This systematic review and meta-analysis evaluated the clinical outcomes of prefabricated zirconia crowns (PZC) in primary teeth compared to stainless steel crowns (SSCs) and resin-based alternatives over six to 36 months. PubMed??, Google Scholar™, Web of Science®, Scopus, Embase®, and Cochrane Library® were searched for randomized clinical trials and observational studies. Cochrane risk of bias tool (RoB 2) and ROBINS-I were used for quality assessment. The pooled results were analyzed using either a fixed-effect model or a random-effects model, with the latter applied when heterogeneity was significant (I² >50%). A total of 40 studies were included in the systematic review. Meta-analyses revealed comparable retention between PZCs and controls at six months (relative risk [RR] equals 1.04, 95 percent confidence interval [95% CI] equals 0.99 to 1.09, P=0.233) and 12 months (RR equals 1.03, 95% CI equals 0.98 to 1.08, P=0.11). Zirconia crowns showed non-significant improvement in gingival health (Cohen's d equals 1.85, 95% confidence interval equals -0.25 to 3.95, P=0.081) but significantly reduced plaque retention (RR equals 1.17, 95% confidence interval equals 1.02 to 1.34, P=0.025) at 12 months. Recurrent caries were equivalent (RR equals 1.02, 95% CI equals 0.98 to 1.05, P=0.26) and opposing tooth wear was insignificant (RR equals 0.96, 95% CI equals 0.91 to 1.00, P=0.091) at 12 months. While prefabricated zirconia crowns matched stainless steel crowns and resin-based alternatives in retention, gingival health, opposing tooth wear, and caries prevention, they provided superior outcomes in plaque resistance with moderate-certainty evidence.

This study examines parental preferences for telehealth versus in-person follow-up visits after general anesthesia (GA) for children treated for dental caries. While GA is effective, it is costly and invasive, with high rates of recurrent caries and low follow-up. Telehealth may address barriers to follow-up care by improving accessibility and reducing travel burdens. A cross-sectional study was conducted with parents of children aged seven years and younger who underwent GA for dental caries at a university-based dental clinic. Participant data, collected via post-visit telephone survey, included demographics, visit modality preferences, and qualitative responses on motivators for modality preference. Quantitative and thematic analyses were performed to identify key factors associated with parental preferences. Among 155 eligible children, 46 families participated. The majority (84.8 percent, n equals 39) preferred telehealth, citing flexibility, reduced transportation challenges, and ease of managing caregiver responsibilities. Those preferring in-person visits (15.2 percent, n equals seven) valued direct provider interaction and sought to avoid technology-related barriers. The mean distance to the clinic was significantly greater for the in-person group (104.2 km versus 49.6 km, P=0.017). The strong preference for telehealth suggests its potential to improve follow-up visit accessibility. However, implementation barriers must be addressed to ensure equitable telehealth integration.

To compare oxygen saturation measurements when pulse oximeter sensors were simultaneously placed on the index finger and the second toe, and compare blood pressure recordings with non-invasive blood pressure (NIBP) cuffs simultaneously placed on the upper arm and the lower calf in children receiving general anesthesia. A total of 50 children, aged three to nine years, defined as ASA Class I or II receiving comprehensive dental treatment in the operating room with general anesthesia, were included. Pulse oximeter sensors were simultaneously placed on each subject's index finger and ipsilateral second toe. Non-invasive blood pressure cuffs were simultaneously placed on the upper arm and ipsilateral lower calf above the ankle. The same anesthesia regimen was used on all patients. Following induction of general anesthesia, measurements were simultaneously recorded every five minutes during the dental procedure. Index finger oxygen saturation measurements were significantly lower than the second toe (P<0.001). Arm systolic blood pressure measurements were significantly lower than calf measurements (P<0.001). Arm diastolic blood pressure measurements were significantly lower than calf measurements (P<0.001). Discrepancy of vital sign measurements may be notable depending on the site from which measurements are obtained. If blood pressure is taken on the calf of a child in the Trendelenburg position, the reading will likely produce a higher systolic and diastolic measurement and should be interpreted with caution. A pulse oximeter placed on the first finger or second toe of healthy children can be regarded as interchangeable in a clinical setting.

