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With diagnostic and therapeutic advances, over 80% of children diagnosed with cancer become long-term survivors. As the number of childhood cancer survivors (CCS) continues to increase, dental practitioners become more likely to have CCS among their patients. CCS may develop late complications from damage caused by their cancer treatment to endocrine, cardiovascular, musculoskeletal, and other organ systems. These complications may surface decades after the completion of treatment. Adverse outcomes of childhood cancer treatment frequently involve oral and craniofacial structures including the dentition. Tooth development, salivary gland function, craniofacial growth, and temporomandibular joint function may be disturbed, increasing oral health risks in these individuals. Moreover, CCS are at risk of developing subsequent malignancies, which may manifest in or near the oral cavity. It is important that dental practitioners are aware of the childhood cancer history of their patients and have knowledge of potential late complications. Therefore, this narrative review aims to inform dental practitioners of late oral complications of cancer treatment modalities commonly used in pediatric oncology. Furthermore, selected common non-oral late sequelae of cancer therapy that could have an impact on oral health and on delivering dental care will be discussed. [ABSTRACT FROM AUTHOR]

Aim: An individual with a blood–injection–injury (BII) phobia often avoids exposure to triggers, such as blood tests and clinic appointments, leading to potentially serious health complications. This population‐based study examined the prevalence, stability and course of BII phobia in children and adolescents. Methods: The data came from the Trondheim Early Secure Study, conducted from 2007 to 2018. All children born in Trondheim, Norway, in 2003 and 2004 were invited to attend. Clinical interviews were conducted by trained personnel to assess BII phobia in 1042 children (51% female) every 2 years from 4 to 14 years of age. Latent growth curves and logistic regression analyses were used in the data analysis. Results: Just under 20% of the cohort experienced a BII phobia at least once, with no significant sex differences. The prevalence of BII phobias increased from 3% at 4 years of age and peaked at about 8% at 10 years of age, before levelling off. The two‐year stability increased as 12–14 years of age approached. Conclusion: The prevalence of BII was affected by age, but not sex. Early BII phobias often recede with time, but children may need treatment if they persist from 8 years of age. [ABSTRACT FROM AUTHOR]

Purpose: Oral mucositis is a common complication for patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and causes pain and difficulties in functions like eating and swallowing, resulting in lower quality of life and greater need of treatment with opioids and parenteral nutrition. This prospective multicenter study focused on pediatric recipients of HSCT in the neutropenic phase concerning oral complications, timing, severity, and patient experience. Methods: The cohort comprised 68 patients, median age 11.1 years (IQR 6.3) receiving allogeneic HSCT at three clinical sites. Medical records were retrieved for therapy regimens, concomitant medications, oral and dental history, and subjective oral complaints. Calibrated dentists conducted an oral and dental investigation before HSCT. After HSCT graft infusion, study personnel made bedside assessments and patients filled out a questionnaire once or twice a week until neutrophil engraftment. Results: We followed 63 patients through the neutropenic phase until engraftment. 50% developed oral mucositis of grades 2–4. Peak severity occurred at 8–11 days after stem cell infusion. Altogether, 87% had subjective oral complaints. The temporal distribution of adverse events is similar to the development of oral mucositis. The most bothersome symptoms were blisters and oral ulcerations, including mucositis; 40% reported severe pain and major impact on activities of daily living despite continuous use of opioids. Conclusion: This study highlights the burden of oral complications and their negative effect on the health and quality of life of HSCT recipients. [ABSTRACT FROM AUTHOR]

Background: The etiology of dental fear (DF) is multifactorial and involves other contributing factors than dental traumatic experiences. Aim: To study, among adolescents, associations between DF and exposure to child physical abuse (CPA), intimate partner violence (IPV), and bullying. Design: We extracted data from a population‐based survey of 4977 adolescents who were 15–17 years old in 2017. The questionnaire queried socioeconomic background factors, DF, self‐perceived oral health, general health, and exposure to child abuse. To estimate associations between DF and exposure to child abuse, we used multivariate logistic regression analysis. Results: Overall, 8.2% reported DF, girls (10.5%) reported DF significantly more often than boys (5%), and adolescents not identifying themselves as girl or boy reported the highest prevalence of DF (25.5%; p <.001). 15.3% had been exposed to child physical abuse; 11.1%, to IPV; and 11.2%, to bullying. Experiences of IPV and bullying, but not physical abuse, were statistically significantly associated with DF. The odds of developing DF for adolescents exposed to any type of violence was 1.9 times the odds for adolescents with no exposure to child abuse. Conclusion: Exposure to violence is associated with dental fear in adolescents. [ABSTRACT FROM AUTHOR]

