Showing papers in "European Archives of Paediatric Dentistry in 2012"

Parental knowledge, attitudes and cultural beliefs regarding oral health and dental care of preschool

Abstract: AIM: Preschool children are dependent upon their parents for their dental care. The aim of this study was to assess the knowledge, attitude and beliefs of parents towards oral health and dental care of their children aged 1–4 years in an Indian population. METHODS: Parents of 620 preschool children, who visited Krishna Dental College and Hospital, Ghaziabad, India for dental treatment were recruited into this study and completed a self-administered questionnaire. RESULTS: It was revealed that the lack of knowledge and awareness of importance of the primary teeth, dental fear of the parents and the myths associated with dental treatment, created barriers to early preventive dental care of preschool children. The oral hygiene and feeding practices were found to be disappointing and the knowledge about the essential role of fluoride and transmission of Streptococcus mutans bacteria was found to be limited. The elders in the family, especially grandparents, highly influenced the decisions of the parents regarding dental treatment of their children. CONCLUSIONS: Parents’ knowledge, attitudes and beliefs about the importance of dental health need to be improved. Coordinated efforts by paediatricians, paediatric dentists and other health professionals are required to impart dental health education about oral hygiene, feeding practices, importance of the primary dentition and to promote preventive dental programmes.

Rationale for restoration of carious primary teeth: a review.

Abstract: BACKGROUND: The literature regarding dental and systemic effects of Early Childhood Caries (ECC), consequences of leaving carious primary teeth untreated, benefits of appropriate treatment, and concerns regarding dental treatment of young children and the potential for dental anxiety, is reviewed. ECC has consequences, affecting both the child’s dental health and his/her general health. This paper reviews the literature regarding ECC and its consequences (pain, sepsis, space loss, disruption to quality of life, failure to thrive, effects on intellectual development, greater risk of new carious lesions in both primary and permanent dentitions, higher incidence of hospitalisation and emergency visits, and increased treatment costs and time). The effects of treatment of ECC are also reviewed; and concerns regarding purported associations between treatment of ECC and dental anxiety are addressed. SEARCH METHOD: A Pub Med search was conducted of peer reviewed papers published in the English language in the years 1986–2011, using the search terms: Early Childhood Caries (ECC), Nursing Caries (NC), Consequences and ECC/NC, Treatment and ECC/NC, Treatment outcomes and ECC/NC, Dental anxiety, Dental fears, Onset of dental anxiety/fear, Dental experiences and dental fear/anxiety. More than 300 articles were studied. Reference lists of the selected articles were also studied, and frequently quoted articles were thus also located. Articles with small sample size, poor or poorly described methodology, and unclear or unsupportable conclusions were rejected. A representative sample is presented in this paper, citing the articles with greater levels of evidence, with a description of study methods, where appropriate. CONCLUSION: This review has demonstrated that ECC has implications for both the dental and general health of the affected child. Such problems are potentially serious, even life-threatening. Evidence has been provided of the beneficial effects on dental and general health of dental rehabilitation of children with caries. Causes of dental anxiety are multifactorial, and treatment of ECC does not invariably contribute to dental anxiety, as long as the child’s experience of dentistry is not traumatic. Children with the highest levels of dental disease are primarily from disadvantaged communities. Failure to adequately treat their dental disease may further disadvantage these children. Paediatric Dental Societies, renowned experts in Paediatric Dentistry, and the Medical Protection Society (Dental Protection, Professional Insurance) do not support a policy of leaving carious primary teeth untreated.

Prevalence and characteristics of Molar Incisor Hypomineralisation (MIH) in the child population residing in Gandhinagar, Gujarat, India.

Abstract: Most prevalence studies on Molar Incisor Hypomineralisation (MIH) have been carried out in European countries and data from Asia especially south Asian populations are lacking. AIM: To investigate the prevalence and clinical characteristics of MIH in children residing in a western region of India. METHOD: A cross-sectional survey including 1,366 children from 5 age cohorts, 8–12 years, studying in primary schools or attending the University Department, was carried out in the area of Gandhinagar, Gujarat, India. The dental examination was performed by a single well-trained and calibrated examiner in day light conditions. Full mouth inspection of wet teeth was conducted using the EAPD 2003 criteria for diagnosis of MIH. Results were recorded and statistically analysed using Chi-square test, independent sample t-test and Pearson correlations. RESULTS: Prevalence of MIH was 9.2% in the examined population. Males and females were equally affected. Among 12 index teeth involved in the examination, the most commonly affected were in descending order 46, 36,16,11 [FDI] and the least 42, 32, and 22.17.4% of the cases revealed only molars involved, the remaining 72.6% having both molars and incisors affected; all four first permanent molars showed in 23% of the cases while no cases of only affected incisors were found. Of the MIH teeth 77.3% revealed mild defects and 22.7% severe defects. All incisors were mildly affected, as compared with only 67.1% of the molars, the remaining 32.9% being severely affected. As age increased, a statistically significant larger total number and severity level of affected teeth were recorded. CONCLUSION: Prevalence of MIH using EAPD 2003 criteria was found to be similar to other studies evaluating children in different geographic locations such as Europe, South America etc. Using the EAPD standardised criteria, more studies should be conducted in other Indian regions, in order to further evaluate prevalence, characteristics and treatment needs for this clinically demanding condition.

