Dental approach for Apert syndrome in children : a systematic review

Apert Syndrome (AS), or type I acrocephalosyndactyly, is a rare, congenital craniosynostosis condition resulting from missense mutations in the gene encoding fibroblast growth factor receptor 2. It is characterized by three specific clinical features: brachycephalic skull; midface hypoplasia, and limb abnormalities (syndactyly of hands and feet). The disorder exhibits variable presentations in bones, brain, skin, internal organs, and in the oral/maxillofacial region. The aim of the present paper was to show the main results from a systematic review of AS. A search of the literature was performed from April to June 2016 in five electronic databases. Clinical interventional or observational studies, reviews, and case reports were included. The present systematic review was carried out strictly following PRISMA and Cochrane Collaboration criteria. A total of 129 potential references were identified. After reviewing titles and abstracts, 77 of these did not meet the desired criteria and were discarded. The full text of the remaining 52 manuscripts was critically screened. Finally, 35 relevant papers were identified for inclusion in the present systematic review and classified according to topic type. According to the information gathered, dentistry practitioners must be able to supply an early diagnosis through the recognition of AS clinical features and provide correct oral management. Additionally, they should be integrated in a multidisciplinary medical care team in order to improve the quality of life of the affected patients

Non-syndromic craniosynostosis in children : scoping review

Craniosynostosis (CS) is a complex condition consisting of the early fusion of one or more cranial sutures in the intrauterine stage. The affected infant exhibits abnormal head shape at time of birth or shortly thereafter. It can be observed in normal individuals (non-syndromic CS or NSCS) or as a part of a multisystem syndrome. The purposes of the present article were to carry out a scoping review on Non-Syndromic CS and to discuss the most important findings retrieved. The steps of this scoping review were as follows: first, to pose a research question; second, to identify relevant studies to answer the research question; third, to select and retrieve the studies; fourth, to chart the critical data, and finally, to collate, summarize, and report the results from the most important articles. Relevant articles published over a 20-year period were identified and retrieved from five Internet databases: PubMed; EMBASE; Cochrane Library; Google Scholar, and EBSCO. Fourteen articles were finally included in the present scoping review. The following four most important clinical issues are discussed: (i) normal cranial development, clinical manifestations, and pathogenesis of NCSC; (ii) clinical evaluation of NCSC; (iii) treatment and post-surgical follow-up; and (iv) additional considerations. NSCS may be present with associated head shapes. Multiple early surgical reconstructive options are currently available for the disorder. Pediatric Dentistry practitioners must be familiarized with this condition and form part of a multi-approach health team as those responsible for the opportune oral health care of the affected child

Early identification of permanent maxillary canine impaction : a radiographic comparative study in a Mexican population

Opportune diagnosis, prediction, and interceptive treatment of permanent maxillary canine (PMC) impaction is fundamental for pediatric dentists and orthodontists. In children and young adolescents, diagnostic information obtained from a panoramic radiograph is valuable for the overview and prediction of a potential PMC ectopic eruption into the oral cavity. The aim of the present study was to calculate and compare the prevalence of impaction of PMC in a Mexican pediatric sample (7 to 13 years old), through the use of the Ericson & Kurol (EK/L) and the Power & Short (PS) measurement analyses performed on panoramic radiographs. This investigation was a cross-sectional study performed on 515 panoramic radiographs, which were evaluated to assess the intraosseous position of right and left PMC, from patients who had attended our clinic between 2010 and 2017. Both analytical methods were applied on the same radiography. Outcomes from both analysis methods were expressed dichotomously (impacted or non-impacted). Thus, prevalence was calculated from each method, and the difference between them was verified through the Pearson?s Chi-square test. No statistical difference could be detected between both prevalence rates (p = 0.475). It was found a significant predilection of the condition to the female sex (p = 0.034). Further, the two radiographic methods employed here were highly concordant each other (kappa = 0.92). Through the EK/L method a PMC prevalence of 5.64% (95% CI = 3.66, 7.62) was obtained, while the PS Method the prevalence was 8.83% (95% CI = 6.38, 11.28). In addition, a significant predilection of canine impaction to the female gender was found

