The Agency for Toxic Substances and Disease Registry convened a workshop in Atlanta, GA, that evaluated approaches and methods to ascertain whether there are neurobehavioral sequelae to children and adults exposed to hazardous substances in the environment. This article, developed from that workshop, addresses the feasibility of employing extant neurobehavioral tests to screen pediatric populations. A matrix lists basic functions to be assessed during eight developmental periods ranging from birth to high school. The best of these neurobehavioral tests for pediatric populations and the types of assessment tools that are still needed are discussed. We make 10 specific recommendations to establish a hazardous substances neurobehavioral screen for pediatric populations, including appointing a review panel, developing a structured questionnaire, convening a conference on design and analysis, addressing minority and socially disadvantaged populations, coordinating adult and child assessment methods, information sharing among Federal agencies, baseline data, methodology research, research associated with hazardous worksites, and establishment of a pediatric databank.

Adolescent↗

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Attentional correlates of dentin and bone lead levels in adolescents.

In an effort to determine whether specific aspects of attention are impaired by lead, the performance of 79 subjects (aged 19 and 20 y) on a neuropsychologically based battery of tests of attention was examined in relation to lead levels in deciduous teeth (dentin), current blood, and tibia and patella bones measured by K-X-ray fluorescence. Dentin lead levels averaged 14 micrograms/g. Most bone lead levels were less than 10 micrograms/g. Dentin lead levels were related inversely to scores on two of four attention factors: focus-execute (ability to select and respond to critical information) and shift (ability to shift focus adaptively). Few significant associations were observed between bone lead levels and performance. Five individuals with the ALA-D 1-2 isozyme phenotype tended to achieve more optimal scores. Executive and self-regulation functions may be among the cognitive skills targeted by lead.

Adolescent↗

PubMedDate not supplied

Patterns of use of inpatient pediatric dental consultation services.

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Child↗

PubMedDate not supplied

The effect of radiotherapy in the treatment of retinoblastoma upon the developing dentition.

Two patients who received supervoltage x-ray external beam irradiation for treatment of retinoblastoma by standard techniques showed interference with the root formation of the maxillary deciduous molars and abnormalities of crown and root formation of the permanent maxillary molars. Both patients showed a relative maxillary retrognathism thought to be related to radiation effects on maxillary bone growth. Simulation of lateral radiation portals with subsequent beam shaping using an appropriate block placed in the radiation beam is suggested as a means to eliminate the dental complications of radiation therapy for retinoblastoma.

Child↗

PubMedDate not supplied

Periodontitis in the child and adolescent.

Early onset periodontitis (EOP) which affects individuals thirty-five and younger is characterized by a rapid rate of bone loss and disease progression with defects in host response and a specific etiological microbial flora. Within this classification, there are three subsets of the disease: prepubertal periodontitis, juvenile periodontitis, and rapidly progressive periodontitis. The characteristics of each disease are described along with illustrative cases that will help clinicians diagnose EOP in their patients. Currently prescribed treatment modalities and guidelines from the literature are also discussed in this paper. EOP may represent a complex set of diseases that are likely to be reclassified as further advances in microbiological and genetic research are made. Clinicians should be aware of such changes in order to diagnose, treat, and refer their patients for comprehensive care.

Adolescent↗

PubMedDate not supplied

Reports of pain by children undergoing rapid palatal expansion.

PURPOSE: This study described and quantified the prevalence, timing, and intensity of pain during the expansion phase of rapid palatal expansion (RPE) in children and investigated whether pain was related to age, sex, or rate of expansion. METHODS: Ninety-seven children, 38 males and 59 females, between the ages of 5 to 13 years (median 7.7 years) undergoing RPE procedures with the Hyrax, Dentaurum, Newtown, PA, appliance were surveyed. The appliance was expanded with either one or two turns (1/4 mm/turn) per day based on the provider's preference. The child's pain response was measured no more than 5 minutes after each turn for the entire period of expansion using both the Facial Pain Scale and the Color Analog Scale. RESULTS: Ninety-eight percent of the children reported at least some pain during RPE. The highest levels of pain were reported during the first 10 turns with the greatest intensity during the first 6 turns and a steadily decreasing amount of pain thereafter. Pain medication was taken after 7% of the expansion turns in the study with the majority of children taking the medication during the first 6 turns. Forty-eight percent of the children took pain medication at least once during the expansion phase of RPE. There was no difference in either reported pain or use of pain medication based on age, sex, or stage of dentition. During the first 10 turns, children whose rate of expansion was two turns/day were more likely to report pain and take pain medication than children whose rate of expansion was one turn/day, thereafter there were no differences. CONCLUSIONS: The vast majority of children undergoing the active phase of rapid palatal expansion with a Hyrax appliance report pain. The pain generally occurs during the initial phase of expansion and diminishes thereafter, with two turns/day resulting in reports of pain greater than those expanding only once/day.

