For some patients, a visit to the dental office for treatment can be an effortless experience. Unfortunately, for other patients it can be a terrifying and traumatic experience that can be unbearable. Fear of the dentist has hindered how children receive care at a dental office and determines the quality dental service a patient receives. It is important for dentists to develop a strong relationship with their patient in order to deliver high quality and effective treatment and to also increase their chances of returning to the dentist for annual checkups to ensure healthy oral habits. There are numerous factors that contribute to fears in a dental office. Sensory stimuli are one of the reason patients have major anxiety at their appointments. In a dental office there are many sensory stimuli. These include bright florescent lights, touch in and around the mouth, as well as the taste and smell of oral care products which can trigger a patient’s anxiety and cause them to have a negative experience. While in a dental office, patients also feel a sense of insecurity when laying in a dental chair in a supine position and giving all of their control to the dental provider. This increases negative responses such as moving, crying, kicking, etc., which makes it difficult for dentists to provide precise, accurate and successful treatment. Dental fear and anxiety start from as young as two years old. Creating a rapport during a child’s first dental visit can minimize their fear and will most likely make additional visits less stressful. In addition, a friendly relationship will help the patient gain trust for their dentist and will help children adapt to specific stimuli such as the sight of anesthetic needles, drilling sounds and sensation of the dental hand pieces which are aspects in dentistry known to increase anxiety. The fear of the dentist amplifies for children with special needs patients, specifically those with autism spectrum disorder (ASD). Autism is characterized by insidious disability in communication, social interaction, and using language and abstract concepts. Parts of the brain such as the cerebellum and limbic system are known to have deformities, which translate to severe behavioral issues. Dental care for these patients can be difficult because they are unable to communicate their discomfort or issues they experience during treatment. Therefore, it may be difficult for a dental provider to understand what they need at the time of treatment. In addition, dental care may also be difficult to access for patients with ASD because dental students are most likely not exposed to patients with disabilities when studying dentistry and may be hesitant to provide care to these patients when they graduate and are practicing. It is vital to overcome barriers on how to successfully treat not only children and adults, but specifically patients with autism spectrum disorder, especially with the prevalence rates of ASD rising. There are many techniques available to help patients overcome their fears and anxiety in a dental setting. Children often enjoy pictures and screens with different shapes and colors to ease their anxiety. By incorporating pictures and visual techniques this can be a way to calm a child and increase cooperativity so that they can not only get the required care, but also allow the dentist to provide outstanding treatment. In addition, dental providers may opt to work closely with occupational therapists and other clinicians that are more familiar and knowledgeable on patients with ASD. This way the dental provider gets proper training and advice on how to treat patients with behavioral and cognitive difficulties.