Aim: To study the association of parental country of origin—expressed as low‐, medium‐ and high‐Human Development Index (HDI) countries—with caries experience in children of immigrant families in Stockholm. Methods: This registry‐based cohort study included all children born in 2000–2003 who resided in Stockholm County, Sweden, at age 3 years (n = 83,147) with follow‐up at 7 years of age. A logistic regression was performed for the multivariate analysis with adjustments for socio‐demographic factors. Results: After adjustments, logistic regression analyses revealed that, compared with Swedish children of the same age, the risk of caries was highest when the immigrant parents originated in a medium (OR 4.22 (95% CI 3.99:4.47)) or low (OR 2.80 (95% CI 2.56:3.06)) income country background at age 7 years, but was increased also for high‐income country background, OR 1.77 (95% CI 1.52–2.05). Furthermore, the risk of presenting with caries experience at age 7 years increased for all children in the 1st (lowest) household income quintile in the host country Sweden. Conclusion: This study shows that the developmental level of the parental country of birth as well as the family socioeconomic position in Sweden influence the risk for caries development in their children. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular disorders (TMDs) are multifactorial, and high levels of stress seem to increase symptoms. The association with exposure to violence has not been explored in adolescent populations. Objective: To examine the association of self‐reported symptoms of temporomandibular pain and jaw dysfunction with child physical abuse, intimate partner violence, forced sexual intercourse, and bullying victimisation. Methods: An epidemiological, cross‐sectional, school‐based study was conducted in Olinda, northeast Brazil. The sample comprised 2,431 adolescents aged 14–19 years. TMD‐related symptoms and exposure to violence were assessed with questions from the 3Q/TMD screener and queries on exposure to different forms of violence. Multilevel logistic regressions were conducted to evaluate how 3Q screen‐positive responses are associated with self‐reported exposure to violence. Results: Self‐reported TMD‐related symptoms had a prevalence of 40.5%. Significantly more females than males screened positive to all 3Q/TMD questions (p <.001). Adolescents experiencing intimate partner violence (p =.012) and bullying (p <.001) had significantly higher odds of 3Q positive responses than those who reported no exposure to violence. Significant associations of TMD‐related symptoms with forced sexual intercourse (p =.014) and with bullying (p =.007) were observed. Conclusion: Adolescents with self‐reported symptoms of temporomandibular pain and jaw dysfunction were significantly more often exposed to some type of violence. The number of adolescents reporting TMD‐related symptoms increased in a dose‐response manner with the number of violence forms the individual had experienced. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether treatment with tacrolimus plus sirolimus (Tac/Sir) as a prophylaxis for graft‐versus‐host disease worsens severe oral mucositis and delays healing compared to cyclosporine plus methotrexate (CsA/Mtx) following haematopoietic stem cell transplantation. Subjects and Methods: The study comprised 141 patients: 73 randomized to receive Tac/Sir and 68 to receive CsA/Mtx. The oral mucositis assessment scale and toxicity grading according to WHO were used to assess the severity, peak and duration of oral mucositis from the day −3 to day 24 post‐transplant. Results: Eighty‐seven patients developed oral mucositis in the first 24 days post‐transplant. No significant difference in oral mucositis severity between the Tac/Sir and CsA/Mtx groups was observed. The peak oral mucositis score occurred on day 10 in both groups. Although oral mucositis scores had returned to baseline in the CsA/Mtx group on day 24 post‐transplant, no significant difference compared with the Tac/Sir group was found. Conclusions: The introduction of tacrolimus/sirolimus as a graft‐versus‐host disease prophylaxis in haematopoietic stem cell transplantation increased neither the incidence nor severity of oral mucositis compared with cyclosporine/methotrexate. Furthermore, oral mucositis healing was not prolonged and followed the same time pattern as cyclosporine/methotrexate. [ABSTRACT FROM AUTHOR]

