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PubMed2003

British Society of Paediatric Dentistry: a policy document on oral health care in preschool children.

This policy document was prepared by Janet Rayner, Ruth Holt, Fiona Blinkhorn and Karen Duncan. Policy documents produced by BSPD represent a majority view, based on a consideration of currently available evidence. They are produced to provide guidance, with the clear intention that the policy be regularly reviewed and updated to take account of changing views and developments.

Cariostatic Agents↗
PubMed1998

A repeated criterion-based audit of radiographic usage by a paediatric dentistry unit.

AIMS: To report a simple clinical audit which was conducted within a single hospital paediatric dental unit and to demonstrate the potential value of such small-scale projects. DESIGN: A criterion-based audit of radiographic practice which was repeated after 3 years in order to evaluate changes. SETTING: Six 1 hour meetings of an audit group consisting of the staff and postgraduate students of the Unit. SAMPLE AND METHODS: Various aspects of radiographic usage were quantitatively assessed using a sample of patient records and a pre-planned check list to assess the extent to which agreed good-practice criteria were being met. The initial audit identified areas for improvement which were addressed before repeating the exercise 3 years later. RESULTS: Clinical note-keeping to accompany radiographic examinations was found to be the least satisfactory area of practice. When the exercise was repeated, encouraging improvements were demonstrated. CONCLUSIONS: The audit was worthwhile because it appeared to produce improvements in standards of patient care.

Child↗
PubMed2006

An inhalation sedation patient profile at a specialist paediatric dentistry unit: a retrospective survey.

AIM: To report on the characteristics, treatment, attendance, scheduling and duration of treatment sessions of child patients attending a specialist paediatric dental hospital service for inhalation sedation. METHODS: A retrospective study was carried out of all 88 patient case notes of inhalation sedation recipients between September 2004 and March 2005. The recorded data included: child's age, gender and level of social deprivation together with the details of the treatment that was undertaken, the time between the first and current/last sedation appointment and the total number of appointments attended, cancelled and missed. RESULTS: Twenty of the subjects were excluded giving a sample of 68; 51% male, mean age at start of treatment 9.8 years (range 4 to 15) and mean age at end of treatment 10.6 years (range 4 to 16). Of these children 35 (51%) were socially deprived. In respect to treatment, 29% had extractions, 22% endodontics, 81% restorations and 25% fissure sealants. In respect to the number of quadrants that had teeth requiring treatment; 26.5% had one, 25% two, 22% three and 26.5% four. The mean number of treatment sessions required was 4.4 with a mean duration between first and last appointments of 9.5 months (range 0.25 051). There were 27% of appointments cancelled, while 12% of patients failed to keep their appointments. CONCLUSIONS: Although over half of the children treated under inhalation sedation came from socially deprived areas, attendance was reasonable and the majority required less than 5 appointments for treatment completion. The treatment provided was variable not only in respect to the procedures but also to the number of quadrants treated.

Adolescent↗
PubMed2007

The use of theatre time for paediatric dentistry under general anaesthesia.

OBJECTIVE: The aim of this paper was to determine the use of theatre time for all procedures performed under general anaesthetic on a paediatric dental list. METHODS: A prospective study of paediatric dental general anaesthetic procedures was undertaken at Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK. Data were collected prospectively for 71 operating lists over a 3-year period from April 2003 to March 2006. Both operator status and the procedure being undertaken were recorded. In addition, pre-anaesthetic, anaesthetic, operating and disconnection times were recorded. RESULTS: Of the 71 lists examined, 61 either finished early or on time, with a median unused time of 32.50 min (interquartile range = 19.50, 50.00 min), whilst 10 lists finished late with a median overrun time of 30.50 min (interquartile range = 9.25, 45.50 min). Comparing lists which finished late with those which were completed within time, the median pre-anaesthetic time was significantly longer (Mann-Whitney U-test, W = 20.05, P = 0.048). Overall, the theatre was in use for 78.22% of time combining pre-anaesthetic, anaesthetic, operating and disconnection times; hence, there was poor time utilization of theatre for 21.78% of the total theatre time. CONCLUSIONS: Overall, 85.9% of theatre sessions for dental procedures under general anaesthetic in children finished early or on time. Where lists finished late, the duration of the pre-anaesthetic time appeared to be the significant factor.

