搜索结果：Journal of dentistry for children (Chicago, Ill.)

Purpose: To evaluate the sensitivity and specificity of the near-infrared light transillumination caries detection method by using DEXIS CariVu (DCV) for imaging of interproximal primary molar surfaces (IPMS).<br/>Methods: A retrospective evaluation of patient records at a university pediatric dentistry (PD) clinic identified 22 patients with unrestored IPMS, which had images of both bitewing radiography (BW) and DCV. A scoring system (no caries, incipient caries, dentinal caries) was developed for the study. Two investigators (pediatric dental faculty) identically scored 90 IPMS in both BW and DCV images, establishing benchmark IPMS scores. The 180 images were then compiled in a randomized order in a questionnaire, which was answered by 24 raters (PD residents and faculty) using the study caries scoring system. Data analysis included raters and experts' percent agreement, Vassar Stats for sensitivity and specificity, and Kendall's correlation coefficient for interrater reliability.<br/>Results: The overall agreement between raters and experts for DCV images was 48 percent (54 percent for no caries, 23 percent for incipient caries, and 68 percent for dentinal caries). The DCV's sensitivity and specificity to detect any caries were, respectively, 0.72 and 0.54, 0.60 and 0.53 for incipient caries, and 0.82 and 0.53 for dentinal caries. The BW's sensitivity and specificity to detect any caries were respectively, 0.82 and 0.87, 0.98 and 0.86 for incipient caries, and 0.99 and 0.87 for dentinal caries. The overall interrater reliability was 0.48 (95 percent confidence interval equals 0.46 to 0.50).<br/>Conclusion: The use of DCV as a stand-alone caries detection method for IPMS is limited.

Purpose:To assess the impact of the Covid-19 pandemic on applicants for advanced education programs in pediatric dentistry in the United States and provide recom- mendations for virtual interviews (VI).<br/> Methods:A cross-sectional survey was emailed to pediatric dentistry applicants in the 2020-2021 cycle.<br/> Results:One hundred seventy-five applicants responded. Virtual interviews were the universal format during this timeframe. Forty-four percent admitted to applying to programs they were not initially strongly considering and 42 percent accepted inter- views they would have declined if they had to travel. Applicants found social events with residents only (80 percent), a program overview presentation (86 percent), a virtual tour (77 percent) and a question-and-answer session with residents (85 percent) to be helpful. One-on-one or paired faculty interviews were the most preferred inter- view method. More than half (55 percent) thought programs were not able to learn about them as effectively through virtual compared to an in-person format.<br/> Conclusions: VI caused different applicant behavior due to the low time and financial investment. Applicants valued their time with residents to learn about programs, but were split in their preferences for virtual, in-person or hybrid interviews. Programs can use findings from this study to plan future recruitment cycles.

To assess acceptance and use of protective stabilization devices (PSD) by Pediatric Dentistry Diplomates. Surveys were electronically mailed in 2013 to 2922 members of the American Board of Pediatric Dentistry's (ABPD) College of Diplomates. Bivariate (assessing provider personal and practice characteristics) and multivariate analyses were performed on reported acceptance and use of PSD. Response rate was 28 percent. Providers more likely to report acceptance and use of PSD were those in practices with lower SES patient base, where there was the perception that patients' parents were more accepting of PSD, and those with low patient volume. Provider who were more likely to report acceptance and use of PSD were female, not working solely in private practice, and from Southeast or North Central regions of the U.S. Neither PSD use during residency nor ABPD Board cohort (<2009 versus 2009-2013) was associated with current acceptance or PSD use. Upon multivariate assessments of practice and personal characteristics, only perception of parent acceptance was associated with provider acceptance whereas perception of parental acceptance, practitioner sex and practice setting were associated with provider use of PSD. Practitioner sex, practice setting, region, and perception of parental acceptance are all important factors related to PSD acceptance and 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.

Purpose: To identify factors that influence oral health behaviors in the pediatric population treated for caries under general anesthesia (GA).<br/>Methods: Nineteen semi-structured key informant interviews were conducted with caregivers while their children received comprehensive dental care under GA. Interviews were recorded on audio and professionally transcribed. Transcripts were coded using an inductive approach, with codes categorized and themes identified in an iterative process among four investigators.<br/>Results: Data from 14 English and five Spanish interviews were reported. Factors that impacted accessing dental services, toothbrushing, and sugar intake were related to experiences living with severe caries and family dynamics. Many caregivers found the process of accessing care challenging, with barriers ranging from a caregiver's denial of disease severity to insurance status and provider availability. Discordant dynamics between parents and their children hindered efforts to change oral health behaviors. Stress of daily life impacted the ability for some caregivers to prioritize oral health.<br/>Conclusion: Our findings provide a better understanding of how a family's experiences and dynamics prior to dental care under GA can serve as barriers to changing oral health behaviors within an urban, Medicaid-enrolled population. Future work should address the complexity and context of familial interactions in efforts to improve surgical outcomes.

