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Table of Contents
REVIEW ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 3-7

Recognizing and plugging the gaps toward holistic pediatric dental care


1 Department of Paedodontics and Preventive Dentistry, K.M. Shah Dental College, Sumandeep Vidyapeeth University, Vadodara, Gujarat, India
2 Department of Paedodontics and Preventive Dentistry, College of Dental Sciences, Bhavnagar, Gujarat, India

Date of Web Publication20-Jun-2019

Correspondence Address:
Dr. Pratik B Kariya
Department of Paedodontics and Preventive Dentistry, K.M. Shah Dental College, Sumandeep Vidyapeeth University, Vadodara, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JIHS.JIHS_6_19

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  Abstract 


Pediatric dentistry is the most versatile branch of dentistry that caters to the dental needs of infants to young adults. Pediatric dentists believe in delivering comprehensive oral health care and aim at providing welfare to the child as a whole. Various researches are been carried about the treatment modalities and material science, but literature lacks details about the role of a pediatric dentist in the fields such as dental neglect, child abuse, and sports dentistry. Pediatric dentists play a major role in recognizing, managing, and treating children of child abuse. In the similar way, they are also making an effort to spread awareness to eradicate dental neglect. Dental trauma during sports can be also be prevented with appliances such as custom-made mouthguards provided by the pediatric dentists. With the increase in competition and expectations from children, development of bruxism due to stress has increased significantly; hence, it is a major concern for paedodontists to treat such patients before they develop severe symptoms. This review article intends to highlight upon the role of a pediatric dentist in such scenarios.

Keywords: Child abuse, dental neglect, sports dentistry, stress, temporomandibular joint disorders


How to cite this article:
Buch A, Shah S, Kariya PB, Mulchandani V. Recognizing and plugging the gaps toward holistic pediatric dental care. J Integr Health Sci 2019;7:3-7

How to cite this URL:
Buch A, Shah S, Kariya PB, Mulchandani V. Recognizing and plugging the gaps toward holistic pediatric dental care. J Integr Health Sci [serial online] 2019 [cited 2019 Sep 23];7:3-7. Available from: http://www.jihs.in/text.asp?2019/7/1/3/260831




  Introduction Top


The concept of pediatric dentistry has changed a lot since its inception. From being one of the most neglected branches of dentistry to one of the most versatile and sought-for aspects of oral health, pediatric dentistry has become the foundation of oral health care.

Pediatric dentistry covers a wide area of dental treatments including preventive therapies, corrective treatments, and even provides comprehensive treatments for special children. A lot has been researched about the various dental treatments provided to children and various materials and techniques used. However, the role of a paedodontist in conditions such as child abuse and dental neglect, sports dentistry, and stress-related orofacial problems in children is less discussed upon.

Sports dentistry is an important aspect of pediatric dentistry. It aims at preventing injuries to the head-and-neck region including the oral cavity, caused during contact sports. Considering the increase in the interest of children and parents to learn a variety of sports and increase in awareness about their ward's safety, pediatric dentist comes across a lot of children who opts for precaution tools such as mouthguards.

Similarly, children who are the victims of child abuse often rush to the dentist by parents because of the dental injury caused due to the abuse. The role of pediatric dentist in such cases is not only to treat the traumatic injury but also to diagnose or observe any uncanny physical as well as mental behavior. Moreover, dental neglect, a part of child abuse and neglect, is equally prevalent among Indian parents because of which the oral cavity of children is highly affected. Inadequate education and misbelieves among the society forms the pillar of dental neglect in countries like India.

While it is not always easy to recognize when kids are stressed out, short-term behavioral and physical changes can be noticed sometime. Habits sucha s clenching of teeth or rubbing the teeth against each other can lead to long-term deleterious effects. Early diagnosis and relieving of stress can prevent such long-term effects. Pediatric dentists are well trained in understanding the psychology and behavioral patterns of children and hence play a crucial part in detecting such ailments.

A systematic review, involving questions regarding the behavior management techniques, operating and nonoperating caries management, and prevention and management of chronic dental diseases, was done in 2015.[1] It was concluded that, although prevalent, there was still a scarcity of research and awareness about the most commonly used preventive and restorative treatment modalities in pediatric dentistry. However, there is a scarcity of literature regarding the role of a pediatric dentist in situ ations such as child abuse, temporomandibular joint (TMJ) disorders, and sports-related dental trauma.

This article tends to review those needs of pediatric dentistry whose occurrence although has become common in the last decade has not been much paid heed. These areas of pediatric dentistry are sports dentistry, child abuse, dental neglect, and stress-related dental and TMJ disorders.