Molar Incisor Hypomineralisation: Possible Aetiological Factors In Children From Urban And Rural Areas

Abstract: AIM: To analyse factors potentially associated with molar incisor hypomineralisation (MIH) development. METHODS: A population-based study was carried out with 903 children aged from 6–12 years old, born and residing in rural and urban areas of the town of Botelhos, State of Minas Gerais, Brazil. Their mothers completed a structured medical history questionnaire, from pregnancy to the child’s 3rd year of life. Two examiners evaluated children for MIH according to criteria suggested by the European Academy of Paediatric Dentistry. Descriptive analyses of the data and odds ratios (OR) with 95% test-based confidence intervals (CI) were estimated. Chi-square test was used to evaluate the differences between groups. RESULTS: The prevalence of MIH in children from rural area (RA) was significantly higher than those from the urban area (UA) (24.9% versus 17.8%, p= 0.01). In urban children, neither significant associations with MIH nor medical problems were found. In rural children, however, MIH was significantly more common among those whose mothers had experienced medical problems during pregnancy (OR=2.11; 1.0124.37 CI 95%; p=0.04), who had throat infections (OR=2.93; 1.47.87 CI 95%; p=0.01), who had high fever (OR=1.91; 1.07.39 CI 95%; p=0.02), and who had used amoxicillin associated with other antibiotics (OR=1.92; 1.02.62 CI 95%; p=0.04) during the first 3 years of life. CONCLUSION: This study suggests a link between MIH and health problems during pregnancy, as well as environmental factors.

Oral health status of children with autistic disorder in Chennai

Abstract: AIM: To assess the oral health status of autistic children in Chennai. DESIGN AND METHODS: Oral health status was assessed for 483 children with autism, solicited from special education schools, autistic child centres and therapy centres. Conditions assessed were plaque accumulation, gingival health, dental caries, malocclusion, developmental anomalies, oral injuries and restorations. STATISTICS: Chi-square and Fisher’s exact tests of significance were used to compare groups. Proportions testwas used to compare the significance of the parameters between boys and girls. RESULTS: Autistic children with primary dentition showed significantly higher incidence of dental caries (24%), when compared to other oral conditions. Children with mixed dentition had more gingivitis (50%) and children with permanent dentition had more gingivitis (48.96%) and malocclusion (71.15%). All the oral conditions were seen more in boys than girls. CONCLUSION: Autistic children have significantly poor oral hygiene and higher incidence of malocclusion and dental caries when compared to other oral conditions.

Oral hygiene and periodontal status of 12 and 15-year-old Greek adolescents. A national pathfinder survey

Abstract: AIM: To investigate oral hygiene and periodontal status of 12- and 15-year old Greek adolescents, in relation to sociodemographic and behavioural parameters. METHODS: A stratified cluster sample of 1,224 12-year old and 1,257 15-year old adolescents of Greek nationality were selected and examined by calibrated examiners. Periodontal and oral hygiene status were assessed using the Community Periodontal Index (CPI) and the simplified Debris Index (DI-s) respectively. The socio-demographic and behavioural data collected included region, location, gender, parental educational level, tooth brushing frequency and reason for dental attendance. RESULTS: The majority of adolescents aged 12 (75.0%) and 15-years (61.4%) had fair oral hygiene levels. The most frequently observed condition in both ages was calculus with or without bleeding (42.8% in the younger and 53.3% in the older age group). Bleeding on probing was found in 41.5% of the 12-year-olds and in 30.0% of the 15-year-olds. The occurrence of shallow and/ or deep periodontal pockets was very low (0.2%). Multivariable modelling revealed that gender, location and tooth brushing frequency were strongly associated with oral hygiene status in both ages; girls, those living in urban areas and brushing teeth more frequently had significantly lower DI-s. Tooth brushing frequency was also associated with periodontal status in both ages, while living in urban areas was associated with better periodontal health only in the 15-year-olds. CONCLUSIONS: The study demonstrated that oral hygiene conditions among Greek children and adolescents are not satisfactory and that the occurrence of gingivitis is high. More efforts on oral health education and oral hygiene instruction are needed to improve their periodontal and oral hygiene status.

In vitro evaluation of apical microleakage of a new MTA-based sealer.

Abstract: AIM: To evaluate the apical microleakage of a new MTA-based sealer; MTA Fillapex (Angelus) and compare it with ProRoot MTA (Dentsply) and AH Plus (Dentsply). METHODS: 51 single-rooted permanent teeth were selected and the roots were prepared using a rotary system. The samples were divided randomly into 3 groups (n=15). Six roots were used as positive and negative controls. The teeth were obturated with respectively; A. AH Plus and gutta percha (DiaDent); B. MTA Fillapex and gutta percha; C. ProRoot MTA. Specimens were placed in 2% methylene blue dye for 72h. Then linear dye penetration was measured. Measurements were analysed statistically. RESULTS: MTA Fillapex group had significantly higher microleakage values (p 0.05). CONCLUSION: The sealing ability of AH Plus and MTA were similar whilst MTA Fillapex showed more microleakage than the other two materials.

