Purpose: This retrospective study assessed the presence of adverse events during moderate sedation for pediatric dental procedures performed in a dental clinic. Methods: Dental treatment completed with sedation between June 2014 to November 2024 was assessed for the presence of any adverse events (AEs). AEs were classified by the modified Tracking and Reporting Outcomes of Procedural Sedation (TROOPS) scale and an adverse event list from the Pediatric Sedation Research Consortium (PSRC). Results: There were 923 completed patient sedation records between the ages of 2 and 16 years from 9 different sedation regimens within the dental clinic included in this study. Overall, the proportion of adverse events was low (4.55%) with an increase in AE with the intranasal dexmedetomidine/orally administered midazolam (odds ratio [OR]=4.7, P<0.01) and a decrease in AE with triazolam (OR equals 0.2, P<0.01). No adverse events required medical intervention. Conclusions: Overall, adverse event proportions were low with pediatric dental moderate sedation supporting the safety of this modality of treatment. More studies are needed to assess adverse events and adverse event scales in pediatric dental sedation.
Purpose: To compare the monomer leaching of 3D-printed denture base materials (NextDent® Denture 3D+ [D3D]) and orthodontic base material (NextDent® Ortho Flex [OF]) with conventional poly-methyl methacrylate (PMMA) resins at 5 time points. Methods: Fifteen standardized samples (N=5 /group) of D3D, OF, and PMMA materials were submerged in artificial saliva for 48 hours. The solutions were extracted, and the monomer release rate and amount were measured using high-performance liquid chromatography (HPLC) at 0, 8, 16, 24, and 48 hours. One-way analysis of variance, independent t-tests, and post-hoc least significant difference tests were used to compare monomer release rates and amounts across different time intervals and materials. Results: Methyl methacrylate was detected in the PMMA group at 0.0034 wt%, which is below the ISO threshold (<4.5 wt%). Significant differences were observed in monomer release rates and patterns among the groups (P<0.001). The highest monomer release occurred within the first 8 hours and decreased drastically over time (P<0.001). Among 3D printing groups, the OF group exhibited a higher release rate than the D3D group at all time points (0, 8, 16, 24, and 48 hours; P <0.001). The D3D group maintained a consistently low release rate. Conclusions: The levels of monomer release in this in vitro study would be considered safe for use in pediatric dentistry. Due to the highest monomer release occurring within the first 8 hours, it is recommended that appliances be delivered at least 8 hours after fabrication to minimize initial exposure.
Injection-related pain and anxiety remain major challenges in pediatric dental care and may negatively influence cooperation and future dental attitudes. This randomized clinical trial compared four anesthetic delivery techniques; conventional manual syringe, computer-controlled local anesthetic delivery (CCLAD), vibration-assisted injection, and needle-free jet injection, in 112 children (6-10 years) undergoing pulpotomy. Pain was measured with the Wong-Baker Faces Pain Rating Scale and FLACC; anxiety with Venham's Picture Test; physiological responses with heart rate and oxygen saturation; cooperation with Houpt's scale; and parental satisfaction by questionnaire. Outcomes were assessed at prespecified procedural phases and analyzed separately for mandibular and maxillary arches. During anesthesia administration the Manual syringe group consistently demonstrated higher self-reported pain (Wong-Baker), greater behavioral distress (FLACC), and higher Venham anxiety scores compared with the three alternative techniques (P ≤ 0.05 for key comparisons). CCLAD was associated with more stable attenuation of both subjective and behavioral pain and relatively lower autonomic responses (heart rate), particularly during anesthesia. Jet injection and Vibration-assisted techniques generally reduced distress relative to the Manual syringe but with some site-dependent variability. Oxygen saturation remained stable across all groups, and Houpt cooperation scores were similar across techniques. Parental satisfaction was significantly higher in the alternative technique groups than in the Manual syringe group (P ≤ 0.05). In conclusion, alternative anesthetic delivery systems reduce injection-related pain and anxiety in children compared with conventional manual syringe administration without compromising physiologic safety or treatment feasibility; among the tested devices, CCLAD showed the most consistent benefit. These findings support selective adoption of alternative delivery techniques to improve the pediatric dental experience. Injection-related distress in pediatric dentistry is technique-dependent and concentrated during local anesthetic administration. The findings of this study support the clinical use of alternative anesthetic delivery systems as effective strategies for reducing pain and anxiety in children without adversely affecting treatment feasibility or safety. Selection of an appropriate anesthetic delivery technique may improve the overall dental experience for pediatric patients, enhance parental satisfaction, and contribute to more positive long-term attitudes toward dental care.
