What's in this issue?
Children with epilepsy are at risk of developing gingival problems and carious lesions but can avoid traumatic oral injuries if seizure attacks are well controlled. The findings are from a study published in the January issue of International Journal of Paediatric Dentistry.
The authors designed the retrospective cohort study to assess the gingival health, caries prevalence, and incidence of orofacial injuries in children who undergo epileptic attacks. The study population included 100 with epilepsy children and 80 children without epilepsy aged 6-12 years who were matched for sex and socioeconomic status.
The authors identified primary study outcomes as caries in primary or permanent dentition, gingivitis, and orofacial traumatic injuries to soft or hard tissues. They identified secondary outcomes as frequency of dental visits and toothbrushing.
The authors assessed caries using the decayed, missing, and filled primary teeth (dmft) index, gingival health using the Löe-Silness gingival index (GI), and orofacial injuries using the World Health Organization classification of trauma. They presented quantitative data as mean (standard deviation [SD]) and 95% confidence intervals (CI). They presented qualitative data as frequencies and percentages with a significance level set at P ≤ .05. They used the Mann-Whitney U test to compare the 2 groups, and the χ2, Fisher exact test, and odds ratios for comparisons among 2 or more groups.
The mean (SD) age of children with and without epilepsy was 8.0 (2.2) and 7.8 (3.1) years, respectively. Boys represented 60% of children with epilepsy and 52.5% of children without epilepsy.
All children with epilepsy took antiepileptic drugs (AEDs). A total of 41 took sodium valproate, 29 used levetiracetam, and 11 used carbamazepine. Another 19 took a combination of drugs. Most children (87%) used AEDs twice daily, whereas 6 children used them 3 times daily and 7 children used them once a day. The authors found a statistically significant difference between the number of dental visits among children with epilepsy and their healthy siblings (P = .002). They also found a statistically significant difference in toothbrushing frequency between children with epilepsy and their healthy siblings (P = .017). The mean values for GI were significantly lower among children without epilepsy than children with epilepsy.
The authors found statistically significantly lower mean (SD) dmft index scores of 2.2 (2.6) in children without epilepsy than in children with epilepsy who had mean (SD) dmft scores of 4.1 (2.1). They found no statistically significant difference between the 2 groups with regard to hard- and soft-tissue trauma (P = .171 and .503, respectively).
“There is an urging need to establish strong collaboration between dental and medical care providers to ensure referral of children with epilepsy to receive regular oral health examinations,” the authors noted, “especially those under long‐term AED treatment.”
Fine motor skills, task performance, make kids better toothbrushers
Children with good fine motor skills and task performance are better toothbrushers and have less plaque, according to a study published in the January/February issue of Pediatric Dentistry.
The authors assigned 60 children to the manual toothbrushing group and another 60 to the electric toothbrushing group. Authors used 4 behavioral diagnostic tools to develop a survey for parents about their children’s daily childhood activities and cognitive indicators of task performance.The authors applied disclosing solution to the buccal and lingual surfaces of all teeth but based their plaque index scores on the examination of 6 surfaces:
- the buccal aspect of the permanent maxillary right first molar;
- the buccal aspect of the permanent maxillary right central incisor;
- the buccal aspect of the permanent maxillary left first molar;
- the lingual aspect of the permanent mandibular left first molar;
- the buccal aspect of the permanent mandibular left central incisor;
- the lingual aspect of the permanent mandibular right first molar.
The authors used the Oral Hygiene Index-Simplified to obtain a baseline plaque index score that ranged from 0 through 3. Zero indicated no plaque, 1 indicated plaque covering up to one-third of a tooth, 2 indicated between one- and two-thirds, and 3 indicated more than two-thirds. Scores from the 6 surfaces were added and then divided by 6 to give a score from 0 through 3.
The authors used a scripted set of instructions to tell all children how to brush their teeth. Children then used a manual or electric toothbrush to brush for at least 30 seconds at a sink without toothpaste or a mirror. Authors grouped children into 4 categories of postbrushing Oral Hygiene Index-Simplified scores: poor (1.9-3.0), fair (o.61-1.89), good (0.10-0.60), and excellent (0.00). Parents completed the survey independently but at the same visit as the brushing and scoring.The authors used a signed rank test to compare prebrushing and postbrushing scores, and Spearman rank correlation to show correlations among score change, brushing time, and age. The authors also used χ2 tests to measure differences in postbrushing score categories between manual and electric toothbrushes.
The authors found that manual and electric toothbrushes were equally effective at removing plaque. Fine-motor and cognitive skills like good handwriting, the ability to write a full address, cut meat or complex shapes, and tie one’s shoes were associated with better brushing. Playing a musical instrument well and washing dishes well were associated with greater plaque reduction.
