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PubMed1996

A multidisciplinary approach to oral rehabilitation with osseointegrated implants in children and adolescents with multiple aplasia.

Oral rehabilitation of children with extensive aplasia includes a number of dental considerations as well as attention to psychological and physical development. The well-documented results of the use of implants in adults have raised the question of the use of implants and the timing of this procedure in children and adolescents with multiple aplasia. Eight-years' experience of a multidisciplinary approach to oral rehabilitation of children with extensive aplasia is described. Special emphasis is placed on early diagnosis, careful therapy planning, and co-ordination and timing of different parts of the therapy. The specific considerations from the point of view of paediatric dentists, orthodontists, oral surgeons, and prosthodontists are presented. A system for integrating all these aspects and knowledge will be a guarantee for high professional standards and a successful outcome. To exemplify the multidisciplinary approach, three treated cases are presented.

Adolescent↗

PubMed1991

A review of referral patterns to paediatric dental consultant clinics.

A retrospective survey of 317 child patients referred to consultant paediatric dental clinics at Glasgow Dental Hospital over a 12-month period is reported. It was found that although there was a wide range of reasons for referral the most frequent problem was the management of the patient. As a result of this finding, the dental hospital is currently establishing a clinic specifically for patients with a fear of dental treatment.

Adolescent↗

PubMed1998

Paediatric dental general anaesthesia rates and dental caries regionally and in districts in the former north western region.

OBJECTIVE: To chart paediatric dental general anaesthesia activity following implementation of the Poswillo Report recommendations and to characterise the relationship between dmft/DMFT and rates of paediatric dental general anaesthesia. DESIGN: An ecological study, using results of the NHS dental epidemiological surveys and routine NHS activity data. SETTING: The general, community and hospital dental services. SUBJECTS: Former regional and district health authorities' residents. OUTCOME MEASURES: Correlations between the regional and district rates of dental general anaesthesia and dmft/DMFT from the NHS dental epidemiology surveys. RESULTS: About half of all paediatric dental general anaesthetics are carried out in the General Dental Service. There were significant correlations between regional mean dmft/DMFT and under 18 combined dental general anaesthesia rates in 1991/2 and 1992/3. In the North West Region there were significant correlations between 0-4-year-old district dental general anaesthesia rates and dmft of 5-year-old children in 1989/90 (r = 0.45, P < 0.05) and 0-17-year-old district dental general anaesthesia rates and 12-year-old DMFT (r = 0.49, P < 0.05) in 1992/3. CONCLUSIONS: The number of paediatric dental general anaesthetics provided since the Poswillo Report was implemented (1991) has increased in the last two years (1993/4 and 1994/5). District rates of dental general anaesthesia bore little relation to dental need as measured by dmft/DMFT, except in 1989/90 for 5-year-old children and in 1992/3 for 12-year-old children. This suggests dental general anaesthesia is not provided in response to dental needs at a district health authority level.

Adolescent↗

PubMed1990

[Medical wastes. 2. Comparative studies of the microbial contamination of wastes from medical practices of different disciplines and household garbage].

Medical consulting room wastes of 7 disciplines were investigated quantitatively and qualitatively for nosocomial infective agents. 20-25 samples from each consulting room were examined for 3 months. The results were compared with those of household refuse and hospital wastes. The whole content of a waste bag was suspended without a preceding sorting and the eluate was microbiologically examined. The results of the investigations proved, that the germ concentration of the medical consulting room wastes was less than that of household refuse. The median for all investigated germ groups was less than 1 log(10)-step compared-to household refuse. The statistical analyses confirmed highly significant differences (p less than 0.001) for total germ concentration, thermoresistant obligate aerobic and facultative anaerobic bacteria and bacteria spores. Exceptionally the paediatric consulting room wastes show smaller differences (p less than 0.01) between the household refuse for obligate and facultative anaerobic bacteria, thermoresistant obligate and facultative anaerobic bacteria and bacteria spores and D-streptococci. From the comparison of total germ concentration for medical wastes from conservative disciplines and household refuse resulted that wastes from medical consulting rooms are less contaminated with nosocomial infective agents than household refuse and hospital wastes. In conclusion wastes from medical consulting rooms can, similar to hospital wastes, be disposed together with household refuse.