Background Pulp necrosis is a prevalent complication following dental caries in primary dentition. Certain bacteria exhibit increased adaptability to adverse conditions and possess virulence factors that enable more effective colonization of dental tissues. The invasion of the root canal system (RCS) by pathogenic microorganisms, compounded by the rising concern of antimicrobial resistance (AMR), emphasizes the necessity for a culture-driven and evidence-based approach to antibiotic selection in pediatric endodontics, wherein the therapeutic efficacy of root canal treatment is inherently dependent on the comprehensive elimination of endodontic microbiota. Aim To isolate, identify, and analyze the antimicrobial susceptibility and resistance profiles of microorganisms associated with endodontic infections in the deciduous teeth of children undergoing pulp therapy. Materials and methods One hundred systemically healthy children aged four to nine years with carious teeth and without direct endodontic exposure were enrolled following Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines at the Department of Pediatric and Preventive Dentistry, University College of Medical Sciences (UCMS) & Guru Teg Bahadur Hospital (GTBH), Delhi, India. Root canal samples from infected or necrotic primary teeth were aseptically collected and cultured on blood, chocolate, and MacConkey agar. Bacterial isolates were identified via Gram staining and standard biochemical assays. Statistical evaluation was conducted using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States). Results Bacterial growth was detected in 68 samples (68%), predominantly involving Gram-positive cocci (n=48; 48%). Enterococcus faecalis (n=25; 25%) was the most common isolate, followed by Staphylococcus aureus (n=17; 17%) and a smaller proportion of Gram-negative bacilli, including Enterobacter cloacae, Escherichia coli, and Klebsiella pneumoniae. All isolates showed complete sensitivity to vancomycin, teicoplanin, linezolid, amikacin, and imipenem, while variable resistance to macrolides, clindamycin, fluoroquinolones, and β-lactams was observed. No extended-spectrum β-lactamase (ESBL) or carbapenem-resistant strains were identified. Conclusion Enterococcus faecalis remains the predominant pathogen in pediatric endodontic infections, with its increasing multidrug resistance presenting significant therapeutic challenges. Nevertheless, β-lactam and glycopeptide antibiotics continue to demonstrate reliable clinical efficacy. These findings highlight the importance of culture-guided therapy and rational antimicrobial stewardship in pediatric dental practice.
Objective: To automatically estimate children's physiological age from pediatric panoramic radiographs, employing a two-stage approach which involves permanent teeth staging assessment followed by physiological age conversion, as well as an end-to-end approach. Methods: From 3 367 radiographs of children aged 4 to 11 years, collected at Pediatric Dentistry, Peking University School and Hospital of Stomatology, between November 2012 and August 2020, 640 images were randomly assigned into training set-1 (392 images), validation set-1 (118 images), and test set-1 (130 images) using Python (version 3.9) scripts. Using manual annotations of Demirjian's stages for 8 left mandibular teeth as gold standard, a YOLOv5-based deep learning model (staging-judgment-model) was