Efficacy of Alternative Medicaments for Pulp Treatment in Primary Teeth in the Short Term: A Meta-analysis

ObjectiveThis systematic review and meta-analysis aimed to evaluate the overall, clinical, and radiographical success rates of alternative pulpotomy medicaments in primary teeth.MethodsA systematic search of five databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Prospective clinical trials using alternative pulpotomy medicaments in children were included. The outcome measures were overall, clinical, and radiographic success, expressed in percentages and converted to odds ratios. Fifteen articles were included in the meta-analysis.ResultsCombined odds ratios for overall, clinical, and radiographic success was 0.55 (95% confidence interval [CI]: 0.12-2.41; P = .42; I² = 76%), 1.03 (95% CI: 0.57-1.86; P = .92; I² = 0%), and 0.84 (95% CI: 0.54-1.47; P = .66; I² = 34%), respectively. The results suggest an inconclusive outcome in the success rate of alternative medicaments.ConclusionsThere is insufficient evidence to support the efficacy of alternative pulpotomy medicaments for use in primary teeth. Further robust studies are required before such alternative medicaments should be used in clinical practice.     

Clinical features and types of paediatric orofacial malignant neoplasms at two hospitals in Nairobi, Kenya

Aim

To evaluate the clinical features and histopathological types of orofacial malignant neoplasms in children.

Patients and methods

The study involved patients aged 15 years and below diagnosed with malignancy at two main referral hospitals in Kenya during the period from July, 2008 to December, 2008. A questionnaire and clinical examination chart were used to document data. Data analysis was done using SPSS 12.0 programme.

Results

65 children (44 males, 21 females) with ages ranging from 0.25 to 14 years were evaluated. The main complaints were swelling 61 (94%) and visual disturbance 29 (45%). The mean duration of symptoms was 0.17-36 months. The commonest signs were leucocoria (white reflection from the retina) 23 (35%), proptosis 19 (29%) and loss of vision 15 (23%). The commonest sites were orbit 30 (46%) and maxilla 11 (17%). Most neoplasms were retinoblastoma 26 (40%), followed by 14 (21%) cases of Burkitt’s lymphoma (BL) and occurred in patients under 5 years of age (40 cases) followed by 19 cases in children aged 5-10 years.

Conclusions

Overall, malignancies were more common in males than females with most having been diagnosed in children aged less than 10 years. Retinoblastoma and BL were the most common neoplasms.     

Efficacy of closed reduction for nasal fractures in children

The aim of this study was to evaluate the efficacy of closed reduction and the effects of the time of intervention on young patients’ satisfaction. Patients older than 16 years and those with additional maxillofacial fractures were excluded. All patients were treated by closed reduction and external fixation. The patients and parents were asked about their satisfaction in a survey 6 months’ postoperatively. They were divided into groups according to the time of intervention, and the results. Twenty-four patients, age range 4–16 years, with isolated nasal fractures were included in the study. The mean (SD) time before intervention was 5.5 (1.8) days. The first group comprised 16 patients whose fractures were reduced between days 1 and 5 after the injury, and the second the 8 whose fractures were reduced between days 6 and 10. At 6 months 15 of the 24 were satisfied with the result, and 9 were not. In the group treated between days 1–5, 12/16 were happy with the result, and in the group treated between days 6–10, 3/8 were satisfied. Closed reduction gives good results in the treatment of nasal fractures in children. Early intervention increases the rate of satisfaction.     

Software Reviews

Abstract

A postal questionnaire survey of consultant orthodontists in England and Wales was undertaken as part of a national audit of the care of children horn with cleft lip/and or cleft palate. A 100% response rate was achieved. The majority of respondents stated that they provide orthodontic treatment for cleft patients hut only 78% of these attend multi-disciplinary cleft clinics. Consultant orthodontists provide treatment not only in the form of appliances for patients born with clefts hut are also involved in the counseling of parents and coordination of regional data bases. Only 24% of hospital orthodontists are involved in the provision of presurgical appliances for cleft babies on a regular basis. The lack of rationalisation of orthodontic services and a low uptake of standardised record keeping protocols for cleft patients by consultant orthodontists gives cause for concern.     

Epidemiology of paediatric minor head injury: Comparison of injury characteristics with Indices of Multiple Deprivation

Background

Head injury (HI) is a common presentation to Child Emergency Departments (CEDs), but the actual number of children attending with minor HI is unclear. Most research has focussed on admitted patients, often relying on hospital-coded admission data. We studied the incidence of minor HI presenting to the CED of a major teaching hospital in Coventry and Warwickshire. HI attendances were compared with population data to identify injury patterns relating to deprivation.

Methods

All CED admissions were screened by the research team, and data on minor head injuries (GCS 13–15) collected prospectively from 1st January until 31st August 2011. Information was collected on demographics, ethnicity, cause and severity of injury, injury location (in or outside the home), other injuries and mode of arrival. Deprivation data were obtained by cross-referencing postcodes with English Indices of Multiple Deprivation (IMD 2010). For comparison, the hospital audit department provided figures for coded head injuries during the same period.

Results

During the 8 month period, hand-searching identified 1747 children with minor HI, aged between 0 and 16 years. Of these 99% had minimal HI (GCS 15 or ‘alert’). In the same period, hospital-coded minor HIs numbered only 1081. HIs formed 9% of all CED attendances. Thirteen children returned to the CED with worrying symptoms after discharge home. Approximately 3.4% of the local paediatric population attend the CED with HI per year (3419/100,000 population). Falls accounted for 62% of HIs overall, rising to 77% in children aged 0–5. Most in-home head injuries (81%) were the result of falls (p < 0.0001). Significantly more injuries took place inside the home for 0–5 year olds (58%) than for older children (20%) (p < 0.0001). Children living in the most deprived areas were more likely to attend the CED with HI (RR: 1.19; CI: 1.06–1.35, p = 0.004), and arrive using emergency services (OR: 1.77; CI: 1.30–2.40, p < 0.001). There were no significant differences between the deprived and non-deprived groups for location or cause of injury.

Conclusions

Young children are particularly at risk of HI and parents should be offered information on injury prevention. More children from deprived areas attended with HI and these families may benefit most from targeted interventions.     

Operative treatment of chance injuries in the paediatric population

Purpose

Chance fractures are an uncommon spine injury in the paediatric population. As such there is a relative paucity of evidence in the literature to guide management decisions. We present our single centre experience in the operative management of these injuries.

Methods

All patients presenting to a tertiary paediatric trauma centre between 2000 and 2008 were included. Retrospective analysis of clinical (SRS-22 and Oswestry) and radiological outcomes was undertaken.

Results

Twelve patients underwent operative stabilization of a Chance type injury. Radiological and clinical outcome measures demonstrated excellent outcomes in the majority of patients with no significant complications.

Conclusions

Operative management of paediatric chance injuries with instrumentation results in excellent clinical and radiological outcomes.