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JADA Specialty Scan - Pediatric Dentistry
Pediatric DentistryJADA Specialty Scan

Carious lesions grow faster in poorer child populations

Children from low socioeconomic backgrounds may experience faster caries progression, according to a study published in the September/October 2017 issue of Journal of Clinical Pediatric Dentistry.

The authors designed the study to measure the progression rate of proximal and occlusal carious lesions in primary molars among children from low socioeconomic backgrounds. The authors based their findings on bitewing radiographs of 95 children aged 5 through 12 years (average 6.9 years, median 6.7 years) at baseline; there were 51 girls and 44 boys. The authors examined radiographs of 135 teeth and 141 tooth surfaces. They also obtained radiographs at 6- to 12-month intervals with a follow-up period of at least 3 years.

Bitewing radiographs were scored for the occurrence and progression of enamel and dentin caries. The authors scored mesial, distal, and occlusal surfaces of the first and second primary molars at every examination. They used the Mann-Whitney nonparametric test to see how the caries score for each tooth changed from the previous appointment and to compare caries progression degree between sexes. They used the Kruskal-Wallis test to check for statistically significant differences between the 3 tooth surfaces (mesial, distal, and occlusal) regarding caries degree during the follow-up period. And they used the Kaplan-Meier analysis to estimate the survival of tooth surfaces with an initial caries stage score of 0 or 1.

The authors based the rate of caries progression on a 6-point scale of radiolucency: 0 indicates none, 1 indicates the outer one-half of the enamel, 2 indicates up to the dentinoenamel junction, 3 indicates a broken enamel-dentin border with no dentin involvement, 4 indicates a spread in the outer one-half of the dentin; and 5 indicates the inner one-half of the dentin.

Statistical analysis showed the lowest rate of caries progression (a 1-point change between first and second visits) occurred in 42% of all mesial surfaces, 50% of all distal surfaces, and 66.7% of all the occlusal surfaces. A higher rate of caries progression (a 2-point change between first and second visits) occurred in 22.0% of all mesial surfaces, 23.8% of all distal surfaces, and 16.7% of all occlusal surfaces. An even higher rate of caries progression (a 3-point change between first and second visits) occurred in 12.0%, 9.5%, and 0% for the mesial, distal, and occlusal surfaces, respectively. The highest rate of caries progression (a 4-point change between first and second visits) occurred in 2% of the mesial surfaces and 0% of the distal and occlusal surfaces.

The authors found no statistically significant difference in caries progression rates between the distal and mesial surfaces (P value = .12) and between the mesial and occlusal surfaces (P value = .099), but they did find a statistically significant difference in caries progression rates between the distal and occlusal surfaces (P value = .014). No statistically significant sex differences were found regarding caries progression rates.

The caries progression rate was faster compared with previous studies, which found that it took roughly 3 years for lesions to progress from the external one-third of the dentin to the pulp. In this study, the authors found that a carious lesion would progress from the outer enamel to the dentinoenamel junction in 10 months and reach the inner part of the dentin in another 1.4 years.

Read the original article here.


Consulting Editor: James R. Boynton DDS, MS
Clinical Associate Professor
Pediatric Dentistry Division Head
University of Michigan School of Dentistry

Consulting Editor: Douglas B. Keck, DMD, MSHEd
Associate Program Director
Advanced Education in Pediatric Dentistry, Providence, Rhode Island
NYU Langone Dental Medicine

Phone it in: remote diagnosis of traumatic dental injury

The remote diagnosis of a traumatic dental injury (TDI) based on pictures from a mobile phone can be just as accurate as a diagnosis made in person, according to a study published online April 28 in Dental Traumatology.

The authors of the study wanted to compare the degree of examiner agreement in cases of TDIs diagnosed remotely and in person.

The sample included 40 patients with 73 traumatized teeth and 90 diagnoses. Patients were examined at 1 private and 1 public dental clinic in Brazil’s Federal District. The diagnoses of the 40 clinical cases were conducted in person by a single examiner.

The 6 pediatric dentists designated as remote examiners were calibrated using clinical diagnosis criteria along with a detailed explanation of the TDI’s clinical characteristics. During calibration, it was stressed to the remote examiners that a traumatized tooth could have more than 1 trauma type.