Improvement in oral health and compliance in a child with congenital hypothyroidism: Case report

Congenital hypothyroidism is a metabolic disorder that requires special health care interventions. It has influence in overall growth and oral conditions in pediatric patients, and also can affect child cooperation during dental treatment because this metabolic condition is the most common preventable cause of mental retardation. The aim of this paper is to report the dental treatment of a child with congenital hypothyroidism who is four years and five months old, with many facial and oral characteristics of the metabolic condition, including severe early childhood caries and malocclusion. At first, it was observed a lack of cooperation of the patient with speech and learning impairment, but with the help of the Pedagogy team at the Pediatric Dental Clinic Playroom, he developed confidence and diminished anxiety every appointment. We present the follow-up during 15 months, where we could observe favorable outcomes in oral health and compliance of the child.El hipotiroidismo congénito es una alteración metabólica que representa una necesidad especial en salud. Tiene influencia en el crecimiento general y las condiciones orales de los pacientes pediátricos, así como también puede afectar en el grado de cooperación del niño durante la consulta porque esta condición metabólica es la causa prevenible más común de retraso mental. El propósito de este artículo es reportar el tratamiento odontológico de un niño con hipotiroidismo congénito de cuatro años y cinco meses de edad, con varias características de la condición metabólica, incluyendo caries de la infancia temprana severa y maloclusión. Al principio se observó una falta de cooperación por parte del paciente, con dificultades para el habla y el aprendizaje, pero con la ayuda del equipo pedagógico de la Sala Lúdica, el niño desarrolló confianza con disminución de la ansiedad en cada cita. Presentamos un seguimiento a lo largo de 15 meses, donde hemos observado resultados favorables en la salud oral y en el comportamiento del paciente

Evaluación radiográfica de la presencia/agenesia de terceros molares en una población infantil Mexicana

In the human being, third molar is the tooth that exhibits more variants during its embryologic development, usually causing diverse anomalies and discomfort when erupting to the oral cavity. It has been pointed out that the prevalence of third molar agenesis is between 9 to 37%. The aim of the present comparative cross-sectional study was to radiographically assess the presence/absence of third molar germs (G3M) in a sample of pediatric patients of Mexican origin. A total of 513 panoramic radiographs were analyzed from patients attending the Pediatric Dentistry Postgraduate Program ( San Luis Potosí University, México), during the years 2011 to 2017. Inclusion criteria were patients between 7 and 18 years old, any gender; children with antecedents of a third molar extraction, previous orthodontic treatment, or with an associated congenital or systemic condition were excluded. Total prevalence G3M agenesis was calculated. Then, statistical comparisons of agenesia proportions per dental quadrant, gender, and age group were performed. 245 panoramic radiographs corresponded to the female gender, while 268 belonged to the male gender. The total prevalence of G3M agenesia was estimated in nearly 56%, and the 7-8 years old group exhibited the highest proportion; however, when this age group was excluded from the analysis, such prevalence decreased to 27.3%. Both mandibular quadrants showed higher proportions of G3M agenesia. There were no significant differences between genders. The total prevalence reported in the present study was found to be well above regarding the international parameters. It is quite possible that lack of radiographic visualization of G3M had been inaccurate in some cases due to the common absence of calcification traces from those teeth during early ages (7-8 years old). The adjusted analysis provided a prevalence value more in line with the recognized standards in the dental literature.En el ser humano, el tercer molar es el órgano dentario que más variaciones presenta durante su desarrollo embriológico, y es causa de diversas alteraciones y malestares durante su proceso de erupción. Se ha señalado que la agenesia del tercer molar tiene una prevalencia entre 9 y 37%. El objetivo del presente estudio transversal comparativo fue evaluar radiográficamente la presencia/ausencia de gérmenes de terceros molares (G3M) en pacientes pediátricos de origen mexicano. Se analizaron 513 radiografías panorámicas de pacientes que asistieron al Posgrado en Estomatología Pediátrica de la Universidad Autónoma de San Luis Potosí (México), durante los años 2011 a 2017. Se tomaron como criterios de inclusión, pacientes entre los 7 y 18 años de edad, sexo indistinto; se excluyeron pacientes con antecedentes de extracción de alguno de los terceros molares, tratamiento ortodóntico previo, enfermedades congénitas y/o síndromes asociados. Se compararon las frecuencias y prevalencias de agenesia de terceros molares, en total y por cuadrantes, comparando por sexo y grupo de edad. 245 radiografías panorámicas correspondieron al sexo femenino y 268 al masculino. La prevalencia total de agenesia del G3M fue estimada en casi 56%, y el grupo de edad de 7-8 años mostró el mayor porcentaje; sin embargo, cuando este grupo de edad se excluyó del análisis, dicha prevalencia disminuyó a 27.3%. Los cuadrantes mandibulares mostraron mayor porcentaje de agenesia. No hubo diferencia estadística significativa en la comparación por sexo. La prevalencia total de agenesia del G3M reportada en el presente estudio se encuentra muy por encima de los parámetros internacionales. Es muy posible que la falta de visualización radiográfica de agenesia de los terceros molares haya sido errónea en algunos casos debido a la ausencia frecuente de indicios de calcificación de este diente durante las edades tempranas (7-8 años). El análisis ajustado proporcionó un valor de prevalencia más acorde con los estándares reconocidos por la literatura dental

