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PubMed2000

Orthodontic extractions: a comparative study of inhalation sedation and general anaesthesia.

OBJECTIVE: To compare directly inhalation sedation and general anaesthesia in terms of treatment success rate, various aspects of morbidity and time taken, when used for patients having orthodontic extractions. DESIGN: Patients requiring orthodontic extractions were treated with either inhalation sedation or general anaesthesia. The two groups were matched for age, sex, number of teeth extracted and pre-operative anxiety. Data were collected by questionnaires. SETTING: Unit of Paediatric Dentistry at the University Dental Hospital of Manchester. SUBJECTS: All patients referred for orthodontic extractions between November 1994 and May 1996 were invited to take part in the study. Total number of patients = 101. INTERVENTIONS: Sixty-six patients commenced treatment with inhalation sedation and 35 with general anaesthesia. Routine orthodontic extractions were carried out. OUTCOME MEASURES: Treatment success rate, various aspects of morbidity and total time taken were measured and compared for the two groups. RESULTS: Treatment success rates were high for both groups. Significantly less morbidity was found to be associated with inhalation sedation and the total time taken was significantly shorter with inhalation sedation than with general anaesthesia. CONCLUSIONS: Inhalation sedation is a successful alternative to general anaesthesia for orthodontic extractions with patients experiencing less morbidity and the time taken being shorter.

Anesthesia, Dental↗

PubMed2000

Dental fluorosis in permanent incisor teeth in relation to water fluoridation, social deprivation and toothpaste use in infancy.

OBJECTIVES: To determine the prevalence and severity of fluorosis in permanent incisor teeth in young children in a fluoridated and a fluoride-deficient community and to establish what relationship, if any, there was between the occurrence of dental fluorosis and the reported use of fluoride toothpaste in childhood. DESIGN: A prevalence study of children aged 8-9 years who had been continuous residents in fluoridated Newcastle or fluoride-deficient Northumberland. METHOD: The permanent maxillary central incisor teeth were examined clinically and photographically by one examiner using the Thylstrup-Fejerskov index; the photographs were read blind to child identity and clinical score. A closed-response questionnaire enquired into the child's early experiences of toothbrushing and use of fluoride toothpastes. Social deprivation was measured by a Jarman score. The study took place in 1998. OUTCOME MEASURE: Prevalence of dental fluorosis measured by the Thylstrup-Fejerskov index. RESULTS: Complete data were available for 78% (n = 409) and 79% (n = 403) of eligible sampled children in the two areas, respectively. Clinical and photographic results agreed closely and had high reproducibility. The prevalence of fluorosis was 54% in the fluoridated area and 23% in the fluoride-deficient area when all grades (> 0) of fluorosis were included; percentage prevalence of mild to moderate fluorosis (> or = 3) was 3% and 0.5% in the two areas, respectively. Multivariate analysis indicated that area of residence (odds ratio = 4.5), Jarman score (odds ratio = 0.99 per Jarman unit) and type of toothpaste (odds ratio = 1.6) were statistically significantly related to presence or absence of fluorosis: the risk factors were--fluoridated area, affluence, and use of adult toothpaste. CONCLUSIONS AND RECOMMENDATIONS: The prevalence of aesthetically important dental fluorosis was low, although higher in the fluoridated area. Use of a child's toothpaste (with lower fluoride concentration) could decrease risk in a fluoridated area. Adherence to the guidelines published by the British Society of Paediatric Dentistry is recommended.

Child↗

PubMed2000

Variations in the presenting and treatment features in reimplanted permanent incisors in children and their effect on the prevalence of root resorption.

