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Introduction: The dentition is one of the most accurate features for age estimation in children. However, there is some evidence that timing of dental development varies across populations. Recent research suggests that dental development may also be susceptible to influence by environmental factors, such as obesity. Given that there are also population differences in average body mass, it is possible that this may be a confounding variable that was not accounted for in prior work. We aim to compare the relative association between body mass index (BMI) and ancestry with timing of dental development. Methods: A retrospective cross‐sectional chart review was undertaken using panoramic radiographs of 6‐ to 12‐year‐olds (n = 281). Age, ancestry, sex, height, and weight were obtained. Dental development was assessed using the Demirjian method, and chronological age was subtracted from estimated dental age to determine relative timing of dental development (ΔAge). BMI was calculated based upon recorded height/weight within 6 months of time of radiograph. Results: We found no difference in timing of dental development (accelerated/delayed) across ancestry groups (African‐American, Euro‐American, Hispanic, Asian; P =.15). Overweight/obese subjects had statistically significantly advanced (precocious) dental development (P <.001). Compared to normal‐weight subjects, children who were overweight's age were overestimated by 5.76 months (0.48 years) and children with obesity by 5.97 months (0.49 years) on average. Conclusions: BMI appears to have a greater impact on relative timing of dental development than ancestry in this population. Our results support other findings that obesity results in accelerated growth and development. [ABSTRACT FROM AUTHOR]

: Following implementation of routine screening for depression in primary care, screening for other behavioral health issues is expanding. However, prior to implementing additional screening it is important to consider patient comfort answering sensitive questions related to behavioral health topics to determine screening acceptability and effectiveness. : A self-report survey was completed by U.S. adults over the age of 18 (n = 378) using Amazon Mechanical Turk. The survey assessed comfort discussing demographics, physical health, behavioral health, oral health, and living conditions with medical providers. Comfort levels of behavioral health topics were compared to comfort discussing depression symptoms and reasons for discomfort discussing topics were also surveyed. : There were significant differences in comfort level discussing various behavioral health issues (F(8) = 51.70, P <.001). Participants reported being more comfortable discussing cigarette smoking and less comfortable discussing trauma, intimate partner violence (IPV) and gun ownership compared to depression. Privacy and perceived irrelevance were the most common reasons for discomfort. : Accurate indices of patient behavioral health are essential for patient care. However, patients may be uncomfortable discussing some topics such as trauma, IPV, and gun ownership that patients view as private and/or unrelated to their treatment. Patient comfort may increase through provider trainings that focus on communication skills training, clear administrative procedures that allow for privacy and adequate time for discussions, and community education that underscores how these issues impact physical health. [ABSTRACT FROM AUTHOR]

Summary: This article describes the implementation and outcomes of a social work program in a university pediatric dental clinic serving low-income families. The goal was to decrease barriers to dental care access, decrease appointment failure, and improve interprofessional practice (IPP). Funding was obtained through a foundation to hire a social worker and two interns, and cover program costs. A survey identified barriers families faced to obtain and complete pediatric dental care. Residents, dental students, and faculty make referrals to the social workers who intervene to help families overcome challenges for their children's care. Findings: The program started in January 2019 and outcomes are reported through June 2021. The largest barriers families identified were lack of a pediatric dentist near home accepting public insurance (91%), the dentist who saw their child only did exams and cleanings but not fillings (84%), and need for specialized dental care (77%). Five hundred and eleven families were referred to the social workers, most commonly for resources, information or other referrals (30.5%), dental insurance lapse (14.9%), caregiver guidance on oral health (10.6%), mental health concerns (10.4%), and poor treatment compliance (9.6%). Social workers provided 424 interventions, mostly about information regarding community resources (26.8%), transportation issues (15.9%), and telephone consults (14.2%). Appointment failure rates decreased from 17% to 13.5%, while the cancelation rate decreased from 19.2% to 14.3% from January 2019 to June 2021, respectively. Applications: Social workers helped decrease barriers to pediatric dental care, improve attendance to dental appointments, and enhance IPP for pediatric dental residents, students, and faculty. [ABSTRACT FROM AUTHOR]