To develop permanent tooth vital pulp therapy (VPT) recommendations. GRADE framework recommendations developed from systematic review data of permanent tooth VPT through June 30, 2024. Teeth with deep caries (extending to inner third or quarter of dentin with intact dentin barrier) diagnosed with normal pulp or reversible pulpitis (NP/RP) can be treated either with indirect pulp treatment (IPT), direct pup cap (DPC), partial pulpotomy (PP), or full pulpotomy (FP) (conditional recommendation, low certainty). Selective caries removal for IPT is strongly recommended (high certainty) for deep caries in NP/RP diagnosed teeth. In case of pulp exposure either DPC, PP, or FP using calcium silicate cement (CS) may be performed regardless of root maturation (conditional recommendation, low certainty). Using sodium hypochlorite (NaOCl) irrigation is strongly recommended for DPC hemostasis (high certainty) over saline and conditionally recommended (very low certainty) for pulpotomy. For permanent teeth with extremely deep caries (no discernible radiographic barrier) or deep carious teeth exhibiting spontaneous, nocturnal, or lingering pain but normal periapical appearance, complete (nonselective) caries removal to expose the pulp for assessment is strongly recommended (moderate certainty). If pulpotomy is indicated in these teeth, FP using CS is recommended over PP (conditional; low certainty). Also, PP and FP success will likely be higher if hemostasis occurs within six minutes (conditional; low certainty). Using magnification likely enhances pulp visualization, facilitating more accurate assessment of its status. Teeth with NP/RP having traumatic exposures, PP/FP is conditionally recommended over DPC. Using nonstaining CS is strongly recommended (high certainty) for VPT on teeth in esthetic areas. Selective caries removal is recommended for teeth having deep caries with NP/RP. CS utilization is recommended for DPC, PP, and FP using NaOCl for hemostasis. Complete caries removal and assessment of pulp status is recommended for teeth exhibiting spontaneous, nocturnal, or lingering pain; if pulp is diagnosed as vital and bleeding is controlled, FP is recommended.

To assess the current sedation practices among pediatric dentistry residents who completed their training from a children???s teaching hospital to align training methods for current residents. Using Standards for Quality Improvement Reporting Excellence guidelines, residency graduates were surveyed on current sedation practices. Information collected included demographics, year of residency completion, education experience, type of sedation medications used during residency and currently, emergency protocols, participation in continuing education courses, barriers to the provision of sedation, and clinical protocols. Descriptive statistics were completed, and information was utilized to update current sedation training protocols. Fifty-four of 90 possible former residents responded, for a response of 60 percent. Thirteen respondents (24 percent) currently perform moderate sedation. Predominant sedation medication preferences have shifted from chloral hydrate to midazolam, meperidine, and hydroxyzine through the years. Feedback from previous learners and continual assessment of educational programs can help to align education with unsupervised practice after graduation. Changing trends in sedation practices highlight the crucial significance that residency program sedation curriculum and continuing education courses meet the needs of patients, thereby upholding a high standard of patient safety.

This cross-sectional study investigated factors associated with attendance to general anesthesia (GA) appointments at an outpatient dental surgery center associated with a pediatric dentistry residency program. The study population included patients scheduled for dental care using GA from December 1, 2022, to December 1, 2023. Variables of interest were identified prior to initiation of the study, and data were collected from electronic health records. During the 12 months of follow-up, a total of 543 patients completed their dental care with GA. Among the GA cases, 92 cancelled with at least 72 hours' notice, 105 canceled with less than 72 hours' notice, and 74 failed (noshow or late cancellation) to attend their appointment. There was no statistically significant association between attendance and sex or language. Patients aged between six and 11 years, with Medicaid, and who had the earliest check-in time (6:30 am to 9:30 am) and shortest distance (less than 20 miles) were less likely to keep their appointments. The most frequent reasons for late cancellation or no-show were illness (53 percent), fasting violation (4.4 percent), change in medical status (4.4 percent), insurance/finances (3.0 percent), and transportation (1.8 percent). A high percentage of patients in this study cancelled with short notice or no-showed for their appointments. This was primarily due to anesthesia-related factors such as illness and fasting violation, but logistical issues (transportation, weather, etc.) also impacted attendance.

To examine dental general anesthesia (DGA) utilization patterns among children in Alberta, Canada, and identify factors contributing to the need for multiple DGAs (between 2010 and 2020). This retrospective population-based cohort study utilized administrative health data to investigate DGA usage among children (younger than 18 years). The study considered all children receiving DGA for oral and dentalrelated issues in publicly funded facilities, regardless of medical status. A descriptive statistic, binary logistic regression, Cox proportional regression, and Kaplan-Meier survival analysis were employed. Among 30,523 children receiving DGA, the majority were younger than six years old (62.8 percent), were from low-income families (54.6 percent), and received treatment at urban hospitals. Most were medically healthy (91.2 percent) and received treatment for dental caries (77.1 percent), with restorations and extractions being the most frequent procedures. Significant predictors of multiple DGA events included younger age at first DGA, identification as having special health care needs (SHCNs), and the type of dental procedures performed during the first DGA. The findings of this study highlight the importance of considering patient characteristics and treatment factors when planning and delivering pediatric dental care. Special health care needs status emerged as a key factor associated with the likelihood of repeated dental general anesthesia, highlighting the need for tailored interventions and resource allocation to improve oral health equity in this population.

