Malocclusion complexity and orthodontic treatment need in children with autism spectrum disorder.

OBJECTIVES This study aimed to investigate the malocclusion complexity and orthodontic treatment need among children with and without autism spectrum disorder (ASD) referred for orthodontic treatment by quantifying the Discrepancy Index (DI) and Index of Orthodontic Treatment Need (IOTN). MATERIALS AND METHODS Dental records of 48 ASD and 49 non-ASD consecutive patients aged between 9 and 18 years (median age 13.0 years) referred for orthodontic treatment were reviewed and compared. The Discrepancy Index (DI) was quantified to determine the malocclusion complexity, and the Index of Orthodontic Treatment Need (IOTN), including the Dental Health Component (IOTN-DHC) and Aesthetic Component (IOTN-AC), was quantified to determine the orthodontic treatment need. Statistical analysis included descriptive analysis, Pearson chi-square tests, Fisher's exact test, Mann-Whitney U tests, and several univariate and multivariate regression analyses. The statistical analysis used descriptive analysis, Pearson chi-square test, Fisher's exact test, and multivariate logistic regression. RESULTS The results show that both malocclusion complexity (DI, p = 0.0010) and orthodontic treatment need (IOTN-DHC, p = 0.0025; IOTN-AC p = 0.0009) were significantly higher in children with ASD. Furthermore, children with ASD had a higher prevalence of increased overjet (p = .0016) and overbite (p = .031). CONCLUSIONS Malocclusion complexity and orthodontic treatment need are statistically significantly higher among children with ASD than children without ASD, independent of age and sex. CLINICAL RELEVANCE Children with autism may benefit from visits to a dental specialist (orthodontist) to prevent, to some extent, developing malocclusions from an early age

General and paediatric dentists’ knowledge, attitude and practises regarding the use of Silver Diammine Fluoride for the management of dental caries: a national survey in the Netherlands

Background: Silver Diammine Fluoride (SDF) is a topical medication used to arrest cavitated carious lesions non-invasively. The primary aim was to investigate, and analyse the relationships between; knowledge, attitudes and practises (including barriers and facilitators) for SDF use in the management of dental caries by general dental practitioners (GDPs) and paediatric dentists (PDs) in the Netherlands. A secondary aim was to explore any differences in these, between these groups. Methods: A randomly selected sample of 600 Dutch GDPs (out of 9,502 respectively) and all 57 registered Dutch PDs were invited to participate in this cross-sectional survey, consisting of four sections: (1) participant characteristics, (2) knowledge (through responses to summative questions), (3) attitudes (through statement agreement using 5-point Likert scale), and (4) practises, use, barriers and facilitators (through multiple choice questions). Results: The response rates were: GDPs 23% (n = 140) and PDs 47% (n = 27). Knowledge: out of 15 questions to test understanding of SDF, the mean number of correct answers were GDPs 6.7; standard deviation (SD) 2.6 and PDs 7.4, SD 2.2 with no significant difference. The mean overall attitude score showed positive attitudes towards SDF use for both groups. Compared to GDPs, PDs were more likely to use SDF (p < 0.001) and expected to increase their use (p = 0.037). The main barrier for users was parental acceptance (47%) and for non-users it was lack of knowledge (60%). The main facilitator for both users and non-users was gaining knowledge through courses and workshops, followed by written information leaflets about SDF for parents. Conclusion: Less than half of the knowledge questions about SDF were answered correctly. Despite low knowledge, attitude towards SDF use was positive. Practitioners believed that its use would be facilitated by professionals having more accessible information and training and by the availability of parent information leaflets. Furthermore, SDF is used more frequently by PDs than GDPs

The efficacy of articaine and lidocaine local anaesthetic in child patients

Data sources Cochrane CENTRAL Register of Controlled Trials, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, SCIEXPANDED (ISI Web of Knowledge). Study selection Two reviewers selected randomised clinical trials (RCTs) that compared the efficacy of articaine and lidocaine in pain rating during dental treatment in child patients. Data extraction and synthesis Two authors extracted data using a standardised form, and risk of bias was assessed based on Cochrane’s Risk of bias tool for RCTs. Meta-analysis was performed on all included studies (n=6) where self-reported pain during and after dental procedure was recorded, and which compared articaine local anaesthesia (LA) to lidocaine LA in children. Then a sensitive analysis was performed excluding the studies with high overall risk of bias (n=3). Results Six studies were included, one had ’low’, two had ’moderate/ uncertain’ and three had ’high’ risk of bias. To evaluate the impact of these studies with ’high’ overall risk of bias, a sensitivity analysis was performed and even when excluding these studies, children who had articaine reported significantly less pain after procedure. However, during the procedure no difference was found between self-reported pain when articaine infiltration and lidocaine inferior dental nerve block were compared. Conclusions Low quality evidence suggests no difference in efficacy between lidocaine Inferior alveolar dental nerve blocks and articaine infiltration when used for routine dental treatment in children. Also, no difference was found in self-reported pain between lidocaine and articaine during treatment procedures, but apparently articaine leads to less pain reporting after the procedure. The body of the evidence is quite low due to the substantial heterogeneity in the reported outcomes and the overall high risk of bias of the included studies