INTRODUCTION: While the progressive joint disease osteoarthritis (OA) affects a significant portion of the US population, there remain a few therapeutic options. Identifying agents that promote cartilage regeneration and protect against cartilage damage could provide breakthroughs for OA prevention and treatment. However, there are no chondroprotective agents approved for clinical application. In the previous studies from our lab, we showed that lysyl oxidase like-2(LOXL2) is elevated in the regenerative response during fracture healing in mice and has a critical role in chondrogenic differentiation. Indeed, LOXL2 is an anabolic effector that attenuates proinflammatory signaling in OA cartilage of the TMJ and knee joint, and induces chondroprotective and regenerative responses (Alshenibr, Tashkandi et al. 2017). The goal of the present study is to evaluate the role of LOXL2 in post-traumatic OA in destabilized medial meniscus mouse (DMM) model. MATERIALS AND METHODS: The approval to obtain human tissues was obtained from Institutional Review Board, and animal experiments were approved by Institutional Animal Care and Use Committee, Boston University. In order to evalute loss of LOXL2 function, Tamoxifen inducible cartilage-specific LOXL2 mice were generated. At 5-6 months of age, the destabilized medial meniscus (DMM) surgeries to induce OA was performed (n=48 mice).Tamoxifen injection was administered to delete LOXL2 (LOXL2-cKO) and vehicle injection (LOXL2-VC) was performed, The gain of LOXL2 function were performed in by administering intra-articular injections of adenoviral-LOXL2 (Adv-RFP-LOXL2) and respective control (Adv-RFP-Empty) followed by an treadmill exhaustion test, allodynia, immunostaining, safranin-O staining, and RT-qPCR to determine knee joint functional and structural analysis. RESULTS: The analysis of data from LOXL2-cKO group compared to the respective control (LOXL2-VC) showed that LOXL2 and aggrecan have reduced levels in DMM LOXL2-cKO mouse model. The comparison of sham surgery group showed LOXL2-cKO has reduction of ACAN and LOXL2 compared to LOXL2-VC . Thus, LOXL2-cKO mice with DMM-operated knee joint has severe changes compared to LOXL2-VC. Safranin-O-staining for proteogylcan and immunostaining and its quantification data shows that DMM surgery in LOXL2-cKO knee cartilage reduced proteoglycan, aggrecan, LOXL2, lubricin whereas elevated MMP13 and IL-1 β compared to LOXL2-VC. In another study the role of adenovirus delivered LOXL2 in the knee joint, the treadmill exhaustion test showed that the treadmill running for time and distance are impaired in the group with Adv-RFP-EMPTY injected group and rescued in Adv-RFP-LOXL2 injected group. CONCLUSION: LOXL2 appears to protect mice from DMM-OA-induced impaired functional changes. Cartilage-specific deletion of LOXL2 shows defects in proteoglycan and aggrecan expression. As expected, LOXL2 overexpression restored knee joint function and impaired structural changes. Earlier studies from our laboratory showed that LOXL2 could have interaction with epigenetic regulators such as lysine-specific demethylase 1. We showed in the current study that LOXL2 could restore structure and function in Lsd1 knockout mice knee joint, and the mechanism must be through LSD1. We have identified novel role of LOXL2 in the mechanism of OA; our studies will provide more information for therapeutic application.

Systematic reviews comparing the anesthetic efficacy of articaine and lidocaine for dental procedures in pediatric patients have been previously published in 2018 and 2020. However, none of them compared the effect of articaine and lidocaine on pain perception and child’s behavior during dental treatment. Moreover, several new randomized clinical trials (RCTs) have been published recently. Hence, the goal of this project was to conduct an updated systematic review to evaluate the evidence available on the effects of articaine on pain perception and behavior when used as a single buccal infiltration in maxilla or mandible among children. The search strategy was formulated according to the PICO methodology following the guidelines outlined by the PRISMA and Cochrane Handbook for Systematic Reviews of Intervention studies. RCTs published between the years 2000 – 2022 were searched in electronic databases, such as PubMed, Cochrane CENTRAL Register of Controlled Trials, EMBASE, and Web of Science. Initial search revealed 20819 articles, from which 270 articles were screened for inclusion. Finally, 24 articles were eligible to be included in this review. Results from self-reported pain perception and behavior scales following different dental procedures in pediatric patients were evaluated among the selected studies. Although there was a clear variability in the statistical significance of the results, it was evident that articaine is useful in better management of pediatric patients during dental procedures.

PURPOSE: To systematically evaluate the available evidence regarding craniofacial morphology and dental characteristics in children and adolescents with sleep disorders. METHODS: A systematic electronic literature search was conducted on May 3, 2022. The Cochrane Library, MEDLINE (PubMed), Embase, CINAHL, Web of Science and Dentistry and Oral Sciences Source were accessed. Hand searching of reference lists and study inclusions were established. Data extraction and quality assessment were carried out for each included study. Significant findings of each study were reported. RESULTS: A total of 18,615 papers were identified, and 4 additional studies with manual searching. Fifty-two papers were included. Obstructive sleep apnea (OSA) was found to be associated with increased lower anterior facial height in 18/47 studies, mandibular retrusion in 16/47 studies, narrow maxilla in 9/47 studies, steep mandibular plane angle in 8/47 studies, cross bite in 8/47 studies, deep palatal height in 6/47 studies, inferior hyoid bone position in 5/47 studies, overjet in 4/47 studies, and longer or larger soft palate in 6/47 studies. Sleep bruxism (SB) was found to be associated with increased incisal overjet in 3/5 studies. CONCLUSION: Within the limitations of the studies included, the most common craniofacial morphologies found in association with OSA children were increased lower anterior facial height, mandibular retrusion, narrow maxilla and steep mandibular plane angle, while the most common dental characteristics found in association with OSA children were cross bite, deep palatal height, overjet and longer or larger soft palate.

