Showing papers in "International Journal of Paediatric Dentistry in 2001"

Variations in number and morphology of permanent teeth in 7-year-old Swedish children.

Abstract: Summary.Objectives. To establish the prevalence of numerical and morphological variations of permanent teeth in Swedish 7-year-olds and to accept or reject the hypothesis of a higher prevalence for these conditions in northern Sweden compared to other areas. Design. Cross-sectional. Setting. Department of Odontology/Pedodontics, Umea University, Sweden. Sample and methods. A total of 739 healthy Caucasian 7-year-olds residing in the city of Umea, northern Sweden in 1976. The children were examined clinically and radiographically. Results. The prevalence of hypodontia (excluding third molars) in girls was 8·4%, in boys 6·5%, and in both sexes combined 7·4%. Of the children with hypodontia, the majority (90·9%) lacked one or two teeth. Lower second premolars were the teeth most frequently missing. The prevalence of hyperdontia was 1·9%; 11 girls and three boys were affected; 78% of the supernumerary teeth were mesiodenses. Of the morphological variations, peg-shaped upper lateral incisors were found in 0·8% of the children, double-formation (gemination) in 0·3%, taurodontism in 0·3% and dens invaginatus in 6·8%. One diagnosis was found in 18% of the children, and in almost 8% of them more than one diagnosis was found. Conclusions. The results agree with those obtained in similar populations and are considered representative of this ethnic group. The hypothesis of a genetically determined higher prevalence of numerical and morphological variations in the study population was not verified.

The role of the mouthguard in the prevention of sports-related dental injuries: a review.

Abstract: ummary. Objectives. This paper examines the literature dealing with oral–facial injuries received during participation in sport and the possibilities open to athletes for their prevention. In particular, the paper examines five different aspects of this topic: the risk of dental injury while playing sports, the role of the mouthguard in preventing injury, types of athletic mouthguard, implications for patients undergoing orthodontic treatment and behavioural aspects of mouthguard wear. Results. It is clear from this review that participation in a number of sports does carry a considerable risk of sustaining dental injury, not only in the so-called contact sports such as rugby and hockey, but also in less obviously dangerous sports such as basketball. Although some evidence exists to the contrary, the majority of studies have found the mouthguard to be the most effective way of preventing such injuries. It is also clear that the custom-fabricated mouthguard, in particular the pressure-laminated variety, is seen to afford most protection. Athletes undergoing orthodontic treatment present a particular problem as they are potentially at greater risk of injury because of increased tooth mobility and the presence of orthodontic appliances. The fabrication of mouthguards for these patients is also problematic and the literature covering this is reviewed. As with other preventive measures, mouthguard usage is often less than the dental profession would like; the reasons for this are explored in a small number of studies. Conclusion. While much progress has been made in this area, the profession could do much more to promote the greater use of mouthguards.

Long-term prognosis of crown-fractured permanent incisors. The effect of stage of root development and associated luxation injury

Abstract: Objectives. The aim of the present study was to investigate pulp healing responses following crown fracture with and without pulp exposure as well as with and without associated luxation injury and in relation to stage of root development. Patient material and methods. The long-term prognosis was examined for 455 permanent teeth with crown fractures, 352 (246 with associated luxation injury) without pulpal involvement and 103 (69 with associated luxation injury) with pulp exposures. Initial treatment for all patients was provided by on-call oral surgeons at the emergency service, University Hospital (Rigshospitalet), Copenhagen. In fractures without pulpal involvement, dentin was covered by a hard-setting calcium hydroxide cement (Dycal®), marginal enamel acid-etched (phosphoric acid gel), then covered with a temporary crown and bridge material. In the case of pulp exposure, pulp capping or partial pulpotomy was performed. Thereafter treatment was identical to the first group. Patients were then referred to their own dentist for resin composite restoration. Results. Patients were monitored for normal pulp healing or healing complications for up to 17 years after injury (x = 2·3 years, range 0·2–17·0 years, SD + 2·7). Pulp healing was registered and classified into pulp survival with no radiographic change (PS), pulp canal obliteration (PCO) and pulp necrosis (PN). Healing was related to the following clinical factors: stage of root development at the time of injury, associated damage to the periodontium at time of injury (luxation) and time interval from injury until initial treatment. Crown fractures with or without pulp exposure and no concomitant luxation injury showed PS in 99%, PCO in 1% and PN in 0%. Crown fractures with concomitant luxation showed PS in 70%, PCO in 5% and PN in 25%. An associated damage to the periodontal ligament significantly increased the likelihood of pulp necrosis from 0% to 28% (P < 0·001) in teeth with only enamel and dentin exposure and from 0% to 14% (P < 0·001) in teeth with pulp exposure. Conclusions. In the case of concomitant luxation injuries, the stage of root development played an important role in the risk of pulp necrosis after crown fracture. However, the primary factor related to pulp healing events after crown fracture appears to be compromised pulp circulation due to concomitant luxation injuries.

