A survey of the oral lesions in newborns and infants: A two-year cross-sectional study

Introduction. Oral lesions in newborns and infants represent a wide range of diseases often creating apprehension and anxiety among parents. Aim. We aimed to assess the type, prevalence and associated factors of oral lesions in newborns and infants. Material and methods. Participants were recruited during a two-year cross-sectional study among children who had their first teething assessed. The mothers answered medical history questions and the children underwent a clinical examination by paediatric dentists after training, calibration, and pilot study. Results. Two hundred and forty-eight children aged up to 12 months took part in the study. The mean number of teeth (SD) was 1.96 (2.55). 1.25% of children had natal teeth. Dental caries was observed in 3.2% children; traumatic dental injuries caused by falling in 7%; enamel hypoplasia in 1.9%, and mucosal lesions in 19.8% (Bohn’s nodules, mucocele, candidiasis). Conclusions. Oral lesions in infants may involve teething, teeth and oral mucosa. One child out of five children has mucosal lesions, most often Bohn’s nodules or candidiasis. There is a significant correlation between the prevalence of natal/neonatal teeth and of Bohn’s nodules.

Children who underwent tonsillectomy due to OSAS have significantly bigger tonsils than those with hypertrophic tonsils without OSAS

Introduction. Tonsillectomy is one of the most commonly performed procedures in otolaryngology departments. Main indications include tonsil hypertrophy with or without obstructive sleep apnea and recurrent throat infections. The size of tonsils in the group of children qualified for tonsillectomy with obstructive sleep apnea may differ from the size of tonsils in the group without obstructive sleep apnea. Aim. Comparison of morphological features of tonsils in children with and without OSAS undergoing tonsillectomy. Material and methods. Retrospective study conducted from 2011 until 2020, including patients under 18 years old who underwent a total or partial tonsillectomy at the Department of Otorhinolaryngology at the University Medical Center in Ljubljana. Results. Among 824 patients included in the analysis, 96 underwent tonsillectomy due to OSAS and 728 due to tonsil hypertrophy without OSAS. Both groups were comparable in terms of mean age and sex distribution. Tonsil size statistically differed in both groups (p = 0.01), with the prevalence of big tonsils (grade 3 of 4) in the non-OSAS group (in 47% of patients) and large tonsils (grade 4 of 4) in the OSAS group (in 53% of patients). Conclusions. In age and sex-matched groups of children who underwent total or partial tonsillectomy, patients who underwent the procedure due to OSAS had bigger tonsils than those with hypertrophy without OSAS.

The attitude of polish dentists towards children treatment

Introduction. The dentist’s attitude towards treating children influences the success of dental treatment and can be shaped by the healthcare system, appropriate preparation for treating young patients, and the use of various methods of cooperation. Aim. The aim of the study was to present the dentists’ approach to the treatment of juvenile patients and to discuss treatment procedures and factors, which have an influence on communication and treatment planning. Material and methods. The study included 736 dentists. The questionnaire consisted of 46 questions and covered topics related to socio-demographic data, number of treated children, pharmacological premedication, adaptation visits, treatment of deciduous and immature permanent teeth, behavioral methods of shaping the child’s attitude, non--cooperative patients as well as dentophobia. Results. Amount of 577 questionnaires were qualified for the final analysis, women: 85.4%, men: 14.6%. The mean age was 33 ± 8.2 years. Only 17.9% of the respondents had a specialization, including 24.3% in pedodontics. Among the respondents, 85.1% treated young children up to the age of 6. Treatment of deciduous teeth without local anesthesia was performed by 18.5% of dentists. According to 84.9% of the respondents, it was possible to overcome the child’s dentophobia thanks to adaptation visits. Prophylactic procedures were performed by 98.0% of physicians, while pharmacological premedication was used by 16.7%. As much as 93.5% of dentists used glass ionomer cement to restore deciduous teeth. Non-cooperative children were referred to treatment under general anesthesia by 71.5% of the respondents. Disabled patients were treated by 60.5%. Every fourth dentist used child immobilization and every sixth expressed an interest in pedodontics courses. Conclusions. The vast majority of dentists treat children, including the youngest up to 6 years old, as well as disabled children. Almost every dentist performs preventive treatment. There is a strong correlation between the age of the dentist and the type of treatment used. Uncooperative children are referred for treatment under general anesthesia. It is possible to overcome dentophobia in young patients thanks to properly planned adaptation visits.

