BACKGROUND:Oral health-related conditions are a leading and preventable cause of paediatric hospital presentations in Australia, contributing substantially to healthcare expenditure and placing increasing pressure on public hospital infrastructure. Preschool-aged children are disproportionately affected, often presenting late with advanced disease requiring resource-intensive care, including emergency extractions under general anaesthesia. In Western Australia, these challenges are further compounded by geographic barriers that limit timely access to public dental services. METHODS:This study provides longitudinal data on dental-related emergency presentations at Perth Children's Hospital (PCH) and its predecessor, Princess Margaret Hospital for Children (PMH), over six years (2016-2021). The primary aim was to characterise the nature, volume, and demographic profile of unplanned emergency presentations associated with odontogenic infection. RESULTS:Emergency presentations for odontogenic infections accounted for 46% of all presentations to the dental department. Children under five years accounted for nearly 60% of these cases, demonstrating a pronounced age-related disparity. A consistent year-on-year increase was observed in emergency presentations, with over 30,000 teeth being extracted, the majority of these requiring general anaesthesia. Posterior primary teeth comprised the majority of extractions, likely reflecting advanced, untreated early childhood caries. CONCLUSIONS:These findings highlight a persistent and escalating burden of preventable disease presenting at a late stage, where care is more invasive, costly, and resource-intensive. Without strategic investment in early, accessible, and preventive models of care, increasing demand will continue to strain hospital-based services and divert resources from other critical areas of paediatric healthcare.

IntroductionAplastic anemia (AA) is a rare condition that frequently manifests with pancytopenia. Management of severe disease is through either allogenic stem cell transplantation or immunosuppressive therapy with supportive care. Drug-induced gingival overgrowth (DIGO) is a potential complication of a number of medications, including cyclosporine and amlodipine.Case ReportThe following report presents the case of a male child who was diagnosed with severe AA at 7 years of age. He was managed with immunosuppressive therapy and developed DIGO as a side effect of treatment, exacerbated by poor oral hygiene. Nonsurgical and surgical management strategies were utilized. Gingival debulking surgery was completed at 9 years of age, once the patient's condition had stabilized. Postoperative care included regular dental prophylaxis and oral hygiene instruction. The patient's medical condition remained stable, and his oral health was maintained without relapse of DIGO.ConclusionThis case emphasizes the importance of coordinated care for managing DIGO in immunocompromised pediatric patients and describes the successful management of DIGO using both nonsurgical and surgical methods.

D1ental caries remains the most common chronic disease in childhood, affecting almost half of all children globally. Dental care and examination of children living in remote and rural areas is an ongoing challenge that has been compounded by COVID. The development of a validated system with the capacity to screen large numbers of children with some degree of automation has the potential to facilitate remote dental screening at low costs. In this study, we aim to develop and validate a deep learning system for the assessment of dental caries using color dental photos. Three state-of-the-art deep learning networks namely VGG16, ResNet-50 and Inception-v3 were adopted in the context. A total of 1020 child dental photos were used to train and validate the system. We achieved an accuracy of 79% with precision and recall respectively 95% and 75% in classifying 'caries' versus 'sound' with inception-v3.

Objective: Dental casts are an important aspect in the treatment planning, documentation, and analysis of the dental arch forms of infants with cleft lip and palate (CLP). Impression taking in a neonate is a technique-sensitive procedure, which can result in foreign body dislodgement and carries a small risk of aspiration and airway obstruction. The advent of digital dental technologies and intraoral scanning may facilitate safer, more effective, and accurate impressions for CLP infants. Design: A digital intraoral scan of a 3-month-old with bilateral CLP (BCLP) was compared with a conventional alginate impression taken prior to primary lip repair. Setting: Princess Margaret Hospital for Children. Main Outcome Measures: To test the applicability and accuracy of digital impression taking for a neonate with BCLP and palate using digital morphometrics. Results: The average deviation of points ranged above and below the plane of superimposition from +0.78 mm to −0.42 mm with a maximum range of +2.80 mm to −2.80 mm and standard deviation of 0.88 mm. The premaxillary segment showed the greatest degree of variation. Conclusions: This is to our knowledge the first report that illustrates the use of a digital impression system to scan the oral structures of a neonate with BCLP. Digital scanning was found to be fast, accurate, and safe, when compared to a conventional alginate impression technique.