Bacteria↗

PubMed1994

[Doctor Francisco Pérez Cascales. Biography and odontologycal chapter of his work].

Given the absence of odontological texts and against the background of the very poor development of this branch of surgery during the XVII century, we have thoroughly investigated the medical, surgical and paediatric texts of the century, all scattered around and of different length, and have bumped against the text of the noteworthy "paediatrician" of the Rénaissance, Francisco Pérez Cascales who, in his "Liber de affectionibus puerorum", tackles, in hand with the Greek and Roman classical authors, only one oral and dental problem: mouth ulcers, and lingers on their aethiology, diagnosis and clinical treatment. We are also remaking the biography of the author, trying to fill in the many blanks found in it and correct the multiple errors through the incorporation of appropriate documents and references.

Adolescent↗

PubMedDate not supplied

Necessity for and control of dental treatment in HIV infected children. Inter-professional relationship between dentist and paediatrician.

HIV infected children frequently suffer from buccal-dental lesions needing dental treatment. This treatment should improve their systemic affection, localised pathology, psychological and affective state and their general quality of life. Hardly any of these children are ever treated; sometimes because of lack of family motivation (the most frequent cause) and others because of the lack of a Paediatric Dental Unit in the hospitals they attend. For this reason we present here two cases of HIV infected children, with HIV infected mothers, who, thanks to the relationship between the Paediatric and Dental Units of the hospital, have had access to dental treatment for multiple caries and candidiasis. An anatopathological diagnosis of gingival inflammation, which was also infected by candida, was also carried out. The treatment included extraction of teeth, pulpotomy, pulpectomy and the fitting of prostheses. It should be made clear that a good inter-professional relationship is needed and it must also be taken into account the great difficulty that is encountered when trying to make this group of patients understand the need for, and benefits of, dental treatment.

Child↗

PubMed2004

Assessment of children prior to dental extractions under general anaesthesia in Scotland.

OBJECTIVE: To determine the type of dental assessment service offered to children prior to exodontia under chair dental general anaesthesia (CDGA) in the community and hospital dental services (CDS, HDS) in Scotland. DESIGN AND SETTING: Telephone interviews were conducted with CDS and HDS clinical directors in Scotland using a semi-structured questionnaire, with written follow-up confirmation. Copies of CDGA referral forms were also requested. RESULTS: All clinical directors, or their nominated deputies, participated (n = 21). Almost half of interviewees indicated that their area offered a "dedicated" pre-CDGA assessment service (n = 10). A range of grades was identified amongst assessors; a minority were described as "specialist paediatric staff". The availability of CDGA alternatives, including local analgesia and conscious sedation varied. Changes to the referral treatment plan were reported to occur "sometimes" or "often" by 11 interviewees regarding the anaesthetic used, and by 16 respondents regarding the number of teeth extracted. The content of CDGA referral forms was diverse. CONCLUSIONS: The method of referral and assessment of children for CDGA in Scotland is diverse, partly reflecting geographic limitations and local need. Guidance on pre-GA assessment, including use of standardised referral forms, may reduce variation and improve the quality of the pathway of care.

Anesthesia, Dental↗

PubMed2005

The effect of supplemental oxygen on postoperative nausea and vomiting in children undergoing dental work.

Administration of 80% intraoperative oxygen has been proposed as being a cheap, safe and effective means of reducing postoperative nausea and vomiting (PONV) but no studies have been performed in the high risk paediatric population. We tested whether 80% intraoperative oxygen reduces PONV in well children undergoing elective day-stay dental treatment under general anaesthesia. Ninety-five children received standardized sevoflurane, morphine, vecuronium anaesthesia with either 30% or 80% intraoperative oxygen and no antiemetic prophylaxis in a randomized, double blind, prospective trial. There was no difference in PONV or in the use of rescue ondansetron between the groups. The total incidence of PONV was 40% in the group that received 30% oxygen and 33% in those that received 80% oxygen. High inspired intraoperative oxygen was not found to significantly reduce PONV in well children undergoing dental work under general anaesthesia.