The examiner took 3 photographic views of each patient: frontal, occlusal, and in occlusion. The frontal view included the maxillary anterior region, capturing the canines, lateral and central incisors, and areas of free and attached gingiva. The occlusal view reached up to the anterior region of the palate. The third view was obtained with the teeth in occlusion. Captured images were uploaded and stored to a cloud drive.

Remote examiners based their diagnoses on digital photographs captured during the clinical examination. The frontal views let the examiners verify the dental structures, color, dental vertical level, and bleeding of the gingival and adjacent tissues. The occlusal views let the examiners measure possible deviations along the dental axis and any buccal, palatal, or lingual dislocations. The in-occlusion views let the examiners note possible occlusal interferences.

The authors noted the trauma category with the highest incidence was subluxation (34.83%) followed by enamel-dentin coronal fracture (23.59%). No cases of intrusive luxation, crown-root fracture, root fracture, or alveolar fracture were identified.

Authors used the first-order agreement coefficient, or Gwet AC1 measure, to evaluate interexaminer agreement. The obtained agreement between the in-person examiner and remote examiner was 0.83 or higher (95% confidence interval, 0.73 to 0.91), and, with the exception of enamel fracture, the distributions of the measures were concentrated around their means. Levels of interexaminer agreement were higher when clinical data were included with the images.

Although some research notes that 2 photographs are enough to diagnose TDI cases, “this study suggests that a third perspective, with the teeth in occlusion, can also be useful as it allows the identification of occlusal interferences,” the authors concluded. “Even though it does not alter the diagnosis in cases of lateral luxation in deciduous teeth, it might affect the choice of treatment. … The use of images captured with cell phones is an effective means for the remote diagnosis of cases of TDI.”

Read the original article here.


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Effectiveness of resin-based sealants with and without fluoride in a high caries risk population

Sealants help prevent new carious lesions and the progression of noncavitated carious lesions in children with high individual caries risk, according to a study published in the April issue of Caries Research.

The authors designed the split-mouth, randomly controlled trial to measure how well dental sealants prevent the occurrence of International Caries Detection and Assessment System (ICDAS) 3-6 carious lesions within a 2-year follow-up. They also compared the effectiveness of sealants with and without fluoride with no sealants.

The study population included 663 tooth pairs in 400 children aged 5 through 15 years considered to be at high individual caries risk. Their mean (standard deviation [SD]) age was 8.60 (2.24) years, and there were 191 girls (mean [SD] age, 8.67 [2.29] years) and 209 boys (mean [SD] age, 8.54 [2.20] years) whose ages did not differ significantly (P = .30). The children also had with at least 1 pair of contralateral permanent molars.

Authors assigned the right molar to a group (sealant or control) and the contralateral molar to the other group when 1 pair of permanent molars was included. They used the mandibular right molar for randomization, and the maxillary molar on the opposite side was in the same group in cases in which 1 molar pair was in the maxilla and the other in the mandible. If both pairs were in the mandible or maxilla, authors used the right first molar while the left second molar was in the same group. The second randomization selected the sealant material (with or without fluoride). When 2 pairs were included, the other sealant material was used to seal the second tooth.

A total of 137 children had 1 tooth pair included, and 2 tooth pairs were from the remaining 263 children. Of the 400 children, 290 (73%) completed the 2-year follow-up.

Risk factors were similar between treatment and control groups at baseline. Univariate analyses showed that sealed molars had a lower risk of developing ICDAS 3-6 lesions than nonsealed molars (hazard ratio (HR) = 0.16; P < .0001) during the 2-year follow-up. This preventive effect remained in multivariate analyses (model 2) (HR = 0.17; P < .0001) and (model 3) (HR = 0.17; P < .0001).

In the group including permanent molars with ICDAS 1-2 lesions (n = 709; HR = 0.16; 95% confidence interval [CI], 0.11 to 0.24; P < .0001), there was a smaller preventive effect than in the group without ICDAS 1-2 lesions (n= 617; HR = 0.02; 95% CI, 0.005 to –0.08; P < .0001) regarding the progression of existing lesions (secondary prevention) and occurrence of new lesion (primary prevention). The preventive effect also decreased in the group that included permanent molars with deep occlusal fissures (n= 832; HR = 0.20; 95% CI, 0.17 to 0.24; P < .0001) compared with the group of molars without deep occlusal fissures (n = 494; HR = 0.11; 95% CI, 0.07 to 0.15; P < .0001), respectively. The protective effect of sealants was clear regardless of the material used or presence of fluoride in the sealant.