The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia: Relationship between erosion, caries and diet in children

Abstract: OBJECTIVES The aim of this study was to investigate the possible association between dental erosion and caries, and variables including socio-economic status, reported dietary practices and oral hygiene behaviour, in a sample of children in Jeddah, Saudi Arabia. A cross-sectional study including dental examination and questionnaire survey was carried out at a number of kindergartens. SAMPLE AND METHODS A sample of 987 children (2-5-year-olds) was drawn from 17 kindergartens. Clinical examinations were carried out under standardized conditions by a trained and calibrated examiner (MAM). Information regarding diet and socio-economic factors was drawn from questionnaires distributed to the parents through the schools. These were completed before the dental examination. RESULTS Of the 987 children, 309 (31%) showed signs of erosion. Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%). Vitamin C supplements, frequent consumption of carbonated drinks and the drinking of fruit syrup from a feeding bottle at bed- or nap-time when the child was a baby, were all related to erosion. Consumption of carbonated drinks and fruit syrups was also related to caries but they were part of a larger number of significant factors including socio-demographic measures and oral hygiene practices. CONCLUSIONS There was no clear relationship between erosion and social class, or between erosion and oral hygiene practices; the reverse was true for caries. Dietary factors relating to both erosion and caries and/or rampant caries were found in this sample of children.

Avulsed permanent incisors: knowledge and attitudes of primary school teachers with regard to emergency management.

Abstract: Summary. Objectives. This study was designed to examine the knowledge and attitudes of primary school teachers with regard to the emergency management of avulsed permanent incisors. Design. Data were collected by self-administered questionnaire. Setting. The study was conducted in primary schools lying within a 2-mile radius of the University Dental Hospital, Cardiff. Sample and methods. A total of 388 teachers in 31 participating schools were asked to complete a questionnaire, which was subsequently collected by two of the authors (CS and AT). Results. Two hundred and seventy-four teachers returned completed questionnaires, a response rate of 70·6%. One hundred and eighty-one respondents (60·1%) had received no advice about the emergency management of dental avulsion. Of the 133 teachers (48·5%) who possessed a first aid certificate, 39 (29·3%) had been given relevant advice as part of this training. Less than one-third of respondents (85 (31%)) cited an optimum extra-oral time of 30 min or less, with only 43 (15·7%) considering that this should be 10 min or less. However, 125 (45·6%) knew milk to be the best transport medium. Two hundred and four teachers (74·5%) stated that they would not be prepared to replant an avulsed tooth themselves, 133 (80%) basing this decision on lack of expertise and training. Two hundred and sixty-two teachers (95·6%) expressed a desire for further information. Conclusions. The majority of respondents possessed, at best, rudimentary knowledge of the emergency management of dental avulsion. Teachers, and other individuals who supervise children in schools, should receive simple instruction in dental first aid.

Provision of Atraumatic Restorative Treatment (ART) restorations to Chinese pre-school children--a 30-month evaluation.

Abstract: Summary.Objectives. The objectives of this study were: to provide restorations using the ART approach to pre-school children in Southern China in a kindergarten environ-ment, using a high-strength glass-ionomer restorative material; to assess the accept-ability of this approach and to evaluate on a longitudinal basis the restorations placed. Sample and methods. A total of 170 ART restorations were placed in 95 children, aged 5·1 ± 0·7 years, by seven final-year dental students using standard ART procedures and hand instruments. The restorations were evaluated every six months thereafter by two calibrated independent examiners using explorers and mouth-mirrors. Results. 93% of the children reported that they did not feel pain during treatment and 86% were willing to receive ART restorations again. The cumulative 12- and 30-month survival rates of Class I restorations were 91% and 79%, respectively. The corresponding figures for Class V restorations were 79% and 70%, while those for Class II restorations were 75% and 51%. The failure rates of Class III and IV restor-ations were high with more than half of them scored as missing within the first year. Conclusions. The ART approach was shown to be acceptable to Chinese pre-school children for providing restorative dental care outside the traditional clinical setting. The success rates were high for Class I and V restorations in primary teeth, modest for Class II, and low for Class III and IV restorations.

The relationship between erosion, caries and rampant caries and dietary habits in preschool children in Saudi Arabia

Abstract: Summary. Objectives. The aim of this study was to investigate the possible association between dental erosion and caries, and variables including socio-economic status, reported dietary practices and oral hygiene behaviour, in a sample of children in Jeddah, Saudi Arabia. A cross-sectional study including dental examination and questionnaire survey was carried out at a number of kindergartens. Sample and methods. A sample of 987 children (2–5-year-olds) was drawn from 17 kindergartens. Clinical examinations were carried out under standardized conditions by a trained and calibrated examiner (MAM). Information regarding diet and socio-economic factors was drawn from questionnaires distributed to the parents through the schools. These were completed before the dental examination. Results. Of the 987 children, 309 (31%) showed signs of erosion. Caries were diagnosed in 720 (73%) of the children and rampant caries in 336 (34%). Vitamin C supplements, frequent consumption of carbonated drinks and the drinking of fruit syrup from a feeding bottle at bed- or nap-time when the child was a baby, were all related to erosion. Consumption of carbonated drinks and fruit syrups was also related to caries but they were part of a larger number of significant factors including socio-demographic measures and oral hygiene practices. Conclusions. There was no clear relationship between erosion and social class, or between erosion and oral hygiene practices; the reverse was true for caries. Dietary factors relating to both erosion and caries and/or rampant caries were found in this sample of children.