Quick Correction of a Skeletal Class III Maloclussion in Primary Dentition with Face Mask Plus Rapid Maxillary Expansion Therapy

Skeletal Class III is a malocclusion characterized by anterior crossbite as a result of an abnormal skeletal maxillary and mandibular base discrepancy, which involves disharmony of craneofacial skeleton and profile. The preferred management for children having skeletal Class III malocclusion with retruded maxilla and/or prognathic mandible is the use of devices that encourage the growth and anterior movement of the maxilla bone and/or restrict the exessive mandible growth. The orthopedic treatment consisting of a face mask with rapid maxillary expansion (RME) produces the most dramatic results in the shortest period of time. The purpose of this article is to review a quick correction of skeletal class III maloclussion in the primary dentition through a case example with use of a face mask plus rapid maxillary expansion therapy in a 5 year-old male patient due to a combination of retruded maxilla and protruded mandible, in primary dentition, who was treated with a Petit face mask in conjunction with a bonded RME intraoral appliance added with bite blocks. The first evident occlusal outcomes were a clockwise rotation of the mandible, a positive overjet of 3 mm, a correct overbite, a canine Class I relationship, and a bilateral flush terminal plane. After discussing the present clinical case report and the related published literature, we concluded that skeletal class III malocclusions should be treated as soon as the first clinical signs of abnormal craniofacial growth are recognized, during the first years of life.La clase III esquelética es una maloclusión caracterizada por mordida cruzada anterior como resultado de una discrepancia esquelética de la base maxilar y mandibular, que implica desarmonía craneofacial y del perfil. El tratamiento de elección para niños con maloclusión clase III esquelética con mandíbula maxilar y/o prognática es el uso de dispositivos que estimulan el crecimiento y el movimiento anterior del hueso maxilar y/o restringen el crecimiento excesivo de la mandíbula. El tratamiento ortopédico que consiste en una máscara facial con expansión maxilar rápida (EMR) produce resultados en un período de tiempo más corto. El propósito de este artículo es revisar una corrección rápida de la maloclusión de clase III esquelética en la dentición primaria mediante el uso de una máscara facial más terapia de expansión maxilar rápida en un paciente masculino de 5 años debido a una combinación de maxilar retruido y mandíbula prominente, en dentición primaria, que fue tratada con una mascarilla Petit junto con un dispositivo intraoral unido con bloques de mordida. Los primeros resultados evidentes fueron una rotación en sentido horario de la mandíbula, un overjet positivo de 3 mm, una sobremordida correcta, una relación canina de Clase I y un plano terminal de descarga bilateral. Después de discutir el presente informe de caso clínico y la literatura publicada relacionada, concluimos que las maloclusiones de clase III esqueléticas deberían tratarse tan pronto como se reconozcan los primeros signos clínicos de crecimiento craneofacial anormal, durante los primeros años de vida

Evaluación del efecto sedativo del Midazolam con y sin Ketamina, por vía subcutánea, en pacientes dentales pediátricos