trained and validated, whose performance was assessed using metrics including accuracy and weighted Kappa. Using chronological age as ground truth, random forest models (age-machine-models) were developed based on automatic staging of teeth 31-37 or 31-38. The full dataset (3 367 images) was randomly allocated into training set-2 (2 031 images), validation set-2 (673 images), and test set-2 (663 images) to train a ResNet-50-based deep learning model (age-deep-model). An external test set (907 images) from the Clinical Division Peking University School and Hospital of Stomatology from June 2022 to December 2022 was collected. Performance was assessed using mean absolute error (MAE), root mean square error (RMSE), and coefficient of determination (R²). Class activation maps were used to reveal the areas of concern for the age-deep-model. Images with an absolute difference between inferred and actual ages exceeding 3 standard deviations from the mean difference were selected for manual reviews. Results: The staging-judgment-model achieved an overall accuracy of 75.95%, with a linear-weighted Kappa of 0.87 and quadratic-weighted Kappa of 0.95. In the test set-1, the MAE, RMSE and R² of the age-machine-models based on automatic staging of teeth 31-37 were 0.592 years, 0.757 years and 0.879, while ones of the age-machine-models based on automatic staging of teeth 31-38 were 0.594 years, 0.754 years and 0.879. In the test set-2, the MAE, RMSE and R² of the age-deep-model were 0.621 years, 0.800 years and 0.918 respectively. The gradient class activation map revealed that the areas of concern for age-deep-model gradually shifted from the crown of the posterior deciduous teeth to the apical area of the posterior permanent teeth with increasing age. The staging-judgment-model might mistake later teeth development stages for earlier ones, resulting in an underestimated assessment of physiological age by age-machine-models. Similarly, orthodontic appliance images might lead the age-deep-model to generate an underestimated age estimation. Conclusions: This study enabled fully automated physiological age inference via two complementary approaches, demonstrating potential for preliminary screening of children with dental developmental abnormalities. Further optimization is required prior to clinical implementation. 目的： 探索基于曲面体层X线片（以下简称曲面体层片）综合应用两阶段和端到端方法推断儿童生理年龄在临床数据中的真实表现，为算法优化与临床应用提供依据。 方法： 从北京大学口腔医学院·口腔医院儿童口腔科2012年11月至2020年8月间拍摄的符合标准的3 367张曲面体层片中抽取640张图像，使用Python（3.9版本）编写程序随机分配为训练集-1（392张图像）、验证集-1（118张图像）和测试集-1（130张图像）。以医师标注的左下象限8颗恒牙的Demirjian分期为金标准构建以YOLOv5为骨干网络的深度学习模型（以下简称分期判断模型），计算分期判断模型的准确率和加权Kappa值，以实际年龄为标准构建基于牙位分期结果换算生理年龄的随机森林模型（以下简称年龄-机器模型）。将全部3 367张图像使用Python（3.9版本）编写程序随机分配为训练集-2（2 031张图像）、验证集-2（673张图像）和测试集-2（663张图像），以实际年龄为标准构建以ResNet-50为骨干网络的深度学习模型（以下简称年龄-深度模型）。收集北京大学口腔医学院·口腔医院第一门诊部2022年6月至2022年12月拍摄的全部4~11岁儿童曲面体层片作为外部测试集（907张图像）。计算年龄-机器模型在测试集-1中、年龄-深度模型在测试集-2中的平均绝对误差（MAE）、均方根误差（RMSE）、决定系数（R²）评价年龄推断的准确性。在测试集-2中使用类激活热力图探索年龄推断深度模型所关注的图像区域。在外部测试集中筛选推断年龄与实际年龄差值的绝对值超过差值均值3倍标准差的图像进行人工审阅。 结果： 分期判断模型整体准确率为75.95%，线性加权Kappa值为0.87，二次加权Kappa值为0.95。在测试集-1中，基于31—37牙位的年龄-机器模型MAE为0.592岁，RMSE为0.757岁，R²为0.879；基于31—38牙位的年龄-机器模型MAE为0.594岁，RMSE为0.754岁，R²为0.879。在测试集-2中，年龄-深度模型MAE为0.621岁，RMSE为0.800岁，R²为0.918。年龄-深度模型的关注区域随着年龄增加从乳牙后牙的冠部逐渐向恒牙后牙的根尖区域转移。分期-判断模型偏向牙齿发育早期可导致年龄-机器模型推断年龄偏低，存在矫治器影像可导致年龄-深度模型推断年龄偏低。 结论： 本研究基于机器学习和深度学习技术实现了儿童生理年龄的全自动推断，能初步筛选出牙齿发育状况异常的儿童，但实际应用前仍需进一步优化。.
