An unusual presentation of erythema multiforme in a paediatric patient

Background: Erythema multiforme (EM) is an acute, vesiculobullous disease of skin and mucous membranes with symptoms ranging from mild to severe. A complex interaction of different factors has been implicated the condition; the majority with a preceding herpes simplex infection. This report describes an unusual presentation of erythema multiforme affecting the lips and oral mucosa of a healthy 7-year-old boy in the form of lip adherence. Case report: Two weeks following eruption of oral ulcerations, a 7-year-old healthy boy developed severe erosive ulceration of both lips, causing complete lip adherence. This was accompanied by marked bilateral submandibular and cervical lymphadenopathy, tremor and sweating. Clinical and laboratory investigations led to a diagnosis of erythema multiforme. The patient was treated initially with gentle application of Vaseline between the lips using cotton buds in an attempt to release lip adhesion, followed by surgical release of the lips under general anaesthesia. Analgesics and topical steroid mouthwash were provided. Follow-up: Seven months later, the patient presented with a recurrence of his EM which included lesions on the skin. The patient was treated with antivirals, topical and systematic steroids to suppress the recurrent attacks of EM. Eighteen months following the initial presentation the patient and parent reported considerable decrease in the frequency, severity and duration of the occurrence of intra-oral ulcers, with no major episode of target lesions on the skin. Conclusion: Erythema multiforme is rare in children, however it should be considered in the differential diagnosis of recurrent erosive oral ulcerative lesions especially when the oral lesions resemble those of primary herpetic gingivostomatitis

Effectiveness and Student Perceptions of Haptic Virtual Reality Simulation Training as an Instructional Tool in Pre-Clinical Paediatric Dentistry: A Pilot Pedagogical Study

Simulation training for invasive dental procedures is a core component of the pre-clinical dental curriculum. Besides conventional mannequin-based simulators, dental schools are now incorporating haptic virtual reality simulation (HVRS) devices to facilitate the transition of students from the simulated dental learning environment to the clinical settings. This study aimed to assess student performance and perceptions of HVRS training as a pedagogical tool in pre-clinical paediatric dentistry. After practicing the primary molar pulpotomy procedure on plastic teeth, participants were randomized into test and control groups. Test group students performed the same procedure on a HVRS device, namely the SIMtoCARE Dente®. Subsequently, both the test and control group students attended another conventional pulpotomy simulation session where the quality of their access outline and pulp chamber deroofing steps were evaluated on plastic teeth. After the control group students also experienced the HVRS, all study participants completed a perception questionnaire on their experience. No significant differences were found between the study and control group students for the quantitative parameters assessed. Although the students regarded HVRS to be a useful adjunct to support their pre-clinical training, an overwhelming majority of the students did not consider HVRS to be a replacement for conventional pre-clinical simulation training

Tooth auto-transplantation: A bibliometric analysis of the top 100 most-cited articles

Background/Aim: Tooth auto-transplantation has recently gained high clinical acceptance. The aim of this study was to identify the top 100 most-cited articles regarding tooth auto-transplantation, to analyse multiple citations and publication metrics and to outline the historical scientific advancements in this field. Materials and Methods: An advanced search of the Clarivate Analytics' Web of Science ‘Core Collection’ and Elsevier's Scopus databases utilising specific keywords related to tooth auto-transplantation between 1971 and 2021 was performed. The retrieved articles were ranked in descending order based on their Web of Science citation counts and further cross-matched with citation data from Scopus. The extracted data included citation counts, citation density, level of evidence, year of publication, contributing authors names and institutes, corresponding author's address, journal of publication, journal local citations index, cumulative growth index, keywords and keywords Plus. Data analysis was performed using descriptive statistics and graphical mapping. Results: A total of 1290 articles were retrieved. The top 100 most-cited articles received a total of 4899 (Web of Science) and 5250 (Scopus) citations. Among these, cohort studies (29%) and case series (18%) were the most common study designs. Scandinavian countries produced major contributions in defining the top 100 most-cited articles and ranked within the top 5 countries based on the number of publications and citations per year. The greatest contributing authors were Schwartz O (n = 12), Andreasen JO (n = 8) and Paulsen HU (n = 6), and they were affiliated with Copenhagen, Denmark. The top contributing journals were American Journal of Orthodontics and Dentofacial Orthopedics, International Journal of Oral and Maxillofacial Surgery, Oral Surgery Oral Medicine Oral Pathology Oral Radiology, European Journal of Orthodontics, Dental Traumatology and Journal of Oral and Maxillofacial Surgery. Conclusion: This bibliometric analysis revealed a large geographical scientific interest and broad development in the field of tooth auto-transplantation spanning multiple dental disciplines.Open Access funding provided by the Qatar National Library