Maternal education is an independent determinant of cariogenic feeding practices in the first year of life

Abstract: AIM: To identify risk factors for cariogenic feeding practices in the first year of life. STUDY DESIGN: Cohort study. METHODS: 500 children born within the public health care system in Sao Leopoldo, Brazil, were recruited in a follow-up program. Anthropometric and demographic data were collected soon after birth; data on feeding practices were assessed at 12 months of age using a standardised questionnaire; clinical examination at 4 years of age allowed identification of cariogenic feeding practices in the first year of life and to quantify their relative risks. In the present study, the attributable risks of each child were summed, and the outcome was assessed for the upper quartile of scores for cariogenic feeding practices. STATISTICS: Adjusted relative risks for the outcome were estimated using robust Poisson regression models. RESULTS: A total of 327 children comprised the final study sample, i.e. were followed from birth to 4 years of age. Multivariate analysis showed that the risk of cariogenic feeding practices doubled in children from mothers with less than 5 years of education (RR 2.19, 95%CI 1.26–3.82) and was 70% higher in children from mothers with 5–8 years of education when compared with maternal education >8 years. The other independent variables were not associated with the outcome. CONCLUSIONS: Low maternal education is a risk factor for cariogenic feeding practices, independently of other factors. Mothers with low educational levels should be the focus of child health promotion interventions, especially those aimed at controlling dental caries.

The success rates of a glass ionomer cement and a resin-based fissure sealant placed by fifth-year undergraduate dental students.

Abstract: AIM: To evaluate retention and caries prevention of a glass-ionomer cement (GIC) and a resin-based fissure sealant placed by fifth-year undergraduate dental students. METHODS: The study was conducted according to a split-mouth, randomised clinical trial. Children with at least one pair of caries-free permanent first molars with deep pits and fissures were included in the study. The children were selected from a population that had a high risk for dental caries. Sealant materials were applied by fifth-year undergraduate dental students on 346 fissures of the first permanent molars in 173 children. The ages of the children ranged from 7–15 years (mean 9.4). Two researchers at the clinics supervised all of the procedures. Intra-examiner reproducibility and inter-examiner reproducibility were 0.90 and 0.86, respectively, for the clinical assessment of sealant retention and caries evaluation. RESULTS: GIC sealants were completely lost in 31.9% and resin-based sealants in 16.6% (p 0.05). CONCLUSIONS: The retention of GIC sealants was markedly inferior to the retention of resin-based sealants; however, GIC when used as a pit and fissure sealant was slightly more effective in preventing occlusal caries.

Development of a new technique (ATP) for training visually impaired children in oral hygiene maintenance

Abstract: AIM: To develop a special oral health education technique and compare plaque scores before and after health education. STUDY DESIGN: Non-randomised before and after comparison trial without controls. METHODS: The final study population comprised of 96 visually impaired children aged 6–18 years old. Silness and Loe plaque index scores were recorded at baseline. ‘Audio tactile performance technique’ (ATP Technique) a specially designed health education method was used to educate these children regarding oral hygiene maintenance. Periodic reinforcement of health education was performed at an interval of 9 months. Re-examination was carried out after 18 months of health education to assess plaque scores. STATISTICS: Wilcoxon’s sign rank test and paired t test was used to assess the difference between the scores before and after health education. RESILTS: There was increase in frequency of tooth brushing after health education. The mean plaque scores pre- and post-health education were 1.41 (±0.58) and 0.63 (±0.39) respectively. The difference was statistically significant (p<0.001). CONCLUSION: Visually impaired children could maintain an acceptable level of oral hygiene when taught using special customised methods.

Trends of oral health care and dental treatment needs in relation to molar incisor hypomineralisation defects: a study amongst a group of Iraqi schoolchildren

Abstract: BACKGROUND: The dynamic properties of molar-incisor-hypomineralisation lesions (MIH) may impact negatively on personal daily oral care resulting in increased treatment needs. AIMS: To describe and compare individual oral health care practices between MIH-affected and non-affected children, to evaluate and compare dental treatment needs between hypomineralised and non-hypomineralised first permanent molars, and to explore the role of reported fluoride exposure in the development of MIH. STUDY DESIGN: A cluster sample of 7–9 year-old Iraqi schoolchildren (823 of 1000 eligible, response rate 82.3%) had their first permanent molars and incisors evaluated using the European Academy of Paediatric Dentistry evaluation criteria for MIH. Of these 153 were diagnosed with the defect and were referred to as MIH-affected children. METHODS: Mothers of the participating children were asked to complete an oral health-questionnaire administered at schools. This included questions regarding child’s history of dental visits, fluoride intake and the pattern of oral hygiene practices. Assessment of the dental treatment requirements for the first permanent molars was performed in a sample subset drawn from a larger data set of affected children (n=100) having their teeth assessed previously for dental caries status following the International Caries Detection and Assessment System. The sample subset consisted of 130 hypomineralised molars and 270 non-hypomineralised molars. RESULTS: Of the total sample, approximately 71% of parents had taken their children to the dentist at some stage. For the total sample, tooth restoration or extraction was the most likely causes for seeking dental care at the first dental appointment (57.9%). Tap water was the main source of water consumed at home by the majority of children (77.8%). The prevalence of dental caries and tooth restorations was higher in hypomineralised affected molars (78.5%) than in the defect-free molars (33.7%). STATISTICS: MIH-affected children reported significantly higher frequency of seeking dental care than their non-affected counterparts (82.4%, 68.2%; respectively). They were over three times (OR = 3.18) more likely to visit the dentist complaining of pain and were over six times (OR = 6.37) more likely to seek dental care due to tooth sensitivity than their non-affected peers. No significant differences were found between the

Risk factors of hypomineralised second primary molars in a group of Iraqi schoolchildren.

