David J. Kenny

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations of Permanent Teeth.

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Impact of treated and untreated dental injuries on the quality of life of Ontario school children

A population-based, matched case-comparison study was undertaken in 30 schools in two Ontario communities to measure the impact of dental trauma on quality of life (QoL) in Canadian school children. Dental hygienists screened 2422 children aged 12-14 years using the dental trauma index, the decayed, missing and filled teeth index (DMFT) and the aesthetic component of the index of orthodontic treatment needs (AC-IOTN). Cases (n = 135) were children with evidence of previous dental trauma. Controls (n = 135) were classmates matched for age and gender. Oral-health-related QoL was assessed using mailed Child Perception Questionnaires (CPQ(11-14)) completed by all children. Data were analyzed using simple and multiple conditional logistic regressions after adjusting for DMFT and AC-IOTN, CPQ(11-14), overall impact and item-specific impacts. Approximately 64% of injuries were untreated enamel fractures and just over 30% were previously injured restored teeth. Untreated children experienced more chewing difficulties (P = 0.026), avoided smiling (P = 0.029) and experienced affected social interactions (P = 0.032) compared with their non-injured peers. When treated and non-injured groups were compared, the only statistically significant effect was difficulty in chewing (P = 0.038). Injured children who were untreated experienced more social impact than their non-injured peers. Restoration of injured teeth improved aesthetics and social interactions but functional deficiencies persisted as a result of periodontal or pulpal pain.

Investigating the stationarity of paediatric aspiration signals

An aspiration signal is the time-varying anterior-posterior acceleration measured infero-anterior to the thyroid notch when foreign material enters the airway during inspiration. The hypothesis of weak stationarity is tested on aspiration signals by the reverse arrangements test. Results indicate that aspiration signals cannot be uniformly regarded as weakly stationary. Forty-five percent of the examined signals violated the stationarity hypothesis. For these signals, time-varying variance and spectral density structure are identified as major sources of nonstationarity. Stationarity test results generally corroborate qualitative clinical descriptions of aspiration. However, stationarity analysis indicates that aspiration signals are highly heterogenous, a finding which poses significant challenges to the automatic detection of aspirations by accelerometry.

Development of a multidisciplinary feeding profile for children who are dependent feeders

The multidisciplinary feeding profile (MFP) is the first statistically based protocol for the quantitative assessment of feeding disorders in severely disabled children. This assessment can be completed in 30–45 min with foods and facilities that are available in homes, hospitals, and chronic care units. This paper describes the state of current testing methods, the parameters of successful feeding activity, the development of the test protocol, and the results of statistical analyses.

Effects of severe dentoalveolar trauma on the quality-of-life of children and parents

BACKGROUND/AIM This investigation assessed the effects of dental trauma on the perception of pain and quality of life (QoL) of patient-parent pairs for a year following severe injuries. SAMPLE A visual analogue scale (VAS) was used to assess the pain of injury and treatment for 27 individuals 8-20 years and their parents. The Child Oral Health Quality of Life (COHQoL) survey was used to assess the effects of dental injuries on the QoL of 23 children aged 8-14 and their parents. RESULTS Mean VAS scores revealed that all patients and parents perceived the pain of initial injury to be significantly greater than pain of splint removal (P < or = 0.05) and that pain decreased in a stepwise manner from injury through emergency treatment to splint removal. The COHQoL questionnaire demonstrated a profound and continuing effect on children and their parents QoL following severe dental injury. The initial parental COHQoL score was significantly greater than the 12-month score (P < or = 0.05) in both 8-10 and 11-14- year-olds. The COHQoL results indicated a measurable reduction in the QoL of patients and parents was still present 12-months after the injuries. At the end of one-year children were still affected by the social and well-being aspects of the injury yet parents exclusively reported that one-year effects were limited to their childrens oral symptoms and functional limitations. CONCLUSIONS Severe dental injuries produce initial and ongoing pain. Detrimental effects on the QoL of both children and parents are still present at one-year and these long-term effects are different for children and parents.

Etiology and environment of dental injuries in 12- to 14-year-old Ontario schoolchildren

This study reports on the etiology and environment where dental injuries occurred and assesses the relationship between dental trauma, socio-economic status and dental caries experience. A population-based, matched case-comparison study was undertaken in 30 schools in two Ontario communities. Dental hygienists calibrated in the use of the Dental Trauma Index (DTI) screened 2422 children aged 12 and 14 years using DTI and Decayed, Missing and Filled Teeth indices. Cases (n = 135) were children with evidence of dental injury. Controls (n = 135) were children randomly selected after screening and matched with cases according to age and gender. Questionnaires were mailed to parents and children. Prevalence of dental injury was 11.4%, mostly minor injuries 63.7% (enamel fracture not involving dentin), affecting one upper central incisor (70.4%). The mean age at the time of dental injuries was 9.5 years (SD = 1.49; range: 6-13 years). Dental trauma most often occurred among boys at school because of falls or while playing sports. The relationship between dental injuries and the socio-economic indicators chosen was not statistically significant. However, a statistically significant direct relationship (P < 0.001) was shown between increased caries experience and dental injuries. This should focus attention on possible common-risk factors such as health-related behavioral problems that may affect both dental disease and dental injuries.