Canceled procedures in pediatric day-case surgery are a serious issue that can disrupt hospital workflow, resource utilization, and patient care. To better analyze this and explore strategies to mitigate such costly inefficiencies, we employed unsupervised machine learning (ML) techniques to analyze data from children undergoing day-case surgery at the Ospedale Pediatrico Bambino Gesù IRCCS between January 2020 and March 2022. We analyzed a dataset including 4,417 operated and 183 non-operated patients. The following variables were considered: age, hospitalization type, surgical specialty, procedure type, and reasons for cancelation. Dimensionality reduction was performed using Factor Analysis of Mixed Data (FAMD). Cluster analysis was conducted using the k-means algorithm, while a Random Forest classifier was employed to assess feature importance and enhance model interpretability. The overall cancelation rate was 3.84%. Among operated patients, the median duration of surgery was 22 min (IQR: 12-32). For non-operated patients, the median waiting time from first consultation to the scheduled surgical procedure was 105 days (IQR: 58-194). K-means clustering (k = 3) identified three distinct patient groups, supported by robust clustering metrics (silhouette score: 0.696; Davies-Bouldin index: 0.447; Calinski-Harabasz score: 10,119.546). The Hopkins statistic (0.003) confirmed a strong clustering tendency in the dataset. Cluster 0 (n = 2,010) was mainly characterized by plastic and maxillofacial procedures (n = 765), andrological procedures (n = 533), and pediatric urology surgeries (n = 194), largely performed in an ambulatory setting (n = 1,779). Cluster 1 (n = 1,773) predominantly included andrological procedures (n = 809) and showed the longest median intervention duration (27.01 min). Significant inter-cluster differences were observed for age (Kruskal-Wallis test, p < 0.001 for clusters 0-1 and 1-2), surgical intervention rates (highest in Cluster 2: 97.92%; χ 2 = 10.11, p = 0.0063), and procedure duration (all pairwise Dunn tests p < 0.001). Random Forest analysis identified hospitalization type (feature importance: 0.47) and procedure type (feature importance: 0.45) as the most influential variables contributing to cluster differentiation. The ML analysis may suggest targeted strategies for optimizing scheduling and resource allocation, ultimately improving patient care and operational efficiency.
Purpose: The purpose of this study was to examine for differences in mean oxygenation levels of healthy pediatric patients and pediatric patients with sickle cell disease (SCD) receiving nitrous oxide (N₂O) for dental procedures and to determine if N₂O decreases oxygen saturation levels for SCD patients. Methods: Patients aged 2 to 17 years with SCD and healthy age-matched patients were recruited at their preventive or restorative dental visits between 2019 and 2023. Up to 50% N₂O was administered during routine restorative treatment. Oxygen saturation was measured via a pulse oximeter before starting nitrous, at 10-minute intervals throughout treatment, and after nitrous oxide termination. Descriptive and bivariate analyses were conducted using statistical software with statistical significance set at P<0.05. Results: There was a significant difference in average oxygen saturation at baseline between cases and controls; however, there was no significant difference at 10, 20, or 30 minutes. There was no significant difference in oxygen saturation between cases and controls after terminating N₂O. Conclusions: Use of up to 50% nitrous oxide for dental treatment was found to be safe in this cohort of sickle cell disease patients. The oxygen saturation of healthy patients and patients with SCD increases with the use of N₂O. In addition, N₂O use in patients with SCD may alleviate anxiety and increase the pain threshold, decreasing the risk for vaso-occlusive crisis.
Burkitt lymphoma is a highly aggressive mature B-cell non-Hodgkin lymphoma characterized by MYC dysregulation and a high proliferative index. Although the sporadic form commonly presents with abdominal involvement, maxillofacial manifestations in children may mimic odontogenic infections, leading to delayed diagnosis. We report a nine-year-old boy with a rapidly progressive unilateral mandibular swelling initially treated as a dental abscess without improvement. Imaging revealed an ill-defined osteolytic mandibular lesion with cortical erosion and soft tissue extension, raising suspicion for malignancy. Histopathology demonstrated monomorphic medium-sized atypical lymphoid cells with high mitotic activity. Immunohistochemistry confirmed B-cell lineage (CD20, CD10, BCL6, c-MYC) with a Ki-67 index of 95%, consistent with Burkitt lymphoma. The patient was treated with rituximab-based multi-agent chemotherapy and showed a favorable response. This case highlights the importance of early radiologic-pathologic correlation and prompt biopsy in atypical pediatric mandibular swellings to enable timely diagnosis and management.