Abstract: AIM: To investigate risk factor/s involved in the development of hypomineralised second primary molars and to relate the location of the affected tooth in the dental arches with the timing of the illness/condition incidence. STUDY DESIGN: A cluster sample of 1,000, Iraqi 7–9 year-old children were invited to have their second primary molars examined for demarcated hypomineralised lesions. METHODS: Mothers of 823 children completed a questionnaire-based interview regarding pregnancy and childhood systemic health history. In the clinical examination, the buccal, occlusal and lingual/palatal surfaces of the second primary molar were evaluated for demarcated hypomineralisation lesions by visual examination. RESULTS: A response rate of 82.3% was obtained. Of the children examined, 53 (6.6%) had hypomineralisation defects in at least one second primary molar and were considered as the hypomineralised second primary molar-affected group. Of the total affected teeth (n=83), maxillary molars were the teeth most frequently affected by hypomineralisation throughout all developmental stages (69.9%). Demarcated opacities were the most prevalent lesion type (71.0%). Ninety-four percent of subjects diagnosed with demarcated defects reported various medical conditions possibly associated with hypomineralisation compared with 44% for their non-affected counterparts. Peri-natal medical conditions (45.3%) were the most frequently reported followed by pre-natal and post-natal conditions (24.5%, 9.4%; respectively). STATISTICS: Ill-health during pregnancy, delivery complications, neonatal complications, acute childhood illness, birth weight and duration of breast feeding were significant potential risk factors (p<0.05). The greater the number of health events reported, the higher was the chance of developing the defect. Children who experienced neonatal complications and whose mothers reported pregnancy and birth problems were approximately six times more likely to have the defect than those whose mothers had delivery complications only (80% vs 14.6%) (p<0.001). Also of those children whose mothers did not report delivery complications, but were breastfed for less than six months, of low birth weight and had history of upper respiratory tract infection, the chance of hypomineralised defects was over four times more likely to happen than in those who did not suffer any of these problems (25.8% vs 6.7%) (p<0.01). No statistically significant association was revealed between the time of the illness/condition occurrence and the location of the tooth in the dental arches. CONCILUSIONS: Children with hypomineralised second primary molars had experienced more medical conditions than their unaffected peers particularly during the peri-natal period. No single factor was identified as a potential cause, leaving the aetiology of the defect unclear.

Dental trauma among Brazilian schoolchildren: prevalence, treatment and associated factors

Abstract: AIM: To assess the prevalence of traumatic dental injury (TDI), as well as associated factors, behaviour of affected schoolchildren and normative treatment needs. METHODS: The present cross-sectional study involved 590 children aged 7–14 years at state schools in Campina Grande, Brazil. The O’Brien classification [1994] was used for the diagnosis of TDI and the body mass index (BMI) was used as an indicator of overweight/obesity. Clinical tests were carried out by two duly calibrated examiners (intra-observer and inter-observer agreement: 0.87 and 0.90, respectively). The Chi-square test was used (5% level of significance) to determine whether TDI was associated with age, gender, ethnicity, overweight/obesity, lip seal and overjet. Backward stepwise multivariate regression analysis was performed. Normative treatment needs were determined based on the criteria of the International Association of Dental Traumatology (IADT). When the absence of treatment was detected, each child/adolescent was asked about the reason for non-treatment. RESULTS: The prevalence of TDI was 12.7%. The most common type of trauma was enamel fracture (67.0%), followed by enameldentine fracture (25.3%). TDI was 4.9-fold greater (95% CI: 1.6-14.4) among children aged 13 and 14 years, 1.9-fold greater (95% CI: 1.1-3.2) among males and 2.6-fold greater (95% CI: 1.2-5.4) among those with inadequate lip seal. The majority of schoolchildren did not undergo treatment (82.6%) due to a belief that it was unnecessary (53.2%). The normative clinical evaluation revealed that adhesive restoration was the most common form of treatment (84.0%). CONCLUSION: The prevalence of TDI was low. Age, gender and inadequate lip seal were associated with dental trauma. A significant number of schoolchildren did not receive treatment for dental trauma.

Articaine use in children: a review.

Abstract: BACKGROUND: Lidocaine has been considered the gold standard for local analgesia agents in dentistry for years. Articaine is now widely used but there has been a reluctance to use it in children. REVIEW: Compared with lidocaine, articaine is 1.5 times as potent and only 0.6 times as toxic and has been shown to be superior in achieving successful anaesthesia following infiltration. The use of inferior alveolar nerve blocks (IANB) can be almost eliminated in children by using articaine due to its ability to effectively anaesthetise teeth up to the first permanent molar region. In addition, diffusion of the anaesthetic agent onto the palatal surface may also eliminate the discomfort of palatal infiltration. Soft tissue analgesia may be prolonged, but the risk of other adverse reactions is similar to other local anaesthetic agents. CONCLUSION: The use of articaine achieves successful pain control while reducing the volume administered and is advocated as a safe and effective alternative to lidocaine for use in children.

Effects of folk medicinal plant extract Ankaferd Blood Stopper(®) in vital primary molar pulpotomy.