Association between early weaning, non-nutritive sucking habits and occlusal anomalies in 3-year-old Finnish children.

Abstract: Objectives, design and subjects. Earlier results on the effect of breastfeeding on the one hand, and non-nutritive sucking habits (pacifier and/or digit sucking) on the other, on the orofacial development of infants are inconclusive. Thus we studied the prevalence of malocclusions and their relationship to the duration of breastfeeding and to non-nutritive sucking habits in a group of randomly selected 3-year-old children (n = 148). Results. Posterior crossbite was detected in 13%, anterior open bite in 18% and large overjet (> 3 mm) in 26% of the children. The proportion of children with anterior vertical open bite was significantly larger among children with non-nutritive sucking habits than among the other children (P < 0·001). Neither posterior crossbite nor large overjet were associated with non-nutritive sucking habits. The duration of exclusive breastfeeding was 5·8 ± 3·6 months while that of total breastfeeding was 7·3 ± 3·8 months on average. The exclusive and total breastfeeding periods of children with posterior crossbite were both significantly shorter than those of the other children (P < 0·01 and P < 0·002, respectively). Children’s height and weight were unrelated to the duration of breastfeeding or occlusal anomalies. Conclusion. We suggest that an early introduction of bottlefeeding, indicating a pattern of low-impact muscular activity, may interfere with the normal development of alveolar ridges and hard palate, and hence lead to posterior crossbite.

The relationships between dietary guidelines, sugar intake and caries in primary teeth in low income Brazilian 3-year-olds: a longitudinal study.

Abstract: OBJECTIVES: To investigate the effects of dietary guidelines on sugar and sugar intake at day nurseries, and other potential risk factors on dental caries in two groups of low socio-economic nursery schoolchildren. DESIGN: Nursery based, longitudinal study. SETTING: Metropolitan area of Recife, north-eastern Brazil. SAMPLE AND METHODS: The study population comprised 510, 3-year-old low socio-economic nursery schoolchildren. Sugar intake at the nursery was based upon a weighed inventory method during 2 non-consecutive days. Parents answered a questionnaire. RESULTS: Children attending nurseries not adopting guidelines on reduction of sugar intake had a higher caries risk, with an odds ratio of 3.6 compared to those attending nurseries with guidelines. A higher caries increment was related to higher daily frequency and weight of sugar intake at nursery, overall daily frequency of sugar intake (sugar intake at home plus nursery), past caries experience, use of fluoride, and habits related to toothbrushing. Children having more than 32.6 g of sugar daily at nursery were 2.99 times more likely to have high caries increment than those having less than that amount. CONCLUSIONS: Sugar intake at nursery and the adoption of guidelines on sugar were associated with lower caries increment in low income nursery schoolchildren. A number of modifiable factors such as a higher daily frequency and weight of sugar intake at nursery, use of fluoride and habits related to toothbrushing were strongly related to caries increment.

Intra-nasal midazolam in conscious sedation of young paediatric dental patients

Abstract: Summary.Objectives. To compare the effects of 3 different doses of intra-nasal midazolam in the conscious sedation of young paediatric dental patients and to compare the effectiveness of the sedation in the fasting and non-fasting child. Design. Double blind random controlled trial. Sample and Methods. Thirty-eight uncooperative young children aged 2–5 years (mean age 4·02 years) were randomly assigned to one of 3 groups. The groups and the doses of midazolam administered intra-nasally were A: 0·3 mg/kg, B: 0·4 mg/kg, and C: 0·5 mg/kg body weight. Each child in each group had two visits for restorative treatment: one without food (fasting) and the other with soft drink and light food (non-fasting) before treatment. Child behaviour and sedative effects were evaluated using the scoring system of Houpt. The vital signs were monitored continuously using a pulse oximeter and Dinamap machine. Results. There was rapid onset of sedation with the maximal effect between 8 and 15 minutes. This sedation lasted for 25–40 minutes in Groups A and B and for 60 minutes in Group C. Conscious sedation and dental treatment were achieved in 79%, 96% and 100% of the children in Groups A, B and C, respectively. Consistently higher Houpt scores were seen in Groups B and C, with statistically significant differences between Groups A and C, and B and C (Tukey’s range test, P 0·05). All the vital signs were within normal physiological limits and there were no significant adverse effects either with or without fasting. Conclusions. All 3 doses of intranasal midazolam were effective in modifying the behaviour of the uncooperative child patient to accept dental treatment. This was irrespective of fasting.

Dental fluorosis and caries experience in relation to three different drinking water fluoride levels in South Africa.

