tubules and induced mineral growth on the surface of the enamel.
Purpose: To assess the direct and indirect effects of oral conditions, family income, child's sex, history of toothache and dental visits on oral health-related quality of life (OHRQoL) of children, according to parents. Methods: A cross-sectional study was conducted with 843 pairs of parents and children aged three to five years of age, in Campina Grande, Paraíba, Brazil. Parents answered a questionnaire with sociodemographic and socioeconomic questions, and their children's use of services and experience of toothache, as well as the Brazilian Scale of Impact on Oral Health in Early Childhood. Three researchers examined for the presence of dental caries, dental trauma and malocclusion. Descriptive and confirmatory factor analyses were conducted to validate the measurement models and constructs. The analysis accounted for confounding factors to ensure precise estimates of the relationships among variables. Structural equation modeling was employed to examine both direct and indirect associations between variables. Results: Absence of dental visits (β =-0.332; 95 percent confidence interval [95% CI]:- 0.471 to -0.193; P <0.001) and toothache (β =-0.748; 95% CI:0.588 to 0.883; P <0.001) directly impacted OHRQoL negatively. Family income (β =0.689; 95% CI: 0.518 to 0.859; P <0.001) and anterior open bite (β =-0.339; 95% CI:-0.613 to -0.184; P <0.001) had indirect effects mediated by dental caries (β =0.748; 95% CI: 0.748 to 0.883; P <0.001). Conclusion: Both direct and indirect factors affect the OHRQoL of preschoolers, emphasizing the importance of considering oral health conditions and socioeconomic factors to evaluate and improve their quality of life.
Diamond-Blackfan anemia is a rare inherited bone marrow failure syndrome. It is part of a group of genetic disorders characterized by a decrease in red blood cells due to bone marrow malfunction. It affects five to seven live births per million per year. Pediatric patients are typically diagnosed within the first year of life; however, clinical manifestations can present at any age. Advances in molecular testing have increased the ability to identify Diamond-Blackfan anemia variants in adults. Patients with the disease have a wide range of features, including distinct physical characteristics; however, there is limited literature highlighting the dental manifestations and implications of the disease. Therefore, the purpose of this case report is to review the literature on Diamond-Blackfan anemia and highlight the unique challenges that dental practitioners may face in the delivery of dental care.
The purpose of this report is to describe a seven year-old boy diagnosed with hypohidrotic ectodermal dysplasia who was rehabilitated with dental implants and partial removal prosthesis. The patient had only three dental elements: primary maxillary right first molar and primary maxillary right and left canines. The patient underwent treatment under general anesthesia in a hospital setting. Two dental implants were placed in the mandibular arch to support a dental prosthesis. Due to the COVID-19 pandemic, there was a prolonged period before continuing with the rehabilitative phase. Upon resumption, peri-implant mucositis was observed. Through professional and home plaque control measures, peri-implant tissue health was restored. A removable prosthesis was fabricated for the maxillary arch and O-ring attachments were used for the mandibular prosthesis. Given the patient's growth, prostheses may need to be replaced approximately every six months until growth is complete.
This case describes an emergency situation with a 10-month-old infant who presented with a sizable, smooth-surfaced, dome-shaped oral lesion. Upon examination, the pediatric dentist discovered a piece of a toy, embedded in the alveolar ridge. The purpose of this case report is to raise awareness about intraoral foreign body embedment in infants, highlighting the potential risks associated with popular toys that can break, adhere to the alveolar ridge and pose choking hazards. Pediatric dentists should advise parents to prevent infants from chewing on toys due to safety concerns.