Abstract: AIM: To compare the clinical and radiographic success rates of two vital pulpotomy agents: formocresol (FC) and Ankaferd Blood Stopper® (ABS), in primary molars during a 12-month follow-up period. STUDY DESIGN: A randomised, single-blind study design was used in a sample of 30 healthy 6–9 year old children with 60 carious primary molars without clinical or radiographic evidence of pulp degeneration. METHODS: The pulpotomy agents were assigned as follows: Group 1 was 1:5 diluted Buckley’s formocresol (FC) and Group 2 was ABS. Clinical and radiographic follow-up at 3, 6, and 12 months used the following criteria: pain, swelling, sinus tract, mobility, internal root resorption, and furcation and/or periapical bone destruction. STATISTICS: The data were analysed using Chi-square tests. RESULTS: The clinical and radiographic evaluation at 3 months revealed total success rates of 100% in the FC and ABS groups. Success rates in FC and ABS groups at 6 months were 96.7% and 93.3% respectively. At the 12-month follow-ups, the total success rates in the FC, and ABS groups were 89.3% and 85.7%, respectively. When the groups were compared according to the time intervals, no significant differences were observed between the 3, 6, and 12 month values. The success rates of the materials decreased over time. CONCLUSIONS: FC and ABS were found successful as pulp dressings in primary molars. ABS appears to be an alternative pulpotomy agent but periodical follow-ups must be considered to evaluate long term success rates.

Investigation of mothers’ knowledge of dental trauma management in United Arab Emirates

Abstract: AIM: To assess, by means of a structured questionnaire, mothers’ level of knowledge with regards to the immediate emergency management of dental trauma in the Emirate of Ajman, United Arab Emirates (UAE). METHODS: A cross-sectional study using anonymous structured questionnaires was employed for mothers chosen at random from child care centres. The questionnaire surveyed mothers’ background, knowledge and management of tooth fracture, avulsion, and also investigated mothers’ self-assessed knowledge of the availability and priority of emergency services of trauma in UAE. RESULTS: The sample consisted of 676 mothers (response rate 96.6%) who attended mother and child care centres in Ajman over a period of two months (January–February 2011). More than half of the mothers participated in this study were in their twenties and 69.4% had university qualifications. Around 61.5% of the mothers had previous direct or indirect experience of dental trauma. Mother’s knowledge of dental trauma seemed to be inadequate. Chi-square test indicated that there was no significant difference in the number of correct responses in relation to age, level of education, or number of observed trauma cases. Most mothers were unaware of the availability of after working-hours emergency services. They were dissatisfied with their level of knowledge of dental trauma and the majority were interested in having further education on the topic. CONCLUSIONS: The level of knowledge of dental trauma management (especially tooth avulsion) among mothers in Ajman was inadequate and education campaigns are necessary to improve the emergency management of dental injuries. Therefore it is important to educate the public of the availability of after hours dental emergency services to overcome any delay in seeking professional help in cases of dental trauma.

Indications for the use of auto-transplantation of teeth in the child and adolescent

Abstract: BACKGROUND: Tooth auto-transplantation has been successfully performed for over 50 years and yet the procedure has still to receive the widespread acceptance that it deserves. AIM: This study demonstrates the numerous clinical situations in which auto-transplantation can be used in order to give a child or adolescent an excellent biological long-term replacement. INDICATIONS: Seven cases are presented that demonstrated the versatility of auto-transplantation in a range of clinical situations. The aim was to show that this technique is not only useful for replacing teeth that are lost due to trauma but has applications for the replacement of teeth that are developmentally missing, or teeth with otherwise poor long-term prognosis. TREATMENT: All cases presented were managed with autotransplatation and included patients with hypodontia, trauma, dilacerated incisors, ankylosis, failed endodontic treatment and aesthetic management of a patient with cleft lip and palate. FOLLOW-UP: Medium and long-term outcomes were demonstrated. CONCLUSIONS: Auto-transplantation provides an excellent outcome in a growing child with the advantage that it is a biologically compatible method of tooth replacement, which promotes pulp and periodontal healing and enables orthodontic movement if necessary.

Effect of consuming different dairy products on calcium, phosphorus and pH levels of human dental plaque: a comparative study.

Abstract: AIM: To determine the calcium, phosphorus and pH levels of human dental plaque after consuming different dairy products. METHODS: 68 students (34 with caries and 34 caries-free) aged 17–20 years from a private dental college, Moradabad city, who agreed to refrain from oral hygiene procedures for 48 hours were selected for the study. Calcium and phosphorus levels of harvested dental plaque were measured using an electrolyte analyser while plaque pH was measured using a digital pH meter after consuming different dairy products (cheese, milk, yogurt) and compared with the control (paraffin) group. RESULTS: Cheese and yogurt groups showed a statistically significant rise in mean plaque concentrations of calcium and phosphorus, whereas milk and control groups showed the least rise in plaque concentrations for both caries-active and caries-free subjects. Plaque pH showed a stronger correlation with plaque calcium and phosphorus concentrations in both caries-active and caries-free subjects. CONCLUSION: Cheese and yogurt without any added sugar (sucrose) are non-cariogenic and to some extent cariostatic as they increase calcium and phosphorus concentration in dental plaque. Dairy products without added sugar can be recommended as after meal desserts, especially to school children, which would help to reduce the incidence of dental caries.

