Pediatric Dental Emergency Pattern and Dental Care Provided during COVID-19 Pandemic Lockdown at a Tertiary Care Center in Kathmandu, Nepal

Introduction: Pediatric dental management is difficult in its own way which was even more challenging during COVID-19 outbreak and lockdown period. Constrained dental providing clinics and hospitals severely compromised the pediatric dental needs and services. Objective: The aim of this study was to describe pattern of dental emergencies encountered and services provided to the pediatric patients visiting a dental hospital during the first lockdown period in Kathmandu, Nepal. Methods: A cross sectional study was done from 24 March 2020 to 21 July 2020 among the pediatric patients who visited dental hospital during lockdown. Data was collected from questionnaire and dental case history sheet, and statistically analyzed in Statistical Package of Social Sciences (SPSS) version 20. Results: Of the total 172 pediatric patients of mean age 8.3± 2.60 years, majority were males (59.3%) and of 6-12 age group (76.2%). Major complain was mobile/retained teeth (38.4%) and most common diagnosis was exfoliating mobility (23.3%). According to American Dental Association (ADA, 2020) guidelines, urgent dental care (46.5%) followed by non-emergency dental care (43.6%) were mostly found. The predominant procedures were emergency (68.6%) and least was elective (9.3%) and treatment given to majority was extraction (51.8%).There was a statistically significant association between age group and pediatric dental care (ADA). Conclusions: The findings of this study regarding dental emergency encountered and definitive treatment received even during pandemic lockdown can be helpful in finding out how dental care was provided and can be applicable in similar future pandemics.

Dental Caries Experience in 6-13 Years Old School Children of Dharan Sub-Metropolitan City, Nepal: A Cross-Sectional Study

Introduction: Dental caries though preventable oral health problem is affecting school children worldwide and around 50% of Nepalese children are suffering from it. Baseline data with good understanding of dental caries and associated risk factors are necessary to form preventive strategies for setting and achieving oral health goals. Objective: This study was conducted to determine dental caries experience and associated risk factors among school-going children of 6-13 years old in Dharan sub-metropolitan city, Nepal. Methods: A cross-sectional study was conducted from 5th Jan 2018 to 4th Jan 2019 among 680 school children selected by multistage cluster sampling method. Pretested, standardized, closed-ended questionnaire answered by the parents was used to gather information regarding the associated risk factors. Dental caries experience was obtained from deft/DMFT (WHO modification 1997). Comparison of categorical data was done using Chi-square test. Multivariable binary logistic regressions were used for the statistical analysis. Results: The overall caries prevalence was 61.6%, in primary dentition it was 48.25% and in permanent dentition it was 34.4%. Dental caries experience was with mean deft 4.67 (±2.7) in primary dentition and mean DMFT 1.72 (±1.05).in permanent dentition. Multivariate analysis showed significant association between dental caries experience and grade three and grade four school children had experienced greater caries (p<0.05, OR =2.7). Dental caries was associated with eating sweets at night (p<0.001, OR=2.5) and snacking in-between meals (p<0.001, OR=2.5). Conclusions: Dental caries among school-children in Dharan showed a significant burden especially within the primary dentition. It was significantly associated with factors like feeding habits -eating sweets in a day, eating sweets at night and snaking in between meals

Virtual Dental Care - Pediatric Teledentistry

Teledentistry falls under virtual dental care where use of virtual communication is in between dentist and the patient to provide dental care and education to patients. Patients receive virtual examinations and are provided consultation, diagnosis, treatment planning, guidance, transmission of dental information and education via tele-communications. During this COVID-19 pandemic it has offered a solution to resume dental practice as a tool ensuring safety for all. Pediatric teledentistry helps by saving time, allowing child- dentist interaction before the visit and reducing stress for patients, guardians and dentists. Telescreening and teletriage can be implemented publically into routine dental practice and also as a triage-based emergency management strategy as it provides an effective compromise between limiting patient admission, ensuring their pain control and symptom relief.

Dental Caries Prevalence among 3 - 14 Year Old School Children of Chitwan

Introduction: Dental caries, an infectious microbiologic disease of dental hard tissues is a global public health problem. It affects people of all ages with the highest priority risk group being school-going children. Objective: This study was done to assess the prevalence of dental caries in the 3-14 years old school children of Chitwan and to compare it across genders, age groups and school groups. Methods: This was a cross-sectional study conducted from January 2018 to May 2018 where WHO criteria was used to examine and calculate DMFT and dft (decayed filled teeth) indices among 360 school children. Statistical analysis was done with SPSS 20. Statistical significance was determined using independent t-test and ANOVA test. Results: The prevalence of the dental caries was found to be 85.83% with mean DMFT of 3.01 ± 2.24 among school children of Chitwan. Caries prevalence was higher in females compared to males, and in government schools compared to private school. Caries experience was highest in middle childhood group 7-12 years (89.20%, mean “DMFT+dft” 3.56 ± 2.33) followed by late childhood group of 13-14 years (84.72%, mean DMFT 2.68 ± 1.95) and early childhood group of 3-6 years (77.33%, mean dft 1.76 ± 1.60) and the differences were statistically significant. The difference in caries experience between private and government school groups as well as in male and female children was not statistically significant. 82.7% of the children had untreated caries while only 5.83% had filled teeth in their mouth. Conclusions: The prevalence of dental caries was higher in middle childhood group and higher percentage of untreated decays, calls for the need of immediate preventive as well as curative interventions.

