Paediatric dentistry

13.Asthma drugs and enamel formation

This research investigated the possible association between the occurrence of developmental defects of enamel (DDE) in first permanent molars, and bronchodilators and/or corticosteroid intake for asthma-like episodic treatment at preschool age, in children 6-12-years-old at the time of the study. Children (n=70) who has attended an asthma unit and used associated drugs in their first four years were compared with a control group. Demographic data including medical history, pregnancy, birth weight, duration of breastfeeding, mother’s smoking habits and antibiotic use at preschool age were obtained through a structured questionnaire. Details concerning asthma drugs used were extracted from medical records. All children had an oral examination. DDE were present in 24 children (34.3%) in the case group in which 41.6% had at least one hypoplastic molar with loss of enamel compared to 6 (8.6%) control children with DDE. Children treated with drugs for asthma-like episodes at a preschool age showed an overall increased risk for DDE in their first permanent molars with frequent severe hypoplastic lesions and loss of enamel.

Mastora A et al. Developmental defects of enamel in first permanent molars associated with use of asthma drugs in preschool aged children: A retrospective case-control study. Euro Arch Paediatric Dent 2017 18: 105-111.

Q It would appear that: 
A DDE is common in 6-12-year-olds currently suffering asthma
B All children who take asthma drugs in early life suffer DDE
C Children who have not taken asthma drugs are 34% likely to experience DDE
D Children who take asthma drugs at an early age may experience DDE of their first permanent molars

14.Computer games for GA families 

A blind randomised controlled trial of 4-10-year-old children scheduled for a general anaesthetic due to caries aimed to compare the effect of an oral health education (OHE) computer game to one-to-one education. One hundred and nine families took part with the experimental group being given a computer game involving OHE while the control group received conventional one-to-one OHE. Both methods of education were highly satisfactory to children and parents. Children in both groups showed significant improvement in recognition of unhealthy foods immediately post-education. A telephone follow-up after 3 months was completed by 55% of all participants who reported improvements in diet, including reducing sweetened drinks and non-core foods intake, with no significant differences between the groups. Children reported twice-daily toothbrushing but no changes in snack selection. Attendance for a 3-month dental review was poor (11%). OHE using a computer game can be as satisfactory and as effective as one-to-one education. The education received can lead to positive dietary changes in some families. 

Aljafari A, Gallagher JE, Hosey MT. Can oral health education be delivered to high-caries-risk children and their parents using a computer game? - A randomised controlled trial.
Int J Paediatric Dent 2017 Jan 4. doi: 10.1111/ipd.12286. [Epub ahead of print]

Q Giving oral health education (OHE) using a computer game:
A Dramatically improves toothbrushing
B Shows some promise as an alternative method for dietary education 
C Is never likely to be as effective as conventional OHE
D Has proved completely effective in 55% of cases

15.Candida carriage 

This study was conducted to establish associations among the Candida carriage rate, the diversity of Candida species carried and the differing caries status of preschool children.
A single expert examined 61 children 2-5 years of age who were divided into three groups; caries-free, moderate caries and severe caries, according to the criteria of an international index (ICDAS). Saliva samples were obtained from the members of each group and cultured. 
The Candida carriage rate and the number of species of the fungus carried were higher in the group with the highest level of caries severity. Whereas Candida albicans was the most predominant Candida species in the saliva of all of the children, C. dubliniensis was identified only in the most caries-affected group in addition to other rare species of Candida non-albicans. A high salivary Candida carriage rate and the presence of specific species of this fungus (such as C. albicans and C. dubliniensis) appear to be related to the severity of caries experienced by preschool children.

Lozano Moraga CP et al. Prevalence of Candida albicans and carriage of Candida non-albicans in the saliva of preschool children, according to their caries status. Acta Odontologica Scandinavica 2017 75: 30-35.

Q Candida:
A In the form of albicans is the least dominant species in child saliva
B Dubliniensis species is rare in high caries pre-school children
C Carriage rate appears to be related to caries experience
D All of the above

16.Decisions, decisions 

Decision aids are tools used to help individuals faced with difficult healthcare decisions by encouraging the sharing of information between patients and clinicians. This work aimed to develop an aid for young patients faced with the decision to undergo dental treatment with inhalation sedation, intravenous sedation, or general anaesthesia (GA). Patients referred for dental treatment with sedation or GA were recruited from a UK dental hospital and qualitative interviews with them (aged 10-16 years), and their parents/guardians were used to inform the content of such an aid. Patients (n=15) and parents/guardians (n=13) assigned to the intervention group received the decision aid and routine clinical counselling, whereas patients (n=17) and parents/guardians (n=13) in the control group only received routine clinical counselling. Participants completed measures of knowledge, decisional conflict, and dental anxiety. Knowledge scores were significantly higher for participants who received the decision aid with particular attention to the impact on attendance and completion rates of treatment.

Hulin J et al. Development of a decision aid for children faced with the decision to undergo dental treatment with sedation or general anaesthesia. Int J Paediatric Dent 2016 Sep 29. doi: 10.1111/ipd.12267. [Epub ahead of print].

Q Decision aids:
A Are tools used to help administrators to fund sedation services
B Show little success in helping patients make informed decisions
C Are mandatory to achieve valid consent
D Encourage the sharing of information between patients and clinicians