The oral health status and dental treatment needs of children affected by osteogenesis imperfecta – part I

Introduction. Osteogenesis imperfecta is an inherited disorder of the connective tissue. Which in most cases, is caused by mutations in the genes encoding collagen type I. Apart from clinical features, there are characteristic dental aberrations. Aim. The purpose of this research was the assessment of the condition of teeth and therapeutic needs of children with the congenital brittle bone disease. Material and methods. The questionnaires with patient’s parents, consisting medical history and dental history were performed. The intra-oral examination included the condition of the dentition, the presence of dentinogenesis imperfecta, malocclusion, the assessment of the attrition index and dmft/DMFT index. Results. 62 patients with osteogenesis imperfecta were examined – 32 boys and 30 girls. There were normal eruption times of deciduous (48 patients – 77.42%) and permanent teeth (34 patients – 82.93%) reported in the majority of the patients with OI. In most cases bad eating and hygienic habits were observed. Dentinogenesis imperfecta in deciduous and permanent teeth was reported mostly in type III of OI. dmft/DMFT index among children with OI were low in comparison to the population studies of corresponding age groups. Conclusions. Despite bad eating and hygienic habits as well as pathological structure of dentition of patients with the congenital brittle bone disease, caries index among these children were low in comparison to the population studies of corresponding age groups.

Treatment methods of deep caries in immature permanent teeth

Caries was qualified by UN as non-communicable disease – NCD. It can be avoided by preventive measures. Especially, deep caries lesions in immature permanent teeth constitute a serious clinical problem for contemporary pediatric dentistry. It is caused by a different anatomical and histological structure compared to mature permanent teeth. The aim of the study was to present contemporary methods of deep caries treatment in histologically and morphologically immature teeth with currently used materials. The literature review was based on Pubmed and Elsevier databases (2005-2018) and two articles out-of-range. The search criteria were: “caries”, “remineralization”, “indirect capping” and “immature teeth”. Development in medicine and biomedical science leads to creating more modern procedural records when it comes to deep caries treatment. They are based on minimally invasive dentistry. Development of bioengineering enables creation of more biocompatible materials which do not have irritating influence on dental pulp. These materials allow deeper remineralization of dental tissues. Deep caries treatment still involves usage of restorations with calcium hydroxide, zinc oxide with eugenol and glass ionomers. Good cooperation with patient, prospects of early diagnosis, and regular examinations of treated teeth have great impact on success of treatment. Further research on methods of diagnosis and treatment needs to be carried out. They should allow regeneration of early qualitative changes to avoid quantitative damages in a tooth’s hard tissue.

Idiopathic left-sided buccal abscess – a case report

Abscesses of the head and neck region account for an important clinical problem. They are most frequently of dental origin (mainly due to carious changes or state after dental interventions), especially when located in the buccal region (about 1/3 cases). The correct diagnosis is the key to determine the proper treatment protocol: systemic antibiotics and/or surgical procedure (usually drainage) in order to prevent further progression of the inflammatory process (including transgression of the blood-brain barrier). Ultrasound is a sufficient first line diagnostic tool for the changes localized in the superficial spaces. Additionally, it is helpful in monitoring the effectiveness of the introduced treatment. Alternatively, MRI could be used, enabling more thorough 3D visualization of the affected areas and tissues differentiation, but due to its cost and availability its role is restricted, especially in monitoring (when examination needs to be repeated regularly). Below we would like to present a case report of our teenage patient, who developed idiopathic left-sided buccal abscess.