Human remains from forensic and bioarcheological contexts are often fragmentary, requiring methods for estimating a forensic profile that are based upon limited skeletal features. In 2017, Berg and Keryhercz created an online application, (hu)MANid, that provides sex and ancestry estimation from mandibular morphoscopic traits and linear measurements. In this study, we examine the utility of the (hu)MANid application in a diverse, urban US adult sample (aged 20–45; n = 143) derived from computed tomography (CT) scans. We secondarily conduct a preliminary analysis of the program's utility in a sample of adolescents (aged 15–17; n = 40). Six morphoscopic, and eleven morphometric traits were recorded as directed by the literature associated with the (hu)MANid program. Percent correct classification and posterior predictive values were calculated for the sex and ancestry estimations output by the program; chi‐squared tests were employed to compare self‐reported and predicted ancestry. In the adult sample, sex was accurately predicted for 75.52% of the sample. Ancestry prediction, however, was less favorable ranging from 19.3% to 50% correct. For the adolescent sample, correct sex estimation (45%) did not surpass what could occur by chance alone, though ancestry prediction fared better than in the larger adult sample (percent correct prediction overall average: 47.5%, range 35.71%–71.43%). The (hu)MANid application shows utility for use with CT scan‐derived adult samples for sex estimation, but caution is warranted for ancestry estimation and use with samples that may not have reached full adult maturity. [ABSTRACT FROM AUTHOR]

Introduction The China Health Authority alerted the World Health Organization (WHO) of several cases of pneumonia, and theWHO has declared the novel coronavirus (COVID-19) a global pandemic. Mastoidectomy is a high-risk aerosol generating procedure with the potential to expose the surgeon to infectious particles. Objective Aim to develop a low-cost prototype for a barrier device that can be used during mastoidectomy. Methods Describe the steps involved during otological emergency, requiring immediate surgical procedure, in untested patients. TheOtorhinolaryngology Surgical TeamofWalter Cantídio Hospital developed the barrier for particle dispersion presented here. Results During surgery, the prototype did not compromise visualization of the surgical field and instrumentation. Microscope repositioning was not compromised or limited by tent Instrumentation and instrument pouch under the Microscope-Tent (MT) performed surgery. After surgery, the plastic sheet was removed simply, without requiring strength. Bone dust and irrigation droplets were collected on the tent. Conclusion Our team developed and practiced, in an otologic emergency, a low-cost and reproducible barrier device that can be used in mastoidectomy in COVID-19 patients. Further tests on efficacy may be necessary. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this pilot study was to evaluate the safety of nitrous oxide (N2O) during dental procedures in pediatric patients with sickle cell disease (SCD). Methods: Patients three to 15 years of age received N2O with oxygen (N2O:O2) during their dental procedure in a university pediatric dental clinic between March 2019 and December 2020. Blood oxygen levels were monitored via pulse oximetry throughout the visit. Caregivers received a follow-up call to assess for postoperative complications. Results: Twenty-three patients were enrolled. The duration of N2O sedation was 20 to 50 minutes. Oxygenation levels during (P<0.001) and after (P=0.004) the procedure were higher than for baseline. No adverse effects were reported in the three days after N2O use. Conclusions: Following dental guidelines for sedation, treatment with up to a 50:50 mixture of nitrous oxide with oxygen increased blood oxygen levels and did not cause postoperative complications in children with sickle cell disease. This is the first formal study confirming the safety of nitrous oxide use in the dental care of SCD patients. [ABSTRACT FROM AUTHOR]

The authors conducted a study to understand patients' preferences and comfort levels in discussing personal medical, behavioral, and social information with their oral health care providers. A self-report survey was completed by US adults 18 years and older (N = 387) using Amazon Mechanical Turk, an online research portal for survey-based research. The survey assessed comfort discussing demographics, physical health, behavioral health, oral health, and living conditions with oral health providers. Factor analysis suggested that participants were comfortable discussing demographics and standard dental questions but were less comfortable answering questions about trauma, stress, coping, and living and behavioral patterns. Demographics did not predict comfort with disclosure, and many participants did not feel personal information was relevant to oral health care. Community education efforts can focus on helping patients understand how oral health is related to behavioral health and social conditions. Dental education should focus on helping oral health care providers communicate comfortably around these topics, balancing education with respect for a patient's willingness to disclose. [ABSTRACT FROM AUTHOR]

Introduction. Skin cancer is a rare indication of sternectomy. Our goal is to report the clinical course of seven patients who underwent sternectomy for skin cancer. Methods. The survey data were collected from medical records of patients treated between 2008 and 2018 at Ceará Cancer Institute. Results. All patients had prolonged sunlight exposure and average disease time of two years and age of 60 years. Most patients recovered favorably after treatment with prolonged survival. Conclusion. Sternectomy remains an option with curative purposes for locally advanced skin cancer. [ABSTRACT FROM AUTHOR]

