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Background: The aim of this study was to assess factors associated with higher odds of undergoing repeat general anesthesia (GA2) for dental treatments., Methods: The authors studied children up to age 48 months of age enrolled in Medicaid who underwent dental treatment under first general anesthesia (GA1). The authors used a case-control design to compare children who had a GA2 within 48 months of GA1 (case patients) with those who did not (control patients)., Results: In total, 60 case patients were age and sex matched to 120 control patients. Mean (SD) age at GA1 was 38 (5.2) months for case participants and 40 (4.7) months for control participants (P = .08). Higher caries involvement of maxillary incisors (P = .04), and lower caries involvment of canines (P = .003), first molars (P = .012), and second molars (P < .001) at GA1 was associated with higher odds of occurrence of GA2. There was a significant inverse association between full-coverage restoration on canines (P = .003), first molars (P = .001), and second molars (P = .002) at GA1 and occurrence of GA2. There was a significant direct association between the use of composites or sealants on second molars in GA1 and occurrence of GA2 (P = .02). The number of extractions at GA1 was not associated significantly with the occurrence of GA2., Conclusions: The use of full-coverage restorations on primary molars and canines under general anesthesia (GA) was associated with lower odds of occurrence of GA2. Resin restorations and sealants on primary second molars were associated with higher odds of occurrence repeat GA. The findings support preferential use of full-coverage restorations for young children undergoing dental GA., Practical Implications: Full-coverage restorations should be considered strongly for young children undergoing GA for dental treatments to reduce the risk of requiring GA2., Competing Interests: Disclosures None of the authors reported any disclosures., (Copyright © 2024 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe triazolam in pediatric dental mild to moderate sedation and report changes to overall visit behavior for permanent first molar extraction. Methods: This retrospective chart review from 2018 to 2022 analyzed demographic, procedural, and behavioral data for children eight years and older receiving triazolam for a permanent first molar extraction. The outcomes included adverse events measured by deviations in heart rate and oxygen saturation and changes to overall visit-level Frankl scores from the referral to sedation visit. Descriptive statistics and non-parametric statistical analyses were conducted. Results: The study population (n equals 82) was predominantly female (61 percent), English-speaking (85 percent), and White (41 percent) or Black (39 percent). The most common indication for mild to moderate sedation was dental anxiety (28 percent). There were zero instances of adverse events requiring emergency intervention or the use of reversal medication. The change in visit-level Frankl scores was significantly positive (P<0.001). Conclusion: Triazolam is likely a safe choice for mild to moderate sedation, leading to improved overall visit behavior in children undergoing a permanent first molar extraction.

Purpose: The aim of this study was to report a novel PRDM5 pathologic variant and ophthalmic findings in a family with 3 children diagnosed with brittle cornea syndrome (BCS). Histopathologic findings and surgical outcome of a child with BCS who underwent full-thickness corneal transplant are described., Methods: This is an observational case report of a nonconsanguineous Laotian family with 3 siblings diagnosed with BCS. Data collected included visual acuity, cycloplegic refraction, slit-lamp biomicroscopy, dilated fundus examination, corneal pachymetry, corneal topography, and general medical findings. Targeted testing through PRDM5 gene sequencing with copy number variation detection was conducted., Results: The 3 siblings included a 12-year-old boy and 8- and 6-year-old sisters, all of whom presented with myopia, blue-tinted sclerae, thin corneas, and variable corneal scarring. All 3 affected children were found to be homozygous for the PRDM5 gene variant c.1117&#95;1123delinsTTTAATGCTTACAAATGTTTG p.Asp373Phefs*57. Coding sequences of PRDM5 and ZNF469 genes were sequenced in their entirety, and this was the only pathologic variant present in this family. The youngest affected sister developed persistent hydrops with severely decreased vision and underwent penetrating keratoplasty. Histopathology revealed severe corneal thinning, diffuse absence of Bowman layer, and ruptured Descemet membrane scrolls., Conclusions: Three siblings with clinical signs of BCS, including corneal thinning, myopia, and blue sclerae, were found to have a novel PRDM5 gene pathologic variant. This pathologic variant has not been previously reported, although 1 downstream nonsense pathologic variant has been reported as pathogenic. The similar phenotypes in all affected patients support the pathogenicity of this variant. Surgical management of BCS presents unique challenges due to severe tissue fragility., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Vitamin A is vital to retinal rod function and epithelial cell differentiation. Although uncommon in the developed world, vitamin A deficiency (VAD) secondary to poor diets or gastrointestinal disease has been reported and can lead to xerophthalmia, which is characterized by night blindness and a spectrum of ocular surface changes. Patients with autism spectrum disorder have been shown to have restrictive diets secondary to sensory issues leading to rejection of foods except for those of certain color or texture., Methods: We present a case series of 6 pediatric patients with autism who developed varying degrees of xerophthalmia due to VAD, which resulted from restrictive eating., Results: All patients presented with a history of eye irritation that was not relieved by antibiotic or allergy eye drops. Further questioning revealed they had restrictive diets consisting of only or mostly white and tan foods, and serum vitamin A testing confirmed severe VAD. Most stages of xerophthalmia were completely reversed with vitamin A supplementation, but in 2 patients more advanced xerophthalmia resulted in irreversible blindness and ocular damage., Conclusions: Both pediatricians and pediatric eye care providers must be vigilant for VAD as an etiology of eye irritation, photophobia, or new-onset visual impairment in autistic children. A review of the child's diet must be implemented as a standard part of routine history taken in this vulnerable population. Early identification and vitamin A supplementation can prevent irreversible ocular compromise and vision loss., (Copyright © 2023 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: U.S. pediatric dentists require access to hospital operating rooms (ORs) to deliver safe and effective dental care to some children but have reported denial of access to ORs for general anesthesia (GA), causing long waiting times, deferral of medically necessary dental care, and unmeasured pain and anxiety for patients. The purpose of this pilot study was to examine the extent and possible underlying causes of operating room access denial. Methods: Public policy advocates (PPAs) of the American Academy of Pediatric Dentistry completed a written or electronic questionnaire about state-specific OR denials during March 2020. Results: Responses from 50 states and the District of Columbia showed 34 PPAs (67 percent) acknowledging OR access problems, with 14 out of 34 (41 percent) reporting a moderate or major problem. Western district PPAs reported the fewest states affected (four out of 11; 36 percent). Hospitals and reimbursement emerged as frequent foci for denials in comment analysis. Conclusions: Operating room access denial is a problem for pediatric dentists in the majority of U.S. states and the District of Columbia; in those states reporting it as a problem, it was considered moderate or major in significance by almost half.

