Non-pharmacological interventions for managing dental anxiety in children

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to assess the effectiveness of non-pharmacological interventions for reducing dental anxiety in children

Sustainable development goals and ending ECC as a public health crisis

Early Childhood Caries (ECC) remains a global issue despite numerous advancements in research and interventional approaches. Nearly, 530 million children suffer from untreated dental caries of primary teeth. The consequences of such untreated dental caries not only limit the child's chewing and eating abilities but also, significantly impact the child's overall growth. Research has demonstrated that ECC is associated with nearly 123 risk factors. ECC has also been associated with local pain, infections, abscesses, and sleep pattern. Furthermore, it can affect the child's emotional status and decrease their ability to learn or perform their usual activities. In high-income countries, dental care continues to endorse a “current treatment-based approach” that involves high-technology, interventionist, and specialized approaches. While such approaches provide immediate benefit at an individual level, it fails to intercept the underlying causes of the disease at large. In low-income and middle-income countries (LMICs), the “current treatment approach” often remains limited, unaffordable, and unsuitable for the majority of the population. Rather, dentistry needs to focus on “sustainable goals” and integrate dental care with the mainstream healthcare system and primary care services. Dental care systems should promote “early first dental visits,” when the child is 1 year of age or when the first tooth arrives. The serious shortages of appropriately trained oral healthcare personnel in certain regions of the world, lack of appropriate technologies and isolation of oral health services from the health system, and limited adoption of prevention and oral health promotion can pose as critical barriers. The oral health care systems must focus on three major keystones to combat the burden of ECC−1. Essential oral health services are integrated into healthcare in every country ensuring the availability of appropriate healthcare accessible and available globally, 2. Integrating oral and general healthcare to effectively prevent and manage oral disease and improve oral health, 3. Collaborating with a wide range of health workers to deliver sustainable oral health care tailored to cater to the oral health care needs of local communities

Oral Health Policies to Tackle the Burden of Early Childhood Caries: A Review of 14 Countries/Regions

Aim: Early childhood caries (ECC) has significant public health implications but has received inadequate global attention. There is limited information regarding the success of oral health policies implemented to address the challenges of ECC. This review aimed to summarize such policies to tackle ECC from different countries/regions.Method: Independent collaborators from 14 countries/regions (Australia, Brazil, Cambodia, China, Hong Kong, Egypt, India, Indonesia, Japan, Nigeria, Thailand, UK, USA, and Venezuela) collected the data. The ECC status, dental workforce, oral health policies on ECC prevention in different countries/regions were summarized by each country.Results: The findings indicated that ECC prevalence varied in different countries/regions. The lowest prevalence of ECC among 5-year-old children was found in Nigeria (7%), and the highest was found in Indonesia (90%). The existing dental workforce and resources are limited in most countries. The smallest dentist to population ratio was reported by Nigeria at 1:48,400, whereas the highest ratio was in Brazil (1:600). Out of 14, three (21%) countries namely India, Venezuela and Cambodia had no national oral health policies addressing ECC and four (29%) countries (Cambodia, China, India, Venezuela) had no publicly funded dental care program for 0–5-year-old children. Water fluoridation is available in four countries/regions (Australia, Brazil, Hong Kong, USA).Conclusion: ECC remains a global health challenge and dental workforce is limited. National/regional programs to tackle ECC are not yet prioritized in many countries/regions. Evidence to support demonstration projects is limited. Further research on the cost-effectiveness of interventions strategies is required for policymakers