  Sports Dentistry Top


It is common for kids to get hurt during any form of sports, especially contact sports, and in such scenario, face is the main area of damage. Sports dentistry is the prevention of oral/facial athletic injuries and related oral diseases and manifestations. To provide comprehensive care, a pediatric dentist must be knowledgeable and adapt in the areas of oral surgery, pediatric endodontics, operative dentistry, orthodontics, hospital dentistry, and patient behavior management.[2]

Sports dentistry, unknown to many, should include much more than mouthguard fabrication and treatment of fractured teeth. Studies have shown that 13%–39% of all dental injuries were sports related and of all sports accidents reporting 11%–18% were maxillofacial injuries.[3]

Pediatric dentists should be well trained in handling sports-related injuries in children starting from the assessment of airway, breathing, and circulation to providing splints and managing oral fractures.

The most commonly encountered dental injuries during sports are as follows:

  1. Soft-tissue lacerations
  2. Contusions
  3. Dental fractures
  4. Root fractures
  5. Avulsions
  6. Dentoalveolar fractures
  7. Mandibular dislocations.


Sports-related oral injury in schoolchildren is mainly seen between the ages of 7 and 11 years.[4] Participants in sporting and recreational activities are often susceptible to dental injury, so use of a mouth guard is recommended in any athletic or recreational activity.[5] The mouthguards do not totally prevent the occurrence of dental trauma; however, the squeal of the trauma can be minimized.[6]

Mouthguards

According to the Australian Dental Association, a mouthguard is a protective device normally worn on the upper jaw, to reduce injures to the teeth, jaws, and surrounding soft tissues.[1] Mouthguards have a definite role in preventing injuries to the teeth and face, and for this reason, they are strongly recommended for all sporting activities where there is a risk of trauma to the teeth and associated structures.[7],[8]

According to report of the 1st International Sports Dentistry Workshop, 2016, the following summary can be drawn.[9]

General considerations

  • Fitted, laminated mouthguards offer the best protection
  • Cover distal of the maxillary first permanent molar
  • Minimum thickness should be 3 mm labially and occlusally, and 2 mm palatally
  • Occlusion should be bilateral and balanced.


Effect on impact force

  • Fitted, laminated mouthguard reduces impact force to teeth
  • Clenching with mouthguard in place enhances impact force reduction
  • There is no effect on impact force to the head.
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Effect on performance enhancement

  • Mouthguard use does affect stomatognathic function related to static or dynamic balance in postural control
  • There is a positive correlation between biting force level and increased limb muscle activity
  • A positive correlation exists between biting force level and neurophysiologic excitability. This contributes to postural stance stabilization and joint fixation.


Sports drinks and nutrition

  • Oral health of athletes frequently consuming sports drinks is generally poor and may negatively affect athletic performance
  • Sports and energy drinks may increase the risk of dental caries and tooth erosion
  • Ingestion of sports and energy drinks


Role of a pediatric dentist in sports dentistry in Indian scenario

  1. Dentists should play an active role in educating the public in the use of protective equipment for the prevention of orofacial injuries while playing
  2. Preventive practices should be taught in schools, institution, and sports coaching centers
  3. Encourage institutions to make use of mouthguards compulsory during sport activities
  4. Encourage coaches/administrators of organized sports to consult a dentist for immediate management of sports-related injuries
  5. Dentists should provide education to parents and patients regarding the prevention of orofacial injuries as part of the anticipatory guidance discussed during dental visits
  6. Public should be made aware of actions to be taken in case of avulsion of teeth and when reported to dental clinic, pediatric dentist should be trained to make the correct treatment plan.



  Child Abuse Top


Any kind of maltreatment to a child that may hamper the physical or mental growth can be termed as child abuse. Dentists can be one of the first people to detect child abuse as the parent or the caretaker would prefer to take the child to a dentist for any wound or injury to areas around the oral cavity. There can be umpteen reasons behind child abuse, poverty, and stress among the parents being the most common one. There are various kinds of child abuse, which are as follows:

  1. Physical abuse
  2. Sexual abuse
  3. Failure to thrive
  4. Intentional drugging or poisoning
  5. Munchausen syndrome by proxy
  6. Health-care neglect
  7. Dental neglect
  8. Safety neglect
  9. Emotional abuse and neglect
  10. Physical neglect.


Oral injuries are more common with physical abuse as oral cavity is used in communication and nutrition.[10] Acute or healed bite marks can also be a sign of abuse which can be identified by a dentist. Not only signs, but an overtly shy, unreasonably scared, and bruised child should always raise the suspect of child abuse among dentists.