Tooth autotransplantation: An umbrella review

Tooth autotransplantation is a versatile procedure with several clinical applications among patients across different age groups. The success of this procedure depends on multiple factors. Despite the wealth of studies available, no single primary study or systematic review is able to report on every factor affecting the outcomes of autotransplantation. The aims of this umbrella review were to evaluate treatment-related and patient-related outcomes of autotransplantation and to assess the pre-, peri- or post-operative factors that could affect these. An umbrella review was conducted according to the PRISMA statement. A literature search of five databases was performed up to 25 September 2022. Systematic Reviews (SR) with and without meta-analysis evaluating autotransplantation were included. Calibration among reviewers was carried out prior to study selection, data extraction and Risk of Bias (RoB) assessment. Study overlap was calculated using corrected covered area. Meta-meta-analysis (MMA) was performed for suitable SRs. The AMSTAR 2 critical appraisal tool was used to evaluate the quality of evidence. Seventeen SRs met the inclusion criteria. Only two SRs were suitable for conduct of MMA on autotransplantation of open apex teeth. The 5-year and 10-year survival rates were >95%. A narrative summary on factors that could affect autotransplantation outcomes and comparisons of autotransplantation to other treatment options were reported. Five SRs were rated as ‘low quality’ and 12 SRs were rated as ‘critically low quality’ in the AMSTAR 2 RoB assessment. In order to facilitate a more homogenous pool of data for subsequent meta-analysis, an Autotransplantation Outcome Index was also proposed to standardise the definition of outcomes. Autotransplantation of teeth with open apices have a high survival rate. Future studies should standardise the reporting of clinical and radiographic findings, as well as the definition of outcomes.Open Access funding provided by the Qatar National Library

A Diagnostic Accuracy Study of Laser Doppler Flowmetry for the Assessment of Pulpal Status in Children's Permanent Incisor Teeth

Introduction: The aim of this study was to assess whether laser Doppler flowmetry is more accurate than the conventional pulp sensibility tests (electric pulp test and ethyl chloride) in assessing the pulpal status of permanent anterior teeth in children and to identify the laser Doppler flowmetry’s Flux cut-off threshold. Methods: A cross-sectional diagnostic accuracy study with randomization was performed and included 74 participants (8- to 16-year-old children). Participants had 1 maxillary central or lateral incisor with either a completed root canal treatment or an extirpated pulp and a contralateral tooth with vital pulp. Outcome measures included the sensitivity, specificity, and predictive values as well as the repeatability of all tests. Results: A significant difference between the Flux values for teeth with vital and non-vital pulps was found. The cut-off ratio for laser Doppler flowmetry was 0.6, yielding a sensitivity of 53% and a specificity of 33%, which were lower than the values of the electric pulp test (sensitivity = 83.8%–94.6% and specificity = 89.2%–97.6%) and ethyl chloride (sensitivity = 81.1%–91.9% and specificity = 73%–81.1%). The repeatability of laser Doppler flowmetry, electric pulp testing, and ethyl chloride were 0.85, 0.86, and 0.81, respectively. Conclusions: Laser Doppler flowmetry was unable to differentiate between teeth with vital and non-vital pulps. The results of this study showed that there was a high probability for false results. Further development of laser Doppler flowmetry in assessing pulpal blood flow would be required before it could be recommended for clinical use, especially in children

The use of aesthetic paediatric full coverage restorations among paediatric dental practitioners: an international survey