Introduction: Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF-supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC). Methods: A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges. Results: Services included provision of general health care, with out-patient care (range between countries 43,343 and 287,163 consultations/year in 2015) and in-patient care (range 1076-16,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12-255 patients/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi-month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and peer support activities. Conclusions: The principles of differentiated HIV care for high-quality ART delivery can successfully be applied in challenging operating environments. However, success heavily depends on specific adaptations to each setting. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe caretakers" self-selected pediatric oral health goals, self-reported compliance, perceived self-efficacy and perceived barriers to goal accomplishment The effect of self-management plans on recall attendance was also evaluated. Methods: Fifty caretaker-patient pairs who presented for examinations at a university pediatric dental clinic were assigned to an intervention group. Fifty age-matched subjects were assigned to the comparison group. At baseline both groups completed a demographic survey. The intervention group developed a self-management plan and selected oral health goals. Follow-up surveys were administered to the intervention group two weeks and six months later. Results: The most frequently selected oral-health goals were brush twice daily (21 percent) and tooth brush before bed (17 percent). At the two-week follow-up, 39 percent of contacted caretakers recalled their chosen goals correctly, compared to 26 percent at six months. Approximately half of the participants in both groups attended the six-month follow-up visit. The difference in recall attendance between intervention and comparison group was not significant (P=0.80). Conclusions: Caretakers most frequently selected goals that were associated with toothbrushing. They initially reported high confidence levels; however, recall and compliance with self-selected oralhealth goals decreased significantly over the course of six months. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the relationship between a history of potentially traumatic events (PTE) and a child’s behavior during dental treatment. Methods: Parents of healthy children, age four years and older and attending their initial dental appointment at a university pediatric dental clinic, were asked to complete the Traumatic Events Screening Inventory-Parent Report Revised and a demographic survey. Following the dental appointment, a pediatric dental resident reported the child’s behavior using the Frank! scale. Results: A total of 170 parent-child pairs participated: 53 percent of parents indicated their child had experienced at least one PTE; 44 percent reported their child had a prior negative experience at the dentist. Adjusted multivariable logistic regression analysis showed no significant association between PTE history and poor dental behavior (P=0.994), but a significant association was observed between a previous negative dental experience and poor dental behavior (P=0.000) as well as between age (younger than five years old) and poor behavior (P=0.006). Conclusions: Children with a history of potentially traumatic events did not exhibit uncooperative behavior more often than those who did not. A previous negative dental experience and the child’s young age were significantly associated with uncooperative behavior. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to characterize the impact of sickle cell disease (SCD) on oral health and examine its impact on quality of life. Methods: Fifty-four study subjects were recruited from the sickle cell clinic and 52 control subjects from the adolescent medicine clinic at Nationwide Children's Hospital, Columbus, Ohio. A dental exam was performed to determine each participant's caries burden. The Child Oral Health Impact Profile survey was used to assess their oral health-related quality of life (OHRQoL). Results: Most subjects in both the SCD and control groups rated their overall health and oral health as "good" or "excellent." There was no statistically significant difference in OHRQoL between these groups. Additionally, no significant relationship was found between white blood cell count, medication intake, or the number of sickle cell crises as related to the caries burden. Statistically significant differences were detected in caries burden between the control group and the sickle cell hemoglobin C disease (HbSC) group (P<.02) and between the sickle cell anemia and HbSC subjects (P=.O4). Conclusions: Adolescents with sickle cell hemoglobin C disease had fewer caries than peers with sickle cell anemia or controls, though the cause of this finding is not dear. [ABSTRACT FROM AUTHOR]

Objectives: To identify associations between specific WHO stage 3 and 4 conditions diagnosed after ART initiation and all cause mortality for patients in resource-limited settings (RLS). Design, Setting: Analysis of routine program data collected prospectively from 25 programs in eight countries between 2002 and 2010. Subjects, Participants: 36,664 study participants with median ART follow-up of 1.26 years (IQR 0.55–2.27). Outcome Measures: Using a proportional hazards model we identified factors associated with mortality, including the occurrence of specific WHO clinical stage 3 and 4 conditions during the 6-months following ART initiation. Results: There were 2922 deaths during follow-up (8.0%). The crude mortality rate was 5.41 deaths per 100 person-years (95% CI: 5.21–5.61). The diagnosis of any WHO stage 3 or 4 condition during the first 6 months of ART was associated with increased mortality (HR: 2.21; 95% CI: 1.97–2.47). After adjustment for age, sex, region and pre-ART CD4 count, a diagnosis of extrapulmonary cryptococcosis (aHR: 3.54; 95% CI: 2.74–4.56), HIV wasting syndrome (aHR: 2.92; 95%CI: 2.21 -3.85), non-tuberculous mycobacterial infection (aHR: 2.43; 95% CI: 1.80–3.28) and Pneumocystis pneumonia (aHR: 2.17; 95% CI 1.80–3.28) were associated with the greatest increased mortality. Cerebral toxoplasmosis, pulmonary and extra-pulmonary tuberculosis, Kaposi’s sarcoma and oral and oesophageal candidiasis were associated with increased mortality, though at lower rates. Conclusions: A diagnosis of certain WHO stage 3 and 4 conditions is associated with an increased risk of mortality in those initiating ART in RLS. This information will assist initiatives to reduce excess mortality, including prioritization of resources for diagnostics, therapeutic interventions and research. [ABSTRACT FROM AUTHOR]