Indicators of child abuse are as follows:[11]

  1. Injuries which are unusual in a specific age group
  2. Specific bruising patterns
  3. Unexplained injuries
  4. Multiple injuries at various sites
  5. Poor self-esteem
  6. Destructive behaviors or anger issues
  7. Poor development of basic skills
  8. Sexually transmitted diseases
  9. Psychological abnormalities in parents
  10. Failure to adhere to medical prescriptions.


The injuries most commonly are inflicted with blunt trauma with an instrument, eating utensils, hands or fingers, or by scalding liquids or caustic substances.[12],[13] Age-appropriate nonabusive injuries to the mouth are common and must be distinguished from abuse on the basis of history; the circumstances of the injury and pattern of trauma; and the behavior of the child, caregiver, or both.[14] Discolored teeth, indicating pulpal necrosis, may result from previous trauma.[15] Dental practitioners have four “R's” of responsibility – recognize, record, report, and refer – to protect our patients and their families from the cycle of violence, all too prevalent in the society today.[16]

Role of a pediatric dentist

  1. All dentists should be well trained to detect and report child abuse
  2. If child abuse is suspected, then proper history should be taken from both the parents and the child with detailed physical and oral examination
  3. They should call for immediate legal help and report to designated child protection agencies such as HEAL, Childline, and RAHI foundation
  4. The pediatric dentist should emphasize and try to handle the situation in a gentle way as the most of the victims of child abuse are more emotionally affected.



  Dental Neglect Top


Dental neglect is often a subheading under child abuse and neglect. Although the problem of dental neglect is ever present, its recognition and report is scarce. In 2016, the American Academy of Paediatric Dentistry has defined dental neglect as willful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection. The following are the few reasons why dental neglect exists specially in developing countries like India.

  1. Social factors such as low socioeconomic levels, poor living conditions, single parent family, or a history of domestic abuse[17]
  2. Quality of parent's oral health and failure to maintain their dental health[18]
  3. Mother's attitude toward oral health care and her interest in child's oral care[19]
  4. Substance misuse among parents tends to present high risk of dental trauma, gingivitis, dental caries, and other oral infections[19]
  5. Parent's and family member's poor education and lack of awareness about oral health and dental problems
  6. Parent's perception of dental treatment is costly and less important for their children.


Various initiatives had been taken by the government or other health service centers, but still, there is a vast existence of dental neglect among parents and caregivers.

Signs of dental neglect are as follows:

  1. Oral cavity of the child might show multiple untreated dental caries with an impaction their daily routine
  2. Extraoral and intraoral untreated ulcers with or without pain
  3. Parents, ignorant and indifferent toward oral health
  4. Children from families having a history of or practicing drug abuse or substance abuse
  5. Dental neglect is also prevalent among children with special needs.


Role of a pediatric dentist

As an individual or as a team, paedodontists in various part of India can take some measures to arrest dental neglect, few of which are mentioned below:

  1. Introduction of school dental health programs which would not only increase the awareness among students and their parents about oral health but also instill a good habit of regular dental check-up among children
  2. Organizing oral health talk about oral health awareness in workplace of parents
  3. Collaborating with pediatricians and gynecologists and encouraging them to spread awareness about oral care of infants and children through adolescence
  4. Facilitating dental treatment for the less privileged ones by introducing them to dental trust hospitals or dental colleges
  5. Spreading awareness about preventive oral health program among parents of special children and teaching them proper oral hygiene methods.


The Dental Neglect Scale assesses the extent to which an individual cares for his/her teeth, receives professional dental care, and believes oral health to be important. It was originally composed of seven items and developed for parents, who were directed to rate their child's behaviors and attitude toward oral health. Children whose parents rated them as having higher dental neglect had more caries and were less likely to have gone to a dentist in the previous 2 years than children whose parents rated them has having less neglect.[20]


  Stress-Related Dental and Temporomandibular Joint Disorders Top


Children in the 21st century have a more stressful lifestyle than their parents and forefathers. This is because of the increasing peer pressure, competition, anxiety, or lack of confidence. These reasons directly or indirectly can affect the oral cavity. Nocturnal bruxism is one of the most common oral features in children under stress. Bruxism is considered the most deleterious parafunctional activity to the stomatognathic system, causing abnormal tooth wear and damage to periodontal tissues, TMJs, and/or muscles.[21] This also lead to morning pain over the TMJ area and sensitivity of teeth.