Case Report: Pre-eruptive intra-coronal radiolucencies revisited

Abstract: AIM: Pre-eruptive intra-coronal radiolucency (PEIR) describes a radiolucent lesion located in the coronal dentine, just beneath the enamel-dentine junction of unerupted teeth. The prevalence of this lesion varies depending on the type and quality of radiographic exposure and age of patients used for assessment. The aetiology of pre-eruptive intra-coronal radiolucent lesions is not fully understood, but published clinical and histological evidence suggest that these lesions are resorptive in nature. Issues around the diagnosis, treatment planning and clinical management of this lesion are explored using previously unreported cases. CASE REPORTS: Case 1: A ten-year-old girl attended for a routine check-up. An intra-coronal radiolucency in the unerupted lower right second premolar was an incidental finding on orthopantomograph (OPT). The tooth erupted and removal of enamel revealed a space filled with soft red tissue, unlike carious dentine in appearance. The tooth was restored with an indirect pulp cap, resin modified glass ionomer base and composite resin. Tissue from the lesion was removed for histopathological investigation. Root development continued to completion and the tooth remained asymptomatic and vital. Case 2: A six-year-old girl attended for her first dental visit. An intra-coronal radiolucency in a lower right first permanent molar was noted on baseline bite-wing radiographs. The lesion was monitored and fissured sealed upon eruption. The lesion was monitored annually radiographically. The tooth remained symptom free for 5 years. The patient presented on an emergency basis having fractured the distolingual cusp overlying the lesion. There was no pain and the tooth was vital. The softened dentine was removed and the tooth was restored using a preformed metal crown. Case 3: A 12-year-old girl was referred for restoration of mandibular left second permanent molar. Clinically there was extensive occlusal destruction. Review of a previous OPT showed that an intra-coronal radiolucency was present in tooth 37 at least one year prior to its eruption. The large mass of coronal soft tissue was removed, the remaining enamel shell was deemed to be unrestoreable and the tooth was extracted. The patient was referred back to an orthodontist for completion of orthodontic treatment. CONCLUSION: Early detection and classification of the PEIR lesion allows an array of individualised treatments to be provided for successful outcome.

Dental students consistency in applying the ICDAS system within paediatric dentistry

Abstract: AIM: To examine dental students’ consistency in utilising the International Caries Detection and Assessment System (ICDAS) one and three months after training. STUDY DESIGN: A prospective study. METHODS: All clinical dental students (Year Two: BDS2; Year Three: BDS3; Year Four: BDS4) as part of their education in Paediatric Dentistry at Aberdeen Dental School (n = 56) received baseline training by two “gold-standard” examiners and were advised to complete the 90-minute ICDAS e-learning program. Study One: One month later, the occlusal surface of 40 extracted primary and permanent molar teeth were examined and assigned both a caries (0–6 scale) and restorative code (0–9 scale). Study Two: The same teeth were examined three months later. STATISTICS: Kappa statistics were used to determine inter- and intra-examiner reliability at baseline and after three months. RESULTS: In total, 31 students (BDS2: n = 9; BDS3: n = 8; BDS4: n = 14) completed both examinations. The inter-examiner reliability kappa scores for restoration codes for Study One and Study Two were: BDS2: 0.47 and 0.38; BDS3: 0.61 and 0.52 and BDS4: 0.56 and 0.52. The caries scores for the two studies were: BDS2: 0.31 and 0.20; BDS3: 0.45 and 0.32 and BDS4: 0.35 and 0.34. The intra-examiner reliability range for restoration codes were: BDS2: 0.20 to 0.55; BDS3: 0.34 to 0.72 and BDS4: 0.28 to 0.80. The intra-examiner reliability range for caries codes were: BDS2: 0.35 to 0.62; BDS3: 0.22 to 0.53 and BDS4: 0.22 to 0.65. CONCLUSION: The consistency of ICDAS codes varied between students and also, between year groups. In general, consistency was greater for restoration codes.

Clinical evaluation of Root ZX II electronic apex locator in primary teeth

Abstract: AIM: To evaluate the accuracy of Root ZX II electronic apex locator (EAL) for root canal working length determination in primary teeth. METHODS: Forty primary maxillary incisor teeth were included in the study. Root ZX II EAL was used to determine the electronic working length (EL). The working length obtained with EAL was evaluated using digital radiography with the measuring file set to EL. The samples were categorised into three groups. Group 1 (acceptable): file tip 0–1 mm short of the radiographic apex; Group 2 (short): file tip ≫ 1mm short of the apex and Group 3 (long): file tip beyond the apex. Digital radiographic working length (RL) was derived by adjusting EL to the radiographic apex. The assigned calibrations were tabulated and statistically analysed. RESULTS: Group 1 included 28 out of 40 teeth indicating a clinical accuracy of 70%. Group 2 contained 10 (25%) teeth whereas group 3 had only 2 (5%) teeth. STATISTICS: Pearson correlation coefficient statistical analysis showed a high correlation (r = +0.82; p =s < 0.001) among the groups. CONCLUSION: Root ZX II EAL can be used as a reliable device for obtaining root canal length in primary maxillary incisor teeth.

Post-operative pain and pain management in children after dental extraction under general anaesthesia

Abstract: AIM: To evaluate post-operative pain in children and compare self-ratings of pain with those of a parent, and to study analgesic use after dental extractions under general anaesthesia (GA). STUDY DESIGN: Prospective observational study. METHODS: One hundred children, aged 3–12 years, who had extractions performed under GA participated. After treatment, the child and one parent assessed post-operative pain on 5 occasions: before discharge, the evening of the treatment day, and the following three evenings. The parent rated the child’s level of pain on a visual analogue scale (VAS), and the child made two ratings, one on a facial analogue scale (FAS) and one on a coloured analogue scale (CAS). Analgesics were recommended 3–4 times daily, and the parent recorded the intake. RESULTS: Seventy-eight children only had primary teeth extracted, 8 children had both primary and permanent teeth extracted, and 14 children only had permanent teeth extracted. The median number of extracted primary teeth was 5 (range 1–12) and of permanent teeth 3 (range 1–4). The median pain ratings were highest in the post-operative ward, VAS=1.0 (max 9.2), FAS=2 (max 10), and CAS=1.4 (max 10). The second highest median values were in the evening following treatment. No significant differences were found between pain ratings of the parent and the child or between the two ratings of the child. 60% took analgesics on day 1. On day 2, 45% took analgesics, of which 29% more than once. STATISTICS: Spearman’s rank correlation coefficient was used to test concordance between ratings. CONCLUSIONS: Most children had mild or no pain, and parent and child pain ratings agreed well. The dentist’s analgesic recommendations were often poorly followed.