This multicentre pilot study examined whether intraoral scanners (IOS) enhance oral health competence in paediatric patients and their caregivers compared with conventional verbal oral health instructions (OHI). Sixty children aged 6-14 years and their caregivers from three European university centres were randomly assigned to a control group (verbal OHI) or an intervention group (verbal OHI + IOS visualisation). Children were stratified into age groups: (6-8, 9-11, 12-14 years). Calibrated dentists performed standardised examinations and delivered OHI. In the intervention arm, an IOS scan was obtained and the 3D model was used to explain individual clinical findings. Comprehension of clinical findings was assessed after the consultation using age-adapted questionnaires. Children in the intervention group additionally rated their IOS experience using a visual analogue scale (VAS, 0-100%). Statistical analysis included descriptive statistics and Kruskal-Wallis tests. Children in the intervention group achieved higher comprehension scores (4.40 ± 1.61 vs. 3.33 ± 1.81; p = 0.019). Caregivers also scored higher in the intervention group (5.03 ± 1.25 vs. 4.10 ± 1.37; p = 0.008). Benefits were greatest in children aged 6-11 years. VAS ratings indicated acceptance: scanning was perceived as "fun" (83.8%), "informative" (81.3%) and "enjoyable to watch" (88.6%). Tip size was rated appropriate (68.7%), whilst agreement with "boring" (25.9%) and "painful" (24.1%) was low. The dentist's explanation was rated as clear (94.8%). IOS improved communication and understanding of oral health findings in paediatric dentistry, particularly amongst younger children and their caregivers.
Purpose: Strabismus management in developmental-delayed children presents challenges, as outcomes are unpredictable due to factors such as limited neuroplasticity, poor central control, and subnormal binocular potential. This meta-analysis evaluates the outcomes of strabismus surgery in these children. Methods: Eligible studies published before 28 May 2023 were extracted from MEDLINE, EMBASE, CINAHL, Cochrane, PsychINFO, and gray literature. A meta-analysis was performed using STATA 14.0. The comparator group were children without developmental delays who underwent strabismus surgery. Fixed-effect and random-effect models were computed based on heterogeneity. Results: Our meta-analysis included 31 articles, with a total of 3687 subjects. There was no significant difference in the surgical dose for children with developmental delays compared to children without developmental delays (SMD -0.06, 95% CI: [-0.36, 0.23]). Post-operatively, developmentally delayed children had a significant improvement in their angle of deviation (SMD 2.79, 95% CI: [2.50, 3.08]) and could achieve a post-operative angle of deviation similar to children without developmental delays (SMD -0.20, 95% CI: [-0.51, 0.11]). The median rate of undercorrection was similar between developmentally delayed and children without developmental delays, at 20.4% and 20.2%, respectively. For the median rate of overcorrection, developmentally delayed children had a higher rate of 12%, compared to 4.35% in children without developmental delays. For developmentally delayed children, the median incidence is 71.45% for needing one surgery, 23.9% for two surgeries, and 7.15% for three surgeries. Conclusions: Strabismus surgery in developmentally delayed children may have higher rates of overcorrection and may need more repeat operations but could achieve significant improvements in their ocular alignment.