Objectives: To determine the impact of orofacial clefts on the oral health-related quality of life of affected children and whether the oral health-related quality of life of children with orofacial clefts differs among different age groups. To assess whether the responses of children with orofacial clefts differ from the caregivers' perceptions of their child's oral health-related quality of life and compare with data from a control group. Design: Cross-sectional study. Patients/Setting: A total of 75 subjects with cleft lip and/or cleft palate (mean age, 13.0 years) from the Nationwide Children's Hospital Craniofacial Anomalies Clinic, as well as their caregivers, and 75 control subjects (mean age, 13.9 years). Main Outcome Measure: Self-reported oral health-related quality of life measured with the Child Oral Health Impact Profile, a reliable and valid questionnaire designed for use with children and teenagers. Results: Children with orofacial clefts had statistically significant lower quality of life scores than control subjects had for overall oral health-related quality of life, Functional Well-being, and Social Emotional Well-being. There was a statistically significant difference in the interaction of age group and Social-Emotional Well-being between children with orofacial clefts and control children. No statistically significant differences were found between the responses of children with orofacial clefts and their caregivers' reports. Conclusions: Presence of an orofacial cleft significantly decreases overall oral health- related quality of life, Functional Well-being, and Social-Emotional Well-being in children and adolescents. The negative impact of orofacial clefts on Social-Emotional Well-being is greater in 15- to 18-year-olds than in younger age groups. Children with orofacial clefts and their caregivers had very similar evaluations of the child's oral health-related quality of life. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART) in resource limited settings (RLS). Design/Setting: A descriptive analysis of routine program data collected prospectively from 25 Médecins Sans Frontières supported HIV treatment programs in eight countries between 2002 and 2010. Subjects/Participants: 35,349 study participants with median follow-up on ART of 1.33 years (IQR 0.51-2.41). Outcome Measures: Incidence in 100 person-years of WHO stage 3 or 4 conditions during 5 periods after ART initiation. Diagnoses of conditions were made according to WHO criteria and relied upon clinical assessments supported by basic laboratory investigations. Results: The incidence of any WHO clinical stage 3 or 4 condition over 3 years was 40.02 per 100 person-years (31.77 for stage 3 and 8.25 for stage 4). The incidence of stage 3 and 4 conditions fell by over 97% between months 0-3 and months 25-36 (77.81 to 2.40 for stage 3 and 28.70 to 0.64 for stage 4). During months 0-3 pulmonary tuberculosis was the most common condition diagnosed in adults (incidence 22.24 per 100 person-years) and children aged 5-14 years (25.76) and oral candidiasis was the most common in children <5 years (25.79). Overall incidences were higher in Africa compared with Asia (43.98 versus 12.97 for stage 3 and 8.98 versus 7.05 for stage 4 conditions, p<0.001). Pulmonary tuberculosis, weight loss, oral and oesophageal candidiasis, chronic diarrhoea, HIV wasting syndrome and severe bacterial infections were more common in Africa. Extra-pulmonary tuberculosis, non-tuberculous mycobacterial infection, cryptococcosis, penicilliosis and toxoplasmosis were more common in Asia. Conclusions: The incidence of WHO stage 3 and 4 conditions during the early period after ART initiation in RLS is high, but greatly reduces over time. This is likely due to both the benefits of ART and deaths of the sickest patients occurring shortly after ART initiation. Access to appropriate disease prevention tools prior to ART, and early initiation of ART, are important for their prevention. [ABSTRACT FROM AUTHOR]

According to the US Census Bureau, the poverty rate for children under 18 years of age increased to 22%, in 2010. Poverty leads to adverse health outcomes in children and adolescents such as harmful effects on learning, psychosocial development, physical health, productivity and family life. Because the citizens and residents of a country are its most valuable assets, it is unwise to allow housing instability, food insecurity and hunger to continue to exist at its current levels. Reducing poverty is likely to prevent illnesses, decrease hospitalizations, and lead to lower health care costs. There is also a need for intervention strategies to ensure equitable access to healthy foods across the world. Children who ore food insecure ore more likely to be in poor health and to hove poor nutritional outcomes. Poverty may lead to poor dental health due to malnutrition or incorrect diet and it may also have an effect on the child's behavior in the dental office. An understanding of poverty will lessen the anger, frustration and prejudice that pediatric dentists may feel when working with low-income families. This manuscript presents a concise overview of the effects of poverty in children's lives. [ABSTRACT FROM AUTHOR]

