Wednesday, September 27, 2017

A review of the diagnosis and management of impacted maxillary canines

Department of Pediatric Dentistry
Langone Medical Center
           
Resident’s Name: Albert Yamoah, DDS                                                                         Date:09/27/2017
Article Title: A review of the diagnosis and management of impacted Maxillary Canines
Author(s): Marisela Bedoya, Jae Hyun Park
Journal: JADA
Date: 2009
Major TopicGrowth and Development and Orthodontics
Main Purpose: This was a literature review regarding the clinical and radiographic diagnoses of impacted maxillary canines, as well as the interceptive treatment (including surgical and orthodontic management) used to prevent or properly treat impacted canines.
Key point/finding:
o    Impacted canines can be detected at an early age, and clinicians might be able to prevent them by means of proper clinical diagnosis, radiographic evaluation and timely interceptive treatment.
o    Surgical techniques that can be used to manage impacted canines vary depending on whether the impactions are labial or palatal, and orthodontic techniques vary according to clinical judgment and experience.
Background: 
o    Upper canines 2nd most common impacted teeth (1st is 3rd molar) + 2x in females + 2% of population
o    Of all patients w/ impacted canines 8% bilateral; 1/3rd labial and 2/3rd palatal

Types of Studies Reviewed: 
The authors reviewed clinical and radiographic studies, literature reviews and case reports.  They selected only studies that pertained to the prevalence, etiology and diagnosis of impacted maxillary canines, as well as the most recent studies regarding surgical and orthodontic techniques for the proper management of impacted maxillary canines.

Results: 
o   Ericson and Kurol: Extracting primary canines before 11yo may normalize erupting position of permanent canine in 91% of cases where crown is distal to midline of later incisor; decreases to 64% if crown is mesial to midline of lateral.
o   Impacted canines can be detected at an early age, and clinicians might be able to prevent them by means of proper clinical diagnosis, radiographic evaluation and timely interceptive treatment.  
o   Management of Impacted Canines: 
·       Labial impaction: Gingivectomy, apically positioned flap, and using closed eruption techniques
·       Palatal impaction: Closed flap, open eruption, open window eruption, tunnel traction
o   Orthodontic techniques: Cantilever system, double arch wire mechanics, TADs, Easy way coil system, Auxiliary spring, K-9 Spring
o   With early detection, timely interception, and well-managed surgical and orthodontic treatment impacted maxillary canines can be erupted and guided to an appropriate location in the dental arch.
Remarks:
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Assessment of Article:  Level of Evidence: Level V: Evidence from systematic reviews of descriptive and qualitative studies



Dental fear/anxiety and dental behavior management problems in children and adolescents: a review of prevalence and concomitant psychological factors

Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident’s Name: Brian Darling                                                                     Date: 9/27/2017
Article Title: Dental fear/anxiety and dental behavior management problems in children and adolescents: a review of prevalence and concomitant psychological factors
Author(s): Gunilla Klingberg; Anders Broberg
Journal: International Journal of Pediatric Dentistry
Date: 2007; 17: 391-406
Major Topic: Behavior management of fearful/anxious children and adolescents
Type of Article: Literature review
Main Purpose: This article aimed to describe the literature regarding the prevalence of dental fear/anxiety and dental behavior management problems and their relationships to age, sex, general anxiety, temperament, and general behavioral problems
Key Points: Understanding of concomitant psychological factors is essential in both prevention and treatment of dental fear/anxiety and behavior management problems.
·      Dental Fear: normal emotional reaction to 1 or more specific threatening stimuli in the dental situation
·      Dental Anxiety: state of apprehension that something dreadful is going to happen in relation to dental treatment and is coupled with a sense of losing control
·      Dental Phobia: severe type of dental anxiety characterized by marked and persistent anxiety in relation either to clearly discernible situations/objects (e.g. drilling, injection) or to dental situation in general
o   Must result in either avoidance of necessary dental treatment or enduring treatment with dread and in an adjusted treatment situation
·      Self-reports are often used when studying adolescents while parental reports are normally for children under 13 years
·      ~9% of children have dental fear/anxiety and/or dental behavior management problems
·      Behavior management problems decline with age
·      Dental fear/anxiety and behavior management problems are more prevalent in girls and related to general fear and internalizing and externalizing behavioral problems
·      General behavior problems correlate with dental behavior management problems more so than it correlates with fear/anxiety
·      Only 27% of children with behavior management problems also have dental fear/anxiety. Only 61% of children with dental fear/anxiety show behavior management problems
·      Dental behavior management problems are not a quality of the child himself/herself but of the relationship between the child and dentist
·      Dental fear/anxiety decreases with age
·      Dental behavior management problems decline with age
·      General fear/anxiety may be correlated with having dental fear/anxiety
·      Children at risk of developing internalizing disorders (anxiety, depression, psychosomatic problems, etc) tend to have more dental fear/anxiety
·      It is likely that children with neuropsychiatric disorders may present with dental behavior management problems as part of their diagnosis. For example, children who react with anger and opposition to sitting still in the dental chair may demonstrate a symptom of oppositional defiant disorder.
·      Dental fear/anxiety is associated with temperamental traits of shyness, inhibition, negative emotionality.
·      Dental behavior management problems are more associated with activity and impulsivity.
·      There is a very low correlation between child and parental rations of the child’s internalizing problems
·      Uncooperative children are not difficult children
·      There is much room for improvement of the CFSS-DS (Children’s Fear Survey Schedule Dental Subscale) and DAS (Cora Dental Anxiety Scale) – the main scales for measuring fear in children and adolescents, respectively.