The COVID-19 pandemic has led to significant restrictions in access to oral health services and may have affected the need for dental treatment in pediatric patients. This study aimed to retrospectively evaluate the effect of the COVID-19 pandemic on the extraction rates of permanent first molar teeth in pediatric patients aged 9-14 years. In this retrospective archival study, the records of patients aged 9-14 years who visited our clinic between January 1, 2017, and December 31, 2025, were reviewed. The study period was divided into three periods: pre-pandemic (January 1, 2017-March 9, 2020), pandemic (March 11, 2020-May 5, 2023), and post-pandemic (May 6, 2023-December 31, 2025). The number of permanent first molar extractions and their proportion of total extractions were compared across ages and periods. Pearson's chi-square test was used to analyse the data, and a significance level of p < 0.05 was accepted. Extraction rates were positively associated with increasing age across all study periods (p < 0.001). It was determined that the rate of permanent first molar extractions increased significantly in the post-pandemic period compared to the pre-pandemic period (RR = 1.82; 95% CI: 1.69-1.95; p < 0.001). Although there was a decrease in the total number of extractions during the pandemic period, the rate of permanent first molar extractions among total extractions were found to be significantly higher than before the pandemic (RR = 1.4; 95% CI: 1.28-1.53; p < 0.001). The COVID-19 pandemic was found to have a significant effect on permanent first molar extraction rates in pediatric patients. Restrictions in access to oral health services and delayed visits during the pandemic may be associated with increased extraction rates in the post-pandemic period. These findings emphasize the importance of continuity of preventive oral health services during extraordinary circumstances.
In high-stakes postgraduate examinations, the cognitive complexity of assessment items is central to evaluating advanced clinical reasoning and decision-making competencies. Alignment between examination content, cognitive demand, and competency-based educational frameworks is essential for assessment validity. This study evaluated the cognitive structure of pediatric dentistry questions in the Turkish Dental Specialty Examination (DUS) using Bloom's revised taxonomy and examined their alignment with curricular expectations. A retrospective cross-sectional analysis was conducted on 127 officially released pediatric dentistry questions administered between 2012 and 2021. Each item was independently classified according to Bloom's revised cognitive levels. Curriculum relevance and scientific accuracy were rated using a 5-point Likert scale. Inter-rater reliability was assessed using weighted Cohen's kappa. Associations between cognitive level and curriculum relevance were analyzed, and temporal trends across examination years were explored. Questions were predominantly concentrated at the Understand and Apply levels, with fewer items categorized at the Analyze level. No questions were classified at the Evaluate or Create levels. Although lower- and higher-order cognitive skills appeared proportionally balanced when dichotomized, higher-order items largely reflected procedural application rather than advanced analytical or evaluative reasoning. No significant temporal progression toward greater cognitive complexity was observed. Curriculum relevance ratings were high overall but showed no significant association with cognitive level. This high-stakes specialty examination predominantly assesses lower- and intermediate-level cognitive processes, with limited representation of advanced higher-order thinking. The findings indicate potential blueprint misalignment with postgraduate competency expectations and underscore the need for deliberate integration of higher cognitive-level items to strengthen assessment validity.
Objective: To analyze the current global development status and research hotspots of dental trauma-related studies, to provide references for future research in this field in China. Methods: Literature related to dental trauma, published from the inception of the Web of Science Core Collection up to December 27, 2025, was retrieved. Visualization analysis was conducted using Bibliometrix, VOSviewer, CiteSpace, and Excel. Results: A total of 2 639 publications were included. The annual publication output showed an overall increasing trend with fluctuations. Levin L was the most prolific author, the Universidade Federal de Minas Gerais was the leading institution, and Brazil was the most productive country/region. Andreasen JO was the most frequently co-cited author, Dental Traumatology was the most frequently co-cited journal, and the reference by Petti et al (2018) was the most frequently co-cited. The top five high-frequency keywords were: "dental trauma, " "teeth, " "traumatic dental injury, " "injury, " and "children." The top five keywords with the highest centrality were: "children, " "dental trauma, " "adolescents, " "tooth avulsion, " and "emergency management." The log-likelihood ratio (LLR) algorithm identified 15 keyword clusters, with "pediatric dentistry" emerging as a burst keyword in 2023. Conclusions: Current global research on dental trauma shows a diversified development trend. In the future, China can further deepen its research in areas such as regenerative medicine, the clinical application of novel biomaterials, precision diagnosis and treatment, multidisciplinary management models, long-term prognosis evaluation, and intelligent assisted diagnosis and treatment. 目的： 分析牙外伤相关研究的全球发展现状及研究热点，为我国牙外伤领域的相关研究提供借鉴。 方法： 检索Web of Science数据库核心合集建库至2025年12月27日发表的牙外伤相关文献，运用Bibliometrix、VOSviewer、CiteSpace、Excel等软件进行可视化分析。 结果： 共纳入牙外伤相关文献2 639篇文献。发文量整体呈现波动上升趋势；Levin L是发文量最多的作者，纳斯吉拉斯联邦大学是发文量最多的机构，巴西是发文量最多的国家/地区；Andreasen JO是共被引频次最多的作者，Dental Traumatology是共被引频次最多的期刊，Petti S（2018）是共被引频次最多的参考文献；排名前5的高频关键词依次为牙外伤、牙齿、创伤性牙外伤、损伤和儿童，排名前5的高中介中心性关键词依次为儿童、牙外伤、青少年、牙撕脱性损伤和急诊管理，关键词应用对数极大似然率算法得到15个聚类，2023年突现了关键词儿童牙科。 结论： 目前，全球学者关于牙外伤的相关研究呈现多元发展趋势，未来我国可在再生医学、新型生物材料的临床应用、精细化诊疗、多学科诊疗模式、长期预后评估及智能化辅助诊疗等方面进一步深化研究。.