Purpose: To evaluate the influence of commonly used restorative materials, including zinc oxide eugenol (ZOE), resin-modified glass ionomer cement (RMGIC) and stainless steel crowns (SSC), on the setting reaction (measured by microhardness) of Endo-Cem Premix Mineral Trioxide Aggregate (PMTA) when used as a pulpotomy agent. Methods: Fifty extracted primary molars had a pulpotomy with a three-millimeter layer of EndoCem PMTA applied to the pulpal floor. Specimens were divided into five groups: group one (control), EndoCem with a moistened cotton pellet; group two, EndoCem with RMGIC; group three, EndoCem with ZOE; group four, EndoCem with RMGIC and SSC; and group five, EndoCem with ZOE and SSC. Teeth were incubated at 37 degrees Celsius and 100 percent humidity for 24 hours. Microhardness was measured at depths of one, two and three millimeters using a Knoop hardness tester. Statistical analyses included analysis of variance and Tukey's post hoc tests (significance at P<0.05). Results: EndoCem PMTA demonstrated effective setting across all experimental groups, with an overall mean Knoop hardness number (KHN) of 65.71±9.98. Group four showed the highest mean KHN (72.66±6.34 at three mm), while the control had the lowest KHN (58.42±11.26 at one mm). Groups three and four had significantly higher KHN than the control group (P<0.01). Microhardness values remained consistent across depths, with the highest values observed at three millimeters. Conclusions: EndoCem PMTA sets reliably, regardless of the restorative material, supporting its application in single-visit pulpotomy procedures. The use of ZOE or RMGIC with SSC further enhanced its mechanical properties.
Purpose: To assess the interrater agreement and reliability of pediatric airway assessments using the Brodsky and Mallampati classifications among pediatric dentistry residents, pediatric dentistry faculty and anesthesiologists. This study also aimed to determine the consistency of sedation decisions and the impact of clinical experience on classification reliability. Methods: A cross-sectional study was conducted with 50 participants who evaluated 17 pediatric airway videos, grading tonsillar obstruction using the Brodsky scale and oropharyngeal visibility using the Mallampati classification. Sedation decisions were recorded as binary outcomes. Assessments were completed twice, seven days apart, for intra-rater reliability. Interrater agreement was measured using Kendall's W and Fleiss' Kappa, while reliability was assessed using the intraclass correlation coefficient (ICC). Statistical differences between groups were analyzed using Kruskal-Wallis and Wilcoxon rank-sum tests. Results: The Brodsky scale demonstrated moderate to good interrater reliability, with anesthesiology faculty showing the highest agreement (ICC=0.627 to 0.612), followed by the dental faculty (ICC=0.654). Residents maintained moderate reliability (ICC=0.578 to 0.536). The Mallampati classification showed lower reliability, with anesthesiology faculty declining from moderate agreement (ICC=0.365) to poor agreement (ICC=0.209) between surveys. Sedation decisions had moderate agreement, with Fleiss' Kappa values of 0.467 for anesthesiology faculty, 0.407 for dental faculty and 0.371 for residents. Conclusions: The Brodsky scale was more reliable than the Mallampati classification, especially among experienced clinicians. The Mallampati classification showed greater variability. Structured training and clear protocols are necessary to improve airway assessment consistency and sedation safety.
Purpose: Several studies have evaluated the effects of cancer-related chemo-radiation on developing teeth, leading to disturbances in the formation of enamel and dentin, affecting the crown and root. However, their impact on dental pulp has not been well explored. The purpose of this study was to evaluate dental pulp calcification among young cancer survivors. Methods: This was a cross-sectional observational study consisting of 240 participants, each among cases and controls. It comprised an evaluation of orthopantomograms of cancer survivors prescribed as part of the follow-up evaluation under the cancer survivorship program. Patients with a confirmed diagnosis of malignancy (with a baseline diagnosis at 21 years of age or younger) who completed cancer treatment, as well as a long-term survivor (i.e., they remained cancer-free for two years), were included. Similarly, controls included were free from dental caries or any other systemic condition that could affect the dental pulp calcification. Results: The prevalence of dental pulp calcification was 24.1 percent (95 percent confidence interval [95% CI=19.15 to 30) among young cancer survivors, whereas among controls it was 8.3 percent (95% CI=5.43 to 12.57), which was statistically significant (P< 0.01). The multivariate regression analysis revealed 2.54 odds of having dental pulp calcification among survivors with initiation of anticancer therapy at the age of five years or younger, and 2.08 odds among those who received chemotherapy and radiation compared to chemotherapy alone. Conclusion: There was an increased likelihood of dental pulp calcification among young cancer survivors, especially when radiation was combined with chemotherapy and initiated at a young age.
Maxillary frenectomies are invasive surgical procedures that are increasingly being performed in dental clinics to address functional and esthetic concerns. The purpose of this case report is to describe a 16-month-old boy who presented with oral bleeding lasting over 12 hours following a laser maxillary labial frenectomy, which eventually led to a diagnosis of severe hemophilia A. This case highlights the importance of thorough patient assessment, including the need to rule out systemic conditions, such as coagulopathies, prior to frenectomies. This report also raises concerns about the number of frenectomies being performed despite insufficient evidence to support their routine use.
