The aim of this study was to analyze the changes and improvements in symptoms of sleep-disordered breathing (SDB) using semi-rapid maxillary expansion (SRME) in children with narrow maxilla and SDB symptoms. Subjects were 15 patients with sleep disorder (apnea-hypopnea index, AHI ≥ 1) and narrow maxillary arch between 7 and 9 years of age. Before the SRME was applied, all subjects underwent pediatric sleep questionnaires (PSQ), lateral cephalometry, and portable sleep monitoring before expansion (T0). All subjects were treated with SRME for 2 months, followed by maintenance for the next 3 months. All subjects had undergone PSQ, lateral cephalometry, and portable sleep monitoring after expansion (T1). Adenoidal-nasopharyngeal ratio (ANR), upper airway width and hyoid bone position were measured by lateral cephalometry. The data before and after SRME were statistically analyzed with frequency analysis and Wilcoxon signed rank test. As reported by PSQ, the total PSQ scale was declined significantly from 0.45 (T0) to 0.18 (T1) (p = 0.001). Particularly, snoring, breathing, and inattention hyperactivity were significantly improved (p = 0.001). ANR significantly decreased from 0.63 (T0) to 0.51 (T1) (p = 0.003). After maxillary expansion, only palatopharyngeal airway width was significantly increased (p = 0.035). There was no statistically significant difference in position of hyoid bone after expansion (p = 0.333). From analysis of portable sleep monitoring, changes in sleep characteristics showed a statistically significant decrease in AHI and ODI, and the lowest oxygen desaturation was significantly increased after SRME (p = 0.001, 0.004, 0.023).In conclusion, early diagnosis with questionnaires and portable sleep monitoring is important. Treatment using SRME will improve breathing of children with SDB.
Cephalometry ; Child ; Diagnosis ; Early Diagnosis ; Humans ; Hyoid Bone ; Maxilla ; Oxygen ; Palatal Expansion Technique ; Polysomnography ; Respiration ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Snoring

Over a hundred billion bacteria are found in human intestines. This has emerged as an environmental factor in metabolic diseases, such as obesity and related diseases. The majority of these bacteria belong to two dominant phyla, Bacteroidetes and Firmicutes.Since the ratio of Firmicutes to Bacteroidetes increases in people with obesity and in various animal models, it has been assumed that phylum composition causes the increase in occurrence of metabolic diseases over the past decade. However, this assumption has been challenged by recent studies that have found even an opposite association of phylum composition within metabolic diseases. Moreover, the gut microbiota affects host energy metabolism in various ways including production of metabolites and interaction with host intestinal cells to regulate signaling pathways that affect energy metabolism. However, the direct effect of gut bacteria on host energy intake, such as energy consumption by the bacteria itself and its effects on intestinal energy absorption, has been underestimated. This review aims to discuss whether increased ratio of Firmicutes to Bacteroidetes is associated with the development of metabolic diseases, and whether energy competition between the bacteria and host is a missing part of the mechanism linking gut microbiota to metabolic diseases.

Over a hundred billion bacteria are found in human intestines. This has emerged as an environmental factor in metabolic diseases, such as obesity and related diseases. The majority of these bacteria belong to two dominant phyla, Bacteroidetes and Firmicutes. Since the ratio of Firmicutes to Bacteroidetes increases in people with obesity and in various animal models, it has been assumed that phylum composition causes the increase in occurrence of metabolic diseases over the past decade. However, this assumption has been challenged by recent studies that have found even an opposite association of phylum composition within metabolic diseases. Moreover, the gut microbiota affects host energy metabolism in various ways including production of metabolites and interaction with host intestinal cells to regulate signaling pathways that affect energy metabolism. However, the direct effect of gut bacteria on host energy intake, such as energy consumption by the bacteria itself and its effects on intestinal energy absorption, has been underestimated. This review aims to discuss whether increased ratio of Firmicutes to Bacteroidetes is associated with the development of metabolic diseases, and whether energy competition between the bacteria and host is a missing part of the mechanism linking gut microbiota to metabolic diseases.

The aim of this study was to evaluate the association between various predicting tools and Apnea-Hypopnea Index (AHI) to identify children with sleep disordered breathing (SDB). From 5 to 10 years old who came for orthodontic counseling, 61 children, whom had lateral cephalograms, pediatric sleep questionnaire (PSQ) records, and portable sleep monitoring results, were included in this study. A total of 17 measurements (11 distances and 6 angles) were made on lateral cephalograms. The measurements of lateral cephalograms, PSQ scales and portable sleep monitoring results were statistically analyzed. 49 of 61 (80%) patients showed AHI > 1, which suspected to have SDB and their mean AHI was 2.75. In this study, adenoid size (A/N ratio), position of the hyoid bone from mandibular plane, gonial angle, and PSQ scale were related to a higher risk of pediatric SDB. Also, oxygen desaturation index (ODI) and snoring time from sleep monitoring results were statistically significant in children with SDB using Mann-Whitney test (p ＜ 0.05).
In conclusion, evaluation of hyoid bone position, adenoidal hypertrophy, gonial angle in lateral cephalogram, and PSQ scale was important to screen out potential SDB, especially in children with frequent snoring.