Abstract: Summary. Objectives. The purpose of this study was to determine the relationship between caries experience, degree of fluorosis and different concentrations of fluoride in the drinking water of children. Sample and methods. The study included 282 children aged 10–15 years, who lived continuously since birth in three different naturally fluoridated areas (Leeu Gamka, 3·0; Kuboes 0·48 and Sanddrif 0·19 p.p.m. F), with virtually no dental care or any fluoride therapy. The teeth of the children were examined for caries using the DMFT index according to the WHO criteria and for fluorosis, using Dean’s criteria according to the WHO guidelines. Results. The prevalence of fluorosis (scores 2, 3, 4 and 5) among the school children was 47% in Sanddrif, 50% in Kuboes and 95% in Leeu Gamka. Almost half the children in the two low fluoride areas had no fluorosis (scores 0 and 1), whereas only 5% in Leeu Gamka had no fluorosis. Of the children in Sanddrif, 42·5% had very mild/mild (scores 2 and 3) fluorosis, 44·3% in Kuboes and 34·1% in Leeu Gamka. Except for one individual in Kuboes, severe fluorosis (score 5) was only observed in the high fluoride area in 30% of the children. According to the Bonferroni adaptation for multiple comparisons, the degree of fluorosis in Leeu Gamka differed significantly from both those of Sanddrif and Kuboes. The mean DMFT for the children in Sanddrif and Kuboes was similar (1·64 ± 0·30 and 1·54 ± 0·24, respectively) but the caries experience of Leeu Gamka (1·98 ± 0·22) was significantly higher (P < 0·05) than that of both the other two areas. A strong positive correlation (P < 0·05) was found between the caries experience and the fluorosis scores of children in the high fluoride area (Leeu Gamka) but no correlation could be found in the other two areas. Significantly (P < 0·01) more children had decayed teeth in the high F area (Leeu Gamka) than in the other two areas. Conclusion. The results suggest a positive association between high F levels in the drinking water and dental caries. Furthermore, a low caries experience and no difference in DMFT and fluorosis between the two low fluoride areas were found.

Primary double teeth. A retrospective clinical study of their morphological characteristics and associated anomalies

Abstract: Aim. To investigate the relationship between morphology and position of double teeth, and the occurrence of other dental anomalies in the same subjects and in their siblings. Sample of children and methods. Fifty-three double teeth in a group of 50 Spanish children were included in the study. All of these children were examined clinically and had radiographs and photographs taken at the time of examination. Twenty-two of the children had a total of 30 siblings who were also examined for the presence of anomalies. Results. Of the 50 subjects, 47 had one and three subjects had two double teeth. Statistically there were no significant differences in occurrence between boys and girls, left and right sides or between maxilla and mandible. Four morphological types were identified: type I, bifid crown–single root; type II, large crown–large root; type III, two fused crowns–single root; type IV, two fused crowns–two fused roots. Type I was seen only in the maxilla and types II and III only in the mandible. Type IV was seen mostly in the maxilla. More than half of the cases showed associated anomalies in the permanent dentition and anomalies of number or shape were also present in six of the siblings. Conclusion. It is suggested that both double teeth and other anomalies in the same children or in their siblings may be manifestations of a primary abnormality in the distribution of dental material.

The prevalence and pattern of nursing caries in Saudi preschool children

Abstract: Summary. Objectives. To determine the prevalence and pattern of nursing caries in Saudi preschool children of Riyadh area. Design. Cross-sectional. Subjects and methods. A list of kindergartens was derived through random selection of one kindergarten from every area of Riyadh. A sample of 1016 children with primary dentition only was examined for dental caries. The criterion used for nursing caries was presence of caries on the labial or lingual surfaces of at least two maxillary incisors with absence of caries in mandibular incisors. Results. Two hundred and seventy-seven (27·3%) children were diagnosed as having nursing caries. The mean dmft of nursing caries children was 8·6 (± 3·4), with dt component of 7·6 (± 3·5), mt of 0·4 (± 0·9) and ft of 0·6 (± 1·7). The older children had significantly higher mean dmft as compared with younger children. The teeth most affected by caries were maxillary central incisors (93·9%), whereas the least affected were mandibular canines (9·6%). A great majority of children (95·7%) had caries in both anterior and posterior teeth. The probability of bilateral molar caries was very high in nursing caries children; highest (94·7%) in mandibular first molars. Conclusions. The caries prevalence was high in the study population. The maxillary central incisors were most affected by caries. The probability of bilateral molar caries was very high.

Children choosing between general anaesthesia or inhalation sedation for dental extractions: the effect on dental anxiety.