A systematic review on the role of psychosocial factors in the etiology of bruxism showed that clinical studies have demonstrated an association between wakeful bruxism and anxiety, stress, depression, and characteristics of personality.[22]

A study conducted by Kim et al. concluded that the group of children with high entrance examination stress showed significantly high perceived degrees of temporomandibular disorder, oral mucosal disease, and xerostomia. Among subfactors of stress, the group with high tension for examination/poor result stress had significantly high perceived degrees of dental caries, temperomandibular disorder, oral mucosal disease, and xerostomia.[23]

Clinical signs in children with stress are as follows:

  1. Sensitivity, occlusal facets in noncarious teeth
  2. History of frequent fractured restoration
  3. Toothache and tenderness of the jaw muscle mainly in the mornings
  4. Pain, crepitation, clicking in TMJ, restriction of mandibular movements
  5. Unexplained headaches.


Role as pediatric dentist

  1. Proper elaborated history should be taken when in doubt
  2. Counseling of parent and child regarding the prevailing problem
  3. Correction of the existing dental problems
  4. Providing nightguards to children for prevention.



  Conclusion Top


A pediatric dentist needs to be compassionate, alert, and gentle at the same time. Each child is different from other and so is their background. The branch of pediatric dentistry cannot be limited to fixed treatment plans and conventional procedures. Pediatric dentists come across various situations sucha s child abuse and neglect where they play a crucial role. Similarly, areas such as sports dentistry and stress-related disorders are also alarmingly gaining importance in the present scenario. This review was prepared to address such less popular situations.



 
  References Top

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Andresean JO, Andresean FM. Textbook of Color Atlas of Traumatic Injuries to the Teeth. 3rd ed. Copenhagen: Munksgaard; 1994.  Back to cited text no. 1
    
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Hegde V, Kiran DN, Anupama A. Mouthguard in sports: A review. Indian J Stomatol 2012;3:50-2.  Back to cited text no. 3
    
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ADA Council on Access, Prevention and Interprofessional Relations, ADA Council on Scientific Affairs. Using mouthguards to reduce the incidence and severity of sports-related oral injuries. J Am Dent Assoc 2006;137:1712-20.  Back to cited text no. 4
    
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Shrestha A, Takahashi T, Kurokawa K, Mitsuyama A, Hayashi K, Ishigami T, et al. Effects of mouthguards on electromyographic activity of masticatory muscles. Int J Sports Dent 2016;9:27-37.  Back to cited text no. 7
    
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Lloyd JD, Nakamura WS, Maeda Y, Takeda T, Leesungbok R, Lazarchik D, et al. Mouthguards and their use in sports: Report of the 1st International Sports Dentistry Workshop, 2016. Dent Traumatol 2017;33:421-6.  Back to cited text no. 8
    
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Thompson LA, Tavares M, Ferguson-Young D, Ogle O, Halpern LR. Violence and abuse: Core competencies for identification and access to care. Dent Clin North Am 2013;57:281-99.  Back to cited text no. 9
    
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Nagarajan SK. Craniofacial and oral manifestation of child abuse: A dental surgeon's guide. J Forensic Dent Sci 2018;10:5-7.  Back to cited text no. 10
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Graham DI. Paediatric head injury. Brain 2001;124:1261-2.  Back to cited text no. 13
    
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Oral and dental aspects of child abuse and neglect. American Academy of Pediatrics. Committee on child abuse and neglect. American Academy of Pediatric Dentistry. Ad hoc work group on child abuse and neglect. Pediatrics 1999;104:348-50.  Back to cited text no. 15
    
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Baptista AS, Laranjo E, Norton AA, Andrade DC, Areias C, Macedo AP. Dental neglect, one type of child abuse – Narrative review. Med Exp 2017;4:1-5.  Back to cited text no. 16
    
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Bradbury-Jones C, Innes N, Evans D, Ballantyne F, Taylor J. Dental neglect as a marker of broader neglect: A qualitative investigation of public health nurses' assessments of oral health in preschool children. BMC Public Health 2013;13:370.  Back to cited text no. 17
    
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Thomson WM, Spencer AJ, Gaughwin A. Testing a child dental neglect scale in South Australia. Community Dent Oral Epidemiol 1996;24:351-6.  Back to cited text no. 18
    
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Mezzich AC, Bretz WA, Day BS, Corby PM, Kirisci L, Swaney M, et al. Child neglect and oral health problems in offspring of substance-abusing fathers. Am J Addict 2007;16:397-402.  Back to cited text no. 19
    
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Coolidge T, Heima M, Johnson EK, Weinstein P. The dental neglect scale in adolescents. BMC Oral Health 2009;9:2.  Back to cited text no. 20
    
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  In this article
Abstract
Introduction
Sports Dentistry
Child Abuse
Dental Neglect
Stress-Related D...
Conclusion
References

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