Advances in pediatric health care have prolonged lives and improved the quality of life for children and adolescents. These advances include not only high-tech devices and new medications but also re-application of available medications to take advantage of unexpected benefits which may not have been known previously or even side effects that can have therapeutic value for diseases and conditions refractory to other treatment. This review describes new uses for anti-epileptic medications, thalidomide, intravenous immunoglobulin, hydroxyurea, methotrexate, botulinum toxin, bisphosphonates, and aspirin in the medical care of children. Methods of action and concerns for the pediatric dentist are described for children benefiting from these new applications. [ABSTRACT FROM AUTHOR]

Dental care is the most unmet health care need of children and adolescents who have chronic conditions and diseases. Because advances in therapy and medical technology have extended the lives of this population, it is very likely that these children will seek care in general dental practices. It is extremely important for dental practitioners to be knowledgeable about their patients' history and medical treatment to deliver care safely. This article reviews four chronic diseases of childhood (asthma, cystic fibrosis, cancer, and sickle cell disease) and discusses recommendations for oral and dental treatment. [ABSTRACT FROM AUTHOR]

The goal of this study was to investigate whether then and women applying for graduate training in pediatric dentistry placed different emphasis on the same factors and program characteristics upon making their final ranking decision. A questionnaire was mailed to the first-year resident class in the United States in 2005 containing both multiple-choice and open-ended questions covering six sections: 1) candidate's background, 2) the application process, 3) program characteristics, 4) nonclinical factors, 5) clinical factors, and 6) the interview process. In sections three through six, respondents ranked factors and characteristics from "not important" or "no influence" to "critical." The response rate was 69.2 percent (180/260), with approximately 57.8 percent females (104/180) and 61.4 percent non-Hispanic white respondents (110/180). Statistically significant differences between genders were as follows: 1) men were older (29.4 years versus 28.1, p<0.05); 2) men applied to more programs (9.9 vs. 8.1, p<0.05); 3) women preferred programs affiliated with their own dental school (p=0.046); 4) women preferred university-based programs (p=0.049); 5) women preferred programs that offered a high amount of patient care under general anesthesia (p=0.040); and 6) women placed more importance on the salary/stipend amount offered by the programs (p=0.045). [ABSTRACT FROM AUTHOR]

The primary goal of this study was to examine the criteria that influence rankings of candidates by advanced education program directors in pediatric dentistry. Secondary objectives were to obtain information on the resident selection process and to explore demographics of current program directors. A survey was sent in 2005 to all sixty-three program directors of pediatric dentistry residency programs accredited within the United States for the graduating class of 2007. The survey had a response rate of almost 78 percent (49/63). Respondents were requested to rank the importance of eleven factors that are typically included in the selection criteria for pediatric dentistry residents. Factors were rated on a scale of critical, very important, fairly important, somewhat important, and not important. The four highest ranked criteria by program directors were the following, in order: National Board scores, dental school clinical grades, class rank, and grade point average (GPA). Other factors ranked in descending order of perceived importance were the following: dental school basic science grades, experience in pediatric dentistry, extracurricular activities, completion of a general practice residency or advanced education in general dentistry program, the application essay, a publication or professional presentation, and private practice experience. All directors ranked personal interviews as very important to critical. Letters of recommendation from a pediatric dentistry department chairperson or faculty member were viewed more favorably than letters from dental school deans and non-pediatric dentistry faculty. Fifty-seven percent of the directors responding (28/49) were male, and 81 percent (40/49) were white, non-Hispanic. Fifty-nine percent of the directors (29/49) graduated from a residency program over twenty years ago, with 39 percent (19/49) having been a director for less than five years. [ABSTRACT FROM AUTHOR]

Hematopoietic stem cell transplant (HSCT) is the treatment of choice for many hematalagic, genetic, oncologic, and immunologic diseases. It is also one of the most aggressive treatments among the different cancer therapies, however, and is associated with severe conditioning-related toxicity, profound neutropenia, a high level of prophylactic immunosuppression and graft-vs-host disease (GVHD). Even with GVHD prophylaxis, chronic GVHD remains a significant complication of HSCT and is a frequent reason for nonrelapse morbidity and mortality following allogeneic HSCT. It primarily targets the skin, gastrointestinal tract, and liver. Approximately 20% of patients who receive matched sibling transplants and 40% of matched unrelated donor recipients will develop chronic GVHD. Risk factors include: (1) history of acute GVHD; (2) hematologic malignancy; (3) female donor to male recipient; (4) use of total body irradiation; (5) donor age of ≥5 years; and (6) recipients >10 years of age. The purpose of this paper was to review the pathogenesis, prevention, and treatment of pediatric chronic graft-vs-host disease, with a focus on its oral manifestations and the dental management of affected children and adolescents. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to describe a child with a noncontributory medical history who sought an emergency dental appointment due to a significant facial and neck swelling. The clinical and radiographic exams revealed no odontogenic infection, and the patient was subsequently diagnosed with acute myelogenous leukemia by the hematology/oncology service. This report underscores the important role pediatric dentists can play in an early referral for further workup of a suspected malignancy, which may initially present as extramedullary disease in the head and neck. [ABSTRACT FROM AUTHOR]