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.

Odontogenic infections are preventable yet common in adults and children, and can progress to life-threatening levels if not definitively managed in a timely manner. Children with odontogenic infections often first present to the pediatric or general dental practice, making pediatric and general dentists key players in the management of odontogenic infections. While the pediatric or general dentist can definitively manage several types of infections, their critical role goes well beyond treatment to include timely and appropriate triage as well as facilitation of care when the severity of the infection exceeds the scope of their practice. Thorough and efficient triage allows the dentist to determine the most appropriate timing and setting of definitive care, thus preventing avoidable delays or inefficient use of health care resources. The purpose of this narrative review is to discuss key concepts in the overall management of odontogenic infections in children, with a focus on the clinical significance of each concept, in an algorithmic format.

Purpose: To evaluate and compare the clinical and radiographic performance of a new type of mineral trioxide aggregate (MTA, NuSmile&#xae; NeoMTA&#xae;) and ferric sulfate (FS) as pulpotomy medicaments for primary molars over 12 months.<br/> Methods: Fifty participants (25 per group) were enrolled, according to specific inclusion criteria. Each participant received a single primary molar pulpotomy either with MTA or FS, depending on random digit table method allocation. Fifteen pediatric dental residents completed all pulpotomies, supervised by specialist faculty. Two calibrated examiners performed outcome assessments according to standardized criteria. Every six months, the study teeth were evaluated clinically and every 12 months radiographically. The inter- and intraexaminer reliability was assessed using Cohen's kappa, and the chi-square test was used for statistical analysis.<br/>Results: At six months, 42 participants (21 in each group) returned for evaluation. The FS group showed 95.2 percent clinical success compared to 100 percent for the MTA group. At the 12-month clinical and radiographic evaluation, the return sample consisted of 29 participants (14 in the MTA group, 15 in the FS group). FS had 86.6 percent clinical success and 60 percent radiographic success, while MTA showed 100 percent clinical and radiographic success. At 12 months, MTA showed a statistically significantly higher success rate compared to FS (P = 0.008). Examiner reliability was excellent with a kappa score greater than 0.88.<br/>Conclusion: At 12 months, MTA showed superior success as a pulpotomy medicament in primary molars compared to FS.

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&#xb1;9.98. Group four showed the highest mean KHN (72.66&#xb1;6.34 at three mm), while the control had the lowest KHN (58.42&#xb1;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.

Vitamin C deficiency, colloquially known as scurvy, has become rare in modern times due to the widespread availability of ascorbic acid-rich foods. Despite this, it continues to be a concern in certain at-risk populations. The purpose of this report is to describe the case of a two-year-old girl who initially presented to a pediatric dental clinic with the chief complaint of hypertrophic gingiva and bleeding. Suspecting a systemic cause, the dental team referred the patient to a hematology clinic for further evaluation. Subsequent assessments and laboratory work confirmed a diagnosis of diet-related vitamin C deficiency. Management with supplements led to the resolution of the oral manifestations and normalization of laboratory values. This report details the clinical presentation and pathophysiology of vitamin C deficiency to assist healthcare providers in recognizing signs and symptoms, ensuring timely referral and facilitating appropriate treatment. Additionally, it underscores the importance of pediatric dentists as potentially the first clinicians to encounter such cases and their role in the multidisciplinary management of these pediatric patients.

Purpose: The maxillary labial frenulum (MLF) has been implicated in clinical concerns, including breastfeeding difficulties, midline diastema and oral hygiene challenges. Despite multiple classification systems, a lack of consensus persists regarding the clinical significance of MLF variations and indications for surgical intervention. This review evaluates existing classification systems, diagnostic approaches and treatment considerations to provide an evidence-based framework for clinical decision-making. Methods: A literature search was conducted using PubMed, Scopus and EMBASE. Studies were screened through a multi-phase process and their quality was assessed using the Critical Appraisal Skills Program. Results: Sixteen studies met the inclusion criteria. Classification systems varied widely, with limited clinical applicability. Midline diastema often resolves naturally, questioning the necessity of early frenectomy. Surgical intervention is only advised when MLF impedes oral hygiene or contributes to orthodontic relapse. Conclusions: Variability in the classification and management of the MLF may contribute to inconsistent clinical decisions. Evidence-based guidelines are needed to support appropriate intervention and reduce the risk of unnecessary procedures.