Remarks:
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Assessment of Article:  Level of Evidence/Comments: III


The communication of pain in Paediatric Dentistry

Department of Pediatric Dentistry
Lutheran Medical Center
           
Resident’s Name: Brian Darling                                                         Date: 9/27/2017
Article Title: The communication of pain in Paediatric Dentistry
Author(s): J. Versloot; KD Craig
Journal: Eur Arch of Paediatric Dentistry
Date: 2009; 10(2): 61-66
Major Topic: Children’s pain communication in dentistry
Type of Article: Topic overview
Main Purpose: This article presents the communication of pain model and its application to understanding and assessing children’s pain in dentistry.
Key Points: When children’s pain is underestimated or a child’s self-report is not seen as credible, there is a considerable risk of failure to deliver needed dental care.  
·      Pain is an inherently private, complex, and subjective experience
·      Age is a good predictor of a child’s ability to conceptualize pain
·      Pain is influenced by intrapersonal factors like personal history and biological endowment as well as by interpersonal factors such as context
·      There are striking individual differences in how people react to tissue insult
·      Conditions that may make local anesthesia difficult – molar-incisor hypomineralization; presence of infection
·      ~9% of children and adolescents have dental fear and anxiety
·      Strongest dental fears are associated with injections
·      Previous positive dental experiences can serve to be protective against fear acquisition and can positively influence the expectation of future treatments
·      Some low level of fear in anticipation of potential painful dental treatment can be argued to have advantages if it mobilizes the use of coping skills and cooperative behavior
·      Children’s anxiety and fear may have a long-term negative impact on responses to future medical care, such as diminished analgesic effectiveness and avoidance of dental treatment
·      Fear of pain and anticipatory avoidance behavior may be as important as the actual reaction to the painful event, so attention to fear and anxiety prior to painful procedures is important
·      Family is an important influencer of coping skills because children who experience problems at the dentist are more likely to come from families where other members have had adverse experiences with dental care
·      Coping strategies during age periods:
o   Younger children (age 4-7) coping strategies are generally behaviorally oriented and may need to be prompted by adults if they are used
o   Age 8-10 years children supplement (but not replace) behavioral coping strategies with cognitive coping strategies
o   Age 11-18 years tend to use more cognitively oriented strategies
·      The presence of parents may be a comfort to some children but others may show greater pain or distress behaviors in their presence because they feel more open to express themselves than if they were alone with clinicians.
·      Upset parents are more likely to be disruptive whereas comfortable parents could be more actively involved in the treatment to teach or help the child
·      Pain assessment tools for children 4 and older may use faces scales and for children 8 years and older may use numerical or visual analog scales
·      When children reported pain levels to both the dentist and the parent, 28% of children reported a higher level of pain to the parent
·      There is a pervasive and systemic tendency to underestimate the pain experiences of others
·      Healthcare professionals who often work with painful procedures can develop “pain blindness,” which can lead to underestimating pain.
·      It is important to be aware of nonverbal cues when working with toddlers and preschoolers who have limited verbal abilities.

Remarks:
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Assessment of Article:  Level of Evidence/Comments: