[Is needleless anaesthesia effective?] / Is naaldloos verdoven effectief.

Needle phobia is an important reason to postpone a dental appointment.Needleless anaesthesia exists, but is it as effective as the conventionalmethods of dental anaesthesia? A literature review showed conclusionsto differ regarding the use of so-called jet injectors, which force a smallquantity of anaesthetic liquid through the mucosa under high pressure.According to some researchers, this technique works sufficiently wellin the deciduous dentition; this has, however, not been confirmed inall studies, nor is effectiveness guaranteed. Topical anaesthesia andanaesthesia for the maxillary teeth delivered via a nasal spray are gainingground but without a guarantee of effectiveness. It is thus difficult to takean unequivocal position on needleless anaesthetics at the moment dueto the lack of high-quality and sufficiently extensive studies available.More research is clearly required on these interesting and patient-friendlymethods of providing dental local anaesthesia.

Diagnostic efficacy of and indications for intraoral radiographs in pediatric dentistry: a systematic review.

PURPOSE: To systematically evaluate the diagnostic efficacy of intraoral radiographs and evidence supporting the indications for taking of intraoral radiographs in children in the following five clinical categories: caries, pathological conditions (including acute odontogenic infections and periodontal disease), dental/developmental anomalies, dental trauma, and enhancement of comfort/technique for taking radiographs in children. This was carried out to facilitate the updating of existing European Academy of Paediatric Dentistry (EAPD) guidelines on dental radiography in pediatric dentistry. METHODS: A systematic electronic literature search was conducted on Cochrane Library (1992-24 July 2018), MEDLINE (PubMed, 1946-24 July 2018), EMBASE (Embase.com, 1974-24 July 2018) and Scopus (pre-1970-24 July 2018). Hand search of handbooks and grey literature search was also performed. Study screening and study inclusions were agreed upon by three authors. Data extraction, and methodological quality and risk of bias assessment were carried out in duplicate for each of the included studies. RESULTS: A total of 9581 papers were identified. Following the primary and secondary assessment process, 36 papers were included in the final analysis. The included studies were further categorized into five main clinical categories for analysis: caries, pathological conditions, dental/developmental anomalies, dental trauma and comfort/technique-related studies. Only one paper was found to be of good quality and at low risk of bias; while, 9 papers were found of be at moderate risk of bias and 26 papers were at high risk of bias. Meta-analysis was not possible for any of the aforementioned clinical situations, and only a narrative synthesis was done. CONCLUSION: There is insufficient high-quality evidence for the use of intraoral radiographs in pediatric dentistry and current guidelines are based largely on expert opinion. There is a clear need for well-conducted and standardized studies regarding the use of intraoral radiography in pediatric dentistry.

Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document.

BACKGROUND: The European Academy of Paediatric Dentistry (EAPD) proposes this best clinical practice guidance to help practitioners decide when and how to prescribe dental radiographs in children and adolescents. METHODS: Four expert working groups conducted each a systematic review of the literature. The main subjects were radiation protection, intraoral dental radiography (bitewing and periapical radiographs), panoramic radiography (PR) and cone-beam computed tomography (CBCT). In addition, three workshops were held during the corresponding EAPD Interim Seminar in Chania (Crete, Greece) in 2019. On the basis of the identified evidence, all invited experts presented their findings and during the workshops aspects of clinical relevance were discussed. RESULTS: Several clinical-based recommendations and statements were agreed upon. CONCLUSION: There is no or low-grade evidence about the efficacy of dental radiographic examinations in young populations. The given recommendations and rationales should be understood as best clinical practice guidance. It is essential to respect the radiological principles of an individualized and patient-specific justification. When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient's exposure to ionising radiation according to the ALADAIP principle (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific).

In vitro analysis of extracted dens invaginatus using various radiographic imaging techniques.

AIM: Dens Invaginatus (DI) is a rare malformation of the teeth, showing a broad spectrum of morphologic variations. The aim of this study was to perform in vitro radiographic analyses of three extracted dens invaginatus (DI) teeth with complex root anatomy using plain radiographs, CBCT, MRI and micro CT techniques. MATERIALS AND METHODS: Study design: Three maxillary lateral incisors (A, B and C) from two patients were extracted due to poor prognosis and were radiographically analysed. Initially, conventional two dimensional digital radiographs were taken. Subsequently CBCT, micro CT and MRI analyses were performed. RESULTS: According to the Schulze and Brand system of classification, teeth A, B and C were classified as A2, B3 and B2 respectively. To detect the relationship between the invagination to the oral cavity and pulp chamber, conventional two dimensional radiographs were of no help. CBCT and MRI images were found to be complementary to each other but provided lesser structural detail than micro CT images. CONCLUSION: Reporting on these three DI teeth, normal conventional radiographs did not provide detailed structural information about the malformation due to geometric distortion and lack of information. Even though Oehlers classification system is the most widely used, classification by Schulze and Brand is more applicable in rare and deviant teeth.