The goal of this study was to identify the factors and program characteristics that influenced the program ranking decisions of applicants to pediatric dentistry residency programs. A questionnaire was sent to the first-year resident class in 2005 with a response rate of 69.2 percent (n=260). Approximately 55 percent were female (104/180) and 61 percent were non-Hispanic white (110/180). The respondents reported that they applied to an average of nine programs, of which five were ranked. Most applicants were interested in a program that had a hospital component with a duration of two years. A program's ability to prepare the resident for an academic career was a minimal influence for 48.6 percent (87/179), and 57.5 percent (103/179) were not interested in a master's or Ph.D. degree. Factors associated with program ranking included modern clinical facilities, high ratio of dental assistants and faculty to residents, availability of assistants for sedation and general anesthesia cases, availability of a salary or stipend, and amount of clinical experience. Important non-clinical factors included hospitality during the interview, geographic location, and perceived reputation of the program. Opportunity to speak with the current residents in private, observing the interaction between residents and faculty, and touring the facilities were also highly considered. These findings may help program directors tailor their interviews and programs to suit the needs of applicants. [ABSTRACT FROM AUTHOR]

Many cultures present several intriguing ethnic dental practices. Therefore, in a multiethnic society, health care professionals have to be attuned to the patients' cultural values and traditions because they impact their attitude in seeking care and the implementation of the professionals' recommendations. Before seeking medical or dental care in the formal health system, families may rely first on an elder or healer for advice and interventions. In East Africa, the unerupted primary canines may be extracted in the first days or months of life because it is believed that they cause persistent fever, vomiting, diarrhea, weight loss, dehydration, infectious diseases and death. The practice is done using nonsterilized instruments leading to harmful localized and systemic sequelae, including fatalities. The purpose of this manuscript was to discuss the case of two Somali siblings who had tooth buds enucleated at a young age, leading to significant dental problems. [ABSTRACT FROM AUTHOR]

Sickle cell anemia is an inherited defect that affects the structure and synthesis of hemoglobin. In sickle cell trait, the affected individuals carry one gene for the abnormal hemoglobin (HbS). Sickle cell disease, however, is the homozygous state in which the abnormal hemoglobin is predominant in red blood cells, leading to devastating multisystem problems. Complications of the disease in children include: painful crises, stroke, pulmonary disease, delayed growth, osteomyelitis, organ damage and psychosocial dysfunction. Oral and dental manifestations include: orofacial pain, paresthesia of the mental nerve, stepladder appearance of the alveolar bone on radiographs, pulpal necrosis and enamel hypomineralization. The purpose of this manuscript was to review: (1) the pathophysiology of the disease; (2) its manifestations in the craniofacial complex; (3) contemporary medical therapy; and (4) recommendations for dental care. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the relationship between a history of potentially traumatic events (PTE) and a child's behavior during dental treatment.Methods: Parents of healthy children, age four years and older and attending their initial dental appointment at a university pediatric dental clinic, were asked to complete the Traumatic Events Screening Inventory-Parent Report Revised and a demographic survey. Following the dental appointment, a pediatric dental resident reported the child's behavior using the Frankl scale.Results: A total of 170 parent-child pairs participated; 53 percent of parents indicated their child had experienced at least one PTE; 44 percent reported their child had a prior negative experience at the dentist. Adjusted multivariable logistic regression analysis showed no significant association between PTE history and poor dental behavior (P=0.994), but a significant association was observed between a previous negative dental experience and poor dental behavior (P=0.000) as well as between age (younger than five years old) and poor behavior (P=0.006).Conclusions: Children with a history of potentially traumatic events did not exhibit uncooperative behavior more often than those who did not. A previous negative dental experience and the child's young age were significantly associated with uncooperative behavior. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to describe the prevalence of radiographically identifiable developmental dental anomalies (DDA) in a university-based pediatric dental clinic and to assess for associations between DDA and health status. Methods: Retrospective data, obtained from the electronic dental records of a three-year pediatric patient cohort, were evaluated by two trained and calibrated examiners. Strict inclusion/exclusion criteria were applied. A validated image quality grading system was used for radiograph assessment, and the physical status classification of the American Academy of Anesthesiology was utilized. A chi-square test and bivariate logistic regression were used for statistical analysis. The inter- and intraexaminer reliability was assessed using Cohen's Kappa. Results: A total of 1,478 subjects (69 percent medically healthy) were enrolled. DDA were identified in 25 percent of the subjects, with hyperdontia, hypodontia, and microdontia being more common. A statistically significant association was found between the presence of DDA and health status (P<0.001) and between DDA and asthma (P=0.035). Patients with systemic disturbances showed 2.12 times greater odds of having DDA (P<0.001, 95 percent confidence interval equals 1.7-2.7). Conclusions: The prevalence of developmental dental anomalies was high, with one in four patients affected. DDA in number were the most common. Patients with systemic disturbances had greater odds of having DDA. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore caregivers' comfort levels and preferences for answering sensitive questions about themselves and their children in a pediatric dental setting. Methods: An electronically delivered survey was completed by 206 caregivers in the waiting area of a dental school's pediatric clinic. The survey items assessed were demographic, general health, behavioral health, oral health, and living conditions. A factor analysis was conducted for each set of questions, and a mean comfort level was calculated for each factor. Comfort levels were assessed on a five-point Likert scale, with one being least comfortable and five being most comfortable. Results: The questions care-givers were less comfortable answering about themselves were concerning traumatic events, stress, coping (mean equals 3.39), and living conditions (mean equals 3.24) versus demographics (mean equals 3.84) and physical and oral health (mean equals 3.99; P<0.001). They were also less comfortable answering questions about their children's trauma, stress, coping (mean equals 3.65), and experiences with violence and sexual activity (mean equals 3.13) than about demographics/general health (mean equals 4.11) and oral health (mean equals 4.21; P<0.001). The main reasons for the discomfort were the questions' sensitive nature and their belief that they had any relationship to their children's oral health. Conclusion: This study provides knowledge of caregivers' lower comfort levels discussing sensitive topics in a dental setting and provides context for interventions focused on how dentists can better communicate with caregivers about their own adverse experiences as well as their children's. [ABSTRACT FROM AUTHOR]