Durational aspects of oral swallow in neurologically normal children and children with cerebral palsy: An ultrasound investigation

Little data exist on the oral management of food boluses in neurologically normal children or children with cerebral palsy (CP). Twenty children with spastic CP and 20 neurologically normal children (age range: 6.2–12.9 years) were monitored with ultrasound imaging of the oral cavity during liquid and solid bolus tasks. A lip-cup contact detector synchronized to ultrasound image output was used during liquid tasks. Data collected from recorded ultrasound images were used to assess durational aspects of the oral phase of swallowing in neurologically normal children and children with CP. Coordinated analysis of ultrasound images with lip-cup contact data allowed timing of intervals in the pre-oral and oral phases of swallowing during liquid feeding tasks. Children with CP required more time than neurologically normal children for collection, preparation, oral transit, and total oral swallow time for 5-ml liquid boluses. Total oral swallow time was longer for solid bolus tasks in children with CP. Oral transit time for solid boluses was significantly longer than for liquid boluses in neurologically normal children and children with CP.Little data exist on the oral management of food boluses in neurologically normal children or children with cerebral palsy (CP). Twenty children with spastic CP and 20 neurologically normal children (age range: 6.2–12.9 years) were monitored with ultrasound imaging of the oral cavity during liquid and solid bolus tasks. A lip-cup contact detector synchronized to ultrasound image output was used during liquid tasks. Data collected from recorded ultrasound images were used to assess durational aspects of the oral phase of swallowing in neurologically normal children and children with CP. Coordinated analysis of ultrasound images with lip-cup contact data allowed timing of intervals in the pre-oral and oral phases of swallowing during liquid feeding tasks. Children with CP required more time than neurologically normal children for collection, preparation, oral transit, and total oral swallow time for 5-ml liquid boluses. Total oral swallow time was longer for solid bolus tasks in children with CP. Oral transit time for solid boluses was significantly longer than for liquid boluses in neurologically normal children and children with CP.

BIOFEEDBACK TECHNIQUES AND BEHAVIOUR MODIFICATION IN THE CONSERVATIVE REMEDIATION OF DROOLING BY CHILDREN WITH CEREBRAL PALSY

In an attempt to decrease the rates of drooling of 12 children with cerebral palsy, the authors investigated the effectiveness of EMG auditory feedback training of the orbicularis oris, of making the act of swallowing a conscious one, and of providing an auditory signal to cue swallowing by means of an Accularm interval timer. After biofeedback training there was a significant decrease in drooling rates and a small increase in swallowing rates. After the Accularm was used the children maintained the decreased drooling rates and there was a further small improvement in swallowing rates. One month after treatment stopped there was a nonsignificant regression in the rates of both drooling and swallowing. The marked decrease in drooling after biofeedback training must be attributed to more effective swallowing as a result of improved oral motor control, rather than to increased rates of swallowing.

Swallowing/ventilation interactions during oral swallow in normal children and children with cerebral palsy

Many children with cerebral palsy (CP) suffer from feeding disorders. Twenty children with spastic CP and 20 neurologically normal children (age range 6.2–12.9 years) were monitored with ultrasound imaging of the oral cavity synchronized with surface electromyographic (EMG) recordings of masseter and infrahyoid museles and respiratory inductance plethysmograph (RIP) recordings during feeding tasks. A lip-cup contact detector signaled contact of the drinking cup on the lip during liquid tasks. Children with CP required more time than normals for collection and organization of 5 ml and 75 ml liquid boluses for swallowing. The ventilatory preparation phase, recovery to baseline resting ventilatory pattern after swallowing, and total time for task completion were longer in children with CP for 5-ml and 75-ml tasks. The interval from lip-cup contact until alteration of ventilation from baseline resting ventilatory pattern was longer for children with CP during 75-ml tasks but not for 5-ml tasks. The interval from completion of the task-related cookie swallow until initiation of the next swallow was longer in children with CP than in normal children. These data provide evidence than children with CP manage solid boluses more easily than liquid boluses and small liquid boluses more easily than large liquid boluses. This investigation statistically confirms empirically based recommendations that children with CP be allowed more time to complete feeding tasks and consume small volume drinks rather than large volume drinks.Many children with cerebral palsy (CP) suffer from feeding disorders. Twenty children with spastic CP and 20 neurologically normal children (age range 6.2–12.9 years) were monitored with ultrasound imaging of the oral cavity synchronized with surface electromyographic (EMG) recordings of masseter and infrahyoid museles and respiratory inductance plethysmograph (RIP) recordings during feeding tasks. A lip-cup contact detector signaled contact of the drinking cup on the lip during liquid tasks. Children with CP required more time than normals for collection and organization of 5 ml and 75 ml liquid boluses for swallowing. The ventilatory preparation phase, recovery to baseline resting ventilatory pattern after swallowing, and total time for task completion were longer in children with CP for 5-ml and 75-ml tasks. The interval from lip-cup contact until alteration of ventilation from baseline resting ventilatory pattern was longer for children with CP during 75-ml tasks but not for 5-ml tasks. The interval from completion of the task-related cookie swallow until initiation of the next swallow was longer in children with CP than in normal children. These data provide evidence than children with CP manage solid boluses more easily than liquid boluses and small liquid boluses more easily than large liquid boluses. This investigation statistically confirms empirically based recommendations that children with CP be allowed more time to complete feeding tasks and consume small volume drinks rather than large volume drinks.