Adolescent↗

PubMed2000

A survey of paediatric dental anaesthesia in Scotland.

A postal survey of NHS hospital-based anaesthetists providing out-patient anaesthesia for dental procedures in children under 10 years of age was conducted in February 1999. Information was sought about quality of care and common practice in Scotland. The experience of the anaesthetists involved in such work was substantial, but the monitoring used did not meet current standards, with only 16% of respondents indicating use of a full range of standard devices. Separate recovery facilities were available to 99%, and all had access to a defibrillator, but the qualifications of dedicated assistant and recovery staff were lacking in 14 and 30%, respectively. Intravenous access was not obtained routinely after inhalational induction of anaesthesia by up to 71% (49%, never; 22%, sometimes). Systemic analgesia or local anaesthesia was used by 88%. Discharge times ranged from 10 min to 6 h.

Ambulatory Surgical Procedures↗

PubMed2003

Pain relief for paediatric dental chair anaesthesia: current practice in a community dental clinic.

AIM: A review of different modes of pain relief for simple dental extractions under general anaesthesia in a community dental setting. PATIENTS AND METHODS: Different analgesia regimens are used by different anaesthetic teams working in a single community clinic. A total of 72 patients were reviewed post-operatively in the recovery room and followed up with a telephone survey 24 h later to assess pain experienced by the patients. The efficacy of different analgesia regimens was analysed. RESULTS: The majority of patients were pain free in recovery, independent of the method of pain relief used. Local anaesthetic injections appear superior to systemic analgesia, and patients with local anaesthetic injections were more settled in recovery. DISCUSSION: Simple dental extractions cause pain and efficient administration of appropriate analgesia should be an integral part of the community dental service.

Adolescent↗

PubMed2004

A short-term follow-up of treatment outcome in groups of uncooperative child dental patients.

AIM: To evaluate the short-term follow-up outcome in four subgroups of uncooperative child dental patients referred to a specialist paediatric dental clinic in Sweden. METHODS: Seventy children, classified into four groups (based on fear, temperament, behaviour and verbal intelligence), were followed-up at their public dental clinics after termination of specialist dental treatment. Questionnaire assessments of children's dental and general fear, parental dental fear, emotional stress, locus of control and parenting efficacy were made by parents pre and post treatment and at follow-up and were analysed within and between groups. At follow-up, parents rated their children's coping and procedure stress, while treatment acceptance was rated by the dentists. RESULTS: Decreases in child dental fear were maintained at follow-up, although a third of children still had moderate or high dental fear. For those children who had been classified into the externalising, impulsive group, an increased risk of non-acceptance (RR=3.7) was indicated. The risk of dental fear at follow-up was increased for the group of fearful, inhibited children (RR=3.8). For the study group as a whole a poorer follow-up outcome could be predicted by avoidance behaviour (OR 12.9-16.6) and moderate or high post treatment dental fear (OR 6.5- 21.3). CONCLUSIONS: Fearful, inhibited child dental patients may need, due to dental fear, extra attention even after successful dental treatment at a specialist clinic. Externalising, impulsive children constitute a special challenge for dentistry. The continued need for adjusted management after termination of specialist treatment can be predicted from avoidance behaviour and post treatment dental fear scores.

Analysis of Variance↗

PubMed1994

Hypoxaemia during paediatric dental anaesthesia in the community.

The object of this paper is to measure the incidence of hypoxaemia during paediatric dental anaesthesia in the community and thus support or refute the recommendations for monitoring in the Poswillo report. Fifty unpremedicated children, ASA grade 1, between the ages of 2 and 16 years undergoing general anaesthesia for teeth extraction were studied. Patients were anaesthetised with a standard anaesthetic which consisted of 30% oxygen in 70% nitrous oxide and supplemented with halothane. A pulse oximeter was used to measure the oxygen saturation continuously. A 12% incidence of hypoxaemia was recorded and a 32% incidence of a 5% fall in the oxygen saturation from the baseline. Three children became hypoxaemic during the operative period and three during the recovery period. Although the incidence of hypoxaemia in this study was significantly lower than in previous studies, the incidence suggests that careful monitoring is essential and the recommendations that have been put forward in the Poswillo report are fully justified.