Abstract: SummaryAim To compare the levels of dental anxiety experienced by children having dental extractions using general anaesthesia (GA) with those having extractions using local anaesthesia and inhalation sedation (IHS) when offered a programmed choice between the two techniques prior to treatment Design Structured interview with child at pre-treatment and at one week (approximately) follow up Setting Community: primary health care centre Subjects Children aged 9–15 years referred to a local NHS Trust dental clinic (n = 88) Intervention Child and parent provided with information about IHS and its benefits over GA for the assistance in tolerating extraction of teeth and provided with a choice of procedure Main outcome measure An eight question modified child dental anxiety scale Results Full information was received from 76 children giving an 86% response rate Post-operative dental anxiety was lower in children who had chosen (with their parent) IHS in comparison to those who had chosen general anaesthesia (P < 0·05) Dental anxiety remained unchanged in the group who chose to have their extractions under GA Conclusion Children and their parents who select IHS as opposed to GA to assist in extractions demonstrate less psychological distress

Comprehensive dental care for children with rampant caries under general anaesthesia.

Abstract: .Objective. Critical reflection on treatment strategy for dental rehabilitation of young children with rampant caries using day-stay general anaesthesia at a university dental clinic. Design. Cross-sectional analysis of 98 cases. Setting. The study was undertaken at the university paediatric dental clinic of Leuven, Belgium. Sample and methods. The sample consisted of 98 healthy patients referred for dental treatment under general anaesthesia with a mean age of 4·8 (± 1·1) years and mean dmft-score of 9·3 (± 3·0). Data were obtained by history taking, clinical examination, questionnaires (filled in by parents) and standardized data records (filled in by dentists and nurses in the recovery area and day-stay clinic). Results. Most patients were referred by their private dentist (74·5%) because of a need for extensive dental treatment in an uncooperative child. Induction of anaesthesia was upsetting in a significant number of cases (68% of children). The mean duration of the whole procedure was 80·9 (± 24·7) minutes. A mean number of 7·2 (± 2·9) primary teeth were filled and 1·8 (± 2·0) extracted per patient. Post-operative problems (nausea/vomiting, temperature rise) were seen in only 8·2% of the patients. Conclusions. The technique used at this centre allows for extensive dental treatment of young children with a high level of acceptability and minimal morbidity, using day-stay general anaesthesia. Based on this review, it became clear that less upsetting methods for the induction of anaesthesia need to be explored. Criteria for the administration of antibiotics need to be defined more clearly and the use of stainless steel crowns should be envisaged for restorations on primary molars. The global outcome of this treatment provision in children at high caries risk should be evaluated over a longer period, including an evaluation of oral health status, restorative treatment (conservation vs. extraction) and behavioural aspects.

A prospective study of factors affecting survival of replanted permanent incisors in children.

Abstract: Objective To examine the factors associated with the onset of resorption in replanted avulsed permanent incisor teeth and to demonstrate their patterns of survival free of resorption Setting Department of Paediatric Dentistry, Belfast Design Prospective recording of the timing of the injury and of replantation, the storage media, the degree of root development and contamination, and the completion of root treatment Clinical and radiographic reviews at 3-month intervals Root resorption classified as replacement and inflammatory Logistic regression and survival curves with freedom from resorption as outcomes Results In 50 avulsed incisors in children aged 6–16 years the best predictor of overall resorption was total time of dryness, and that for replacement resorption was total extra-oral time The timing of detection of resorption varied from 102 days to 997 days Conclusion Both total extra-oral time and time stored dry are important factors for the onset of resorption in replanted avulsed teeth in children

Root resorption in retained deciduous canine and molar teeth without permanent successors in patients with severe hypodontia

Abstract: AIMS: The ability to predict the morbidity of retained deciduous teeth with no permanent successors, a characteristic of hypodontia, would be of considerable value in treatment planning, but is hampered by lack of data. METHODS: This problem was studied using 356 orthopantomogram radiographs (OPGs) from the records of 249 patients who had attended a specialist hypodontia clinic, and had retained deciduous teeth with no permanent successors. Due to their clinical importance, canine and molar teeth were chosen for examination. Resorption was assessed subjectively by three experienced clinicians. RESULTS: Un-weighted Kappa values for reproducibility were > 0.8, and for interobserver error 0.60-0.83. Gender related differences were minimal. Regardless of gender or radiographic age, the lower canines appear to show the least amount of resorption and the upper first molars the most. The upper and lower second molars have particularly unpredictable life spans. Whilst the lower first molars have a predictable life span that is poor, the life span for the upper first molars is slightly worse. CONCLUSIONS: Lower canines have a predictable life span that appears to be good, as do upper canines, but of lesser duration than lower canines. Molars have poorer and less predictable life spans.

Oral mucosal lichen planus in children.

Abstract: Although lichen planus is a relatively common mucocutaneous disorder in adults, it has only rarely been described in children. Moreover, even less data has been published regarding mucosal lesions in children. Six case reports of childhood oral lichen planus are presented and the available literature reviewed. It is believed that this paper documents the largest series of cases of childhood oral mucosal lichen planus to be reported in the literature to date. Lichen planus should be considered in the differential diagnosis of oral mucosal white patches in children, particularly those of Asian origin.