PURPOSE: To review the current evidence on the prevalence and management of oral health conditions among children with special health care needs (CSHCN). METHODS: A scoping review was selected as the most appropriate method of review for our main objective. The research question was defined as: For Special Health Care Needs Children, what is the prevalence of oral health conditions and how are the Special Health Care Needs Children be managed in dental setting? RESULTS: A total of 247 Studies were identified as of potential relevance. Following removal of duplicates (n = 11), 236 articles were screened in detail and 17 studies met the inclusion criteria. The articles included in this scoping review were published between 2000 and 2021. The ages ranged from birth to <21 years. The types of disabilities among children with special needs discussed in the chosen studies are Down syndrome, Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), Intellectual Disability (ID), Cerebral Palsy (CP), Ectodermal Dysplasia (ED), Asthma, Diabetes, Saethre-Chotzen Syndrome (SCS), Idiopathic Short Stature (ISS), Russel-Silver Syndrome (RSS), Growth Hormone Deficiency (GHD), Visual and Auditory Impairments. CONCLUSION: The results indicated that oral health conditions and poor oral health is worse among special needs children compared to children without special health care needs. This is a vital matter that should be addressed and considered by health care professionals and caregiver to help CSHCN to lead a better quality of life.

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This paper demonstrates the need for expanding the Massachusetts dental workforce to include the Advanced Dental Hygiene Practitioner (ADHP), a model successfully used globally for many decades in other countries, to better serve its underserved populations. The underserved population includes children, the elderly, minorities, people with disabilities, and MassHealth members who suffer the most severe consequences from the lack of dental access. Although the first dental therapist was not employed in the United States until 2005 in Alaska, an attempt to increase access by introducing a new member to the dental workforce dates back to 1949 in Massachusetts. However, Massachusetts has yet to include any variation of mid-level providers as part of their dental workforce despite several attempts due to continued opposition from the American Dental Association and organized dentistry. Incorporating ADHPs into the dental care delivery system would help increase access to individuals while lessening the burden placed on the state’s principal dental safety net to those who 1) cannot find a dental provider in their area, 2) cannot find a dentist who accepts Medicaid and/or 3) cannot afford dental care. Evidence has long indicated that dental therapists provide cost-effective, safe, quality dental care.

AIM: To investigate the effect of different definitions of periodontitis, using partial-mouth measurements instead of full-mouth ones, and unmeasured confounders on periodontitis’ associations with diabetes and cardiovascular disease (CVD). METHODS: Adults 30-79 years with ≥1 or ≥2 teeth in the 2009-2014 National Health and Nutrition Examination Survey for study 1 or 2, respectively. For study 1: periodontitis was defined using different thresholds while for study 2: it was defined using the CDC/AAP 2007 categorical definition and continuous measures were estimated using mean clinical attachment loss (CAL), Estimates of periodontitis were derived based on the full-mouth protocol and three partial-mouth protocols (PMPs), including the Ramfjörd teeth, the Community Periodontal Index for Treatment Needs teeth, and the random half-mouth. Effects of exposure and outcome misclassification of periodontitis were evaluated in relation to diabetes. Diabetes and CVD were ascertained using self-report. Percent relative bias (%RB) was calculated by comparing the odds ratios/beta estimates obtained from the full-mouth and PMPs. Study 3 used the dental longitudinal study to look at the effects of simulated unmeasured confounders on survival analysis in the periodontitis-diabetes/CVD and diabetes-periodontitis associations. RESULTS: For study 1: the effects of clinical severity on the odds ratios were association dependent. Clinical measures and extent did not depend on the association. For study 2: percent relative bias was generally less than 10% for the severe categories while it tended to exceed 10% for moderate categories. Mean clinical attachment loss resulted in minimal bias. For study 3: presence of one source of unmeasured confounding (one confounder) showed that the diabetes-periodontitis association was robust to it unlike the periodontitis-diabetes/CVD associations. CONCLUSION: These sources played a role in the periodontitis-diabetes, periodontitis-CVD, and diabetes-periodontitis associations. The associations were affected differently by each source. Some of these sources of systematic errors may change the conclusions of the associations. / 2021-10-10