Children experienced a greater change in plaque score as their ability to wash dishes effectively by hand without help grew from “never” to “sometimes” to “always” (P = .02). Change in plaque scores increased as children progressed from never playing a musical instrument to beginner, intermediate, and advanced levels (P = .02). The authors also found that parents were good judges of their children’s ability to brush independently.
Anterior open bite most visible sign of dental trauma in preschool children
An anterior open bite is most associated with dental trauma in preschool-aged children regardless of confounding variables and other malocclusions. The finding is from a study published in the April issue of Dental Traumatology.
The authors defined dental trauma as enamel fracture, enamel and dentin fracture, complicated crown fracture, extrusive luxation, lateral luxation, intrusive luxation, and avulsion. They also noted discoloration of the dental crown due to dental trauma.
The authors identified occlusal characteristics as posterior cross-bite, dental crowding, and arch shape. They measured maxillary anterior overjet as the distance between the palatal surface of the more projected maxillary incisor and the corresponding mandibular incisor and classified it as normal (< 3 millimeters) or accentuated (> 3 mm). They defined anterior open bite as the lack of vertical overlap of the mandibular incisors. They diagnosed posterior cross-bite when the maxillary molars were in a lingual position relative to the mandibular molars and anterior cross-bite when the mandibular incisors were in front of the maxillary incisors. The authors noted dental crowding in cases of interposed teeth in the dental arch. Lip coverage was considered adequate when the upper lip totally covered the maxillary incisors in the relaxed position.
Cohen ƙ coefficients ranged from 0.88 through 0.90 for intraexaminer agreement and 0.85 through 0.90 for interexaminer agreement for clinical examinations. Authors administered a questionnaire to compile data on sex, age, primary caregiver, mother’s marital status, parents’ schooling, monthly per capita income, absence or presence of daytime and nighttime bruxism, sucking habits, pacifier use, and the absence or presence of finger or thumb sucking. The authors developed multiple logistic regression models to analyze the influence of occlusal characteristics. χ2 tests showed statistically significant associations between dental trauma and maxillary anterior crowding (P = .024), anterior open bite (P = .001), overjet (P = .001), and lip coverage (P = .001). Open bite remained significantly associated with the outcome in all 5 adjustment models (odds ratio [OR], 3.80; 95% confidence interval [CI], 1.42 to 10.16). Maxillary anterior crowding (OR, 2.14, 95% CI, 1.00 to 4.63) and overjet (OR, 1.12, 95% CI, 0.58 to 2.17) were associated with dental trauma separate from the confounding variables of sociodemographics, sucking habits, and lip coverage, but they lost their significance when the authors adjusted for other types of malocclusion. The authors found no statistically significant differences between the case group and the control group.
“Both dental trauma and malocclusion in the primary dentition are preventable and treatable problems,” the authors wrote. “Favouring the normal development of occlusion may reduce the occurrence of dental trauma in the primary dentition and its consequences in the mixed and permanent dentitions.”
Lower lingual arch effective in resolving mandibular incisor crowding
Lower lingual arch (LLA) resolves mandibular incisor crowding without any significant arch perimeter or changes of more than 1 millimeter to arch length. The average resolution of mandibular incisor crowding after LLA placement was 5.10 mm, although the quality of evidence was very low. The findings are from a systematic review and meta-analysis published in the January/February issue of Pediatric Dentistry.
The authors designed the review to measure how many millimeters of mandibular incisor crowding could be resolved by LLA and to compare the effect of using LLA on arch dimensions with not using one. The study’s primary outcome was the amount of resolved mandibular incisor crowding after LLA. Secondary outcomes were the effects of LLA mandibular arch dimension changes compared with untreated controls (UTCs).
Authors searched databases including PubMed, Web of Science, Cochrane Database of Systematic Reviews, and OpenGrey for articles published from January 1940 through March 2018. They used the population, intervention, comparison, outcomes, and study design method to establish inclusion criteria. They defined the population as healthy children in mixed dentition with mandibular incisor crowding and intervention as placement of LLA on permanent mandibular first molars.
The search yielded 559 studies, of which 7 were chosen. The review included 4 retrospective cohort studies, 1 experimental nonrandomized controlled study, and 2 randomized controlled studies. The total population included 307 patients treated with LLA and 74 patients who served as UTCs. The age of participants ranged from 7 through 13 years. Treatment and observation periods ranged from 10.5 months through 4 years.
The authors found that up to 5.10 mm of mandibular incisor crowding could be resolved by LLA (P = .001). Meta-analysis synthesized from 2 studies showed a statistically significant decrease in mandibular incisor crowding after LLA placement regardless of wire placement and appliance design (N = 59; mean distance [MD], 5.10 mm; 95% confidence interval [CI], 2.15 to 8.05; P = .001), with evidence quality assessed as very low. Meta-analysis of 1 retrospective cohort study and 1 RCT showed a significant increase in intercanine arch width in the LLA group (N = 86) compared with UTCs (N = 64) over the treatment period (MD, 0.79 mm; 95% CI, 0.44 to 1.14; P < .001) with the quality of evidence assessed as low.