Prediction of supernumerary teeth in children

Supernumerary teeth are teeth in addition to the normal complement of 20 primary and 32 permanent teeth. The majority of these supernumerary teeth are conical shaped, assume an inverted orientation and remain un-erupted. Therefore, radiographic examination is considered critical for the identification of supernumerary teeth. A meta-analysis to determine the variations in the prevalence figures based on the diagnostic tools employed revealed that a clinical examination plus selected radiograph(s) are essential for determining the prevalence of supernumerary teeth; the vast disparities in the quoted prevalence of supernumerary teeth make their value questionable. Therefore, the reliability of panoramic radiographs and the influence of the level of dental training of the 18 examiners for identifying supernumerary teeth were evaluated, which demonstrated that panoramic radiographs are unreliable as a diagnostic tool, and that a high level of dental training is essential for the identification of supernumerary teeth. Based on the sensitivity figures for panoramic radiographs the prevalence of supernumerary teeth was re-analyzed and this demonstrated that the prevalence figures are higher than reported in the literature, ranging from 2.4% to 6%, or even higher; thus, indicating the need for new diagnostic tools for the identification of supernumerary teeth. Proposed hypotheses and recent molecular research, using animal models to gain new insights into the development of supernumerary teeth, have been unable to identify the etiology of supernumerary teeth. Based on the existing published reports and an additional 10 familial cases, the only definitive factors is that supernumerary teeth have a genetic component to their etiology. To identify the genetic risk factors responsible for the formation of supernumerary teeth large scale genetic epidemiological studies, with efficient and convenient methods for obtaining sufficient genomic DNA from study participants, are essential. Evaluation of the storage stability of saliva at room temperature, over an 18-month period, did not adversely influence the DNA yield and purity, or the genotyping efficacy; which clearly demonstrates that saliva is a possible alternative to blood as a source of human DNA. Supernumerary teeth are commonly associated with cleidocranial dysplasia (CCD), a genetic disorder affecting the skeletal system. Novel identical compound heterozygous mutations were identified in the RUNX2 gene of a southern Chinese family with CCD, which has been the first report of compound heterozygous mutations in CCD patients. Several mouse mutant genes have reported an association with supernumerary teeth; most of these genes have human orthologs. A case-control association study was performed to determine the role of human orthologs of the mouse mutant genes associated with supernumerary teeth in 457 southern Chinese children. DNA samples were obtained and 140 single nucleotide polymorphisms (SNPs) from 19 genes were genotyped. The findings revealed that polymorphisms on SNPs rs17619858 and rs12699798, in the sclerostin-domain containing-1 (SOSTDC1) gene on chromosome 7, were associated with the development of supernumerary teeth in the anterior region of the maxilla. This dogma of genetic risk assessment for early diagnosis facilitates the implementation of the proposal of Genetic Risk Assessment for Personalized Health and Individual Care (GRAPHIC) concept in dentistry.published_or_final_versionPaediatric DentistryDoctoralDoctor of Philosoph

Six-month recall dental appointments, for all children, are (un)justifiable

Each child is an individual with specific needs, which necessitates a different plan of management based on the type of oral disease or disability present. This raises a question as to whether the customary fixed sixmonth recall visits for children commonly advocated by dental professionals need to be altered/adjusted so as to reflect the individual's oral health needs more closely, in order to optimize their clinical and costeffectiveness. This paper provides a comprehensive review of the evidence to either justify or refute the sixmonth recall dental appointments for all children. Based on the available evidence, we conclude that the judgment about appropriate intervals should be made by the dental practitioner on an individual risk basis as insufficient evidence exists to either justify, or refute the six-month recall dental appointments.link_to_subscribed_fulltex

An unusual white lesion in a 10 month old child

Introduction: Oral lesions commonly diagnosed in neonatesinclude Epstein’s pearls, Bohn’s nodules, dental lamina cysts,natal teeth and congenital epulis. Nevertheless, intriguing caseswhich have rarely been reported in the literature are sometimesencountered by clinicians. We report a case of an unusual whitelesion in a 10-month old male infant. Clinical management: The infant’s mother had noticed a smallwhite swelling in the anterior region of the maxilla in the morningwhich increased in size by the late afternoon. Hence, she wasurged by the paediatrician to seek dental advice. Intra-oralexamination revealed a white mass (approximately 5 mm indiameter) in the maxillary right central incisor region, firm inconsistency and adherent to the mucosa. Radiographic examina-tion indicated that the white mass was radiolucent. The parentswere reassured and advised to monitor the lesion. The parentsreturned 3 weeks later reporting that the white mass had, thatday, shed spontaneously. It had a uniform hemispherical outlineand measured 10 mm · 5 mm in diameter. Histopathologicalexamination reported the mass to be acellular and amorphous;as it did not resemble any known bodily tissues, it was diagnosedas a Ôforeign bodyÕ.Conclusion: Infants tend to explore things with their mouths; hencethey put anything they can hold into their oral cavity to determinethe size and texture. This case serves to illustrate that theunexpected can occur and that in children the differential diagnosisshould include a Ôforeign bodyÕ.link_to_OA_fulltex

The importance of the primary dentition to children - Part 1: Consequences of not treating carious teeth