Purpose: To describe toothbrushing frequency/duration and toothpaste use among young children in an urban, vulnerable population in Chicago, Ill., USA.<br/> Methods: Caregivers of children younger than three years old were recruited from university and community pediatric dental clinics. Caregivers completed a 37-item questionnaire in English or Spanish about predictors/covariates (demographics, child/caregiver oral health, access to dental care) and primary outcomes (child toothbrushng behaviors, toothpaste use). Models employed generalized logit and ordinal logistic regression.<br/> Results: A total of 148 caregivers completed the survey. The average child age was 18.8 months (&#xb1;7.4 SD). Approximately 41 percent of children brushed once a day or less, and 19 percent of caregivers did not regularly assist. Almost all children used toothpaste (96 percent), but 36 percent of caregivers did not know if it contained fluoride. Increased child brushing frequency was associated with older child age, higher caregiver brushing frequency, history of a child dental visit, and caregiver assistance (P<0.05). Children with a history of dental visits were seven times more likely to brush for 30 seconds or more, and receiving caregiver assistance was associated with brushing longer than two minutes (P <0.05).<br/> Conclusion: Most children brushed at least once daily and nearly all of them used toothpaste. Access to dental care, parental involvement, and parental oral health were associated with favorable child toothbrushing behaviors. Toothbrushing duration, frequency, and encouraging family assistance are modifiable protective factors and opportunities for intervention.

Purpose: To identify pandemic-related behavioral and attitudinal changes in caregivers. Methods: A 38-question cross-sectional survey was developed and distributed to English-speaking caregivers accompanying children for dental care in a hospital dental clinic. The questionnaire surveyed caregiver beliefs and behaviors regarding COVID19, whether the pandemic altered their use of medical and dental care or at-home health habits, as well as their attitudes toward medical and dental teams. Results: The 594 respondents varied in age, marital status, education and income level. Trust was high regarding medical and dental teams, government public health management and mask policies for children. However, those respondents who did not think children should be required to wear masks at school if the health department recommended it and respondents who did not think that government agencies would protect them if another pandemic happened were less likely to change perceptions on dental care, preventive dentistry, sugar intake and toothbrushing (P<0.05). No other strong and consistent relationships were found. Conclusions: In a safety-net dental clinic population, over half of caregivers changed dental behaviors and attitudes following the pandemic. Caregivers cynical of mask mandates and governmental pandemic management were not in the group to change their dental attitudes and behaviors. No other consistent pattern of demographic variables offered a clear profile of group beliefs and behaviors, suggesting the necessity of inquiring individuals and families about their oral health perceptions and behaviors.

Purpose: To describe the geographic distribution of pediatric dentists (PDs) in Florida and the sociodemographic characteristics of communities in which they are located compared with communities without a PD.<br/>Methods: The ratio of PDs to children for each county in Florida and the distribution of PDs in Florida counties at the census tract (CT) level were calculated. Each CT was categorized as having or not having PDs to examine the geographic distribution of PDs, and the sociodemographic differences between CTs with and without a PD were tested by using t-tests. PDs' participation in Medicaid and acceptance of new patients were also investigated.<br/>Results: Of the 67 counties in Florida, 31 had no PD. There were 4,181,677 children younger than 18 years served by 388 PDs, for a statewide ratio of 9.2 PDs per 100,000 population (range 0 to 34.9). Median household income, family income, and education were higher in CTs with PDs, and poverty level, unemployment rate, and percentage of African American population were higher in CTs with fewer PDs. Although 49 percent of PDs accepted Medicaid, only 32 percent accepted new patients.<br/>Conclusion: There are regional and sociodemographic disparities in the distribution of PDs in Florida.