OBJECTIVE: To examine variations in the presentation and treatment of reimplanted incisors in children and to determine the effect of these on the prevalence of external root resorption. SETTING: Departments of Paediatric Dentistry, Belfast and Newcastle upon Tyne. DESIGN: Recording of the timing of the injury and the storage mediums (including air) and of reimplantation, the stage of root development, the degree of contamination and the time of commencement of root treatment. Cases were reviewed clinically and radiographically at intervals of 3 months. Root resorption was classified as present or absent. Logistic regression and cross-tabulations were produced with the presence of resorption set as the outcome. RESULTS: 128 reimplanted permanent incisor teeth, their median dry time prior to reimplantation being 15 minutes (range 4-52 mins), the median time in a liquid medium being 45 minutes (range 0-650 mins), with a median splinting time of 15 days (range 4-52 days) and a median pulp extirpation time of 15 days (range 0-612 days). There was a lower prevalence of resorption when the period of dryness was less than or equal to 5 minutes (p = 0.025). The prevalence of resorption in teeth with no visible contamination was 57.1%, for those with contamination which were washed clean it was 75%, in those rubbed clean it was 87.5%, and it was 100% for those reimplanted with visible contamination still present (p = 0.014). The corrected odds ratio for contamination was 2.99 and for an extension of 10 minutes of dryness it was 1.29. CONCLUSION: The degree of contamination and the period of dryness were the major risk factors for resorption in this study of reimplanted teeth in children.

Adolescent↗

PubMed2001

It's only teething...a report of the myths and modern approaches to teething.

Paediatric dentistry is not my usual field of work. I am now based almost entirely in restorative dentistry and it is five years since I worked in the dental department of a children's hospital. An essay on teething would appear to be an unusual choice of topic. With the current professional climate of 'general professional education' and 'lifelong learning' I can easily justify my time and effort studying a subject somewhat removed from my regular work. However, to be completely honest, I have reached that age when many of my friends, relatives and colleagues are enjoying the sleepless nights that accompany expanding families. Add to this the fact that I have recently married into a family of midwives, health visitors, nurses and new mothers. I was not sure that I was giving the best, most up to date advice when asked about teething. So some reading around was required. If only it were that simple. I now feel equipped to give a little more help than simply saying, "It's only teething..."

Child, Preschool↗

PubMed2002

Informed consent: optimism versus reality.

OBJECTIVE: To determine whether parents of children attending the outpatient general anaesthesia (OPGA) session at the Eastman Dental Hospital, London fully understand the proposed treatment. DESIGN: Observational study supported by structured questionnaires and interviews. SETTING: Casualty service in the Department of Paediatric Dentistry and the Victor Goldman Unit (a day-stay general anaesthetic unit) of the Eastman Dental Hospital. MAIN OUTCOME MEASURES: The parents' understanding of the consent was assessed based on their knowledge of the actual treatment procedure, the type of anaesthesia to be used and the number and type of teeth that would be extracted. RESULTS: Fifty-two of the 70 subjects (74%) approached completed both parts of the survey (interviews one and two). Results showed that 40% of the written consent obtained from the parents were not valid. The subjects' knowledge of the proposed treatment improved on the day of the actual treatment although 19% of them still did not fully understand the procedure. There was a statistically significant increase in the proportion of valid consent on the day of the actual treatment. Many of the subjects had no knowledge of the type of anaesthesia that would be used for their children but were more aware of the number and type of teeth that were going to be extracted. The time interval between the consent process and the actual treatment did not have any significant effect on the subjects' understanding of the consent, but it implied that with time the subjects' knowledge improved. CONCLUSION: A proportion of subjects did not fully understand the proposed treatment procedure even after being adequately informed. Appropriate measures should be taken to ensure that the patients or their guardians truly understand the proposed treatment.

Adolescent↗

PubMed1991

Liquid gallium alloys for metallic plastic fillings.

Ga-In-Sn alloys that are liquid at room temperature have been developed to replace mercury in metal plastic fillings. These liquid alloys were mixed with Ag-Pd-Sn-Cu-Zn to form powder alloys, 'a plasto-metallic body'. Various physical properties of these materials were evaluated. Strength increased markedly immediately after mixing, and polishing was possible on the same day. A good marginal seal could be expected as these materials expand on setting. The technique for filling is simpler and more rapid than is the case with amalgam materials. These materials also seem to be useful in paediatric dentistry for the handicapped, where extensive treatments are frequently performed under general anaesthesia.