Analysis of tracheotomy indications in children treated in the Department of Pediatric Otolaryngology of Medical University of Warsaw between 2015-2020

Introduction. Tracheostomy is the opening enabling breathing without the larynx, throat and mouth, which aims to restore and sustain airway patency. Indications of this intervention have changed over the years. The selection of patients for this procedure, as well as the moment, when it has to be performed are still not clearly defined. Those require a multidisciplinary approach and a standardized protocol. More analyses are necessary to create widely available guidelines. Aim. Analysis of tracheotomy indications in children performed between 2015-2020 in the Department of Pediatric Otolaryngology, Medical University of Warsaw. Material and methods. During the 5-year period (2015-beginning of 2020) 64 children with tracheostomy were treated in the Department of Pediatric Otolaryngology. Groups of tracheotomy indications were separated after a retrospective overview of the 64 cases from our clinic and after manual and electronic search through medical databases for indications for tracheotomy in previous years. Then patient’s data (age at the time of surgery, concomitant diseases and/or disabilities) was collated, which allowed to present the characteristics of children and compare the tracheotomy indications in previous years with the results of this research. Results. Tracheotomy was performed among 64 children. The median patients’ age was 0.5 year and the average age was 4.26 years. Our patients were affected by many various conditions. We divided them into 8 main groups: congenital malformation syndromes, trauma, vocal folds palsy, perinatal complications, infection, autoimmune diseases, oncological and post-intubation subglottic stenosis. Currently, congenital malformation syndromes turned out to be the most common indication for tracheotomy. Conclusions. 1. Tracheotomy indications in children have changed over the years. 2. There is increasing number of tracheotomies due to various congenital defects. 3. New groups of tracheotomy indications among children are autoimmune diseases and injuries; those groups have the highest average of age. 4. The result of effective pharmacological treatment of laryngeal hemangiomas is the lack of tracheotomy performed in this indication. 5. The number of tracheotomies performed due to post-intubation stenosis has decreased. 6. Vocal cords palsy as an indication for tracheotomy in children is most often a complication of cardiac surgery due to congenital heart defect; this group of patient’s is the youngest among all. 7. Viral infections are still the tracheotomy indication among children.

Computed tomography-assisted morphological assessment of the components of the temporomandibular joint – a pilot study

Introduction. Temporomandibular joint (TMJ) disorders are a common diagnostic problem. No universal radiological parameter of the analysis was introduced. Aim. Comparison of values of selected radiological parameters between asymptomatic patients and those with the TMJ arthropathy. Material and methods. Retrospective analysis of CT scans of patients of the Department of Dental and Maxillofacial Radiology and the Department of Cranio-Maxillofacial Surgery, Oral Surgery and Implantology, Medical University of Warsaw. Patients were divided into two groups: 1. without TMJ disorders, 2. with TMJ dysfunction symptoms. Following parameters of heads of mandible were analyzed bilaterally: shape, anteroposterior and lateromedial dimensions, the distance between lateral points of both heads (HL-HR), distance between a head and the mandibular fossa. The angle between the horizontal axis of the head of mandible and the line drawn by posterior points of heads of mandible was measured. Results. The most common type of the head of mandible in group 1 (40 patients; 13 women, 27 men) was convex (14 patients), in group 2 (16 patients; 14 women, 2 men) – plane (8 patients). Significant differences between groups were obtained for: GL-GP (group 1 – 120.35 mm, group 2 – 115.4 mm), dimensions of heads of mandible: lateromedial – 19.7 mm, 18.14 mm, anteroposterior – 8.03 mm, 7.04 mm for group 1 and 2, respectively. Conclusions. Computed tomography allowed for an accurate analysis of the TMJ components. Measurements of structures discussed in this work should be a part of the diagnosis of patients with TMJ dysfunction.

