Dental Traumatology in Pediatric Dentistry

In this chapter, epidemiology of dental trauma will be discussed in terms of its incidence and prevalence among primary and permanent dentition. Dental trauma causes and its distribution in accordance with age and sex will be highlighted. Classification of dental trauma based on soft and hard tissue injuries will be outlined, and subsequently, clinical examination and diagnosis will be featured. Treatment modalities and variations between permanent and primary dentition will be discussed along with the new treatment era namely regenerative approach and decoronation. Splints, techniques, and follow-up routines will also be discussed. Last but not least, prevention of dental trauma will be discussed

Use of a Computerized C-Reactive Protein (CRP) Based Sepsis Evaluation in Very Low Birth Weight (VLBW) Infants: A Five-Year Experience

<div><p>Background</p><p>Serial C-reactive protein (CRP) values may be useful for decision-making regarding duration of antibiotics in neonates. However, established standard of practice for its use in preterm very low birth weight (<1500 g, VLBW) infants are lacking.</p><p>Objective</p><p>Evaluate compliance with a CRP-guided computerized decision support (CDS) algorithm and compare characteristics and outcomes of compliant versus non-compliant cases. Measure correlation between CRPs and white blood count (WBC) indices.</p><p>Methods</p><p>We examined 3 populations: 1) all preterm VLBW infants born at Vanderbilt 2006–2011 – we assessed provider compliance with CDS algorithm and measured relevant outcomes; 2) all patients with positive blood culture results admitted to the Vanderbilt NICU 2006–2012 – we tested the correlation between CRP and WBC results within 7 days of blood culture phlebotomy; 3) 1,000 randomly selected patients out of the 7,062 patients admitted to the NICU 2006–2012 – we correlated time-associated CRP values and absolute neutrophil counts.</p><p>Results</p><p>Of 636 VLBW infants in cohort 1), 569 (89%) received empiric antibiotics for suspected early-onset sepsis. In 409 infants (72%) the CDS algorithm was followed; antibiotics were discontinued ≤48 hours in 311 (55%) with normal serial CRPs and continued in 98 (17%) with positive CRPs, resulting in significant reduction in antibiotic exposure (p<0.001) without increase in complications or subsequent infections. One hundred sixty (28%) were considered non-compliant because antibiotics were continued beyond 48 hours despite negative serial CRPs and blood cultures. Serial CRPs remained negative in 38 (12%) of 308 blood culture-positive infants from cohort 2, but only 4 patients had clinically probable sepsis with single organisms and no immunodeficiency besides extreme prematurity. Leukopenia of any cell type was not linked with CRPs in cohorts 2 and 3.</p><p>Conclusions</p><p>CDS/CRP-guided antibiotic use is safe and effective in culture-negative VLBW infants. CRP results are not affected by low WBC indices.</p></div

Flow diagram detailing analysis of serial CRP values and ANCs in blood culture positive neonates.

<p>Of 517 patients available for analysis during the study period, 384 fit the inclusion/exclusion criteria. Among these eligible patients, we analyzed 362 independent cases of positive blood cultures with available ANC and serial CRP data. These cases were stratified according to initial (t₀) CRP status, serial (t₄₈) CRP status, organism class (CONS vs. non-CONS), and finally by ANC status at initial (t₀) evaluation. Only cases deemed to be confirmed positive blood cultures were included in this stratification scheme.</p

Cumulative distribution function (CDF) plot of t₄₈ CRP values in infants with continued antibiotics for elevated CRP value (s).

<p>The blue line depicts the distribution of CRP values among 126 infants in which antibiotics were continued because of elevated t0 and/or t48 CRP results; 44.5% had t48 CRP values 10–20 mg/L and 34.4% had values >20 mg/L.</p

Reasons stated by clinical providers in the clinical decision support (CDS) module for continued antibiotic therapy despite negative serial CRP values.

1<p>Providers were able to state more than one reason.</p>2<p>Included preterm premature rupture of membranes (PPROM), Group B <i>streptococcus</i> (GBS) status, chorioamnionitis, fever.</p>3<p>Included concerns for respiratory and gastrointestinal pathology.</p