Despite the recent growing evidence in support of prefabricated zirconia crown use as a successful option in managing grossly carious anterior and posterior primary teeth, the use of such crowns remains controversial within the paediatric dental profession. This study aims to assess the use of aesthetic full coverage paediatric restorations among paediatric dentists worldwide, with emphasis on aesthetic prefabricated zirconia crowns. This was an online cross-sectional survey questionnaire study comprising of 38 multiple-choice questions disseminated worldwide through the contact lists of national, regional and international paediatric dental organisations and social media platforms. The survey was completed by 556 respondents thus achieving power, with 391 (70.3%) females and 165 (29.7%) males. The respondents were from 55 different countries spread across six continents. The use of aesthetic full coverage restorations was reported by 80% (n = 444) of the respondents. For restoring anterior teeth, participants mainly used either composite strip crowns (94.4%, n = 419) or zirconia crowns (73.6%, n = 327), while those who used aesthetic crowns for restoring posterior teeth mainly used zirconia crowns (68.2%, n = 303). Within the limitations of this study, the results have shown a wide use of full coverage aesthetic restorations, including the use of zirconia crowns, of primary teeth within this international sample of practicing dentists.Scopu

Effect of dental trauma management resources on dental practitioners' confidence and knowledge: A pilot cross-sectional study

Background/Aim: The knowledge of standardized care guidelines is critical to the confidence of practitioners in managing dental trauma. Therefore, the aim of this study was to assess the awareness, use and impact of the International Association of Dental Traumatology guidelines, and the online Dental Trauma Guide on general dental practitioners' self-reported confidence and knowledge in managing traumatic dental injuries in the primary and permanent dentitions. Materials and Methods: A cross-sectional, pre-piloted, 27-item self-administered questionnaire survey was distributed electronically to general dental practitioners' working within five member states of the Gulf Cooperation Council countries (Kingdom of Bahrain, Kingdom of Saudi Arabia, Kuwait, Oman, and Qatar) between September and December 2020. Data were collected and analysed using descriptive statistics and Wilcoxon Signed Rank test analysis for relevant comparisons. Results: A total of 294 respondents completed the survey, with the majority being from the Kingdom of Saudi Arabia (47.4%) and Qatar (27.3%). A lack of evidence-based knowledge in managing traumatic dental injuries was evident among more than half of the respondents. Respondents who were cognizant of the recent International Association of Dental Traumatology guidelines (2020) and those who use the Dental Trauma Guide routinely demonstrated a higher self-reported confidence level in managing both simple and complex primary dentition trauma, as well as simple traumatic dental injuries in the permanent dentition (p <.05). Conclusion: This survey highlights critical deficiencies in the knowledge of a large number of the respondents in the management of dental trauma which is likely to cause irreversible long-term patient effects.Open Access funding provided by the Qatar National Library

Use of the Hall technique by specialist paediatric dentists: a global perspective.

Background The Hall technique (HT) is popular with UK paediatric dentists (PDs). Global PDs perception/use of HT is unknown.Aim To investigate global PDs opinions/use of HT.Materials and methods A cross-sectional questionnaire of 26 questions was sent to specialist PDs across the globe.Results Responses of 709 PDs from six continents were obtained. The majority (n = 654, 92.32%) had heard about HT but only 50.6% (n = 358) used it, with wide country variations. Respectively, 37.5%, 31.5% and 31% were neutral, against or supportive of HT when they initially heard about it. Only 17% of HT users said it was always the treatment of choice for non-pulpal asymptomatic carious primary molars (NPACPMs), 62% would take a pre-operative radiograph, 65% would consider using high speed drills before HT, 63% would never consider HT under general anaesthesia, 56% would use HT under N2O sedation. Finally, in a clinical scenario of a NPACPM in a cooperative 6-year-old, 75% of PDs would choose conventional restorative methods over the HT.Conclusion The HT is recognised, but not used, by an outright majority of PDs across the globe. Identifiable barriers such as lack of training, perception as substandard dentistry and perceived lack of evidence reduced its use

Predicting Patients’ Intention to Use a Personal Health Record Using an Adapted Unified Theory of Acceptance and Use of Technology Model: Secondary Data Analysis