The purpose of this study was to investigate trends in dental sedation of Korean children and adolescents.
A retrospective study was conducted on patients under 20 years of age who received dental treatment under sedation using National Health Insurance Service-National Sample Cohort Database from 2002 to 2015. Based on the 1 million standard data, there were 436 cases of dental treatment under sedation in 2002, but 4002 cases in 2015, showing a trend increasing every year. The 3 - 5 year old group accounted for the largest portion (54.2%), while the 6 - 8 year old group increased recently. Nitrous oxide inhalation sedation is the most commonly used, accounting for 45.9% in 2002, but increased to 89.5% in 2015. Combination of nitrous oxide inhalation sedation, chloralhydrate and hydroxyzine was the most common, accounting for 5.7% in 2002, but decreased to 2.9% in 2015.
There is a trend to use the sedation method more safely and in a way that reduces side effects.

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare, autosomal recessive disorder; affected patients are characterized by inability to feel pain and to sweat over the entire body, as well as by mental retardation. Because, in the oral examination, no specific findings on soft or hard tissue may be found except possible lesions due to self-mutilation, early recognition and diagnosis are essential for these patients. Pediatric dentists must be aware of the clinical manifestations and treatment considerations related to uncontrolled body temperature, tactile hyperesthesia and lack of pain reflex. In this case report, dental management of CIPA was suggested by presenting a 6-year follow-up of young patient.
Body Temperature ; Dentists ; Diagnosis ; Diagnosis, Oral ; Follow-Up Studies ; Hereditary Sensory and Autonomic Neuropathies ; Humans ; Hyperesthesia ; Hypohidrosis ; Intellectual Disability ; Pain Insensitivity, Congenital ; Reflex ; Sweat

The purpose of this study was to analyze outpatient referral patterns of children in Jeonbuk National University Dental Hospital. All patients under 16 years old who were consulted from the external facilities were reviewed based on the electronic medical record of Jeonbuk National University Dental Hospital from 2015 to 2018.Total 720 boys and 460 girls with an average age of 7.4 years were referred from local dental clinic (85.2%) for treatment severity (90.2%). 3.2% of patients has disability with the highest number of intellectual disabilities. The patients were usually referred at the pre-treatment stage with higher rates if they had disability or medical problem. Referral rate by chief complaints was highest in surgery, followed by reparative treatment and orthodontic treatment. 2(nd) referrals in pediatric dentistry had a higher rate of referrals to minor surgery and pulp treatment than of first referrals. The time point of 2(nd) referral was relatively delayed with increased ratio of ‘during treatment’.These results suggest necessities of appropriate case selection and referral based reasonable criteria for pediatric dentist.
Child ; Dental Clinics ; Dentists ; Electronic Health Records ; Female ; Humans ; Intellectual Disability ; Jeollabuk-do ; Minor Surgical Procedures ; Outpatients ; Pediatric Dentistry ; Referral and Consultation

The purpose of this study was to investigate pediatric emergency department visits patterns and characteristics of children and adolescents under the age of 20 in South Korea from 2002 to 2015 due to dental conditions. This study used a stratified sample of approximately 1 million people from the Health Insurance Review and Assessment Service Database. The age, region, household income, and treatment cost were included for the patient characteristic analysis. Pediatric patients were compared to the adult group (over 20 years old).In children and adolescents, the rate of emergency department visits due to dental conditions was higher for traumatic conditions than for non-traumatic conditions. Children and adolescents with higher household income visited the emergency department more often than those with lower household income. The region with the highest number of children and adolescents visiting the emergency department for dental conditions was Busan (per 100,000 population).Although this study could not confirm the annual trend of children and adolescents’ dental emergency visits due to the sample size limitation, the characteristics of children and adolescents’ dental emergency visits were compared with those of adults using a stratified sample.

The aim of this study was to investigate the risk factors associated with sleep disordered breathing (SDB) by comparing intraoral factors, body mass index (BMI), and medical history with pediatric sleep questionnaire (PSQ) findings.Seven hundred eighty-seven subjects aged between 7 to 11 years old were included. Their caregivers were asked to complete questionnaires. Oral manifestations including Angle’s classification, overjet, and Brodsky tonsil grade were examined. Children with PSQ scores of more than 0.33 points were classified into the SDB high-risk group.Among the 787 subjects, 34 (4.3%) were classified into the SDB high-risk group. Children with allergic rhinitis, atopic dermatitis, excessive overjet, or large tonsil size had a significantly higher risk for SDB versus those without. Also, there was a significant difference in SDB risk according to BMI status. Gender, gestational age, breastfeeding, and Angle’s classification were not associated with SDB.Children at high risk for SDB were predisposed to tonsillar hypertrophy, allergic rhinitis, obesity, and atopic dermatitis. Children with these factors could be candidates for early intervention to prevent the progression of SDB.

This study aimed to evaluate the relationship between parenting styles and childhood dental caries using a sample of 3 to 6 years old children in Korea.
The subjects were 158 children aged 3 to 6 years old and their parents in Korea. The parenting styles were divided into three groups (authoritative, authoritarian, and permissive) using a translated version of the Parenting Styles and Dimensions Questionnaire (PSDQ).
Among the 353 parents/child dyads, 158 questionnaires were returned. Authoritative parenting style was the majority (95.6%), followed by authoritarian (3.8%), and permissive (0.6%). There were no statistically significant differences between dental caries and parenting styles. The mean of dft index in authoritative group was lower than others. In the authoritative domain, the higher the authoritative tendency, the lower the dft index.
Overall, authoritative parenting styles resulted in low rates of dental caries for the children. The stronger the authoritative tendency of the parents, the lower the experience of dental caries in the children. Therefore, parenting styles were likely to affect the oral health of a child, but it seemed necessary to supplement the evaluation tool to evaluate the parenting styles.