Oblique lateral radiographs and bitewings; estimation of organ doses in head and neck region with Monte Carlo calculations.

OBJECTIVES: When bitewing radiographs are not possible (e.g. patients with special needs), oblique lateral radiographs may offer an alternative. The aims of this study were to assess the impact of horizontal projection angulation, focus-to-skin distance, exposure time and age of the patient on the equivalent radiation dose of several organs in the head and neck region by means of personal computer X-ray Monte Carlo (PCXMC) calculations and to assess the dose obtained from conventional bitewing radiographs. METHODS: PCXMC v. 2.0 software (STUK(®), Helsinki, Finland) was used to estimate the equivalent radiation doses and the total effective dose. Three exposure times, five age categories, two focus-to-skin distances and eight horizontal geometric angulations were assumed. The organs involved were the thyroid gland, oesophagus, salivary glands, bone marrow, oral mucosa, skull, cervical spine and skin. A similar calculation was also performed for bitewings taken with a rectangular collimator. Results and conclusion Bitewings taken with rectangular collimation decrease the radiation burden of the patient to 50%, compared with circular collimation. In the oblique lateral radiographs, focus-to-skin distance, patient's age and beam collimation had a significant impact on the equivalent doses measured in this study. Exposure time had a significant impact on the equivalent doses of the salivary glands, oral mucosa, skull and skin. Horizontal angulations had a significant impact on the equivalent doses of the thyroid gland, bone marrow, oral mucosa, skull and cervical spine. The total effective radiation dose was significantly influenced by all parameters investigated in this study.

Cone beam computed tomography in paediatric dentistry: overview of recent literature.

BACKGROUND: The use of cone beam computed tomography (CBCT) in paediatric dentistry has been mentioned in numerous publications and case reports. The indications for the use of CBCT in paediatric dentistry, however, have not yet been properly addressed. On the other hand, the three basic principles of radiation protection (justification, limitation and optimisation) should suffice. REVIEW: A review of the current literature was used to assess the indications and contra-indications for the use of CBCT in paediatric dentistry. Paramount is the fact that CBCT generates a higher effective dose to the tissues than traditional dental radiographic exposures do. The effective radiation dose should not be underestimated, especially not in children, who are much more susceptible to stochastic biological effects. The thyroid gland in particular should be kept out of the primary beam as much as possible. CONCLUSION: As with any other radiographical technique, routine use of CBCT is not acceptable clinical practice. CBCT certainly has a place in paediatric dentistry, but its use must be justified on a patient case individual basis.

Flemish general dental practitioners' knowledge of dental radiology.

The aim of this study was to assess general dental practitioners' knowledge of dental radiography and radiation protection in order to alert the Belgian authorities and dental professional societies. Prior to attending a postgraduate course on intraoral radiology, general dental practitioners in Flanders, Belgium, were asked to fill in a questionnaire regarding the radiological equipment and the techniques they used for intraoral radiography. The availability and type of dental panoramic equipment were also assessed. A total of 374 questionnaires were available for this study. 15% of the attendants used radiographic equipment that was more than 27 years old and 43% reported equipment that operated with a clockwork timer. 32% and 75% respectively had no idea what the kV or mA settings were on their intraoral equipment. 5% were unaware which cone geometry or geometric technique (paralleling or bisecting angle technique) they were using. 81% claimed to be using a short cone technique. 47% did not know what collimation meant, whereas 40% stated that they were using circular collimation. 38% used digital intraoral image detectors (63% were photostimulable storage phosphorplate (PSPP)), but 16% were not sure about the type of sensor they were using (PSPP or solid-state sensors). 61% also had dental panoramic equipment available, 25% of which was digital (10% charge coupled device (CCD) and 15% PSPP). These results clearly indicate the need for continued education on this subject. The latter is an important signal to Belgian authorities and dental professional societies.

Early Childhood Caries (ECC): what's in a name?