An atypical presentation of mechanical failure of eruption of a mandibular permanent molar: diagnosis and treatment case report.

Abstract: BACKGROUND: Failure of eruption of mandibular permanent molars occurs infrequently but is a difficult clinical problem. It can be due to local or systemic factors or failure of the eruption process. Primary failure of eruption (PFE) is a rare condition that can result in severe posterior open bite, requires complex treatment strategies and has unfavourable outcomes. Mechanical failure of eruption (MFE) is more unusual but can respond positively to treatment. Differentiating between the two is crucial in making the correct diagnosis and managing the case successfully. CASE REPORT: A 10-year-old girl presented with a partially erupted mandibular right first permanent molar, 46. She had no relevant medical or dental history and no family history of tooth eruption failure. TREATMENT: 46 was monitored for 6 months to allow spontaneous eruption. Local and systemic factors were eliminated. Progress radiographs and longitudinal clinical data were collected. Attempted eruption of 46 was completed by surgical luxation and elevation by orthodontic force. FOLLOW-UP: Surgical luxation and elevation of 46 was repeated with the removal of the mandibular right second permanent molar, 47, which was mechanically obstructing the eruption of 46. With continued orthodontic force the tooth was righted up and brought into occlusion with no complication of ankylosis. The mandibular right third molar continues to erupt and migrate mesially. The patient now exhibits a bilateral functioning posterior bite three years after the treatment was commenced. CONCLUSION: Through a combination of sequential monitoring with treatment including surgical luxation and orthodontic force, a therapeutic diagnosis of MFE was made. The appropriate treatment was carried out and the tooth erupted into occlusion.

Short communication: A pan-European comparison of the management of carious primary molar teeth by postgraduates in paediatric dentistry

Abstract: AIM: To assess the preferences amongst European postgraduates (PG) in Paediatric Dentistry for the treatment of a child with differing caries severity in a primary molar tooth. STUDY DESIGN: An on-line structured questionnaire. METHODS: All European Paediatric Dentistry PGs were contacted by e-mail and asked to participate in an on-line questionnaire. The survey described four different case scenarios of a 5-year-old child, presenting with a mesio-occlusal cavity in tooth 85 with varying symptoms and signs. Treatment options were listed and participants asked to select the single most preferred treatment for each case. The same scenarios were presented for both non-anxious and dentally-anxious patients. RESULTS: Responses were received from 32/56 (F: 27; M: 5) PGs. A range of treatment options were selected for patients with no indication of pulpal involvement for non-anxious patients whilst the Hall technique was selected by 16/32 students for a dentally-anxious patient. For both a non-anxious and dentally-anxious patient, the preferred option for a tooth which produced pulpal symptoms was extraction selected by 16/32 students in both cases, although the mode of extraction differed. CONCLUSION: There was no consistency of response by PGs in Paediatric Dentistry within Europe. The Hall technique appeared to be a favoured option by half of the students for treatment of an asymptomatic carious primary molar tooth in a dentally-anxious child patient. Dental extraction was an option for a tooth demonstrating pulpal symptoms in both non-anxious and dentally-anxious patients.

Long-term effect of maternal xylitol exposure on their children's caries prevalence.

Abstract: AIM: To evaluate the long-term outcome of a motherchild project in which mothers (n=173) with high counts of salivary mutans streptococci were randomly assigned to daily chewing gums containing xylitol (A), chlorhexidine/xylitol/sorbitol (B), or sodium fluoride/xylitol/sorbitol (C) for one year, when the child was between 6 and 18 months METHODS: 140 of the off-springs were re-examined at the age of 10 years and 204 children of mothers with low counts of salivary mutans streptococci three months after delivery served as positive controls (D) Caries was scored in the young permanent dentition on enamel (noncavitated) and dentine (cavitated) levels RESULTS: The long-term attrition rate was 15% The overall caries prevalence in the combined groups at 10 years of age was 31% (21% non-cavitated; 17% cavitated) with a mean DS of 07 (SD 13) No significant differences were found between the three experimental groups (A-C), or when compared with the control group A statistically significant (p<005) positive relationship between the levels of salivary mutans streptococci at 18 months of age and the caries experience at the age of 10 years was disclosed for all groups combined CONCLUSION: No beneficial longterm effects of maternal xylitol gum exposure on their children’s dental health were demonstrated when compared with gums containing chlorhexidine and fluoride

Erosive effects of beverages in the presence or absence of caries simulation by acidogenic challenge on human primary enamel: an in vitro study