Ambulatory Surgical Procedures↗
PubMed2005

Dental emergencies presenting to a university-based paediatric dentistry clinic in the West Indies.

OBJECTIVES: The aims of the present study were to investigate the type and prevalence of dental emergencies presenting at a teaching hospital paediatric emergency clinic in Trinidad, and to describe the socio-demographic factors related to the use of the service. DESIGN AND METHODS: The authors used a prospective study of consecutive dental patients presenting to a paediatric emergency clinic. Data recorded included type of presenting emergency and socio-demographic variables. RESULTS: Data were available for 309 participants; 47% were male and 53% female. The average age of the participants was 8.66 years (SD = 3.75 years; range = 1-16 years). Seventy-three per cent of the participants' parents were involved in manual work or unemployed, and 21% were in nonmanual/professional employment; the occupation was not known in 6% of cases. Caries-related problems accounted for 74% of emergencies. Dental trauma mostly affected the upper permanent incisor teeth, with concussion, subluxation and intrusion being the most common injuries. CONCLUSION: Dental emergencies presenting to this university-based clinic were predominantly related to caries and trauma. The service was more frequently utilized by children in the mixed dentition stage, children from lower socioeconomic groups and those living in the local area. The frequency of caries-related problems indicates the need for more community-based preventive strategies, including encouraging greater attendance for routine dental care and dental health education. Strategies for oral health promotion should also be developed to prevent dental trauma.

Adolescent↗
PubMed2003

The interdisciplinary management of hypodontia: background and role of paediatric dentistry.

This paper is the first of a series on the comprehensive management of young people with hypodontia. The paper looks at the background to the condition, the possible aetiological factors, the prevalence of hypodontia and other related conditions. Lastly there is consideration of the role of the paediatric dentist in interdisciplinary management of the affected child and adolescent patient.

Adolescent↗
PubMed2002

Teaching paediatric dentistry by multimedia: a three-year report.

Clinical cases can now be simulated utilising multimedia and used to teach case management to dental students. The modules developed should provide intellectual stimulation, user-interaction and immediate feedback, in addition to being intuitively navigated and user-helpful. Five paediatric dental case modules (early childhood caries, anterior trauma, anterior coronal fragment, anterior crossbite and dentigerous cyst) were created, installed in a multimedia presentation tool, PathFinder (from Westmead Hospital Dental Clinical School, New South Wales, Australia), and used to teach three classes of fourth year dental students at The University of Melbourne. Questionnaires, focus groups and a review were conducted by an external educational expert. Students responded anonymously to general learning questions and case specific questions using a five-point Likert scale (strongly agree to strongly disagree). Student responses indicated they were very enthusiastic about learning via multimedia, although a few students disliked this educational approach. Focus groups and external review indicated that the modules were navigated readily and were suitably interactive.

Case Management↗
PubMed1997

The establishment of current opinion within consultants in paediatric dentistry in the UK for the taking of dental radiographs of children.

There is an increasing realization that every effort should be made to minimize the exposure to ionizing radiation of patients and members of the dental team. There are, however, few published guidelines to assist the general practitioner in deciding whether or not radiographs are needed. There is even less information concerning the taking of dental radiographs of children. Using the Delphi Technique this study set out to seek a consensus amongst Consultant Paediatric Dentists (n = 36) working in the UK as to when dental radiographs should and should not be taken of children cared for within general dental services. A two-stage questionnaire was used and a response of 94% and 76% was obtained in the first and second questionnaire respectively. A consensus view was reached regarding whether or not radiographs should be taken in a series of 17 specific clinical situations.

Child↗
PubMed2005

Case report: ultrasonic cavity preparation -- an alternative approach for caries removal in paediatric dentistry.

BACKGROUND: Since the invention and application of rotating instruments, the operative treatment of carious lesions has often resulted in considerable removal of tooth structure. Moreover, conventional caries removal and cavity preparation by a combination of the use of a turbine and a handpiece with a bur presents disadvantages to very young patients, whose perception of drilling is unpleasant. This report concerns an alternative approach for caries removal in a child using ultrasound and discusses the advantages and disadvantages of this technique. CASE REPORT: A 2-year-old male child was brought by his mother to a private paediatric dental clinic in Rio de Janeiro, Brazil. The mother's main complaint was the presence of dental caries in her son's anterior teeth. Intraoral clinical examination revealed that the patient had two carious lesions in the maxillary central incisors on mesial surfaces. Cavity preparation was performed using ultrasound and restoration with a light-curing resin. FOLLOW-UP: One year and a half after the restorative procedure the patient presented with the restored teeth in perfect condition.