Adolescent↗

PubMedDate not supplied

The influence of medical history on restorative procedure failure rates following dental rehabilitation.

PURPOSE: This study evaluated the association between patient medical history and the outcomes of restorative procedures performed under general anesthesia. METHODS: The dental records of patients who had dental rehabilitation under general anesthesia at Children's Hospital in Boston (1990-1992) and Children's National Medical Center in Washington, DC (1994-1998) were examined. Data regarding restorative outcomes and the association between patient medical history and restorative failures were assessed using chi-square tests with correction for continuity. T-tests were performed on parametric data. RESULTS: Significantly higher stainless steel crown failure rates were found in young patients diagnosed with developmental disabilities when compared to patients without such disabilities (p<0.025, x2 = 5.50). However, there was no difference in the failure rates of SSCs in young patients with significant medical histories compared to patients without significant medical histories. Regarding amalgam and composite restorations, there were no differences in failure rates among patients with and without significant medical histories, including developmental disabilities. CONCLUSIONS: SSC failures were higher in young children with developmental disabilities compared to children without these disabilities.

Adolescent↗

PubMedDate not supplied

Antecedents and correlates of hypoplastic enamel defects of primary incisors.

Four hundred and fifty-five exfoliated primary incisors were obtained from children whose mothers provided information about a wide range of pre-, peri-, and postnatal characteristics of both the mother and child. These teeth then were examined for the presence of hypoplastic enamel defects (HED). The basic form of the null hypothesis tested was that children who had HED of a primary incisor did not differ from those who did not have such a defect. Of the primary incisors examined, 18.5% had HED (25.0% maxillary and 10.1% mandibular). The following items were found to be associated most strongly (P less than 0.003) with an increase in a child's risk of developing HED; 1) maternal antenatal history of smoking, higher prepregnancy weight, and failure to obtain prenatal care during the first trimester; 2) prematurity, low birth-weight and their associated correlates; and 3) postnatal measles infection. Left-handedness, maternal tea and Tylenol (McNeil Consumer Products Co., Fort Washington, PA) consumption, and failure to screen for undue lead burden were associated less prominently (P less than 0.05) with HED prevalence. Season of birth and serum and dentin lead levels were not related to the prevalence of HED. Many of these risk factors are also covariates of low socioeconomic status such as suboptimal nutrition and increased risk of infection. Additional investigation is needed to delineate the associations between specific pre- and perinatal nutritional and infectious factors, socioeconomic status, and HED development.

Child, Preschool↗

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Risk factors associated with atypical root resorption of the maxillary primary central incisors.

Maxillary occlusal radiographs of 233 children between 42 and 60 months old were examined for the presence or absence of atypical root resorption (ARR). In addition, the dental records of these children were examined to determine if an association existed between ARR, oral habits, documented trauma and overjet. Thirty-three (14.2%) of the patients had radiographic evidence of ARR of either maxillary primary incisor. Children with a positive history of both trauma to the incisors and oral habits had a statistically higher prevalence of ARR than those without either finding (P = .03). ARR was more prevalent as overjet increased, independent of trauma, and oral habits (P = .03). Furthermore, as the number of risk factors (large overjet, documented trauma, and oral habits) increased, the likelihood of developing ARR also increased.

Analysis of Variance↗

PubMedDate not supplied

Macroscopic enamel defects of primary anterior teeth--types, prevalence, and distribution.

A total of 40.7% of 509 exfoliated primary anterior teeth from children who were healthy products of uneventful pregnancies exhibited at least one macroscopic enamel defect. Twenty percent of the teeth exhibited hypoplastic defects (HD), 12.4% exhibited white-cream opacities (WCO), and 9.8% exhibited yellow-brown opacities (YBO). Slightly more than a third (33.6%) of the teeth had defects we considered to be developmental enamel defects (DED). The occurrence of DED did not vary with gender, side of mouth, individual tooth types, or racial background. DED occurred with increased frequency on maxillary teeth, facial surfaces, and the middle third of affected surfaces. These locations have thicker enamel than other sites and may be more susceptible to insult if vulnerability is a function of metabolic demand of the rapidly secreting ameloblasts. Twenty-five per cent of the maxillary incisors and 10.1% of the mandibular incisors exhibited HD whose locations coincided with enamel forming at birth. A third (33.3%) of the canines exhibited HD, which occurred most commonly in the middle third of the facial surfaces. These defects are believed to occur approximately six months postnatally and may be primarily due to mechanical trauma. YBO most commonly occurred on the middle third of the facial surfaces, while WCO on the gingival third. Neither YBO nor WCO followed a chronologic pattern.

Child↗