To determine the detectability of the intra-oral photographic method in comparison to the baseline, comprehensive dental examination (CDE), in children when performed by different levels of dental practitioners.

Objective: Dental emergencies are a significant impact on the health system. The resource needs are complex and consume services in the tertiary health sector. It is important that we examine the reasons and types of attendances to look for ways to mitigate this demand. The aim was to identify the rate of dental emergencies according to age groups, genders and Indigenous status.Design: A retrospective analysis of dental emergencies at the Princess Margaret Hospital (PMH; tertiary children hospital in Perth) was performed. Setting: The study included data from hard-copy files of patients admitted to the PMH.Main outcome measures: The records of 239 children who attended the PMH in Perth with dental emergency problems during the first 3 months of 2017 were analyzed. Findings: The major reasons for dental emergencies were infection and trauma. The most common age group was children between 3 to 6 years old. In this age group, boys attended more than girls due to dental injury. Although there were equal presentations of dental infection and dental trauma cases, dental infection cases mostly required hospitalization and treatment under general anesthetic. Conclusion: While some dental emergencies are unavoidable, increasing awareness about dental hygiene, regular checkups and early dental treatments in children could decrease emergency visits and prevent conditions such as dental infections

At birth, pulmonary vasodilation occurs during rhythmic distension of the lungs with oxygen. Both mechanical and humoral factors are involved, including the release of vasoactive substances such as prostacyclin and endothelium-derived nitric oxide (EDNO). However, the exact mechanisms remain unclear. Because endothelin-1 (ET-1) produces potent pulmonary vasodilation in the fetus via EDNO release and ET-1 concentrations are increased at birth, we considered that ET-1 activity may participate in the pulmonary vasodilation that occurs with O2 ventilation. Therefore, we studied and compared the changes in pulmonary hemodynamics associated with in utero O2 ventilation with and without ET-1 receptor blockade induced by an infusion of Ro 47-0203 (Bosentan, a nonselective ET receptor antagonist), in 13 late-gestation fetal lambs. In all fetal lambs, prostaglandin synthesis was prevented by an infusion of meclofenamate, and ductus arteriosus constriction was prevented by prior formalin infiltration. The infusion of Ro 47-0203 blocked the decrease in pulmonary vascular resistance induced by injections of either ET-1 (-0.985 versus +0.012 mm Hg/mL/min/100 g of lung,p < 0.05) or 4-Ala-ET-1 (an ETb receptor agonist) (-0.717versus -0.052 mm Hg/mL/min/100 g of lung, p < 0.05). However, ET receptor blockade did not change the increase in pulmonary blood flow or decrease in pulmonary vascular resistance associated with in utero O2 ventilation. This study suggests that endogenous ET-1 activity does not play an important role in the vasodilatory response to ventilation with O2 in utero.

The mechanisms by which acute alveolar hypoxia induces pulmonary vasoconstriction remain unclear. Previous studies suggest that hypoxia-induced vasoconstriction is endothelium-dependent and is associated with the release of endothelin-1 (ET-1), a potent vasoactive paracrine hormone produced by vascular endothelial cells. The vasoconstrictive effects of ET-1 are likely to be mediated by ETA receptors located on vascular smooth-muscle cells. BQ-123 is a selective ETA receptor antagonist. To determine the role of ET-1 and ETA receptors on resting tone and hypoxic pulmonary vasoconstriction, we studied the effects of ET-1 and BQ-123 at rest and during hypoxia-induced pulmonary vasoconstriction in 12 intact newborn lambs (< 1 week old). At rest, the intrapulmonary infusion of BQ-123 did not change resting pulmonary arterial pressure but completely blocked the rapid increase in pulmonary artery pressure produced by high doses of ET-1 (2,000 ng/kg) (23.0 +/- 10.8% versus -12.6 +/- 27.5%; p < 0.05). During mechanical ventilation there was no difference in the increase in mean pulmonary arterial pressure and pulmonary vascular resistance induced by alveolar hypoxia before and after BQ-123 (34.0 +/- 8.9% versus 30.5 +/- 10.9% and 25.3 +/- 11.6% versus 35.2 +/- 22.4%). This study suggests that the pulmonary vasoconstrictive effects of ET-1 are mediated by ETA receptors and that ET-1 does not mediate acute hypoxic pulmonary vasoconstriction in intact newborn lambs.