To evaluate the bond strengths of stainless steel molar bands (SSMBs) on NuSmile BioFlx crowns (BFCs) using glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), self-adhesive resin cement (SARC), and zinc polycarboxylate cement (PXC). Eighty BFCs (size 4) and SSMBs (size 35+) were closely fit on the crowns. Four different types of luting cements (20 per group: group one-GIC; group two-RMGIC; group three-SARC; and group four-PXC) were used to cement the SSMBs onto the BFCs. The bond strength between the SSMBs and the BFCs was tested using a universal testing machine. The adhesive remnant index (ARI) was used to quantify the residual cement on the crown surface to determine the mode of bond failure. One-way analysis of variance was used to compare the mean bond strengths between the groups, and the chi-square test was used to assess the predominant site of bond failure. The mean bond strength was highest (2.76±0.07 MPa) and lowest (1.38±0.2 MPa) in the SARC and PXC groups, respectively. The bond strength was significantly different be- tween the groups (P<0.05). Bond failures were observed more frequently at the crown-cement interface in the SARC, RMGIC, and GIC groups and at the band-cement interface in the PXC group. SARC had the lowest ARI score, and PXC had the highest. Self-adhesive resin cement significantly had the highest bond strength and the lowest adhesive remnant score after debanding, followed by resin-modified glass ionomer cement, glass ionomer cement, and zinc polycarboxylate cement, respectively.

To evaluate the association between preventive medical and dental visits before age 30 months with dental utilization after age 30 months. This retrospective cohort study used Medicaid enrollment and claims data from Partners for Kids, a pediatric accountable care organization in Ohio. Medical periodicity adherence was defined by the HEDIS W30 measure, and early preventive dental care was defined as having a preventive dental visit by age 30 months. Dental utilization outcomes were measured from ages 30 months to eight years. Descriptive statistics, chi-square tests of independence, and stratified, multiple-variable logistic regression were used in the analysis. Among 14,800 included children, 64 percent (N equals 9,322) met medical periodicity adherence and only 15 percent (N equals 2,141) met the early preventive dental care measure. Children who met both medical and dental measures had the highest frequency of caries-related treatment visits (50.3 percent, P<0.001), and had two times the odds of having a caries-related treatment visit (odds ratio equals 1.9, 95 percent confidence interval equals 1.7 to 2.1) than children who met neither measure. Medicaid-enrolled children were much more likely to complete their medical well-child visits than preventive dental visits. Physicians may be the initial source of dental care when access to dental care is limited. Promoting earlier access to dental care or integrating dental care into medical well-child visits may improve pediatric oral health.

To conduct a systematic review of the literature relating the influence of dental caries rehabilitation (DCR) on the oral health- related quality of life (OHRQoL) of children, adolescents, and families. Six databases, grey literature, Google Scholar, and manual search were accessed. Eligibility criteria (PICO) were outlined: P (population)-children, adolescents, and family; I (intervention)-DCR; C (comparison)- OHRQoL before and after DCR; O (outcome)-OHRQoL status after DCR. Two investigators independently applied the eligibility criteria, extracted qualitative data, and assessed the risk of bias. For quantitative data, a meta-analysis was conducted using the RevMan 5.4 program. The certainty of evidence was evaluated using the GRADE system. Of 2,432 records, 35 were included, totaling 3,358 participants and 11 types of instruments. A total of 25 studies exhibited good methodological quality. The meta-analysis detected improvements in OHRQoL after DCR for children aged one to nine years (P<0.001; 95 percent confidence interval [95% CI] equals 1.47 [0.90 to 2.03]), four to nine years (P<0.001; 95% CI equals 1.23 [0.99 to 1.46]), and eight to 10 years (P<0.001; 95% equals CI 0.76 [0.46 to 1.06]), adolescents aged 11 to 15 years (P=0.03; 95% CI equals 0.75 [0.07 to 1.44]), and family from children aged one to nine years (P<0.001; 95% CI equals 1.02 [0.56 to 1.49]). However, the certainty of evidence was very low. Dental caries rehabilitation was associated with an improved oral health-related quality of life for children and adolescents aged one to 15 years and families with children aged one to nine years. This influence highlights the potential benefits of DCR interventions in reducing the negative effects of dental issues on daily life, although further research with higher-quality evidence is needed to strengthen these findings.