Background: Self‐perceived oral health (SPOH) is a summary of multiple determinants related to oral health and has been suggested for use in clinical practice as a health assessment tool. Aim: To analyse determinants of SPOH among adolescents. Design: In 2018, we selected 1742 participants from eight high schools in Olinda/PE, Brazil, using a multistage stratified cluster sample. The main survey item of SPOH was 'How would you rate your oral health'. Determinants of were queried with a questionnaire and a clinical examination: socio‐demographic variables, exposure to family violence, somatic symptoms, and orofacial and general health factors. Pearson's chi‐square test and logistic regressions evaluated associations between determinants and SPOH. Results: Very poor SPOH had a prevalence of 8.7%. Nearly half (43.5%) rated their oral health as 'fair'. Very poor SPOH was associated with poor self‐perceived general health (OR = 2.60), anterior open bite (OR = 2.24), not cohabiting with one or both parents (OR = 2.40), caries experience (OR = 1.93), dental pain (OR = 1.91), and temporomandibular disorders (OR = 1.77). Conclusion: Very poor self‐perceived oral health indicates life stress and associates with poor oral conditions. Assessments should be used to explore individual treatment needs and abilities to comply with recommendations. [ABSTRACT FROM AUTHOR]

Aim: To evaluate oral health outcomes and early oral health promotion of children in a Swedish, parental support programme conducted in a collaboration between Child Health Services and Social Services. Methods: The intervention offered first‐time parents six home visits from a paediatric nurse and a parental advisor with Social Services. On the fourth visit (infant age 6‐8 months), parents received a toothbrush and fluoride toothpaste from non‐dental staff. Twice, at child ages 18 and 36 months, a dentist used the International Caries Detection and Assessment System to record caries and conducted a structured interview with the parents on oral health habits. The intervention group (n = 72) was compared to a reference group (n = 100) from the standard child healthcare programme, which included one home visit. Results: Significantly, caries prevalence was lower and tooth brushing habits more consistent in the intervention group compared to the reference group in the standard child health programme. The difference was most pronounced at 18 months and had decreased at the 36‐month follow‐up. Conclusion: The extended postnatal home visiting programme had a positive impact on oral health. Early oral health promotion delivered by non‐dental professionals could be a beneficial approach to early caries prevention. [ABSTRACT FROM AUTHOR]

To determine the association between maternal age at delivery and caries in offspring. This registry-based cohort study included all children born between 2000 and 2003 and who were residing in Stockholm County, Sweden, at 7 years of age. Between 2007 and 2010, the cohort (n = 65,259) was examined to determine caries experience (deft scores) at 7 years of age. Age of mother at childbirth was retrieved from the patient histories. Data were analysed using linear regressions. The lowest mean deft occurred in children born to mothers aged 25–34 years. The final model – adjusted for sex, income, educational level, migration background, family situation, smoking, obesity, small for gestational age, and number of siblings – found that young mothers and older mothers were significant risk indicators for caries experience at 7 years of age. The present study found a U-shaped relationship between maternal age at childbirth and caries experience in the offspring at age 7 years. The offspring of mothers under 25 or over 34 years of age are at greater risk of having more teeth with caries experience. [ABSTRACT FROM AUTHOR]

Aim: To study trends in prevalence and risk factors of child physical abuse over 10 years in Sweden.Methods: This study analysed responses from school surveys in 2008, 2011, 2014 and 2017 in Södermanland County, Sweden with average 5125 respondents per year, 15 and 17 years old. There were identical questions on exposure to violence and risk factors including parental employment, separated parents, disability or disease, foreign background and lack of adult support. Intimate partner violence was included at three occasions. Data were analysed with bi- and multivariate models, and mean of accumulated risks were compared.Results: Child physical abuse decreased significantly between 2008 and 2017. Repeated abuse decreased to a less degree than abuse once. In bivariate analyses, the share of risk factors declined for those exposed to physical abuse. In multiple analyses, it was found significant associations with exposure. There was and a dose-relationship between numbers of accumulated risk categories and self-reported abuse.Conclusion: Exposure to child physical abuse decreased substantially between 2008 and 2017. However, prevalence of abuse is still unacceptable, and the finding that prevalence of the more severe forms of CPA decreased less during the same time, draws attention to the need of ongoing efforts. [ABSTRACT FROM AUTHOR]

