Paul S. Casamassimo

Epidemiology of dental trauma treated in an urban pediatric emergency department.

Study objective To describe the epidemiology of traumatic dental injuries to children treated in an urban pediatric emergency department (ED). Design A descriptive study of a consecutive series of patients. Setting The ED of a large, academic childrens hospital. Participants Children presenting to the ED with dental trauma from December 1992 to November 1993. Results Of 1459 children treated for dental emergencies, 541 had dental trauma (37%) and were enrolled in this study. Patients ranged in age from five months to 18 years. Fifty-nine percent of patients were less than seven years of age, and 59% of patients were male. Falls caused 63% of injuries, followed by being struck (17%), and motor vehicle crashes (2%). Injuries to the soft tissues included lacerations (32%), swelling (8%), abrasions (7%), and contusions (6%). Injuries to hard dental structures included tooth fractures (33%), luxations (18%), concussions (12%), avulsions (8%), and jaw fractures (1%). Tooth luxation and concussion were more common among children less than seven years of age, and fractures to the tooth crown with dentin exposure (Ellis class II) were seen most often among children with permanent dentition (x2 = 41.4, P < 0.005). The central incisors were the teeth most frequently traumatized. Conclusion Findings of this large consecutive series provide a useful description of the epidemiology of this common type of pediatric trauma for pediatric emergency care providers.

Relationship between Sports Drinks and Dental Erosion in 304 University Athletes in Columbus, Ohio, USA

Acidic soft drinks, including sports drinks, have been implicated in dental erosion with limited supporting data in scarce erosion studies worldwide. The purpose of this study was to determine the prevalence of dental erosion in a sample of athletes at a large Midwestern state university in the USA, and to evaluate whether regular consumption of sports drinks was associated with dental erosion. A cross-sectional, observational study was done using a convenience sample of 304 athletes, selected irrespective of sports drinks usage. The Lussi Index was used in a blinded clinical examination to grade the frequency and severity of erosion of all tooth surfaces excluding third molars and incisal surfaces of anterior teeth. A self-administered questionnaire was used to gather details on sports drink usage, lifestyle, health problems, dietary and oral health habits. Intraoral color slides were taken of all teeth with erosion. Sports drinks usage was found in 91.8% athletes and the total prevalence of erosion was 36.5%. Nonparametric tests and stepwise regression analysis using history variables showed no association between dental erosion and the use of sports drinks, quantity and frequency of consumption, years of usage and nonsport usage of sports drinks. The most significant predictor of erosion was found to be not belonging to the African race (p < 0.0001). The results of this study reveal no relationship between consumption of sports drinks and dental erosion.

Nontraumatic Dental Emergencies in a Pediatric Emergency Department

The objectives of this study were to describe nontraumatic dental emergencies among children treated in a pediatric emergency department. The children studied received emergency treatment for a nontraumatic dental problem from December 1992 through November 1993. Among the 1,459 children treated for dental emergencies, 949 had a nontraumatic emergency (65%) and were enrolled in this study. Patients ranged in age from 1 month to 19 years, with a mean age of 6.9 years. Fifty-two percent of patients were male. The teeth were involved in 99% of cases. An abscess was present in 33% of patients; and among these patients, 26% also had a fistula. Pericoroni tis was seen in 4% of patients, primary viral stomatitis in 1%, and an eruption hematoma in 0.5%. Caries is the etiology of the problem prompting the emergency department visit in 73% of patients, and baby bottle caries accounted for 18% of all cases of caries. Other etiologies included the late effects of trauma (8%), iatrogenic (7%), idiopathic (3%), and periodontal processes (2%). Tooth ex traction was performed in 45% of patients. Findings of this large consecutive series provide a better understanding of this type of visit to the pediatric emergency department.

RELATIONSHIPS BETWEEN ORAL AND SYSTEMIC HEALTH

Oral and systemic health cannot be separated. This article addresses some established and emerging relationships that highlight the association between systemic and oral health. The physicians role requires an understanding of the effects of disease and its treatment on oral health. Also, physicians should be able to identify abnormality in the oral cavity that might be attributable to disease or be a compromising factor in the health, growth and development, or functioning of children and make a referral. Cooperation between dentist and physician can mean good overall health for children, including oral health.