Adolescent↗

PubMed1991

A report on the feasibility of establishing a paediatric emergency dental service at Glasgow Dental Hospital.

A six-month pilot emergency service for children was established at Glasgow Dental Hospital to provide care for patients in pain, offer preventive advice and ensure ongoing dental care. The service was staffed by experienced community dental officers. In the main study period 2965 patients were seen. The majority (54 per cent) were referred from general dental practitioners; however, 27 per cent came directly to the hospital without seeking dental advice in their locality. The most common problems were toothache (55 per cent), occasional pain (28 per cent) and swelling (14 per cent). Eighty per cent of the patients were directed to oral surgery for extractions under general anaesthesia and six per cent for extractions under local anaesthesia. Dental caries still causes pain and distress to a large number of Glasgow school children. Clearly water fluoridation would greatly improve dental health and in so doing reduce the proportion of children requiring extractions under a general anaesthetic. The emergency service is currently being reorganised so as to place more emphasis on following up those patients who do not have a dentist, or who presented for care without a referral letter.

Adolescent↗

PubMed1990

The fate and survival of amalgam and preformed crown molar restorations placed in a specialist paediatric dental practice.

The fate of 1688 amalgam restorations and 716 preformed crowns placed in permanent and primary molars in a specialist paediatric dental practice over a 10-year period by one operator is reported. For primary molar amalgams, the replacement rate, true failure rate and 5-year survival estimates were, for Class 1 restorations, 16.1%, 3.9%, 73.3%, respectively, with an estimated median survival time greater than 8.5 years, and for Class 2 cavities 14.7%, 11.6%, 66.6%, with an estimated median survival time greater than 7.5 years. For permanent molar amalgams, the replacement rate, true failure rate and 5-year survival estimates were for Class 1 restorations 11.5%, 6.5%, 76.8%, respectively, with an estimated median survival time greater than 9.3 years, and for Class 2 restorations 9.8%, 8.0%, 82.2%, with a median survival time greater than 8.5 years. For all preformed crowns, the replacement rate, true failure rate and 5-year survival estimates were 2.8%, 1.9%, 92.0%, and the estimated median survival time greater than 7.64 years. No relationship was observed between the age of the patient and the age of replaced restorations. No significant difference was found between the survival rates of Class 1 and 2 amalgam restorations in primary or permanent molars, nor between first and second primary molars.

Adolescent↗

PubMed2005

A review of referrals of new patients to the paediatric department of a teaching hospital during a six-month period in 2004.

AIMS: The aims of this review were to assess the reasons why patients were referred to a specialist dental paediatric unit and the quality of the referral letters received. MATERIAL AND METHOD: All patients referred to the paediatric consultation clinic at the Liverpool University Dental Hospital from January 2004 to July 2004 were included in the review. The reasons for their referral, as stated by the referring practitioners, were compared with the clinical findings from initial assessments in the consultation clinic and the quality of referral letters was assessed. RESULTS: Ninety-nine out of a total of 102 referrals were from general dental practitioners. Sixty were girls and 42 boys. Their mean age was 9.5 years. The commonest reason (25 patients) was for treatment under general anaesthesia. In 90 (88.2%) cases the main reason for referral stated in the letters was consistent with the findings of the clinical assessment in the consultant clinic. All 102 letters included the patient's name, address, date of birth and telephone number and 89 (87.3%) were dated. However, only 25 (24.5%) included any mention of medical history and fewer than 30% included details of any treatment provided by the referring practitioner. CONCLUSIONS: The vast majority of patients were referred for good reasons. The quality of the referral letters was generally poor. The use of a structured referral pro forma could improve the quality of the referral.

Adolescent↗

PubMed2004

Appropriate consent and referral for general anaesthesia - a survey in the Paediatric Day Care Unit, Barnsley DGH NHS Trust, South Yorkshire.