Abstract: AIM: To evaluate in vitro the erosive effects of beverages in the presence or absence of caries simulation (acidogenic challenge) on the microhardness of primary enamel. METHODS: Forty human primary teeth were submitted to the erosive effects: 3×20-min-long daily immersion in fresh orange juice (orange group), strawberry yogurt drink (yog group), or cola soft drink (cola group) separately or in combination with acidogenic challenge (pH cycling for 10 days). Specimens were also submitted to acidogenic challenge alone, and in the negative control group specimens were not submitted to any treatment. Mineral loss was evaluated by cross-sectional microhardness determination. The data (Knoop hardness numbers, KHN) were subjected to 2-way analysis of variance and Tukey’s post hoc test (α = 0.05%). RESULTS: All the test beverages significantly reduced the sample cross-sectional enamel hardness (KHN ± SD, 235.93 ± 18.15, 257.23 ± 21.79, and 253.23 ± 13.86 in the orange, yog, and cola groups, espectively) compared to samples in the negative control group (290.27 ± 3.92). In vitro acidogenic challenge exacerbated the mineral loss induced by all beverages (166.02 ± 4.28,190.43 ± 17.55, and 198.39 ± 21.39 in the orange, yog, and cola groups combined to acidogenic challenge, respectively) compared to acidogenic challenge alone. CONCLUSIONS: All beverages exhibited erosive effects on primary enamel. Simulated caries challenge considerably exacerbated the enamel softening of primary teeth.

Caries prevention with xylitol lozenges in children related to maternal anxiety. A demonstration project.

Abstract: AIM: This was to compare the effect of a prevention program between children of anxious and non-anxious mothers. METHODS: Mothers (n=120) with high and low dental anxiety scores (DAS≥15 and DAS ≤8, respectively), and with high levels of mutans streptococci (≥105cfu/mL) were recruited at a maternity clinic of Tartu, Estonia. Two groups: 30 highly anxious, and 30 non-anxious mothers used xylitol (6 g/day) for 33 months and a non-treatment group of 60 mothers, both highly and low anxious (30 in each sub-group), acted as controls. All mothers were interviewed for oral health habits and education, and their dental health was examined. Due to discontinued participation 75% of the children (n=90) were examined at 2 and at 3 years of age. RESULTS: Anxious mothers brushed less frequently (p=0.014), had a longer time since their last dental visit (p<0.0001), and a lower level of education (p<0.0001) than their non-anxious counterparts. However, maternal anxiety had no effect on children’s dental health, contrary to the caries prevention program which was effective both at 2 and at 3 years of age (p<0.01; OR 6.6, 1.8–25.0 and OR 3.9, CI 1.5–10.0, respectively). CONCLUSION: Children benefited from the caries prevention program, irrespective of maternal anxiety.

Idiopathic pre-eruptive coronal resorption of a maxillary permanent canine

Abstract: BACKGROUND: Coronal resorption is a coronal degeneration of enamel and dentine in which ultimately the crown is replaced by vascular connective tissue through a defect in the enamel organ of an unerupted tooth. This is also known as pre-eruptive coronal resorption. However, the aetiology of resorption remains unclear. CASE REPORT: A 13 years 7 months old Caucasian boy who attended an orthodontic consultation for anterior crossbite correction presented with idiopathic pre-eruptive coronal resorption of an erupted right maxillary permanent canine (FDI 13). Clinically, the enamel remaining on the crown was extremely thin and had a shell-like appearance. There was erythematous soft tissue within the parameters of the crown that resembled pulp tissue. From the radiographs, the irregular radiolucency area within the crown portion extended widely into the enamel and dentine. Treatment: Following excisional biopsy, it was decided to retain the right maxillary canine and monitor its progress. FOLLOW-UP: He has been reviewed at frequent appointments over 18-months since the time there was radiographic evidence of resorption. CONCLUSION: It is prudent to make an early diagnosis of this condition and to formulate short and long-term treatment plans, which may involve keeping the affected tooth to retain the alveolar bone height and width to allow for the option of planning for an implant.

Caries incidence in a cohort of primary school students in Lagos State, Nigeria followed up over a 3 years period.

Abstract: Aim: To describe the progression of dental caries in pupils who had access to an education intervention programme over a three years period. STUDY DESIGN: This was a prospective cohort study. METHODS: A school-based study consisting of 251 children aged 2–10 years old attending three primary schools in Lagos State, Nigeria. Baseline and exit dental examinations were conducted. Study exit examination was conducted 3 years after the baseline. The deft and DMFT index was used to assess caries severity. The key outcome measure recorded in the study was the development of new cavities in any of the previously caries-free teeth. The presence or absence of caries was represented by the change in deft and or DMFT status. STATISTICS: In the analyses, the incidence of new cavities was recorded at both the subject and tooth levels. Incidence rates for the development of new caries were calculated for all children who: were caries-free at recruitment had caries at recruitment were caries-free at recruitment but developed caries during follow up. Relative risk (RR) analysis was also computed for caries-risk estimation. RESULTS: The caries incidence for the study cohort was 9.9%. About 11.0% of children who were caries free at inception of the study developed caries three years later. The cumulative incidence of caries for the cohort of children who were caries-free at the commencement of the study was 105 new cases per 1,000 persons. Of the 40 children who had caries at the inception of the study, 21 (52.5%) developed new caries lesions. The cumulative incidence of caries for the cohort of children who had caries at the commencement of the study was 525 new cases per 1,000 persons. The relative risk of developing caries over a three year period was significantly higher (RR=4.99; 95% CI = 2.88 − 8.64; p<0.001) in those who had caries at baseline than those who were caries-free at baseline. Caries severity remained stable over the 3 years period. CONCLUSIONS: Caries incidence and severity was low for the study cohort. The relative risk of developing new caries lesion was significantly higher in those with caries when compared with those without caries.