Purpose: To determine if caregivers' race and ethnicity impact their willingness to accept passive immobilization for their child's dental treatment and to determine if a detailed description of passive immobilization will make caregivers more likely to accept the technique.<br/> Methods: Caregivers of one- to 11-year-old patients were recruited in a university pediatric dental clinic. They completed two surveys and reviewed a written and pictorial description of passive immobilization.<br/> Results: A total of 266 caregivers participated. Subjects were willing to accept passive immobilization at the following percentages by race/ethnicity: Hispanic (84 percent); African American (66 percent); Asian (50 percent); and non-Hispanic Caucasian (24 percent). There was a significant association between a caregiver's race and ethnicity and the willingness to consent to passive immobilization (P =.000), and in willingness to accept passive immobilization after reviewing its detailed description (P =.000).<br/> Conclusion: Differences in acceptance of passive immobilization were observed based upon race and ethnicity. African American and Hispanic caregivers were more willing to accept the technique than their Asian and non-Hispanic Caucasian counter- parts. Caregivers were more likely to accept the use of passive immobilization after they were given more information about the technique. (J Dent Child 2019;86(1):3-9) Received May 30, 2018; Last Revision August 3, 2018; Accepted August 7, 2018.

The purpose of this study was to assess the occlusal characteristics of individuals with growth hormone deficiency (GHD), idiopathic short stature (ISS), and Russell-Silver syndrome (RSS), and compare them to the means of a normal population. Data about the stage of dentition, diastema, maxillary transverse deficiency, overjet, overbite, molar classification, and maxillary and mandibular crowding were obtained from orthodontic screening notes and standardized clinical exams of children with growth disorders seen at screening events. The prevalence of these occlusal characteristics was calculated and compared to the pooled mean of a normal population as determined by the National Health and Nutrition Examination Survey studies. Twenty RSS subjects and 16 subjects with GHD or ISS were studied. The RSS cohort presented statistically significant greater mean overbite as well as mandibular and maxillary crowding compared to the general population. Descriptive statistics were performed for the GHD and ISS group. Occlusal abnormalities are prevalent in children with growth disorders.

Aggressive fibromatosis (AF) is an uncommon, benign, collagen-forming soft tissue neoplasm that is characterized by monoclonal myofibroblast cell proliferation and derived from musculoaponeurotic structures. It has a locally invasive pathological behavior and a high potential for recurrence. Fibromatoses with onset in infancy and childhood are characterized with higher cellularity and more aggressive growth. The mainstream management of AF is surgical removal with microscopically lesion-free margins. In advanced cases, radical surgery can lead to function loss and disfigurement. Hence, early diagnosis and management can avoid complications. Although uncommon (two to four cases per million per year are reported), approximately 25 percent of AF incidents occur in children younger than 15 years of age. Pediatric dentists are likely to be the first practitioners to encounter new cases of AF in younger populations and should have knowledge and understanding of this entity. The purpose of this report is to present a rare case of AF affecting the mandible of a young patient.

Purpose: To assess the effectiveness of Biodentine&#x2122; (BD), mineral trioxide aggregate (MTA) and ferric sulfate (FS) as pulpotomy agents in primary molars and evaluate the impact of behavior guidance strategies on pulpotomy success.Methods: In this retrospective cross-sectional study, data from 374 cases (50.5 percent male, aged two to 10 years) undergoing 469 pulpotomies at a university pediatric clinic between April 1, 2016 and January 1, 2020 were analyzed. Clinical and radiographic outcomes were evaluated by two calibrated examiners using validated criteria. Statistical analysis included descriptive statistics, logistic regression (P <0.05), Kaplan-Meier survival curves and Cox proportional hazard models, with inter- and intra-examiner reliability confirmed by Cohen's Kappa. Results: Among the materials, BD and MTA showed the highest clinical (98.5 percent and 97.9 percent, respectively) and radiographic (95.2 percent and 93.6 percent, respectively) success, significantly outperforming FS (88.9 percent and 80.9 percent, respectively). Pulpotomy failures were notably higher with the use of protective stabilization (P =0.002), while treatment under general anesthesia and good patient cooperation were associated with better outcomes. Conclusions: BD and MTA demonstrated superior effectiveness over FS for primary molar pulpotomies. The success of pulpotomy is significantly influenced by behavior guidance techniques, with less restrictive methods correlating with improved outcomes.

Knowledge of microbiology-related issues in dentistry is fundamental to clinical practice and patient care. The purpose of this literature review is to comprehensively describe the roles microbes play in pediatric dental practice, with a special focus on eight continuing and emerging microbiological issues related to waterline safety, dental material contamination, effects of oral bacteria on systemic health, antibiotic resistance, continuing COVID-19 findings and risks associated with animal-assisted therapies. Key points are highlighted on each topic, with current reports demonstrating microbial impacts on human health and clinical settings. Advice and risk management strategies related to patient care and clinical practice are provided.