BACKGROUND: In November 1998 the General Dental Council introduced guidelines for dental practitioners when referring a patient for general anaesthesia (GA). The practitioner is required to explain the risks associated with GA and the alternatives, give a detailed medical history and a clear justification for providing GA in the letter of referral. METHOD: A survey was administered on 202 parents or guardians, which aimed to investigate whether they felt that their dental practitioners had advised them of any risks of GA prior to referral. A record was also made if any reasons were given for the provision of GA in the letter of referral. RESULTS: The majority of the parents or guardians (66%) felt that they were not informed of any of the risks of GA and 25% felt that they were. From the letters of referral, 37% contained a reason for GA and 63% did not give any reason or justification for GA. CONCLUSION: There is evidence that referring practitioners do not adequately explain the risks of the anaesthetic to parents or guardians of children undergoing GA. There is also a lack of clear justification in the letters of referral for providing GA. PRACTICE IMPLICATION: It is essential that the alternatives and the risks of GA are discussed and if GA is still required, a clear justification should be contained in the letter of referral as part of informed consent. More importantly the referring practitioner should keep a contemporaneous record of this, preferably with a signature from the parent or guardian on agreement of referral.

Adolescent↗

PubMed2005

The survival of resin modified glass ionomer and stainless steel crown restorations in primary molars, placed in a specialist paediatric dental practice.

AIMS: To prospectively report on the survival of resin-modified glass ionomer cement (RMGIC), photac-fil and pre-formed stainless steel crown (SSC) restorations in primary molar teeth placed over a seven-year period in a specialist paediatric dental practice under private contract of remuneration. METHOD: All primary molar restorations placed by a specialist paediatric dentist over a seven-year period were reviewed and the outcome results recorded. Data were recorded at review visits until June 30, 2003. Data recorded included Class I restorations, Class II restorations and SSC. The Class II cavities were either mesial or distal, with or without buccal/palatal extensions. If both proximal surfaces were decayed or if after cavity preparation the resultant outline form was significantly larger than the minimal classical form, RMGIC was not used; an SSC was placed instead. Stainless steel crown preparation followed conventional guidelines. The crowns were cemented with reinforced zinc oxide and eugenol (Kalzinol). The status was recorded as satisfactory restoration, tooth exfoliated, tooth extracted for orthodontic reasons with the date of extraction, or needing replacement. If replaced then the reason for replacement was also recorded. RESULTS: A total of 544 Class I RMGICs, 962 Class II RMGICs, and 1,010 SSCs were placed. At the last review of each restoration, 98.3% of Class I, 97.3% of Class II RMGICs and 97.0% of SSCs were either satisfactory or withdrawn intact. CONCLUSION: Under the conditions of private specialist practice-based study SSCs continued to prove very successful for the restoration of larger cavities and for pulp-treated primary molar teeth. For the smaller cavities RMGIC were also very successful.

Adolescent↗

PubMed2006

Conscious sedation guidance.

