admission for the management of acute dental infections that threaten the airway and require intensive care.Patients with substantial swellings can progress to life-threatening emergencies, which can increase risks in the setting of reduced health-care availability. For such patients, extractions of the causative pathogenic teeth should be prioritised over resto rative rescue, and input from dedicated oral surgery and oral and maxillofacial services and close follow-up should be instigated as locally appropriate. This approach has many benefits, including stewardship of antimicrobials, but is a deviation away from routine dentistry that should be thoroughly discussed with patients. Decisions on undertaking treatment should therefore be made with appropriate patient consent. Clinicians might wish to follow up patients digitally (eg, through video calls), if appropriate, to ensure patient safety, but also to minimise repeated patient contact.Testing for coronavirus disease 2019 (COVID-19) in dental professionals should be undertaken with the same high priority as that of medical healthcare workers in hospitals. The risk of a dental practitioner being positive for COVID-19 and potentially infecting patients attending emergency dental services should not be underestimated. Proactive and preventive measures need to be established as mainstay pro tocol to contain the spread of the virus.We declare no competing interests.
Purpose
To determine in which clinical situations it is indicated or contra-indicated to prescribe cone beam computed tomography (CBCT) for paediatric patients.
Methods
Systematic review of in vivo paediatric research studies of diagnostic efficacy using CBCT, with supplementary searches for guideline documents on CBCT and for systematic reviews permitting inclusion of ex vivo and adult studies.
Results
After screening, 190 publications were included, mostly case studies. No systematic reviews were found of in vivo paediatric research. Fourteen studies of diagnostic efficacy were identified. The supplementary searches found 18 guideline documents relevant to the review and 26 systematic reviews. The diagnostic efficacy evidence on CBCT was diverse and often of limited quality. There was ex vivo evidence for diagnostic accuracy being greater using CBCT than radiographs for root fractures. The multiplanar capabilities of CBCT are advantageous when localising dental structures for surgical planning. Patient movement during scanning is more common in children which could reduce diagnostic efficacy.
Conclusions
No strong recommendations on CBCT are possible, except that it should not be used as a primary diagnostic tool for caries. Guidelines on use of CBCT in the paediatric age group should be developed cautiously, taking into account the greater radiation risk and the higher economic costs compared with radiography. CBCT should only be used when adequate conventional radiographic examination has not answered the question for which imaging was required. Clinical research in paediatric patients is required at the higher levels of diagnostic efficacy of CBCT.
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