Dental Alloys↗

PubMed1998

The dental practitioner's role in protecting children from abuse. 1. The child protection system.

The last British Dental Journal article on child protection was in 1986. Since then there have been major changes in both legislation and approaches to child protection. A local authority child protection specialist and a consultant in paediatric dentistry outline the development of child protection and the dental practitioner's role in the inter-agency child protection system in this, the first of three inter-related articles.

Child↗

PubMed1998

Comprehensive dental treatment of healthy and chronically sick children under intubation general anaesthesia during a 5-year period.

OBJECTIVE: To quantify the number of extractions and/or restorations placed in chronically sick children under intubation general anaesthesia and compare these findings with healthy children. SETTING: Two large paediatric dentistry units in Central London: a tertiary referral centre dealing with severe chronic sickness in children and an undergraduate dental school with a large commitment to special needs dentistry in children. DESIGN: Prospective comparison of treatment received for (a) chronically sick children and (b) dentally anxious (otherwise fit) children receiving intubation general anaesthesia during July 1991 to June 1996 inclusive. The statistical tests used were the Shapiro-Wilks test for normality and the Mann Whitney U test for non-parametric comparison of independent groups. MAIN OUTCOME MEASURES: Mean total treatment tally (TTT)--the sum of extractions and restorations for each child presented as summary data. RESULTS: Different patterns of dental care were found between the healthy and chronically sick groups. For similar levels of disease, a significantly greater number of extractions were carried out for chronically sick children (P < 0.0001), and significantly fewer restorations (P < 0.0001). The number of pulpotomies and stainless steel crowns provided to sick children was significantly smaller than to healthy children (P < 0.0001). This paper discusses the influences of chronic ill health on dental treatment provided under general anaesthesia. CONCLUSION: The underlying medical disorder in chronically sick children significantly influences the pattern of treatment when this is provided under general anaesthesia.

Anesthesia, Dental↗

PubMed1998

The use of inhalation sedation and local anaesthesia as an alternative to general anaesthesia for dental extractions in children.

OBJECTIVE: To determine the extent to which inhalation sedation might replace general anaesthesia for extractions in children and assess the success rate, cost and parental reaction in comparison to general anaesthesia. DESIGN: A matched pair design. SETTING: Unit of paediatric Dentistry at the University Dental Hospital of Manchester, UK between December 1992 and June 1994. SUBJECTS AND METHODS: Subjects aged 3 to 16 years who had been referred for extractions under general anaesthesia were used. Data were recorded for each visit and parents were asked to complete a simple post-operative questionnaire. OUTCOME: Treatment success was defined as completion of all treatment planned for the patient. Relative costs were derived from the time taken and staff costs. RESULTS: 265 subjects, mean age 7.63 (+/- 2.45) years had treatment attempted with sedation of whom 221 (83.4%) completed successfully. Young age, multiple extractions and irregular dental attendance predisposed to treatment failure, whereas orthodontic extractions had a similar success rate (97.6%) to general anaesthesia. The cost of sedation was less; parental reaction to sedation was also significantly better. CONCLUSION: Inhalation sedation can be used for many children referred for general anaesthesia. Greater use of this technique in the primary sector is needed to reduce the number of child referrals for general anaesthesia.

Adolescent↗

PubMed2004

Partial caries removal and cariostatic materials in carious primary molar teeth: a randomised controlled clinical trial.