Pyogenic Granuloma of Lower Lip: An Unusual Presentation

Pyogenic granuloma is a benign inflammatory hyperplasia of connective tissue. It depicts an overzealous tissue response to a known stimulus or injury and is commonly found in the gingiva, especially in the anterior maxilla, and rarely on lips, oral mucosa, and tongue. It is commonly seen during the second, third, and fourth decade in females, with predilection in the third decade. This case report depicts the unusual presentation of pyogenic granuloma of the lower lip in an 11-year-old male child following a positive history of trauma and lip biting, which was successfully managed by excision under local anesthesia.

Conservative Management of Submandibular Space Infection in a 5-Year-Old Child: A Case Report

Submandibular space infection is a potentially fatal infection that could arise as a result of odontogenic or non-odontogenic infections. The management should be prompt as the infection can spread rapidly leading to airway obstruction. A 5-year-old child reported with a complaint of swelling on the left side of the face for four days. On examination, patient had a diffuse swelling involving the left submandibular region with decreased mouth opening secondary to carious 75. The patient was administered intravenous (i.v) fluids, antibiotics and analgesics. Incision and drainage of the abscess was done extraorally under i.v sedation using midazolam with local anaesthesia followed by rubber drain placement. Patient responded to the treatment with progressive decrease in the swelling. Pulpectomy of 75 was performed followed by stainless-steel crown placement. This case highlights the importance of prompt appropriate treatment supplemented by salvage treatment to overcome the associated morbidity at this very young age.

Ulcerated White Lesion of Tongue in a 7-Year-Old Child: A Diagnostic Dilemma

Tongue is a complex organ associated with functions of taste, speech, mastication, deglutition, and development of jaws. It is considered the mirror of physical health as it can be the site of infections, immunological and drug-induced reactions, neoplasms and systemic diseases. This paper aims to present challenges in diagnosing a case of a 7-year-old male child who presented with ulceration and extensive white coating on the dorsum of tongue accompanied by fever, chills, tonsillitis, and submandibular lymphadenopathy. Despite symptomatic treatment done, the white coating with patches of depapillation lasted for a relatively long time. This may be the first reported case in the literature with such unusual tongue lesions in a child till date. Thus, pediatric dentists should have sound knowledge of the commonly encountered oral soft tissue lesions along with the rarer lesions and unusual presentation of common lesions for timely diagnosis, appropriate treatment, and referral if necessary.

Conservative Management of Ankyloglossia by Diode Laser: A Case Report

Ankyloglossia or tongue-tie is a congenital condition that results when the inferior lingual frenulum is too short and is attached to the tip of the tongue, limiting its normal movements. Ankyloglossia can lead to different problems such as difficulties in breastfeeding, speech impediments, poor oral hygiene, malocclusion, inability to deglutition, thus being an undesired problem in normal life activity. Among various methods of treatment of ankyloglossia, laser-assisted lingual frenotomy is the simplest, safest, and less traumatic with the most promising results. Here, a case of ankyloglossia and its management by frenotomy with diode laser is reported in a four-year-old female child. After performing partial frenectomy (frenotomy) using a diode laser of 980nm there was an immediate tongue protrusion and slight improvement of phonetics of the patient immediately and altogether improved after six months.

Pre-surgical Alveolar Molding: An Adjunct to Surgical Repair in Cleft Lip and Palate Rehabilitation

Bilateral cleft lip and palate (CLP) with a severely protruded premaxillary segment can present as a challenge during surgical lip repairing. Pre-surgical alveolar molding, as described in this case report, is one such technique which aids in the approximation of the cleft segments thereby improving the esthetic result of the surgical repair. The present case highlights the importance of a simple molding appliance in re-positioning the protruded premaxillary segments of a neonate with bilateral CLP thereby serving as an adjunct to the surgical repair.

Post Pandemic Era – Adopting Tele-dentistry

Dentistry, the field of medicine where the communication sets standards for success. A continuous patient and dentist as well multidisciplinary dental communication leads to accuracy in diagnosis, increased efficiency as well as better patient satisfaction and long term positive outcomes. However the COVID-19 has brought a hindrance in the regular dental practice. The dental work demands a close proximity between the dentists with the patient which pitches them at a higher risk of being affected by the virus. Hence, international as well as national policy making associations and organizations have suggested only emergency and minimal aerosols generating treatment procedures. The dentists have almost been in hibernation, along with the waves of the pandemic and the constant lockdowns, carrying out free consultations for regular patients of their practices, through the phone and even chats. Can this be an opportunity to include tele-communication tools in routine dental practice?