Oral myiasis: a case report

Abstract: Oral myiasis is a rare condition caused by the invasion of tissues by larvae of flies. A case of gingival myiasis is presented in a 12-year-old boy with learning disability. The patient was unaware of the lesion, although it produced a swelling partially covering the teeth. The lesion was treated with ether, which forced the larvae out, and irrigated with warm saline solution. Follow-up examination revealed complete subsidence and healing of the lesion.

Dental maturation of 18th and 19th century British children using Demirjian's method.

Abstract: Aim. To compare dental age with chronological age in a group of children born approximately 200 years ago and a group of modern children. Methods. Dental maturation of 15 skeletal remains (range 3·0–15·1 years) of London children of known age-at-death was compared to an age and sex matched control group of contemporary children (n = 30). The method of Demirjian, Goldstein and Tanner (1973, 1976, 1978) was used to assess maturity. Results. The difference between dental age (DA) and chronological age (CA) for both groups was not significant, suggesting similar maturation over 200 years, however, many of the younger children from Spitalfields were dentally delayed. Several of the younger individuals from both groups had a dental age less than the lowest limit of this scale (2·5 years), highlighting one pitfall of this method. Conclusion. These results suggest that this method is not entirely suitable for younger children.

Preventive oral health care and health promotion provided for children and adolescents by the Municipal Dental Health Service in Denmark.

Abstract: Summary.Objective. To describe the current organization of health promoting and preventive activities within the Danish Municipal Dental Health Service and to assess how the service has chosen to comply with the directives as formulated by the National Board of Health. Design. A cross-sectional survey of the municipal dental health services was carried out on a national scale. Postal questionnaires were used to collect information on active and passive preventive care activities and community-orientated health promotion. Setting. The survey was conducted to aid the reorientation and adjustment of the Municipal Dental Health Services in Denmark. Subjects. All municipal dental health services in Denmark were considered relevant for the survey and 141 services (71%) responded to the questionnaire. Outcome measures. Quantitative methods were used to measure recall-intervals for children and adolescents, passive and active prevention, identification of and care for individuals at risk, and health education. Qualitative methods were applied to record the organization of community health activities. Results and conclusions. The majority of dental services stated that preschool children are called at regular intervals (every 3, 6 or 8 months); school-children and adolescents are most often recalled according to individual needs. Chairside assistants, dentists or dental hygienists give oral hygiene instructions systematically to children of grades 0 through to 3. Fluoride is frequently administered through topical application by dentists; fluoride tables are not used. Permanent molars are sealed when this is indicated. Clinical and socio-behavioural criteria are used to identify children at risk. Half of the services reported school-based health education, and in one-quarter of the municipalities community health activities took place. Adjustment of the services should consider population-directed activities and greater use of ancillary personnel.

Oral health survey of 5-12-year-old children of National Guard employees in Riyadh, Saudi Arabia.

Abstract: Objectives. To assess the oral health status, preventive practices and mutans streptococci (MS) levels among the children of National Guard personnel living in Riyadh, Saudi Arabia. Design. Cross-sectional study of schoolchildren. Setting. Dental Clinic of the National Guard Hospital in Riyadh, Saudi Arabia. Sample and methods. A sample of 272 5–12-year-old children, 154 males and 118 females (95% Bedouin), were selected from approximately 35 National Guard schools in the Riyadh area. An examination was performed in the dental clinic in the National Guard hospital. Oral hygiene was assessed using the Simplified Debris Index (DI-S); Gingival Index (GI) was used to measure gingival health; dental fluorosis was recorded according to the criteria of Dean. Dental caries (dmft, dmfs, DMFT and DMFS) was recorded according to the recommendations of Haugejorden. Concentration of MS in saline rinse samples was assessed by routine laboratory methods and expressed as colony forming units (CFU) per ml (log10). Results. There was a high level of dental caries (mean dmft = 3·8 ± 3·2; mean dmfs = 21·5 ± 15·7; mean DMFT = 2·0 ± 1·9; mean DMFS = 3·1 ± 3·7). Only 0·7% of the children had no caries experience (dmft + DMFT). MS levels ranged from 0 to 7·5×105 CFU per ml (mean MS = 4·10 ± 0·90 log10 CFU per ml). A significant relationship between MS and caries experience was observed (P = 0·003). Mild fluorosis was observed in 14% of the children. Oral hygiene scores indicated that most of the examined tooth surfaces had detectable plaque (mean DI-S = 1·78). Gingivitis was present in 100% of the children and was considered moderate to severe in 14% (mean GI = 1·18). Conclusions. The study revealed a high level of oral diseases and poor oral hygiene in the study population and a need for therapeutic and preventive measures.

A treatment decision-making model for infraoccluded primary molars

Abstract: The objective of this paper is to clarify the literature's findings and provide guidelines for decision-making during the long-term treatment planning of infraoccluded primary molars. This paper presents a synopsis of findings concerning prevalence, aetiology, diagnostic methods, diagnostic criteria and treatment options. Treatment decisions are mainly guided by the clinical assessment of the presence or absence of succedaneous tooth, evaluation of onset, time of diagnosis, resorption rate, rate of progression of infraocclusion, risk of adverse effects over time, and predictive clinical patterns of infraoccluded primary molars. These models are a result of a comprehensive review of the literature and presents a compilation of findings in a format that is of practical use to the clinician.