Humans are diphyodonts, which means that they have two successive sets of teeth: primary and permanent. The primary teeth are important in a child's life as they help in mastication, in speech, contribute to aesthetics and preserve the integrity of the dental arches, finally guiding permanent teeth into their correct positions. Dental caries (decay) which is avoidable, remains a common chronic disease of early childhood with an occurrence rate five times higher than that of asthma and seven times higher than that of allergic rhinitis. Untreated carious teeth in young children frequently lead to pain and infection, necessitating emergency visits to the dentist. Carious teeth in early childhood are not only indicative of future dental problems, they also adversely affect growth and cognitive development by interfering with nutrition, sleep and concentration at school. In addition, they may have a significant impact on an individual's quality of life. Primary teeth are not always given a high priority although physicians and health policy-makers have an interest in playing an active role in children's oral health, owing possibly to lack of simple well-defined practical guidelines to follow when performing dental screenings and other activities relating to the infant's oral health. Also, many parents are unaware of the importance of primary teeth; consequently, dental attendances before the age of two years are uncommon. They consider primary teeth to be only temporary and think that related problems are rarely life-threatening. Intervention to prevent or arrest dental caries should focus on reducing the availability of refined carbohydrates (substrate), reducing the microbial burden (causative organism), increasing the resistance of the teeth (host) to caries, or a combination of these approaches. Nevertheless, dental caries can be effectively treated using various restorative materials with suitable pain control measures. This is possible if proper advice and referral is made by medical practitioners who have early and often frequent contact with young children. There seems to be no logical reason for leaving carious primary teeth untreated in a child's mouth. Early recognition and timely referral of infants and young children with dental caries is critical in preventing the unpleasant complications. Primary care providers who have contact with children are well placed to offer anticipatory advice to reduce the consequences of dental caries.link_to_subscribed_fulltex

Agenesis of maxillary permanent first molars: literature review and two case reports

Congenital absence of teeth is the most commonly known developmental dental anomaly in humans. Agenesis of the permanent first molars has the least frequency of all the tooth types and when present, usually occurs in association with oligodontia or anodontia. Generally, it is easy to diagnose agenesis of the permanent first molars retrospectively, based on the clinical morphology and x-ray photographic features of the permanent second molars; while it is often debatable when made prospectively. Several hypotheses have been promulgated to explain the etiology of hypodontia with evolutionary and anatomic models. Nevertheless, clinical epidemiology does not completely support these hypotheses and therefore clinicians should be cautious; while speculating the missing tooth type based on these hypotheses. We encompass a comprehensive review of the literature on missing permanent first molars and illustrate two cases of missing maxillary permanent first molars to emphasize the complexity involved in their diagnosis.published_or_final_versio

The genetic basis of a dentigerous cyst associated with a supernumerary tooth?

Oral Sessions - O12/Syndromes and Genetics 2INTRODUCTION: Supernumerary teeth are teeth additional to the normal complement and the frequent clinical indicators are noneruption or delayed eruption of teeth, crowding, displacement and dentigerous cyst (DC) formation. Approximately, 95% of DCs involve the permanent dentition and only 5% are associated with supernumerary teeth. The objectives of this study were to: (i) report a pair of siblings with supernumeraries of whom, one developed a dentigerous cyst and (ii) analyze fragile histidine triad (FHIT) and p53 gene status in DC associated with supernumerary teeth. CLINICAL MANAGEMENT: This six-year-old Chinese boy complained of swelling in the maxillary right incisor region. Radiographs revealed the presence of two supernumeraries in the premaxillary region, one of which had evidence of an enlarged follicle. Histopathology confirmed that the cystic lining was consistent with a DC. The patients elder sister also exhibited two supernumeraries in the premaxilla which was subsequently surgically removed. Blood samples were collected and the DNA extracted using the Qiagen_ mini blood kit. The DNA yield was quantified using 260 nm/280 nm ratio. After isolation, aliquots of the DNA samples were prepared for analyzing the status of the FHIT and p53 gene. CONCLUSION: Occurrence of supernumerary teeth in siblings indicates that inheritance is a major contributory factor in their development. Although DCs are uncommon in the first decade of life, regular inspections of radiographs are important. It is hypothesized that aberrations of FHIT and p53 genes could be considered as markers responsible for the development of DCs associated with supernumerary teeth.link_to_OA_fulltextThe 22nd Congress of the International Association of Paediatric Dentistry, Munich, Germany, 17-20 June, 2009. In International Journal of Paediatric Dentistry, 2009, v. 19, suppl. s1, p. 32, abstract no: O12-8