Purpose: To assess the attitudes and preferences of caregivers accompanying children to dental appointments toward greetings by dental staff.
Methods: English-speaking caregivers accompanying children to dental appointments completed a sex-specific survey consisting of 21 questions pertaining to the current visit, demographics, subject's relationship to the child, preference for greeting by providers, and previous uncomfortable experiences with greetings by providers.
Results: The sample included 238 subjects: 197 (82.8 percent) biological parents; 17 (7.1 percent) biological grandmothers/grandfathers; and 24 (10.0 percent) adults had a different relationship to the child. The single most preferred greeting was "mom" (70.0 percent) or "dad" (72.2 percent), with some variation in preferences among caregivers who were not biological parents. The second most preferred greeting was the first name for both males and females. African-American females preferred to be greeted by the first name compared to white females ( P <.03). Older females preferred to be greeted by "grandma" compared to younger females ( P <.01).
Conclusion: No single greeting was acceptable to all subjects. Using "mom" or "dad" was acceptable to most caregivers but not universally accepted. First name was acceptable to most, including caregivers who were not biological parents.

Purpose: The purpose of this study was to use National Poison Data System (NPDS) data to identify cases of local anesthetic (LA) adverse events related to dentistry for children. Methods: NPDS data were queried for all human cases from 2004 to 2018 that identified a parenteral LA agent as the substance, in children 12 years old and younger, which led to a medical outcome classification ranging from moderate to death. For cases that met inclusion criteria, deidentified records with case notes were requested. Results: Twenty-seven dental cases that met review criteria and had available case notes were reviewed. Most subjects were female (N equals 20 out of 27, 74 percent), and the average subject age was 6.8 years. Twenty cases (74 percent) had a moderate effect, seven cases (26 percent) had a major effect, and no fatalities were reported. The most common clinical effects classification was a seizure (N equals 13, 48 percent). One case of LA overdose was identified. Conclusions: No cases of permanent damage or fatal outcomes were found. Seizure activity following the administration of local anesthetic was the most common event, suggesting intravascular administration or a toxic dose.