Background: Since birth outcome is associated with maternal and newborn health, it can be a predictor of the future health of the child. Aim: To investigate the association between adverse birth outcomes and dental caries. Design: The present registry‐based cohort study included all children born in 2000‐2003, residing in Stockholm County, Sweden and who received a dental examination at the age of 3 years (n = 74 748). National registries supplied data on socioeconomic conditions, maternal health, maternal health behavior, and birth outcomes. Forward stepwise binary logistic regression was performed to determine predictors of caries experience in the 3‐year‐olds. Results: Of the subjects, 6.0% had caries experience (decayed, extracted, and filled teeth [deft] ≥ 1), 5.6% were born preterm (<37 weeks); 2.2% were born small (SGA) and 3.7% large (LGA) for gestational age. Of the studied adverse birth outcomes, only SGA was significantly associated with caries experience at 3 years of age, and only for mothers who had refrained from smoking during pregnancy. Conclusions: SGA is associated with caries experience in 3‐year‐old children; however, this relationship occurs only in mothers who did not smoke during pregnancy. [ABSTRACT FROM AUTHOR]

Background: No longitudinal study has evaluated the mutual relationship between dental fear and oral health in the same investigation. Aim: To evaluate the reciprocal longitudinal relationship between dental fear and oral health in schoolchildren. Design: This longitudinal study monitored 416 Brazilian children aged 5‐7 years of age at baseline for 2 years. The decayed, filled and missing teeth were clinically assessed for each child. Dental fear was evaluated by Dental Anxiety Question. Multilevel mixed‐effects linear and logistic regressions analysed the reciprocal relationship between dental fear and oral health. Results: Children with caries experience had 1.8 times higher odds of dental fear compared to children who were caries free. The presence of a carious tooth increased the odds of dental fear by 1.2 times. Children with dental fear had 0.46 additional carious tooth; an additional 0.22 tooth indicated for extraction; and a 0.67 higher caries experience score compared to children without dental fear. Conclusions: We observed a reciprocal relationship between dental fear and poor oral health. Both parents and dentists should provide realistic information for the children, discouraging biased negative expectations regarding dental treatment. Ultimately, the child would acquire positive perceptions of the dental environment, reducing their phobia and consequently improving oral health. [ABSTRACT FROM AUTHOR]

Objective: To economically evaluate a caries-preventive program "Stop Caries Stockholm" (SCS) where a standard program is supplemented with biannual applications of fluoride varnish in toddlers and compared it with the standard preventive program.Material and Methods: Data from the cluster randomized controlled field trial SCS including 3403 children, conducted in multicultural areas with low socioeconomic status was used. The difference in mean caries increment between the examinations; when the toddlers were 1 and 3 years old, was outcome measure of the intervention. The program was evaluated from a societal as well as a dental health care perspective. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental cost for each defs prevented.Results: Average dental health care costs per child at age 3 years were EUR 95.77 for the supplemental intervention and EUR 70.52 for the standard intervention. The ICER was EUR 280.56 from a dental health care perspective and EUR 468.67 and considered high.Conclusions: The supplemental caries intervention program was not found to be cost-effective. The program raised costs without significantly reducing caries development. A better alternative use of the resources is recommended.Trial Registration: www.controlled-trials.com (ISRCTN35086887). [ABSTRACT FROM AUTHOR]

Mesenchymal stromal cells (MSCs) are increasingly used in regenerate medicine. Placenta-derived decidual stromal cells (DSCs) are a novel therapy for acute graft-versus-host-disease (GVHD) and hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (HSCT). DSCs are more immunosuppressive than MSCs. We assessed adverse events and safety using DSCs among 44 treated patients and 40 controls. The median dose of infused cells was 1.5 (range 0.9–2.9) × 106 DSCs/kg. The patients were given 2 (1–5) doses, with a total of 82 infusions. Monitoring ended 3 months after the last DSC infusion. Three patients had transient reactions during DSC infusion. Laboratory values, hemorrhages, and transfusions were similar in the two groups. The frequency of leukemic relapse (2/2, DSC/controls) and invasive fungal infections (6/6) were the same in the two groups. Causes of death were those seen in HSCT patients: infections (5/3), respiratory failure (1/1), circulatory failure (3/1), thromboembolism (1/0), multiorgan failure (0/1), and GVHD and others (2/7). One-year survival for the DSC patients with GVHD was 67%, which was significantly better than achieved previously at our center. One-year survival was 90% in the DSC-treated HC group. DSC infusions appear safe. Randomized studies are required to prove efficacy. [ABSTRACT FROM AUTHOR]