OBJECTIVE: To determine the durability and effectiveness of a black copper cement (BCC) and a conventional glass ionomer cement (GIC) when used to restore primary molars following partial caries removal (PCR) and to compare these results with conventional cavity preparation and restoration. DESIGN: Split-mouth randomised controlled clinical trial. SETTING: Department of Paediatric Dentistry, Dundee Dental Hospital, Dundee, 1998-1999. SUBJECTS: Patients with previously unrestored, matched carious cavities in non-pulpally involved primary molars. INTERVENTIONS: Three treatment groups: (1) Partial caries removal followed by lining with BCC and restoration with GIC (PCR:BCC); (2) Partial caries removal and restoration with GIC alone (PCR:GIC), and (3) Complete caries removal and conventional restoration (CR). Restoration durability and effectiveness was assessed both clinically and radiographically over 24 months.Main outcome measures Median survival time (MST) of restorations. RESULTS: Forty-four patients (F: 31; M: 13), mean age 6.8 years (range: 3.7-9.5), had 120 restorations placed (PCR:GIC: 43; CR: 41; PCR:BCC: 36). Eighty-six molars (29 patients) (PCR:GIC: 30; CR: 29; PCR:BCC: 27) were reviewed at 24 months. The median survival times (MST) with 25% and 75% quartiles in parenthesis were as follows: PCR:BCC, MST = 24 months (6, 24); PCR:GIC, MST = 24 months (24, 24) and CR, MST = 24 months (24, 24). The MST for PCR:BCC restorations was significantly less than for PCR:GIC and CR restorations (W = 1163.5, P = 0.028 and W = 1081.0, P = 0.004 respectively). CONCLUSION: There were no differences in the proportions of restorations lost between restoration types, although PCR:BCC restorations did have significantly more abscess/sinus formation over the 24-month study period.

Aluminum Silicates↗

PubMed2005

General dental practitioners' views on the use of stainless steel crowns to restore primary molars.

AIM: To ascertain general dental practitioners' views on the use of stainless steel (pre-formed metal) crowns to restore carious primary molars. METHOD: Ninety-three general dental practitioners were selected at random from those practising in Lancashire, Cheshire and Greater Manchester in 2003 and interviewed separately about the clinical care they provide to the primary dentition. Before the interview participants recorded the care they would provide for a case scenario, describing a child with a carious lesion that the British Society of Paediatric Dentistry (BSPD) guidelines indicate should be treated with a stainless steel crown. RESULTS: In answering the case scenario only six (7%) of the dentists reported that they would fit a stainless steel crown. Of the 93 dentists interviewed 71% knew of the BSPD guidelines, but only 18% had ever fitted a stainless steel crown in general practice. Reasons given for not using stainless steel crowns were they are inappropriate for many children, time consuming to fit, difficult to manipulate, expensive, and ugly. CONCLUSION: The BSPD guidelines on the use of stainless steel crowns do not reflect the views of the majority of general dental practitioners who consider these crowns unsuitable for most children and an impractical restorative technique in busy daily practice.

Attitude of Health Personnel↗

PubMed1997

Reported infant feeding, oral hygiene and dental attendance patterns in children aged 5 years and under referred for extraction of teeth under general anaesthesia.

This study was designed to examine reported infant feeding, oral hygiene, and dental attendance practices in children who had established dental disease before attaining school age. Data were collected by structured interview from the mothers of 150 children aged 5 years and under who were referred to a hospital Paediatric Dentistry Unit for the extraction of teeth under general anaesthesia. Few children in this study had been exclusively breast-fed, and, although unconfirmed by data derived from matched caries-free controls, the development of dental caries would appear to be related to prolonged bottle-feeding, including the use of a night-time bottle until just before weaning, the early introduction and regular consumption of larger than average amounts of confectionery, coupled with reportedly regular but unsupervised toothbrushing. Although decay was already established in over a third of children before they visited a dentist for the first time, little evidence of restorative care was found. It would appear that the primary care services fail this youngest age-group.

Age Factors↗

PubMed1999

Pre- and post-treatment levels of salivary mutans streptococci and lactobacilli in pre-school children.