Meta-analysis of 4 retrospective cohort studies, 1 RCT, and 1 nonrandomized clinical trial showed a significant increase of 1.13 mm in intercanine width after LLA (N = 242; MD, 1.13 mm; 95% CI, 0.78 to 1.48; P < .001), with the quality of evidence assessed as very low. Meta-analysis of 3 retrospective cohort studies, 2 RCTs and one nonrandomized clinical trial showed a significant increase in intermolar width after LLA (N = 268; M, 1.08 mm; 95% CI, 0.39 to 1.77; P = .002).
“The LLA prevents the incisors from tipping or collapsing lingually, as most likely would happen in crowded cases,” the authors wrote. “The distal drifting of the canines will result in a greater intercanine distance that is not a true arch expansion in the canine area. We believe this is the first time a meta-analyses shows nonsignificant arch perimeter and arch length changes yet significant changes in the intercanine width measurements.”
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Pediatric dentistry courses at ADA FDI World Dental Congress
ADA FDI 2019 Sept. 4-8 in San Francisco offers Pediatrics Track and additional courses in Pedodontics, Child and Adolescent Dentistry. Basic registration is FREE for all ADA members and North American attendees. Most of these CE courses are priced at just $25, $50 or $75.
Courses to consider:
- A Mixed Bag of Practical Oral Lesions in Tots and Teens (#4102), CE HOURS: 7
- 4 'Ps' of Pediatric Dentistry (#7133), CE HOURS: 3
- Clinical Techniques in Pediatric Dentistry (#6142), CE HOURS: 2.5
- Help! I Have a One-Year-Old in My Chair (#6107), CE HOURS: 2.5
Created in partnership with the ADA Council on Advocacy for Access and Prevention; Sponsored by 3M Oral Care
- Stainless Steel Crowns Are a Snap (#6216 or #6217), CE HOURS: 2.5
- Ouch! That Hurts: Dental Emergencies in Children (#6143), CE HOURS: 2.5
- The Caries-Free Child: Understanding and Sharing the Science (#7134), CE HOURS: 3
- Difficult Cases in Pediatric Dental Practice - Diagnosis and Management (#6113), CE HOURS: 1
Register today at ADA.org/meeting.
ADA CE Online pediatric courses
Need CE? ADA CE Online has hundreds of hours of CE that you can earn from the comfort of your own home. Take a look at our pediatric courses that you can implement in your own practice. Too many to choose from? Take them all! Get an ADA CE Online subscription for one year and enjoy unlimited access. Subscribe now!
AAPD Safety Symposium: Hidden Threats and Safe Practices: Steps to Creating a Safe Dental Home
November 8-9, 2019
Renaissance Chicago, IL
Medicine was awakened to the hidden dangers in the Academy of Medicine's “To Err is Human” but the dental profession has yet to delve into potential risks of dental care. This inaugural course from the American Academy of Pediatric Dentistry provides a look at safety in pediatric dental care and provides practical tools and the latest clinical advice on how to improve office safety for patients, team members and pediatric dentists. Featuring recognized experts from major areas of dental and medical practice, this fast-paced session will help attendees develop a culture of safety, mitigate potential harm related to providing dental care, and become proactive for you and your patient’s well-being.
- Sedation/general anesthesia: Safety, competence and vigilance
- Infection control: Prepare for new bacterial strains
- Hidden dangers: Higher risk office areas you don’t even think about
- Case studies: In-depth look at high potential adverse events
- Malpractice carriers: Which risk exposures require your greatest attention
- Medicine’s evolution of patient safety: What dentistry can learn from medicine
- Designing for safety: Tips from Boeing
Course chairs are Paul Casamassimo, DDS, MS and Jade Miller, DDS. Speakers are Jed Best, DDS, MS, Terry Davis, MD, Karel DeLeeuw, DDS, MD, Steve Ganzberg, DMD, MS, Barry Jacobson, DMD, John Molinari, PhD, Mike Mullane, Michael Ragan, DDS, and Duane Tinker.
This course is designed for dentists and all members of the clinical team that treat children and offers 14.75 CE credits. Learn more at the AAPD website.
What's in this issue?
The consulting editor for JADA+ Specialty Scan — Pediatric Dentistry is James R. Boynton, DDS, MS, Clinical Associate Professor, Pediatric Dentistry Division Head, University of Michigan School of Dentistry.
The consulting editor for JADA+ Specialty Scan — Pediatric Dentistry is Douglas B. Keck, DMD, MSHEd, Associate Program Director, Advanced Education in Pediatric Dentistry, Providence, Rhode Island NYU Langone Dental Medicine.