Oral health is integral to general health. The oral cavity may harbor manifestations of systemic disease and can be the harbinger of early onset. Primary care providers (PCPs) can therefore use the oral cavity to support working diagnoses. Conversely, systemic diseases and treatments can affect oral health and require interactions between PCPs and dental providers. Acute oral manifestations of systemic disease may involve teeth and/or gums. This article reviews oral and systemic disease connections for some diseases, identifies issues that benefit patients through medical-dental collaboration, and highlights some nondental oral injuries that might confront PCPs or emergency medical providers., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Infant oral health (IOH) is a preventive service advocated by major medical and dental organizations. IOH aims to prevent early childhood caries (ECC) and impart health strategies to families for continued oral health and prevention of future caries. IOH reaches across disciplines, is low cost, and is covered by Medicaid and many private dental payers. Increasing evidence points to immediate and long-term positive oral health outcomes of reduced disease, reduction in costly care, and reduction in ECC-associated morbidities., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose of Review: This article reviews the literature on past and recent trends in contact lens-related microbial keratitis from bacterial, fungal, and Acanthamoeba infections., Recent Findings: Contact lens wear is the most important risk factor for microbial keratitis. Despite increased use of daily disposable contact lens wear, the incidence of bacterial ulcers related to contact lens wear remains high. Overnight contact lens wear is the leading risk factor in contact lens-related bacterial infections. There may be a trend towards increasing antibiotic resistance of Gram-positive bacteria to fourth-generation fluoroquinolones. The incidence of Acanthamoeba and fungal infections, despite resolution of two outbreaks involving multipurpose solutions, are also on the rise., Summary: Contact lens-related microbial keratitis is rising and may be associated with more severe, vision threatening, infections.

Purpose: We investigated effects of smoking and other risk factors on the development of advanced Fuchs' endothelial corneal dystrophy (FECD) and on central corneal thickness (CCT)., Methods: Eyes from Caucasian probands, affected and unaffected family members, and unrelated controls matched for age from the FECD Genetics Multi-Center Study (n = 2044 subjects) were examined. Univariate and multivariate models, adjusted for family correlations, were used to determine the effect of smoking, sex, diabetes, and age on FECD case/control status and CCT., Results: In a multivariate model, sex and smoking were associated significantly with advanced FECD (grades 4-6) development (P = 0.016 and P = 0.047, respectively). Female sex increased odds by 34%. Smoking increased odds by 30%. In a multivariate model, diabetes was associated with an increase of 9.1 μm in average CCT (P = 0.021). Female sex was associated significantly with a decrease in average CCT by 6.9 μm (P = 0.015). Smoking had no significant effect on CCT in any model. As shown previously, advanced FECD was associated with large increases in CCT (31.4-94.2 μm)., Conclusions: Smoking was associated with an increased risk of advanced FECD and self-reported diabetes was associated with increased CCT. Further study of the impact of smoking and diabetes on FECD development and changes in corneal thickness is warranted.

Objective: To study the epidemiology, clinical observations, and microbiologic characteristics of fungal keratitis at tertiary eye care centers in the United States., Design: Retrospective multicenter case series., Participants: Fungal keratitis cases presenting to participating tertiary eye care centers., Methods: Charts were reviewed for all fungal keratitis cases confirmed by culture, histology, or confocal microscopy between January 1, 2001, and December 31, 2007, at 11 tertiary clinical sites in the United States., Main Outcome Measures: Frequency of potential predisposing factors and associations between these factors and fungal species., Results: A total of 733 cases of fungal keratitis were identified. Most cases were confirmed by culture from corneal scraping (n = 693) or biopsies (n = 19); 16 cases were diagnosed by microscopic examination of corneal scraping alone; and 5 cases were diagnosed by confocal microscopy alone. Some 268 of 733 cases (37%) were associated with refractive contact lens wear, 180 of 733 cases (25%) were associated with ocular trauma, and 209 of 733 cases (29%) were associated with ocular surface disease. No predisposing factor was identified in 76 cases (10%). Filamentous fungi were identified in 141 of 180 ocular trauma cases (78%) and in 231 of 268 refractive contact lens-associated cases (86%). Yeast was the causative organism in 111 of 209 cases (53%) associated with ocular surface disease. Yeast accounted for few cases of fungal keratitis associated with refractive contact-lens wear (20 cases), therapeutic contact-lens wear (11 cases), or ocular trauma (21 cases). Surgical intervention was undertaken in 26% of cases and was most frequently performed for fungal keratitis associated with ocular surface disease (44%). Surgical intervention was more likely in cases associated with filamentous fungi (P = 0.03). Among contact lens wearers, delay in diagnosis of 2 or more weeks increased the likelihood of surgery (age-adjusted odds ratio = 2.2; 95% confidence interval, 1.2-4.2)., Conclusions: Trauma, contact lens wear, and ocular surface disease predispose patients to developing fungal keratitis. Filamentous fungi are most frequently the causative organism for fungal keratitis associated with trauma or contact lens wear, whereas yeast is most frequently the causative organism in patients with ocular surface disease. Delay in diagnosis increases the likelihood of surgical intervention for contact lens-associated fungal keratitis., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the incidence of herpes simplex virus (HSV) epithelial recurrence and graft survival after penetrating keratoplasty (PK) in patients with and without self-reported atopy., Design: Retrospective cohort comparative study., Setting: Cornea Service, Wills Eye Hospital., Study Population: Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004 and who underwent primary PK for ocular HSV at the Cornea Service. From the 58 patients invited, 49 patients (50 eyes) were included. Nine patients were ineligible in accordance with the exclusion criteria: no active classic HSV episode before PK, immunosuppression, less than one year of follow-up, previous history of PK before presentation at the Service. Eligible patients filled out a questionnaire regarding their history of atopic disease, considering: presence of allergic rhinitis, asthma, or atopic dermatitis. Ocular history was obtained through chart review. main outcome measures: Incidence of epithelial HSV recurrences and corneal graft survival in both groups., Results: Each group (atopic and nonatopic) included 25 eyes. The atopic patients had a mean incidence of 0.07 episode/eye year (SD +/- 0.9) compared with 0.12/eye year (standard deviation [SD] +/- 0.21) in the nonatopics (P = .002). At 10 years of follow-up, the survival rate in the atopics was of 92% and in the nonatopics was of 79% (P = .88)., Conclusions: Nonatopics had significantly more epithelial recurrences after PK compared to atopics; however, both groups presented low incidences of recurrences and high graft survival rates.