Purpose: The pilot study aimed to evaluate the association between women's depression risk and their children's return for dental treatment. Methods: A total of 175 female caregivers of children's presenting for an initial dental examination between May and October 2019 at a university clinic answered demographic questions and a validated survey on depression risk. An analysis of caregiver's depression risk relative to children's attendance at the next treatment appointment was made. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate and compare in vitro the effect of overlying materials, including zinc oxide eugenol (ZOE), resin-modified glass ionomer cement (RMGIC), and stainless steel crowns (SSC) cemented with glass ionomer cement (GIC), on the setting of Biodentine ® (BD) used as a pulpotomy agent in primary molars that were restored definitively in a single visit. Methods: Forty extracted primary molars were prepared to replicate pulpotomy procedures. The teeth were randomly allocated to four restorative groups: (1) BD, ZOE, SSC; (2) BD, RMGIC, SSC; (3) BD, SSC; (4) BD only (control). All samples were incubated for 24 hours, sectioned mesial-distally, and polished. BD setting was measured as a function of Knoop hardness value (HK) using a Leco Microhardness Tester. Each sample was tested in three zones with 50 gf load force and 30 seconds dwell time and at one, two, and three mm distance from the BD-material interface. A one-way analysis of variance was used to determine statistical significance between groups (P<.05). Results: There was no statistically significant difference between the mean HK value among the four groups and three zones. Conclusions: Overlying materials, including zinc oxide eugenol, resin-modified glass ionomer, and stainless steel crowns cemented with glass ionomer cement, showed no effect on the BD final set. This in vitro study found no evidence against immediate definitive restoration of Biodentine ® pulpotomies. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness of articaine local infiltration with lidocaine inferior alveolar nerve block (IANB) for restorative treatment of primary mandibular molars (PMMs). Methods: In this double-blind, parallel-design, randomized, controlled, clinical trial, participants were enrolled according to specified inclusion criteria ( four to 10 years of age, need of PMM restorations, Frankel four behavior) and randomly assigned into either an articaine or lidocaine group. One investigator administrated all local anesthesia (LA). Nineteen trained and calibrated examiners, blinded to LA type, evaluated participants’ reactions during LA administration and treatment using Modified Behavioral Pain Scale (MBPS). Participants rated their experiences using Wong-Baker FACES Pain Rating Scale (WBFS). The subjects’ blood pressure and pulse were recorded throughout procedures. Statistical analysis employed Mann Whitney-U test, repeated measures analysis of variance (P<0.05), and Cohen’s kappa. Results: A total of 110 participants (n equals 55 per group; mean age equals 6.42 years; 60 percent males) were enrolled. The mean MBPS rating during LA administration was higher for lidocaine IANB (3.89) compared to articaine infiltration (2.24; P<0.001). The mean MBPS rating throughout treatment was higher for the lidocaine group (2.51) compared to articaine group (1.69; P=0.012). The lidocaine group had a mean WBFS score of 1.64, while for the articaine group WBFS was 0.872 (P=0.089). All physiological measurements were within normal limits with no difference between groups. Conclusions: This study demonstrated that local infiltration with articaine was less distressing upon administration and may be considered safe and effective alternative to lidocaine IANB for restorative treatment in PMMs. [ABSTRACT FROM AUTHOR]