AIM: It is evident from the number of published scientific papers on Early Childhood Caries (ECC) that interest in this problem has grown in recent years. Many authors have been trying to devise a clear definition or classification for ECC. The aim of this review was to inventory the prevalence of ECC and to seek a consensus regarding definition and diagnosis. Further attention was paid to the aetiological factors including the role of microrganisms. Finally, education, parenting and treatment procedures were discussed. METHODS: For this review, epidemiological studies on caries prevalence in children aged between 0 and 36 months were compiled through a systematic approach using Medline. REVIEW: This clearly showed that ECC continues to be a serious public health problem and that there is a great variety of definitions and diagnoses used worldwide, reflected in the prevalence data. This review confirms the multicausal aetiology and the need for further research. The authors strongly support the recommendations formulated at the workshop in Bethesda 1999, and the policy statements by the AAPD. CONCLUSION: More efforts should be made to reach the high risk groups within populations, in order to reduce the prevalence of ECC and S-ECC (Severe Early Childhood Caries) and consequently to ameliorate the quality of life of these children. Long-term intervention studies are required for the evaluation of these efforts.

Oral hygiene habits and oral health in cystic fibrosis.

AIM: The present study was designed to investigate oral hygiene habits and fluoride use in cystic fibrosis (CF) homozygotes, heterozygotes and healthy controls as a function of caries experience (DMF-T) and oral cleanliness (dental plaque, dental calculus and gingival bleeding). METHODS: Oral hygiene habits in CF homozygotes (n=42), heterozygotes (n=48) and healthy controls (n=62) were used in a multivariate analysis with caries experience (DMF-T) and oral cleanliness (dental plaque, calculus and gingival bleeding) as response variables. RESULTS: CF homozygotes had a significantly lower caries experience (p< or =0.001) and less gingival bleeding sites (p< or =0.02). Oral hygiene habits were not significantly different between the three groups, except for intake of fluoride supplements. Significantly more CF homozygotes had received fluoride supplements. Oral hygiene habits did affect caries experience or oral hygiene differently in each study group. CONCLUSION: No matter what oral hygiene habits were, CF homozygotes had an overall better oral health status. Apparently they seemed to possess intrinsic salivary compensatory mechanisms, as the significant higher use of fluoride supplements appeared not to be responsible for the better oral health.

Mutans streptococci, lactobacilli and caries experience in cystic fibrosis homozygotes, heterozygotes and healthy controls.

Mutans streptococci (MS) and lactobacillus (LB) counts (CRT Bacteria chair-side test) were compared and correlated with the respective caries experience (DMF) of cystic fibrosis (CF) homozygotes (n = 20), CF heterozygotes (n = 20) and healthy controls (n = 20). Each group of subjects was divided into two equal age groups: group A <20 years and group B >20 years. No significant differences were found regarding DMF between the three groups. CF heterozygotes had a significantly higher DMF-S than CF homozygotes (p = 0.040). This was also found in age group B (p<0.02), where it also counted for DMF-T (p<0.01). When in age group B, CF heterozygotes and controls were combined as one group, it was found that they had a significantly higher DMF-T (p = 0.031) and DMF-S (p = 0.008) than CF homozygotes. No significant differences in LB counts between the three groups were observed. CF homozygotes and those in age group A had significantly (p = 0.018 and p = 0.015) more low MS counts. LB and MS counts were positive and significantly correlated with DMF-T/-S in CF homozygotes and in the combined group of CF heterozygotes with controls (p< or = 0.05 and < or = 0.001). No correlations between bacterial counts and DMF were observed in CF heterozygotes. It can be concluded that despite the fact that CF homozygotes behave as high caries risk individuals, they did not have significantly more dental decay. More research is required in order to explore salivary, dietary and medication influences.

A multidisciplinary treatment approach to a complicated maxillary dental trauma: a case report.

This case report describes the treatment of an 18-year-old male who lost two central maxillary incisors due to dental trauma. Because of a deep overbite and serious occlusal instability, the lost teeth 11 and 21 could not be replaced by a conventional fixed prosthesis. The vertical dimension of occlusion was increased using a Hawley-type appliance over a period of 1 year. When sufficient intermaxillary space was gained the alveolar ridge was augmented with a mandibular symphysis graft. Nine months later two one-stage non-submerged implants (ITI, Straumann, Waldenburg, Switzerland) were inserted. After further soft tissue adaptation to two temporary acrylic crowns, porcelain veneers were placed on the two implants and the lateral incisors.