The first dental visit of a 3-year-old child. Reasons and socioeconomic determinants

Introduction. Early childhood caries affects 41.1% of Polish 3-year-olds. If left untreated, it can affect overall health, cause local infections, and reduce quality of life. Objective. To evaluate the first dental visits of children in the first three years of life in the Warsaw agglomeration. Material and methods. A questionnaire survey of parents/legal guardians of children aged 12 to 36 months, living in the Warsaw agglomeration was conducted. The questionnaire included questions about socioeconomic factors (level of education and age of both parents, number of children in the family, economic level of the family) and the child's first dental visit (age and reason for visiting). Statistical analysis was performed on data obtained from correctly completed questionnaires (Spearman's rank correlation coefficient to assess the relationships between selected variables and using the chi-square test to compare the percentages, p <0.05). Results. 496 out of 827 returned questionnaires were included in the analysis. The mean age of the children was 24.16 ± 6.92 months. 249 (50.2%) children visited the dentist. The most common reasons for the first visit were: dental check-up (47.4%), tooth trauma (19.7%) and the presence of carious lesions (13.3%). The first visits due to trauma were usually reported by children aged 12-18 months. Only 57 (11.5%) children visited the dentist in the first year of life. Among them, the most frequent reason for the visit was check-up (34; 6.9% of the entire study group). There was an increasing frequency of the first dental visit with the age of the child, as well as a negative correlation between the level of education of parents and the visit caused by toothache, abscess or the presence of carious lesions. Tooth decay as a reason of first dental visit was also associated with the lower age of the mother. Conclusions. The recommendation to schedule the first dental visit in the first year of a child's life is not satisfactorily implemented in Poland. It is necessary to disseminate recommendations among the medical personnel providing pediatric and dental care.

The foreign bodies in lower respiratory tract in pediatric patients treated in referral academic department of pediatric otolaryngology

Introduction. Foreign bodies in lower respiratory tract for many years are big challenge for otolaryngologists. These objects could present variability of clinical symptoms. Increase of infection and mortality due to delay of accurate diagnosis. Interview is the most important part of examination of patient with suspected foreign body in airways. Any suspicion of aspiration is qualification to diagnostic bronchoscopy. Aim. This paper refers occurrence assessment, clinical course, diagnostic process and treatment of the pediatric patients with suspected foreign body in lower respiratory tract hospitalized in referral Academic Department of Pediatric Otolaryngology. Material and methods. Retrospective analysis of 74 patients with suspected foreign body in lower respiratory tract, who were hospitalized in Clinical Department of Pediatric Otolaryngology in Warsaw Medical University in 2016-2018. Analysis includes demographic data, occurrence frequency, localization and the type of foreign body, diagnostic process and treatment. Results. This study includes 42 boys (57%) and 32 girls (43%) in age of 8 months to 16-year-old. The episode of choking occurs in interview in 71 patients (96%). Foreign bodies in lower respiratory tract were confirmed and evacuated in bronchoscopy procedure in 44 cases (59.5%). In 30 cases (40.5%) there were any foreign body in airways. The most common group of patients admitted to Clinic with suspected foreign body in airways was children in age between 1 to 3-year-old, which accounted for 22 cases (50%). Coughing was the most commonly reported symptom (54.5%), wheezing (27.5%) and dyspnea (15.9%). Twenty-three patients were presenting wheezing and whirring in physical examination. Air trap found in thorax x-ray were in 22 patients (45%). The right main bronchus was the most common place of foreign body retention – 22 patients (50%). The organic foreign bodies were in 32 cases (72.7%) and non-organic in 12 (27.3%). The nuts were the most common foreign body aspirated to airways. Conclusions. Foreign body aspiration should be suspected in every patient, not only those with choking episode but also with patients who presents ambiguous change in physical examination and x-ray scan. In pediatric patient with suspected foreign body in lower respiratory tract, in every time the bronchoscopy is needed to be done, even in patients with no abnormalities in physical examination and x-ray scan.