Purpose: To evaluate the burden of managing permanent first molars (PFMs) in children with molar hypomineralization (MH). Methods: Retrospective data on the cost of treatment of PFMs in children with MH in a university-based pediatric clinic were collected. Data included demographics, health status, zip code, treatment type, number of visits, behavioral guidance (BG), and retreatment. The cost was calculated based on the billing codes for operative treatment and BG. Results: A total of 199 MH patient charts were included. The mean age was 8.07 years (±1.46 standard deviation). Over 25% had behavioral and medical conditions and lived more than 25 miles from the clinic. Operative treatment costs differed significantly by age (P<0.001). Male patients, patients travelling more than 25 miles, and patients with behavioral conditions had significantly higher BG and total treatment costs (P<0.05). Conclusion: Gender, distance from the clinic, and health status were related to higher treatment burden of permanent first molars in children with molar hypomineralization.
Cryoneurolysis is a minimally invasive procedure, guided by ultrasound and electrical stimulation, that uses controlled freezing to manage spasticity by inducing reversible axonotmesis. It has shown promising outcomes in adult and pediatric populations, particularly for patients unresponsive to botulinum toxin. This review highlights the mechanism of action, clinical evidence, safety profile, and cost considerations of cryoneurolysis, highlighting its role as a valuable addition to the multimodal approach to spasticity management. Further studies are needed to refine technique parameters and better understand its long-term effects.
This randomized, double-blind, placebo-controlled clinical trial evaluated the efficacy and safety of fermented oyster extract (FGO) as a functional food ingredient for promoting growth in children with idiopathic short stature (ISS). In total, 80 children aged 6－9 years with height below the 25th percentile for age and gender per the Korean National Growth Charts, 2017, were included. They were randomly assigned to receive either 500 mg/d FGO or a matched placebo for 24 weeks. The primary outcome was a change in height while standing; secondary outcomes included growth rate, height standard deviation score (height-SDS), bone age (BA), and levels of growth-related hormones and bone metabolism markers. In the intention-to-treat analysis, mean height gain at 24 weeks was 3.22±0.71 and 2.38±0.74 cm in the FGO and placebo groups (P<0.001). Growth rate, height-SDS, BA, serum insulin-like growth factor-1, and urinary deoxypyridinoline increased significantly in the FGO group compared with the placebo group (P<0.05). In contrast, growth hormone and insulin-like growth factor-binding protein-3 levels did not vary between groups. No serious adverse events or clinically meaningful laboratory abnormalities were observed; however, two events of mild rash, possibly related to FGO, led to one drop-out. These findings suggest that standardized FGO may safely augment linear growth and bone metabolism in children with ISS. This product could be developed as a marine-derived functional food for pediatric growth support, although more long-term and multicenter studies are warranted to confirm the generalizability of these effects and FGO durability.