Oral opening and other selected facial dimensions of children 6 weeks to 36 months of age

Four hundred twenty-two children (Caucasians, Asians, and blacks) aged 6 weeks to 36 months were recruited. Five measurements (incisal edge distance, alveolar crest distance, closed mouth breadth, open mouth breadth, and nose-lip distance) were made by two calibrated examiners and an average was recorded. Because there were no statistically significant differences among races or genders the data were combined. The normative data for seven age groups (6 weeks to 36 months) and five oral-facial parameters are presented.

Recognizing the Relationship Between Disorders in the Oral Cavity and Systemic Disease

Oral health is integral to general health. The oral cavity may harbor manifestations of systemic disease and can be the harbinger of early onset. Primary care providers (PCPs) can therefore use the oral cavity to support working diagnoses. Conversely, systemic diseases and treatments can affect oral health and require interactions between PCPs and dental providers. Acute oral manifestations of systemic disease may involve teeth and/or gums. This article reviews oral and systemic disease connections for some diseases, identifies issues that benefit patients through medical-dental collaboration, and highlights some nondental oral injuries that might confront PCPs or emergency medical providers.

Infant Oral Health: An Emerging Dental Public Health Measure

Infant oral health (IOH) is a preventive service advocated by major medical and dental organizations. IOH aims to prevent early childhood caries (ECC) and impart health strategies to families for continued oral health and prevention of future caries. IOH reaches across disciplines, is low cost, and is covered by Medicaid and many private dental payers. Increasing evidence points to immediate and long-term positive oral health outcomes of reduced disease, reduction in costly care, and reduction in ECC-associated morbidities.

Safety and Efficacy of 3 Pediatric Midazolam Moderate Sedation Regimens

&NA; Our aim was to characterize effectiveness and complications in children receiving oral midazolam alone, nasal midazolam alone, or oral midazolam with other sedatives. Children received oral midazolam alone, nasal midazolam, or oral midazolam in combination with other sedative medications. All subjects received a presedation history and physical examination and were sedated per protocol by any of 28 resident providers under attending supervision. Sedations were rated for success and complications by clinicians. Postoperative complications were assessed by trained staff up to 48 hours postoperatively. Seven hundred and one encounters, completed over 24 months, yielded 650 usable sedations. The majority of children were healthy (469; 68.2%) and 86% (532) weighed between 10 and 25 kg. Sedations were deemed successful in about 80% of cases. Planned treatment was completed in over 85% of encounters. Oral midazolam alone yielded the best behavior. Physical assessment factors of behavior and age were correlated (P = .035) with effectiveness. Hiccups and a positive medical history were significantly related (P = .049). Side effects of either nausea/vomiting, dysphoria, or hiccups occurred in less than 10% of cases. All 3 regimens were effective with minimal postoperative complications.

Practitioner Training in Procedural Sedation

Practitioner training begins in dental school and can progress in advanced training and after graduation with continuing education courses. Training is based largely on sedation guidelines. Previous emphasis on drugs and pharmacology in training has diminished due to safety concerns. Training in accredited dental educational programs usually offers more rigor, control, and scientific base than courses found in the marketplace, and some specialty training programs specify requirements. States mandate training in a highly variable matrix of rules, equipment, emergency preparedness, and experiential thresholds for acquiring approval to provide sedation. Both accredited educational training offerings and those in the marketplace attempt to provide training to reach the standards set by the states for clinical practice. Auxiliary participants in procedural sedation also have access to training to fulfill personnel requirements in state practice acts and sedation guidelines. Training in procedural sedation continues to evolve as laws, technology, dental practice, and the clinical science of sedation change. State requirements for continuing education to maintain skills vary. Quality measurement, continuing competency requirements, and accountability for clinical outcomes will affect training in the future.

Broader Considerations of Medical and Dental Data Integration

Dental health insurance coverage in the United States is either nonexistent (Medicare and the uninsured), spotty (Medicaid) and limited (most employer-based private benefit plans). Perhaps as a result, dental health in the United States is not good. What public policy makers may not appreciate is that this may well be impacting medical care costs in a way that improved dental benefits would produce a substantial return to investment in expanded dental insurance coverage.