Purpose: To compare the efficacy of oral antiviral prophylactic treatment for herpes simplex virus (HSV) recurrences in patients with and without self-reported atopy., Design: Retrospective cohort comparative study., Methods: setting: Cornea Service, Wills Eye Hospital. study population: Patients who presented with previously diagnosed ocular HSV between March 2003 and March 2004. From 244 patients invited, 54 patients (58 eyes) were included. One hundred and ninety patients were excluded according to exclusion criteria: no active episode during follow-up, immunosuppression, less than one year of follow-up, or previous history of penetrating keratoplasty. The Questionnaire regarding history of atopic disease, considers: presence of allergic rhinitis, asthma or atopic dermatitis, and chart review of ocular history. main outcome measures: Incidence of all types of HSV recurrences with and without antiviral prophylaxis within each group and between groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis., Results: Atopic/nonatopic (P value): mean follow-up without prophylaxis 8.1 (+/- 8.2)/7.3 years (+/- 8.6) (P = .71); mean follow-up with prophylaxis 2.9 (+/- 2.3)/2.6 years (+/- 2.2) (P = .51); the effect of prophylaxis significantly reduced the all recurrences in both groups except in the inflammatory recurrences in the atopic group and in the mixed recurrences in both groups. Prophylaxis decreased infectious episodes by 44% in nonatopic and 76% in atopics and decreased inflammatory manifestations by 69% in the nonatopic group and 8% in the atopic group., Conclusion: Antiviral prophylaxis for HSV recurrences was more effective in reducing infections in atopics and less effective in reducing inflammatory episodes in atopics versus nonatopics.

Purpose: To compare the characteristics of ocular herpes simplex virus (HSV) in patients with and without atopy., Design: Retrospective cohort comparative study., Methods: Patients who presented at the Cornea Service, Wills Eye Hospital, between March 2003 and March 2004 who had been previously diagnosed in the same institution as having ocular HSV diagnosis or were just diagnosed as having the disease were asked to complete a study questionnaire that enabled categorization into atopic and nonatopic. In April 2005, 223 patients who agreed to be in the study had their charts reviewed, and 125 patients were excluded according to exclusion criteria: immunosuppression, follow-up less than one year, previous history of penetrating keratoplasty (PK) out of the Cornea Service, and no active HSV episode during follow-up., Main Outcome Measures: Incidence of all types of HSV recurrences., Secondary Outcome Measures: Bilaterality, visual loss, need for PK , and secondary bacterial infection in both groups. HSV episodes were classified into infectious, inflammatory, and mixed for analysis., Results: Ninety eight patients (110 eyes) were included in the study. Atopic/nonatopic (P value): the mean follow-up was 11.6 (+/- 10.6)/8.8 years (+/- 8.4) (P = .14); the mean incidence of HSV episodes per year of follow-up was: total episodes 0.32 (+/- 0.36)/0.28 (+/- 0.33) (P = .14), infectious 0.16 (+/- 0.22)/0.10 (+/- 0.14) (P < .01), inflammatory 0.11 (+/- 0.19)/0.11 (+/- 0.19) (P < .01), and mixed 0.09 (+/- 0.20)/0.07 (+/- 0.16) (P = .06); bilateral HSV was present in 9/3 patients (P = .22); the mean loss of vision was four lines of Snellen in both groups; PK was performed in 14 of 16 eyes (P = .45); secondary bacterial infection was present in two of four eyes (P = .26)., Conclusions: Atopic patients had considerably more infectious and fewer inflammatory episodes when compared with nonatopics.