OBJECTIVES: To examine the effect of operative and restorative treatment of dental caries on the levels of caries associated microorganisms in saliva and to relate alterations to the type and extent of treatment. DESIGN: Longitudinal. SETTING: Paediatric Dentistry Department at a central hospital in Sweden. SUBJECTS AND METHODS: One hundred and eight pre-school children with severe dental caries scheduled for treatment under general anaesthesia. Chair-side tests were used to estimate the levels of salivary mutans streptococci, lactobacilli and buffer capacity before the surgery and at recall appointments 1 and 6 months after treatment. Caries were assessed according to WHO guidelines and the number of extracted teeth and filled surfaces during surgery were recorded. RESULTS: The results demonstrate that the post-treatment levels of mutans streptococci and lactobacilli were significantly reduced (P < 0.001) compared to pretreatment levels. Lactobacilli levels were more dramatically reduced than mutans streptococci. The reduction of mutans streptococci was positively correlated to the number of extracted teeth (P < 0.01), but not to the number of restored or ground surfaces. Lactobacilli reduction was not significantly related to the type of treatment. CONCLUSION: The findings suggest that extensive operative and restorative dental care effectively reduces the levels of caries associated with microorganisms during a period of at least 6 months.

Anesthesia, Dental↗

PubMed2000

Denture satisfaction and clinical performance in a paediatric population.

OBJECTIVES: The objectives of this study were to investigate the clinical performance of partial upper dentures in children and to assess reported denture satisfaction in this young population. DESIGN: This was a retrospective study using patients' dental records in conjunction with a postal questionnaire. SETTING: The Paediatric Dentistry Clinic, School of Clinical Dentistry, Sheffield. SAMPLE AND METHODS: Fifty-eight children (aged 7-17 years) who had been provided with a partial upper denture to replace one or more missing permanent incisors were included in the study. The patients' dental records were examined for the following details: tooth type missing, presence of retained incisor roots, aetiology of tooth absence, age at which the denture was first provided, total time period dentures had been worn, and frequency and type of any denture repairs or replacements. Next a short questionnaire was sent to each child, which sought an evaluation of several parameters of denture satisfaction including: overall attitude towards wearing a denture, denture appearance, ease of eating, comfort and perceived degree of teasing from peers. Visual analogue scales (VAS) were employed to provide a graded response. RESULTS: 70.7% of subjects had a single missing incisor and trauma was the most common cause of tooth loss (77.3%). The mean age at which patients started wearing a denture was 11.6 years and the mean length of time dentures had been worn, at the time of the investigation, was 2.1 years. A 'T-shaped' denture was most commonly employed (77.5% of dentures). Overall, 36.2% of subjects had required at least one denture repair, 28.2% presenting within a year of denture provision. One or more denture replacements had been received by 60.3% of the patients, and 43.6% had required this within a year. Component failure was highest for the denture tooth (40% of repairs) and a change in the patient's dentition necessitated a denture remake in 66% of cases. VAS scores for parameters of denture satisfaction indicated an overall positive evaluation of the dentures, with the most positive response relating to ease of eating. However, the reported degree of teasing was high and increased with time. The only significant difference for denture satisfaction according to gender was for mastication: girls reportedly found eating easier than did boys. CONCLUSION: Children are generally accepting of upper partial dentures, but their poor clinical performance is of concern and there is need for improvement.

Adaptation, Psychological↗

PubMed2000

Consumer demand in the purchase and prescription of sugar-free medicines.

OBJECTIVES: To determine the current level of consumer demand in the purchase and prescription of sugar-free paediatric medicines. DESIGN: Data were collected by administered questionnaire. SETTING: The study was conducted in a Hospital Paediatric Dentistry Unit and a Community Dental Clinic, both within the Bro Taf area of south-east Wales. SAMPLE AND METHODS: The parents of 240 children attending for routine dental care responded to one of two short questionnaires, depending on whether their child had received a liquid oral medicine in the preceding month. RESULTS: Although aware of the benefits of sugar-free medicines, parents did not appear to be attempting to exercise the power of consumer demand to its full potential. They were more likely to ask a pharmacist (or pharmacist's assistant) than their general medical practitioner for a sugar-free medicine. CONCLUSIONS: We must continue to promote sugar-free medicines. While increasing the importance that health professionals attach to such products, future campaigns should also aim to increase consumer demand.

Administration, Oral↗

PubMed2000

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

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.

Adolescent↗

PubMed2000

An investigation of the oral status and reported oral care of children with heart and heart-lung transplants.

AIM: To investigate the oral health status and oral microflora of children who have received heart and heart-lung transplants. Parental knowledge and current practice of oral health procedures by the child were also investigated. SAMPLE AND METHOD: Thirty-five children attending the Cardio-Thoracic Transplant Unit, Great Ormond Street Hospital for Children were included. Measurements were compared with children matched by age and gender attending the trauma clinic at the Department of Paediatric Dentistry, Eastman Dental Hospital. Teeth were examined for the presence or absence of caries or enamel defects. Plaque deposition, gingivitis, gingival bleeding and gingival enlargement were measured and a swab was taken to look at the oral microbial flora. A questionnaire was used to assess parental knowledge of dental health procedures and the current practice of these. RESULTS: There were no significant differences between transplant and control children in caries experience, plaque or gingivitis. Children with heart or heart-lung transplants had significantly greater numbers of enamel defects and more gingival enlargement than control children, children in the heart transplant group had significantly more gingival bleeding. There was little difference in the dental knowledge and reported behaviour of the transplant group compared to the control group. CONCLUSION: The dental needs of heart and heart-lung transplant patients treated at the Great Ormond Street Hospital for Children were similar to those of the control group in this study, however further improvement could be made in educating parents and children on the importance of caries prevention and good oral hygiene.

Adolescent↗

PubMed2002

Detection of in vitro demineralization of primary teeth using quantitative light-induced fluorescence (QLF).

INTRODUCTION: With the advent of remineralizing therapies and the new, conservative approach to restoration placement, interest in detecting and monitoring subclinical, precavitated lesions has increased. The increased understanding of clinicians about the processes of primary and secondary prevention and the detection of lesions to which these therapies may be applied, is one of the current goals in caries management. Quantitative light-induced fluorescence (QLF) is a new method for the detection of very early caries. OBJECTIVES: To determine the ability of QLF to detect and longitudinally monitor in vitro enamel demineralization. To present the device to the paediatric community and present future in vivo uses of the device. DESIGN: An in vitro study with combined in vivo pilot. SAMPLE AND METHODS: Twelve previously extracted, caries free, primary molars were selected and prepared. Two teeth were randomly selected as controls. Teeth were prepared by gentle pumicing and coating in an acid-resistant nail-varnish, except for an exposed window on the buccal surface. QLF baseline images were taken and the teeth then exposed to a demineralizing solution. Teeth were removed at regular intervals (24, 48, 72, 96, 120, and 144 h), air-dried and QLF images taken. QLF images were analysed by a single, blinded examiner (to control, to length of exposure). Mineral loss, as measured by DeltaQ, was recorded. RESULTS: Demineralization was noted in all experimental teeth by 48 h, and within 24 h in six teeth. The QLF successfully monitored the increase in mineral loss over time (P < 0.05). The detected lesions were not visible clinically until 144 h and then in only the most severe lesions. No demineralization was detected by QLF in control teeth. The device was user- and patient-friendly in vivo, detecting subclinical lesions. CONCLUSION: Detection of very early mineral loss and subsequent monitoring of this loss is possible in primary teeth using QLF. The device is well suited to use in paediatric dentistry and offers applications for both clinicians and researchers. The determination of the status of carious lesions (active/inactive) will be possible with readings taken at recall appointments.

Analysis of Variance↗