Children's fear and anxiety about dental treatment can lead to difficulties in the behavior management by the practitioner, which can be a barrier to successful dental treatment. Non cooperative children may need dental treatment under sedation, which is indicated when the non-pharmacological behavioral guidance is unsuccessful. There are randomized controlled trials comparing different sedative protocols for dental procedures; however, evidence of superiority from one form over another is weak.  The aim of the present study was to evaluate the sedative effect of midazolam subcutaneously, with and without ketamine, on dental procedures performed in non-cooperative pediatric patients.  A randomized, crossover clinical trial with single blinding was performed in 13 children (10 males and 3 females) from 19 to 48 months of age, ASA I and Frankl I behavior. The two methods were applied in the same patient, and the order of the same was assigned randomly, for the two treatment appointments. In each session were evaluated the patient's general behavior, body movements and crying through the modified Houpt scale. In addition, heart rate and oxygen saturation were monitored by means of a pulse oximeter.El miedo y la ansiedad de los niños por el tratamiento dental pueden conducir a dificultades en el manejo de la conducta por parte del profesional, lo cual puede ser una barrera para el éxito del tratamiento dental. Los niños no cooperadores pueden necesitar recibir tratamiento dental bajo sedación, la que se indica cuando la guía de comportamiento no farmacológico no tiene éxito. Existen ensayos controlados aleatorios que comparan diferentes protocolos sedantes para procedimientos dentales; sin embargo, la evidencia de superioridad de una forma sobre otra es débil. El objetivo del presente estudio es evaluar el efecto sedativo de Midazolam por vía subcutánea, con y sin ketamina, en procedimientos odontológicos realizados en pacientes pediátricos no cooperadores. Se llevó a cabo un ensayo clínico aleatorizado, cruzado, con cegamiento simple, en 13 niños (10 del género masculino y 3 del femenino) de 19 a 48 meses de edad, ASA I y comportamiento Frankl I. Los dos métodos se aplicaron en el mismo paciente, y el orden de los mismos fue asignado aleatoriamente, para las dos citas de tratamiento. En cada sesión se evaluaron: el comportamiento general del paciente, los movimientos corporales y el llanto, por medio de la escala de Houpt modificada. Además, se monitorearon la frecuencia cardíaca y la saturación de oxígeno por medio de un oxímetro de pulso

Usos del láser terapéutico en Odontopediatría: Revisión de la literatura. Reporte de casos

The term "LASER" is an acronym for "Light Amplification by the Stimulated Emission of Radiation" (in Spanish "Amplificación de Luz por Emisión Estimulada de Radiación"). The use of laser technology in dentistry has had a constant evolution and development in the last 30 years. Two large groups of lasers should be distinguished: high-power or surgical and low-power or therapeutic. The most used in pediatric dentistry is the therapeutic or LLLT (or "soft"). The therapeutic laser is indicated for various anomalies such as hypersensitivity, gingivitis, herpes, paresthesias, trigeminal neuralgias, trismus, TMJ dysfunction, implants, activation of teeth whitening chemicals, among others. This article intends to perform an update of the applications of low power laser in the field of Pediatric Dentistry, as well as the presentation of 4 representative clinical cases.El término “LÁSER” es un acrónimo de “Light Amplification by the Stimulated Emission of Radiation” (en español "Amplificación de Luz por Emisión Estimulada de Radiación"). La utilización de la tecnología láser en Odontología ha tenido una constante evolución y desarrollo en los últimos 30 años. Se deben distinguir dos grandes grupos de láseres: De alta potencia o quirúrgicos y de baja potencia o terapéuticos. El más empleado en odontología pediátrica es el terapéutico o LLLT (o “blando”). El láser terapéutico está indicado para diversas anomalías tales como la hipersensibilidad, gingivitis, herpes, parestesias, neuralgias del trigémino, trismus, disfunción ATM, implantes, activación de químicos de blanqueamiento dental, entre otros. Este artículo pretende realizar una actualización de las aplicaciones del láser de baja potencia en el ámbito de la Odontología Pediátrica, así como la presentación de 4 casos clínicos representativos