Tooth size and morphology in twins.

Abstract: Summary. Objective. To assess concordance of tooth size and occlusal morphology in monozygotic (identical) and dizygotic (non-identical) twins compared to unrelated controls in order to determine how much these dental traits are related to inheritance. Methods. Mesiodistal and bucco-lingual dimensions of tooth size in 34 pairs of twins were measured with dial callipers. In addition, the occlusal morphology of nine pairs of teeth was assessed using a co-ordinate measuring machine with a non-contact laser probe. Results. The results showed greater concordance in tooth size for both mesiodistal and bucco-lingual dimensions within twin pairs compared to twin and unrelated controls. Furthermore, monozygotic (MZ) twins showed greater concordance than dizygotic (DZ) twins for all permanent teeth with statistically significant variance for the mesiodistal dimension (P = 0·01) but not bucco-lingual dimension. Superimposed computer models of the digitized occlusal surfaces showed a high degree of similarity for MZ twins compared to DZ twins. The mean intrapair deviation was 147 µm for MZ, 209 µm for DZ and 258 µm for unrelated controls. Conclusions. The remarkable similarity in the tooth size and morphology of monozygotic twins suggests a strong inheritability factor to tooth size and shape and that these may be useful as additional tools for zygosity determination along with other dental traits.

Oral manifestations and dental status in paediatric HIV infection.

Abstract: Objective. To describe the incidence and prevalence of oral manifestations of HIV infection in a population of perinatally infected children. Design. Retrospective and prospective study of a cohort of perinatally HIV-infected children. Setting. Community hospital and community-based paediatric clinic. Sample and methods. Forty perinatally HIV-infected children with a median age of 12 months were eligible and selected for the study, which included a medical chart review from birth and prospective follow-up. Each child was examined quarterly for oral manifestations, tooth eruption, and for 27 children, caries and periodontal status. Results. The incidence of pseudomembranous candidiasis was 43% (95% CI, 27–58%) within 6 months of birth. Oral candidiasis (defined as pseudomembranous or erythematous) was positively associated with low CD4 counts and the occurrence of plaque. Children with low CD4 counts were also found to have fewer teeth than children with high CD4 counts, after adjusting for age. Conclusions. Oral manifestations are common in paediatric HIV infection and are possible predictors of HIV disease progression. Primary care of HIV-infected children should include periodic oral examinations to monitor their HIV disease progression and to alleviate symptoms associated with oral opportunistic infections.

Dental caries prevalence and dental health behaviour in HIV infected children.

Abstract: Objectives. To determine dental caries prevalence in a group of HIV positive children and their reported dental health behaviour. Design. Standardized epidemiological dental examination and structured interview. Setting. Paediatric HIV outpatient department in a South London hospital. Study population. HIV-positive children attending the above outpatient clinic over a 6-month period (30 subjects) and parents (20 informants). Methods. Epidemiological examination of children was undertaken by one trained and calibrated examiner to determine caries prevalence using dmft/DMFT. Parents were interviewed to obtain information on their children’s dental health behaviour: tooth-brushing, diet, fluoride; oral medication and dental attendance were explored. Results. Sixty-three per cent (n = 19) of children had dental caries experience, much of it untreated. Mean dmft/DMFT was 4·4. Sixty per cent (n = 18) of all children presented with active or untreated caries and the care index for those at/under age 5 years was low (10%). Unfavourable dental health behaviour included: consumption of nonmilk extrinsic sugars at night, use of sugar-based medications, low fluoride intake, late commencement of toothbrushing and poor dental attendance. Dental health was not considered a priority for many of these children. Parents did not necessarily disclose their child’s HIV status on dental attendance. Conclusion. Caries prevalence was high, much of the disease untreated, and unfavourable dental health behaviour, including the use of sugar-based medicines was common. HIV infected children should be considered a high caries risk and receive appropriate dental care, in terms of both treatment and preventive services, following confirmation of seropositivity.

Microleakage of three sealants following conventional, bur, and air-abrasion preparation of pits and fissures