Early dental experiences play an important role in shaping a child's attitude toward dentistry. Non-pharmacological behavior management techniques such as Tell-Play-Do (TPD), modeling, and Tell-Show-Do (TSD) aim to reduce dental anxiety and improve cooperation during treatment. To compare the effectiveness of Tell-Play-Do and Filmed Modeling, integrated with the Tell-Show-Do method, with Tell-Show-Do alone among children aged 4-7 year during restorative treatment. This randomized clinical trial included 99 children (Frankl rating 2 or 3) requiring restorative treatment. Participants were randomly allocated to three groups: Group 1 (TPD), Group 2 (Filmed Modeling), and Group 3 (TSD). Behavior was assessed using the Facial Image Scale (FIS), and anxiety levels were measured using pulse rate at four different intervals: before intervention, after intervention, during the procedure, and at the end of the procedure. Data were analyzed using ANOVA, the Kruskal-Wallis test, paired t-tests, and the Wilcoxon signed-rank test. All three groups showed a reduction in anxiety over time, as indicated by decreasing FIS scores and pulse rates. Significant reduction was observed in TPD and filmed modeling groups in within-group comparisons. Pulse rate analysis demonstrated a statistically significant decrease from baseline to the end of the procedure in the TPD and Filmed Modeling groups. Tell-Play-Do and Filmed Modeling are more effective than the TSD technique in reducing dental anxiety among children.The study protocol was registered on the Central Trials Registry - India (CTRI/2023/08/057068).
The Journal of Hospital Medicine Digital Media Team celebrates 20 years of publishing with this perspective, highlighting some of the most popular and impactful articles from 2025. Themes for the year emerged from clinical care, communication, hospital operations, and pediatric hospital medicine. While the team wishes to celebrate the work of all authors, reviewers, and editorial team members, they are happy to share a small sampling and invite readers to find their own favorites, too.
Purpose: This study compares the accuracy of dental students in diagnosing different breathing sounds using traditional versus artificial intelligence-assisted precordial stethoscopes (AIPS). Methods: The study involved 45 3rd- and 4th-year dental students who completed a pre-test to assess their baseline knowledge of breathing sounds. After watching a learning video, participants were randomized into 3 groups: conventional stethoscopes (Group A), AIPS (Group B) with audio, and AIPS with audio and video (Group C). Participants were evaluated in their diagnosis ability by listening to 10 recorded episodes of specific breathing sounds and then took post-tests to evaluate their learning. A post-survey was administered to evaluate the confidence and satisfaction of the participants with diagnostic responses, and to collect demographic information. Statistical significance was evaluated using a 1-way analysis of variance and paired sample t-test (P<0.05). Results: Significant improvements were observed in diagnostic accuracy (P<0.001) and knowledge (P=0.047) across all groups. AI groups demonstrated higher diagnostic accuracy for specific sounds (normal breathing, partial airway obstruction, and apnea). The confidence and satisfaction of the participants were strongly correlated with diagnostic accuracy (P<0.001), with those in Groups B and C reporting higher satisfaction. Group C responded fastest for apnea (P=0.021) and Group A for normal breathing (P=0.005), while Group A had the highest missing diagnosis proportion (53.3%). Conclusions: Artificial intelligence-assisted precordial stethoscopes enhance diagnostic accuracy and learning outcomes, particularly for students with lower baseline knowledge. These findings suggest that integrating artificial intelligence tools can improve the detection of respiratory complications during sedation, enhancing patient safety.
Purpose: This study investigated whether the position of the maxillary frenum is associated with the presence and severity of anterior tooth caries in children aged 6 to 36 months. Methods: Five dentists from the South Texas Oral Health Network (STOHN) assessed 319 children using the International Caries Detection and Assessment System (ICDAS) and classed frenum attachment. Results: Of 319 patient children, 170 (53.9%) exhibited no anterior caries, while 149 (46.1%) demonstrated varying levels of decay with higher caries grades observed in older children (P<0.001). Most participants (79%) were enrolled in Medicaid. Frenum attachment was classified as Class III or IV in 57% of cases. Statistical analysis revealed no significant association between caries grade and frenum attachment (P=0.32), nor between caries and insurance status (P=0.31). Conclusion: In the population studied, maxillary frenum attachment classification does not significantly correlate with the severity of anterior caries in children aged 6 to 36 months.