Background Tooth decay is the most common childhood disease and it disproportionately affects low-income children. The dietary risk factors associated with socio-economic status (SES), such as food insecurity and fast-food consumption, are poorly understood. Objective To better understand how upstream social factors are related to dietary behaviors by testing the hypothesis that food insecurity mediates the SES--fast-food consumption relationship. Design A 36-item survey was administered to caregivers of children younger than age 18 years (n=212). The predictor variable was SES, measured by whether the child was insured by Medicaid (no/yes). Food insecurity, the potential dietary mediator, was measured using the six-item US Department of Agriculture Household Food Security Survey (food secure/food insecure without hunger/food insecure with hunger). The outcome variable was whether the household reported eating at a fast-food restaurant ≥2 times a week (no/yes). We used logistic structural equation and mediation models to test our hypothesis. Results About 63% of children were classified as low SES. Thirty percent of caregivers reported food insecurity (with or without hunger) and 18.6% of households consumed fast food ≥2 times per week. Lower SES was significantly associated with food insecurity (odds ratio [OR] 3.03, 95% Cl 1.51 to 6.04; P=0.002), but SES was not related to fast-food consumption (OR 1.94, 95% CI 0.86 to 4.36; P=0.11). Food insecurity was not associated with fast-food consumption (OR 1.76, 95% CI 0.86 to 3.62; P=0.12). The mediation analyses suggest food insecurity does not mediate the relationship between SES and fast-food consumption. However, there are important potential differences in fast-food consumption by SES and food insecurity status. Conclusions Future dietary research focusing on tooth decay prevention in vulnerable children may need to account for the differential effects of SES on food insecurity and dietary behaviors like fast-food consumption. Studies are needed to further elucidate the mechanisms linking SES, dietary behaviors, and tooth decay in children. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the effectiveness of articaine local infiltration to lidocaine inferior alveolar nerve block (IANB) for restorative treatment of primary mandibular molars (PMM). Methods: Four- to 10-year-old children who needed PMM restorations were enrolled according to inclusion criteria and randomly allocated into the articaine or lidocaine group. One operator administered all local anesthesia. Using the Modified Behavioral Pain Scale (MBPS), 15 trained and calibrated examiners, blinded to LA type, evaluated the subjects' reactions during LA administration and treatment. Children rated their experience using the Wong-Baker FACES Pain Rating Scale (WBS). Subjects' blood pressure and pulse throughout the visits were recorded. Statistical analysis included independent t-tests, Mann Whitney-U, and repeated measures analysis of variance (P<0.05). Examiner reliability was determined by Cohen's kappa score. Results: Thirty subjects (53 percent male; mean age: 6.3 years) participated. While the mean total scores for articaine (2.13 MBPS; 0.53 WBS) were better than for lidocaine (3.07 MBPS; 1.33 WBS), there were no statistically significant differences between groups. All physiological measurements were within normal limits. Conclusions: This pilot study indicated that articaine infiltration might be as effective as a lidocaine inferior alveolar nerve block for restorative treatment of primary mandibular molars; however, a larger sample is required to confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose: To test the accuracy of the London Atlas for age estimation of Hispanic children and to determine if there is any difference in age accuracy between Hispanic males and females.Methods: The London Atlas was used to estimate age from panoramic radiographs of 17 males and 17 females for each year of age from six to 15.99 years, using the electronic patient database of a dental school. Exclusion criteria included gross pathology, hypodontia, hyperdontia, and previous orthodontic treatment.Results: There were 332 panoramic radiographs evaluated. In all age groups, 34 radiographs (from 17 males and 17 females) were reviewed, except for the age bracket 6-6.99 years, for which only 26 radiographs were available. The mean age estimated of the entire sample by the London Atlas (11.44 years) was greater than the mean chronological age (11.09 years), which was statistically significant (P<.001). The mean difference between chronological and estimated ages for males was .30 years and for females was .40 years, but the difference between sexes was not significant (P=.324). One hundred sixty-two radiographs (49%) were estimated to the exact age interval while 45 (14%) were under-estimated and 125 (38%) were over-estimated. Two hundred and forty radiographs (72%) were estimated to a value within one year of the actual age.Conclusion: There was no difference in age estimation prediction accuracy between Hispanic males and females but an age overestimation of three percent in the cohort was seen. The London Atlas accuracy is suitable for use in forensic investigation. [ABSTRACT FROM AUTHOR]