This study investigated caries recurrence in young children in China who received multiple-visit outpatient dental treatment, and explored potential risk factors. A total of 371 one-to four-year-old outpatients with caries were recruited from seven pediatric dentistry clinics in Beijing, China. Oral examinations were performed, and medical and demographic information were recorded at baseline and at three, six, nine, and 12 months. This included the number of decayed teeth (dt), decayed surfaces (ds), demographic data, plaque index, Cariostat index, dental behavior, and oral health practices. According to caries recurrence, the children were divided into relapse and non-relapse groups, the data from which were compared to explore the potential risk factors related to caries relapse. During the 12-month follow-up, the plaque index, Cariostatindex, and behavior score of the children significantly improved compared to the baseline (P<0.05). However, 62.26 percent of the children experienced caries recurrence. No significant differences were found in parents' education level, children's age, sex, oral health practice, plaque index, or behavior score between the relapse and non-relapse groups (P>0.05). The Cariostat index at baseline and 12 months, frequency of sugar intake, and dt in the relapse group were significantly higher than for the non-relapse group (P<0.05). Young children's awareness and effectiveness in maintaining oral hygiene significantly improved during multiple visits. However, caries recurrence remained high, indicating that treatment and long-term maintenance of dental caries in this demographic still face considerable challenges. High frequency of sugar intake was an important risk factor for recurrence of caries.

To investigate the role of behavioral, familial, and psychosocial factors in the etiology of temporomandibular disorders (TMD) in children and adolescents. A cross-sectional observational study was conducted with 139 participants (70 TMD patients, 69 healthy controls) aged nine to 18 years and their parents. TMD diagnosis was made using the Diagnostic Criteria for TMD (DC/TMD). Psychosocial, behavioral, and familial status were evaluated using Patient Health Questionnaire-4 (PHQ-4), Oral Behavior Checklist (OBC), Child Behavior Checklist/4-18 (CBCL/4-18), Family Assessment Device (FAD), and Visual Analog Scale (VAS). Statistical analyses employed the Mann-Whitney U test, Pearson's chi-square test, and Spearman's rho correlation with a significance level of P<0.05. TMD patients exhibited significantly higher PHQ-4, OBC, and CBCL/4-18 scores compared to controls (P<0.001). Social withdrawal and introversion problems, such as anxiety and depression, as well as extraversion scores, such as criminal and aggressive behaviors, and diligent control scores, were higher in the TMD group. FAD scores did not differ significantly between groups (P=0.315). A statistically significant positive correlation was observed between OBC and VAS scores (r equals 0.390, P=0.001). These findings suggest that psychosocial and behavioral factors may play an important role in the clinical profile of temporomandibular disorders and should be considered in their assessment and management. (Pediatr Dent 2025;47(4):240-6) Received December 23, 2024.

This study aimed to evaluate clinical outcomes of digitally and orthodontically repositioned permanent incisors following extrusive and lateral luxation injuries. In this retrospective study, patient records from 105 permanent incisors with traumatic luxation injuries that were treated by means of digital (N equals 67) or orthodontic repositioning (N equals 38) were included. The main outcome was pulpal necrosis leading to the need for endodontic therapy. Cox-proportional regression was used to estimate the association between type of treatment and the main outcome, and a Kaplan-Meier plot comparing the survival of injured teeth in each group was obtained. Most participants were boys (62 percent) with a mean age of 10 years. Fewer teeth in the orthodontic group (n equals eight versus n equals 27 in the digital) developed pulp necrosis requiring endodontic therapy (P=0.04). Although not statistically significant, multivariate analyses revealed that teeth treated by means of orthodontic reduction are less likely to develop pulpal necrosis (hazard ratio equals 0.47; 95 percent confidence interval equals 0.2 to 1.0). Acknowledging the limitations of this study, luxated permanent incisors treated via orthodontic repositioning may exhibit more favorable outcomes. Additional studies with various injuries are needed to establish universal adoption of management guidelines.

To evaluate changes over time in oral health fatalism (OHF) and oral health self-efficacy (OHSE) in the context of an intervention, in caregivers of children with autism spectrum disorder (ASD). This secondary analysis used questionnaire data from a parent study of 118 Medicaid-eligible families of children with ASD enrolled in a longitudinal, multi-site randomized clinical trial testing the efficacy of a novel parent training (PT) intervention relative to psychoeducational toolkit for improving home oral hygiene and dental health. OHF and OHSE belief endorsements were evaluated at baseline, three months, and six months. At baseline, 25 percent of caregivers disagreed with the OHF-endorsing statement "Most children eventually develop dental cavities," and 11 percent did not report confidence with OHSE statements. At six months, 34 percent did not endorse OHF and five percent did not report confidence with OHSE. Using the generalized linear mixed model, the percent change from baseline to six months in caregivers disagreeing with OHF and endorsing OHSE was significant (P<0.05). A repeated mea- sures analysis of variance test determined the relationship between the effects of treatment and time on OHF and OHSE. No difference was found in OHF and OHSE beliefs over time between groups (P>0.05); however, a significant effect was found on OHF change over time within subjects (P<0.05). There was no statistically significant difference in endorsement of OHF or OHSE between groups at six months. However, within all subjects, OHF beliefs became less endorsed and OHSE confidence improved over time.