Purpose: To assess antibiotic-prescribing practices at a university-based pediatric dental clinic, evaluating adherence to the American Academy of Pediatric Dentistry (AAPD) best practice recommendations. It aimed to determine the appropriateness of antibiotic selection, dosing, frequency and duration, and identify factors associated with inappropriate prescriptions. Methods: A retrospective cross-sectional study of electronic health records was conducted for patients aged zero to 17 years who received antibiotics for odontogenic infections or related dental conditions over 27 months, including a three-month COVID-19-related clinic closure. Data on patient demographics, clinical diagnoses, prescribed antibiotic type, dosage, administration frequency and duration were analyzed. Adherence to the AAPD prescribing recommendations was assessed and statistical analyses, including chi-square tests and logistic regression models, identified factors linked to inappropriate prescribing. Cohen's kappa statistics determined intra- and inter-examiner reliability. Results: Among 279 patient records, adherence to AAPD guidelines was 61.6 percent. Inappropriate prescriptions were significantly more frequent in younger children aged zero to seven years and medically compromised patients, with the latter twice as likely to receive an inappropriate prescription (P=0.0033, odds ratio [OR]=2.15). Infections involving permanent teeth were associated with a higher likelihood of prescribing errors (P=0.0353, OR=1.95). Weight-based dosing errors occurred in 6.5 percent of cases, mostly due to underdosing. The COVID-19 pandemic reduced overall prescriptions, but the proportion of inappropriate prescriptions remained unchanged. Conclusions: Antibiotic prescribing in pediatric dentistry showed moderate adherence to AAPD guidelines, with inappropriate prescriptions influenced by patient age, medical status and tooth type. Strengthening antibiotic stewardship and provider education is necessary to improve prescribing practices.
Dental replantation is the treatment of choice for tooth avulsion; however, complications such as root canal obliteration, pulp necrosis and tooth resorption can arise, influenced by factors like extra-alveolar time and the storage medium in which the tooth was maintained. This case report discusses a seven-year-old child who experienced a traumatic avulsion of a permanent maxillary right central incisor with incomplete root formation. While the tooth was successfully replanted and both pulp vitality and complete root formation (apexogenesis) were initially maintained, the tooth later developed root canal obliteration and ankylosis, followed by external replacement root resorption. The tooth was extracted after six years due to advanced root resorption, leading to the placement of a space maintainer during childhood. Subsequently, an osseointegrated dental implant with a ceramic crown was placed. A 10-year follow-up post-implant installation demonstrated successful oral rehabilitation 20 years after the trauma. This case highlights the importance of long-term follow-up and a multidisciplinary approach in treating severely traumatized permanent teeth.
There is a scarcity of reports regarding the application of digital technology in pediatric dental prostheses after full-mouth dental rehabilitation. The purpose of this report is to describe a case involving the dental rehabilitation process of a six-year-old boy with sickle cell disease (SCD) who received multiple dental extractions under general anesthesia. The authors employed an innovative approach to prosthetic rehabilitation using digital fabrication of removable partial dentures and compared it with dentures fabricated using the conventional method. The digital workflow facilitated a straightforward fabrication process for denture-making as the child grew, enhanced the esthetics by customizing the teeth, improved the fit and decreased chairside time. In this context, the application of digital technology offers a potential solution for improving the oral health and quality of life of pediatric patients with SCD.
Langerhans cell histiocytosis (LCH) is a rare disease marked by the proliferation of Langerhans cells and the destruction of tissue. LCH can be limited to the oral cavity where it can present with gingival bleeding, swelling, tooth mobility and bone loss. This case report describes a 13-year-old male with LCH who presented with a one-month history of painful jaw swelling. Clinical examination revealed a firm, ulcerated mass adjacent to the mandibular right second premolar. Biopsy and subsequent histopatho- logic examination confirmed LCH. The lesion resolved spontaneously post-biopsy and the patient remains disease-free. Recognizing oral manifestations of LCH in dental practice is crucial for prompt diagnosis, appropriate multidisciplinary management and improving the survival rates and future quality of life for children with LCH.
The purpose of this report is to present the case of a 17-year-old girl diagnosed with cyclic neutropenia (CN), who had undergone six months of treatment with zoledronate three years before. She sought treatment for extreme mobility of the mandibular left lateral incisor, canine and first premolar that had been present for one month. Clinical features included calculus, severe gingival recession and mandibular bone exposure. Panoramic radiographs and cone beam computed tomography confirmed bone sequestration. Conservative treatment comprising antibiotic therapy, use of perio- dontal instrumentation and a hyperbaric chamber proved unsatisfactory. An unfavor- able evolution was confirmed by the presence of bone sequestration that required bone removal, together with the teeth located in the block of the detached bone. The diagnosis was osteonecrosis of the jaw. The patient presented moderate periodontal involvement associated with CN; therefore, periodontitis was unlikely to have been the main factor triggering the local and systemic complications.>.
PURPOSE:To evaluate the bonding effectiveness of a new universal adhesive system compared to its predecessor on carious primary dentin using the etch-and-rinse and self-etch techniques. METHODS:Twenty human primary molars were subjected to artificial induction of carious dentin and then randomized into four experimental groups according to universal adhesive (Scotchbond Universal Plus, SBU Plus and Scotchbond Universal-SBU) and bonding techniques (etch-and-rinse and self-etch). The adhesives were applied according to the manufacturer's instructions and the starch tube molds were filled with a flowable composite resin. Bond strength was determined using a testing machine and the data were analyzed using two-way analysis of variance. All specimens tested were assessed for failure pattern classification. RESULTS:No significant differences in bond strength values were observed when com- paring universal adhesive systems (P =0.83), etching technique (P =0.34) or the cross- interaction adhesive system versus etching technique (P =0.96). CONCLUSION:Regardless of the bonding technique, SBU Plus showed similar bond strength compared to its predecessor when applied to carious dentin of primary molars.
Peripheral odontogenic fibroma (POdF) is a rare and benign mesenchymal odontogenic tumor that stands out as a distinctive entity. It is predominantly found in the gingiva and can present as a diagnostic challenging lesion due to its potential resem- blance to reactive oral lesions. The purpose of this report is to describe a case of a POdF in a 10-year-old child and highlight the importance of recognizing this lesion in the pediatric population. This report also explores the essential diagnostic differentials that clinicians should consider when examining a palpable soft tissue nodule with a firm consistency. Radiographically, well-defined small radiopacities were visible within the lesion, which was indicative of calcified structures. A complete surgical excision was done and histopathological analysis was diagnostic of POdF. The presence of calcifications exhibiting an osteoid/cementoid appearance was confirmed within the lesion. There were no signs of recurrence noted during the 16-month postoperative follow-up period. This case underscores the significance of PodF, which may be included in the differential diagnosis of gingival lesions in pediatric patients.
Purpose: To investigate associations between parent-reported children's taste preferences, children's feeding practices and early childhood caries (ECC). Methods: A convenience sample of children younger than 72 months was recruited from several clinics and a health center in Winnipeg, Manitoba, Canada, between April 2019 and July 2022. The parents of participants were guided through a questionnaire assessing their children's taste preferences and feeding practices. Data were stored in REDCap and analyzed using NCSS 2022 and 2023 software. Statistical significance was defined by a P-value <= 0.05. Results: Overall, 467 children with a mean age of 45.7 +/- 15.4 months were recruited, of which 49 percent were female and 60 percent had ECC. Children with ECC had a higher mean taste preferences score, indicating greater preferences toward sugary foodstuffs (caries-free [CF]=0.63 +/- 1.07, ECC=0.96 +/- 1.02; P<0.001), with a great proportion showing preferences toward candies, ice cream and sugary drinks. Children with ECC also displayed a higher mean snacking frequency (CF=2.57 +/- 1.20, ECC= 3.13 +/- 1.22; P <0.001) and a great percentage (CF=36 percent, ECC=56.8 percent; P<0.001) frequently snacked before going to bed. A great proportion of parents of children with ECC also reported adding sweeteners to their children's drinks. Conclusions: Overall preferences toward sugary foods and individual preferences toward candies, ice cream and sugary drinks are associated with the presence of caries, as are unhealthy feeding patterns. Preferences toward a cariogenic diet may be a risk factor for developing ECC.