Abstract: Summary. Objectives. The aim of this study was to compare the microleakage of a filled sealant with a drying agent (UltraSeal XT plus), a filled sealant (Prismashield) and an unfilled sealant (Delton), after conventional, bur, and air-abrasion tooth preparation techniques. Setting. The study was completed in a clinical setting at the Simulated Practice Environment Clinic, School of Dentistry, University of Western Ontario, London, Ontario, Canada. Sample and methods. One hundred and eighty extracted teeth were cleaned and divided randomly into three groups. Group 1 was prepared using acid etch only. Group 2 was prepared with a 1/4 round bur in a low-speed handpiece followed by acid etching. Group 3 was prepared with high speed (120PSI) microabrasion using 27 µm α-alumina particles in a Midwest Airtouch™ unit. The teeth in each group were randomly assigned to one of the three subgroups according to the sealant applied. Subgroup A was sealed with a filled sealant with drying agent, B with a filled sealant only, and C with an unfilled sealant. All teeth were stored in artificial saliva for 7 days at 37 °C. After this, the teeth were coated with nail varnish 1 mm from the sealant and immersed in 1% methylene blue dye for 48 h at 37 °C. Each tooth was sectioned at four locations buccolingually and a total of 665 sections were ranked (0–3) for microleakage. Statistical analysis was completed using the Chi-squared test and Fisher’s exact test. Results. UltraSeal XT plus, the filled sealant with drying agent, showed significantly less microleakage than the other two sealants (P < 0.05). Delton, the unfilled sealant, showed significantly less microleakage than Prismashield, the filled sealant (P < 0.05). Air abrasion with acid etch showed significantly less microleakage than either bur with acid etch or acid etch alone. There was however, no significant difference between the bur and acid etch tooth preparations (P < 0.05). Conclusions. UltraSeal XT plus was the most effective sealant for preventing microleakage in this study. The most successful method of preparation was air abrasion with acid etch.

A review of clinical features in 13 cases of impacted primary teeth

Abstract: Summary.Aim. The aim of this study was to review clinical findings in 14 impacted primary teeth in 13 cases treated at a Paediatric Dental Clinic over a period of 18 years. Method. The retrospective study used clinical records, radiographs and oral photographs. Data included age, gender, presenting complaints, location, radiographic findings, aetiological factors, treatment and prognosis of impacted primary teeth and their permanent successors. Results. The patients included five males and eight females aged from one year two months to seven years five months. One case had impacted bilateral, mandibular primary central incisors and the remaining 12 cases each had one impacted tooth. The maxillary second primary molar was the tooth most frequently involved. Permanent successor tooth germs were identified in 12 teeth but not in two. Five cases were impacted because of odontomas, in the case with bilaterally affected mandibular primary central incisors these were malpositioned and were erupting ectopically. In seven cases, aetiology was unknown. Four impacted primary teeth were extracted because eruption was unlikely. In four cases, odontomas were surgically removed and the teeth kept under observation. The remaining six were surgically exposed. Traction was applied in two of the six. Eight of the teeth erupted. In two teeth in which traction was used, one was subsequently extracted, and one erupted. In the cases of seven, permanent successors erupted. These were hypoplastic teeth and were delayed in development and eruption. Conclusions. Impacted primary teeth may be associated with defects in development and eruption of their permanent successors, long-term observation is therefore necessary until the permanent successors erupt.

Utilization of day stay general anaesthesia for the provision of dental treatment to children in New South Wales, Australia.

Abstract: Objectives. To assess the demand for paediatric dental general anaesthetic services at a specialist paediatric dental unit in Australia and to evaluate the changing pattern of general anaesthetic use in children at this unit over the past decade. Methods. A retrospective review of hospital records of a random sample of children receiving dental treatment under general anaesthesia during the years 1984 and 1996. Demographic and clinical data was collated and analysed using SPSS for Windows. Results. The number of children managed under general anaesthesia increased from 189 in 1984 to 777 in 1996. This was accompanied by an increase in the time the patients waited for treatment. There was little difference in the mean age of the patients with over two-thirds of the children being under the age of 6 years. Whilst children of Anglo-Saxon origin accounted for the majority of patients across the 13-year period there was a significant increase in the number of children from Asian or Middle Eastern backgrounds. A disproportionate number of these children accessed the services as self-referrals. Caries remained the most common reason for referral, with trauma and dental anomalies accounting for less than 10%. Conclusions. Despite the general decline in dental caries there remain an important group of young children who have high treatment needs and for whom general anaesthesia provides a useful treatment option. Preventive strategies should be targeted towards these groups of children.

Betel quid chewing among Bangladeshi adolescents living in east London.

Abstract: Summary.Objectives. Ascertain level and predictors of betel quid (pan) chewing in Bangladeshi adolescents. Design. Cross sectional questionnaire study. Setting. Bangladeshi cultural centres in East London. Sample. Consecutive adolescents attending 4 randomly selected centres. Method. Self-completed questionnaire. Results. 204 (70%) of 290 teenagers invited to participate did so. Fifty-eight (28%) chewed pan; 30 (51%) of whom chewed on most days. The median age of first chewing was 9 years. Only 7 (2%) added tobacco to their quids. Pan chewers tended to come from lower socio-economic status families, liked the taste of pan and were less inclined to think that it adversely affected their appearance or that it could cause cancer. Conclusions. The prevalence of pan chewing was lower than that found among adults reported in earlier studies in the UK. This reduction in the level of pan chewing could be attributed to acculturation. Few teenagers knew about the association between pan chewing and cancer but the widespread concern about the effect of pan chewing on the appearance of their mouth suggests this is a useful health promotion message within common risk/health factor approach.