BackgroundWith the rise in the use of information and communication technologies in health care, patients have been encouraged to use eHealth tools such as personal health records (PHRs) for better health and well-being services. PHRs support patient-centered care and patient engagement. To support the achievement of the Kingdom of Saudi Arabia's Vision 2030 ambitions, the National Transformation program provides a framework to use PHRs in meeting the triple aim for health care - increased access, reduced cost, and improved quality of care - and to provide patient- and person-centered care. However, there has been limited research on PHR uptake within the country.ObjectiveUsing the Unified Theory of Acceptance and Use of Technology (UTAUT) as the theoretical framework, this study aims at identifying predictors of patient intention to utilize the Ministry of National Guard-Health Affairs (MNG-HA) PHR (MNGHA Care) application.MethodsUsing secondary data from a cross-sectional survey, data measuring intention to use the MNGHA Care application along with its predictors, were collected from adults (N=324) visiting MNG-HA facilities in Riyadh, Jeddah, Dammam, Madinah, Al Ahsa, and Qassim. The relationship of predictors (main theory constructs) and moderators (age, gender, experience with health applications) with the dependent variable (intention to use MNGHA Care) was tested using hierarchical multiple regression.ResultsOf the eligible population, a total of 261 adult patients were included in the analysis with a mean age of 35.07 years (± 9.61), male (n=132, 50.6%), university-educated (n=118, 45.2%), and at least one chronic medical condition (n=139, 53.3%). The model explained 48.9% of the variance in behavioral intention to use the PHR (P=.377). Performance expectancy, effort expectancy, and positive attitude were significantly associated with behavioral intention to use the PHR (PConclusionsThis research contributes to the existing literature on PHR adoption broadly as well as in the context of the Kingdom of Saudi Arabia. Understanding which factors are associated with patient adoption of PHRs can guide future development and support the country's aim of transforming the health care system. Similar to other studies on PHR adoption, performance expectancy, effort expectancy, and positive attitude are important factors, and practical consideration should be given supporting these areas.</p

Predicting patients' intention to use a personal health record using an adapted unified theory of acceptance and use of technology model : secondary data analysis

Background: With the rise in the use of information and communication technologies in health care, patients have been encouraged to use eHealth tools such as personal health records (PHRs) for better health and well-being services. PHRs support patient-centered care and patient engagement. To support the achievement of the Kingdom of Saudi Arabia’s Vision 2030 ambitions, the National Transformation program provides a framework to use PHRs in meeting the 3-fold aim for health care—increased access, reduced cost, and improved quality of care—and to provide patient- and person-centered care. However, there has been limited research on PHR uptake within the country. Objective: Using the Unified Theory of Acceptance and Use of Technology (UTAUT) as the theoretical framework, this study aims at identifying predictors of patient intention to utilize the Ministry of National Guard-Health Affairs PHR (MNGHA Care) app. Methods: Using secondary data from a cross-sectional survey, data measuring the intention to use the MNGHA Care app, along with its predictors, were collected from among adults (n=324) visiting Ministry of National Guard-Health Affairs facilities in Riyadh, Jeddah, Dammam, Madinah, Al Ahsa, and Qassim. The relationship of predictors (main theory constructs) and moderators (age, gender, and experience with health apps) with the dependent variable (intention to use MNGHA Care) was tested using hierarchical multiple regression. Results: Of the eligible population, a total of 261 adult patients were included in the analysis. They had a mean age of 35.07 (SD 9.61) years, 50.6 % were male (n=132), 45.2% had university-level education (n=118), and 53.3% had at least 1 chronic medical condition (n=139). The model explained 48.9% of the variance in behavioral intention to use the PHR (P=.38). Performance expectancy, effort expectancy, and positive attitude were significantly associated with behavioral intention to use the PHR (P Conclusions: This study contributes to the existing literature on PHR adoption broadly as well as in the context of the Kingdom of Saudi Arabia. Understanding which factors are associated with patient adoption of PHRs can guide future development and support the country’s aim of transforming the health care system. Similar to previous studies on PHR adoption, performance expectancy, effort expectancy, and positive attitude are important factors, and practical consideration should be given to support these areas