Child, Preschool↗
PubMed2003

Changes in dentists' attitudes and practice in paediatric dentistry.

AIM: The purpose of the study was to determine if there had been any changes in the clinical practice and attitudes to the care of children by general dental practitioners over a ten year period from 1986 to 1996, following the introduction of a system of capitation payments in the United Kingdom. METHODS: A questionnaire was mailed to 1,290 general dental practitioners practicing in Yorkshire (UK) in an identical way to a previous survey ten years before. Practitioners were asked questions concerning their practice of dental caries prevention, behaviour management, restoration of primary teeth and pulp therapy. Responses were compared with the results of the 1986 survey. RESULTS: Of the total of 687 replies (53.2% response) 61% practiced, or said they practiced, diet evaluation and gave dietary advice. Oral hygiene instruction was reported by 87% and 57% used fissure sealants. The routine use of amalgam, previously 80%, had declined to 35% in favour of glass ionomer cements (57%). There had been a significant improvement in the use of pulp therapy for primary teeth at 35% compared with previous 3%. The use of rubber dam also increased, but only from 0% before to 9% in the present study. The usage of stainless steel crowns had changed from 2% over ten years to 8% and strip crowns from 1% to 5%. CONCLUSION: The use of paediatric dental techniques by general dental practitioners had generally increased, particularly in preventive measures and pulp treatment. Restorative techniques had marginally changed, but a dramatic shift away from amalgam had occurred. There was still a very low usage of stainless steel crowns and rubber dam was also not used to the extent that it should be.

Adolescent↗
PubMed2000

Repeat general anaesthesia for paediatric dentistry.

AIMS: To investigate patterns of referral, disease and treatment for healthy children who had received two or more dental general anaesthetics (DGA) for exodontia. METHODS: Records from 200 episodes of repeat DGA were studied retrospectively. RESULTS: The mean age of patients at first referral was 5y4m, and the mean interval before repeat was 22 months. Self-referrals rose from 14% at DGA1 to 30% at DGA2. New caries at second referral, where all diagnosed disease had been treated at DGA1, accounted for only 15% of the total. Where a specific request was made in the referral, only 8% of letters matched the charting made in hospital. 30% of all specific requests were honoured, but then required treatment for previously diagnosed caries at DGA2.75% of single-tooth extractions required repeat DGA for caries left at DGA1. CONCLUSIONS: It may be too optimistic to address only the most grossly diseased teeth when a child requires GA exodontia. A more radical treatment-planning approach, combining primary care, secondary care and public health considerations, may be required to avoid the unnecessary use of DGA.

Anesthesia, Dental↗
PubMed2005

Which is the most effective drug or method of sedation used for anxious children? What are the most effective techniques for the use of conscious sedation behaviour management in paediatric dentistry?

DATA SOURCES: Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Dissertation Abstracts, SIGLE, the World Wide Web (Google) and the Community of Science Database were searched for relevant trials and references. Reference lists from relevant articles were scanned and the authors contacted to identify trials and obtain additional information. There were no language restrictions. Trials pre-1966 were not searched. STUDY SELECTION: Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in anxious children up to 16 years of age. DATA EXTRACTION AND SYNTHESIS: Information regarding methods, participants, interventions and outcome measures and results was independently extracted, in duplicate, by two authors. Specialist advice was sought to categorise interventions. Authors of trials were contacted for details of randomisation and withdrawals and a quality assessment was carried out not using any formal scoring system. The Cochrane Oral Health Group statistical guidelines were followed. RESULTS: Fifty-three studies were included with 2345 subjects in total. Overall quality of studies was found to be disappointing with poor reporting, often the main problem. Data reported could not easily be aggregated into groups to facilitate description of results. Meta-analysis of the available data was also not possible for the same reason. The variety of differing drug regimens compared made it difficult to isolate groups of studies that were sufficiently similar in design to allow sensible comparison. Where groups of studies could be isolated, the differing outcome measures used made their meta-analysis impossible. CONCLUSIONS: Authors were not able to reach any definitive conclusion on which was the most effective drug or method of sedation used for anxious children. A list of proposed areas of study was described.

Comment↗