Read the original article here.


Tobacco use, harm perceptions among U.S. youth go up in smoke

Self-reported data show that much of America’s youth remains in denial about their own tobacco use and the perceptions of harm, according to a study published in the April issue of Pediatrics.

Researchers designed the study to see whether teens who used only e-cigarettes (e-cigs), hookahs, cigars, cigarettes, smokeless tobacco products, or roll-your-own (RYO) or pipe tobacco, as well as used at least 2 tobacco products in the past month, identified themselves as recent tobacco users. They also measured risk beliefs about tobacco products as a whole and for individual products.

Authors used data from a national sample of 20,675 U.S. middle and high school students who participated in the 2016 National Youth Tobacco Survey. Among all respondents, 50.6% were boys, 55.8% were in high school, and 52.3% were non-Hispanic white. Data analysis included single-product users of cigarettes, hookah, e-cigs, cigars, smokeless tobacco (including chewing tobacco, snuff, dip, snus, and dissolvable tobacco products), and loose tobacco products (including RYO and pipe tobacco), as well as poly-tobacco users.

Authors defined “single-product use” of each product type as use of that product type but none of the others in the past 30 days. They defined “poly-tobacco use” as use of at least 2 tobacco product types in the past 30 days. Authors calculated the percentage who did not self-identify as current users of any tobacco product among single-product and poly-tobacco users. They performed multivariable logistic regression analyses to measure the correlates of denying being a user of any tobacco product among single-product and poly-tobacco users combined.

Of all the participants who reported the use of at least 1 specific tobacco product type in the past 30 days, 52.5% used only 1 tobacco product, and 47.5% used at least 2 tobacco products. Roughly 2 in 3 single-product users of e-cigs and cigars and 4 in 5 users of RYO or pipe tobacco did not consider themselves as tobacco product users.

Among users of at least 1 specific tobacco product type in the past 30 days, those denying having used any tobacco products in the past 30 days included single-product users of RYO or pipe tobacco (82.2%), e-cigs (59.7%), cigars (56.6%), hookah (44.0%), smokeless tobacco (38.5%), and cigarettes (26.5%), as well as poly-tobacco users (12.7%).

Analyses of the dichotomized harm perception variables revealed that although most exclusive users believed all tobacco products were harmful, fewer believed their own specific tobacco product was harmful. Among those who believed that all tobacco products were harmful, users of e-cigs (74.6%), hookah (60.8%), smokeless tobacco (41.8%), and cigarettes (15.5%) reported conflicting beliefs that their own products were not harmful.

“These exclusive users may not consider their products to be part of the universe of all tobacco products,” the authors concluded. “Despite significant efforts by the public health community to educate people about the risks of tobacco products, particularly among youth, there is confusion about what constitutes a tobacco product.”

Read the original article here.

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Pediatric dentistry course in September designed for all dentists

Do you treat children in your practice? There’s no better way to brush up on your knowledge than with the experts themselves! The American Academy of Pediatric Dentistry offers a Comprehensive Review Course that is recently available to general practitioners and members alike. This course will help to refresh and reassure your pediatric dentistry knowledge and features recognized leaders in the field who will cover topics including: growth and development, assessment and prevention, oral pathology, care for special needs patients, restorative dentistry and materials, trauma, behavior management, and pulp therapy. Come to the Grand Hyatt Denver Sept. 7-9, 2018. Visit for more information or to register.


Children’s airway health course planned for August

Children’s Airway Health – A Practical Conference kicks off August 24-25, 2018.

Join us this summer at ADA Headquarters in Chicago for a 2-day educational summit that will bring together some of the greatest leaders in sleep medicine for a comprehensive learning experience you will not want to miss. 

Physicians, dentists, psychologists and myofunctional therapists such as Christian Guilleminault, M.D. and David Gozal, M.D. (plus many more) will guide you in developing the tools to recognize compromised airway health in your pediatric patients.

For more information and to register, go to


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JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.

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