SCOPE AND PURPOSE: This guidance is intended to promote good clinical practice for the provision in dentistry of conscious sedation that is both safe and effective. It is not a recipe book for sedation and therefore does not include details of drug dosages. The recommendations are applicable to all patients receiving conscious sedation, to facilitate the provision of any type of dental treatment whether it is delivered in a dental practice, a community dental service clinic or a hospital setting. It also covers the provision of conscious sedation for dental treatment provided on a domiciliary basis. Specifically excluded from this guidance, however, are patients who require assisted ventilation, intensive care sedation, premedication for general anaesthesia, postoperative analgesia, sedation in palliative care, night sedation and sedation in the home setting other than for the provision of dental treatment on a domiciliary basis. METHODS: Existing guidelines, relevant systematic reviews, policy documents, legislation or other recommendations were reviewed and appraised for their quality of development, evidence base and applicability to the remit of the guidance under development. To supplement this information, key questions were formulated by the Guidance Development Group and used as the basis for designing systematic literature search strategies to identify further research evidence that may address these questions, including unpublished work where relevant.The following internet sites were searched for guidelines: New Zealand Guidelines Group, Canadian Collaboration on Clinical Practice Guidelines in Dentistry, National Guidelines Clearinghouse, FDI World Dental Federation, National Electronic Library for Health Guideline Finder, and Medline. The Cochrane Library was searched for systematic reviews and Medline, Embase and the Cochrane Library for studies to address key questions. The searches were supplemented by material already known to members of the Guidance Development Group. Titles and abstracts of the identified references were screened for relevance independently by two researchers who were not members of the Guidance Development Group. Disagreement about the inclusion of specific individual references for further consideration was resolved by discussion and if necessary the opinion of a third researcher was sought. Included references were appraised and data was abstracted independently by two researchers using a specifically designed data-abstraction form. This information was then checked for inconsistencies, which were resolved by discussion, and used to construct evidence tables. The evidence tables were presented to the Guidance Development Group to inform their decision-making and their recommendations related to the key question under consideration. Levels of evidence were assigned by two researchers who were not members of the Guidance Development Group. Formulation of each recommendation was achieved by consensus reached through discussion, drawing on the broad range of interest and experience of sedation related to dentistry within the membership of the Guidance Development Group. Consultation and peer review were conducted prior to publication. A draft of the guidance was the subject of discussion at the Dental Sedation Teachers Group annual symposium in April 2004. Subsequently, approximately 100 copies were distributed throughout the UK to a range of professional organisations and individuals who have an interest in dental sedation, and comments were requested. In addition, all dentists in Scotland who recently claimed the National Health Service allowance for treatment with sedation were invited to comment. The consultation draft was also made available on the group's website (www.scottishdental.org/cep). All comments received through this consultation were considered and the guidance was amended accordingly prior to peer review. Further amendments were made in response to feedback from peer reviewers before publication. REVIEW AND UPDATING: The guidance will be reviewed in 2 years' time (2008) and if there have been significant changes it will be updated accordingly. RECOMMENDATIONS: The detailed guidance make 48 recommendations in a range of areas: REFERRAL: Discuss alternative methods of anxiety management with patient and ensure that dental care with sedation meets agreed definition of conscious sedation. ASSESSMENT AND RECORD KEEPING: As part of a thorough assessment, discuss with patient all aspects of their conscious sedation treatment and also provide written instructions. Obtain patient's written consent; maintain comprehensive and contemporaneous patient records. ENVIRONMENT AND FACILITIES: Ensure that environment for sedation is safe and that correct equipment and drugs are provided for each sedation technique used. Ensure that equipment and drugs for dealing with medical emergencies or complications related to sedation are immediately available. TRAINING: Ensure all members of dental team are correctly trained in sedation techniques used, including monitoring of patient during treatment and management of any sedation-related complications. For oral and transmucosal sedation, ensure that sedationist is trained in other titratable techniques and skilled in performing venous cannulation. Ensure that teams giving conscious sedation provide treatment for patient groups they are experienced in managing. CONSCIOUS SEDATION TECHNIQUES: For inhalation sedation, ensure that a titrated dose of nitrous oxide is administered using dedicated purpose-designed equipment. Oral, transmucosal and intravenous sedation require pulse oximetry and blood-pressure monitoring. A titrated dose of midazolam is recommended for intravenous sedation. AFTERCARE: Monitor patients throughout the recovery period until discharge by sedationist into the care of responsible adult escort who has also been given written postoperative instructions. An escort might not be required after nitrous oxide inhalation sedation. RESEARCH RECOMMENDATIONS: A number of recommendations were made regarding the future conduct and reporting of clinical trials. The following areas were highlighted as requiring further high-quality research: Fasting before conscious sedation. Conscious sedation of paediatric dental patients. Dental conscious sedation using combinations of drugs. Dental conscious sedation using continuous infusion. The choice of sedation method for dental patients. Cognitive and behavioural effects of conscious sedation. The interaction of pharmacological and nonpharmacological anxiety management techniques. The complete guidance is available for download at www.scottishdental.org/cep/guidance/dentalsedation.htm.

Anesthesia, Dental↗