Dental fear and anxiety in children: a review of the environmental factors.

Dental fear and anxiety are psychological reactions that interfere significantly with daily life. They are problems suffered by many patients worldwide that remain a significant challenge to providing adequate dental care. The multifactorial etiology of children's dental fear and anxiety identifies the influence of many different risk factors in its development.The aim of this review article is to analyse the scientific literature regarding the different factors associated with dental fear and anxiety in children. Our review of the literature presents a critical analysis of the contributing factors in dental environment that have been investigated in the literature and provides an insight into the possible explanations on the influence of these factors in pediatric patients.Being familiar with these factors would facilitate behaviour management in anxious children. The findings of the literature review give grounds to undertake studies investigating the influence of contributing factors in all pediatric age subgroups.

Influence of Er:YAG Laser on Objective and Subjective Parameters of Stress during Sealant Application in Children.

BACKGROUND: Acceptance of lasers as alternatives and accessory tools to traditional methods in dental medicine has created an explosion of interest. Er:YAG laser is recommended for enamel conditioning. There is no study evaluating the anxiety in children during fissure sealing procedures when using Er:YAG laser compared to the routine application technique. AIM: To evaluate the objective and subjective stress parameters in children during a preventive procedure when using Er:YAG laser for additional enamel conditioning before pit and fissure sealant application compared to the routine clinical application technique. MATERIALS AND METHODS: The study included sixty-four 6-12-year-old children, divided into two equal treatment groups. A standardized fissure sealant application was performed, as in the intervention group before acid etching, the occlusal surfaces of teeth were conditioned with Er:YAG laser (2940 nm). During the procedure, objective and subjective stress parameters were recorded. RESULTS: Significantly lower degree of dental anxiety was found at the end of the dental visit of the study group (p<0.001). During the professional cleaning of the tooth surface, the mean heart rate was low (95.55±14.29 bpm) within the physiological normal range. The objective and subjective stress parameters show no significant differences between the two subgroups during sealing procedure (p>0.05). CONCLUSIONS: Application of Er:YAG laser during sealant application does not provoke anxiety and is well accepted by children in dental environment. Preventive procedures at the beginning of a dental visit decrease the initial levels of dental anxiety and contribute to an effective treatment process.

Scanning Еlectron Мicroscopy of Еnamel and Dentin of Тeeth with Hypocalcified Аmelogenesis Imperfecta.

UNLABELLED: The histological features of teeth with hypocalcified amelogenesis imperfecta (AI) have been poorly studied, which calls into question the effectiveness of modern adhesive techniques used in the treatment of these noncarious defects. AIM: The aim of this study was to investigate the morphological features of the enamel and dentin of teeth with AI using scanning electron microscopy (SEM), and compare these features with those of healthy teeth. MATERIALS AND METHODS: We examined four primary teeth extracted on indication from a 10-year-old girl with hypocalcified amelogenesis imperfecta. The same number of primary teeth extracted from healthy subjects was used as controls. The morphological characteristics of the enamel and dentin are described after investigating the teeth and photographing the specimens with scanning electron microscope. RESULTS: The SEM photos of the enamel of AI teeth show presence of external defects, incorrectly oriented enamel prisms and enlarged interprism spaces. Thickening of the peritubular dentin and partially obliterated dentinal tubules characterize the dentin of these teeth. CONCLUSION: The enamel and dentin of teeth affected by hypocalcified AI diff er considerably from normal hard dental structures in their morphological characteristics.

Behaviour Evaluation Scales For Pediatric Dental Patients - Review And Clinical Experience.

The present article makes a review of the relevant literature on the scales used in the assessment of behaviour of pediatric dental patients as well as presents the results we have had of using a modified Kurosu Behaviour Evaluation Scale to assess a study sample. The review makes a critical analysis of current evaluation methods and the design of assessment scales. The assessment tools most commonly used in pediatric dentistry are presented in a chronological order from the past to the present. The clinical study we conducted used a modified Behaviour Evaluation Scale developed by Kurosu for the assessment of the behaviour of children. The study showed that during dental treatment of children in the age range of 6 to 12 years the prevailing objective behaviour characteristics in accordance with Kurosu's behaviour evaluation scale are related to the eyes and the facial expression. The findings from the literature review and the results of our study warrant further studies to develop easy-to-use assessment tools that would enhance the objective assessment of behaviour.

Perceived sources of stress in fifth year dental students--a comparative study.

INTRODUCTION: The term "stress" refers to the effect of certain external factors (physical or mental) on the individual's physical and psychological health. Stress is very high in dental medicine. It may well be generated by the process of training in dentistry. During their training dental students express high levels of stress and considerable stress-related symptoms such as physical problems, depression, obsessive-compulsive and personality disorders. The perceived stress can be dependent on socio-cultural factors. The type of personality, gender, emotional intelligence and other individual characteristics may also influence the stress effects. AIM: To determine the main sources of stress in students during their dental training and compare the level of stress fifth-year dental students experience in the Faculty of Dental Medicine, Plovdiv, Bulgaria and the Faculty of Dentistry in Montpellier, France. METHODS: We recruited in the study fifth-year students from the Faculty of Dental Medicine in Plovdiv, Bulgaria and the Faculty of Dentistry in Montpellier, France. The modified Dental Environment Stress (DES) questionnaire was used to assess the effect of the various stressors. The questionnaire survey was conducted between February and March 2008. RESULTS: The living arrangements domain indicates higher levels of stress in Bulgarian students compared to their French counterparts with significant statistical difference for all factors. In personal factors the highest levels of stress were found with respect to the reduced holidays during school year and financial problems. Exams were the highest stressor in academic work domain and for the survey as a whole. In educational environment factors the stressors with the highest significance were the interactions with patients, academic environment (for French students) and risk of cross transmitted infections (for Bulgarian students). The high stress during clinical work is related to completing the assigned clinical workload quota and the shortage of time for clinical work. CONCLUSIONS: The students from both faculties report the highest mean levels of stress are related to examinations and clinical factors. Bulgarian students experienced higher mean levels of stress compared to their French colleges. The differences in mean stress levels are associated with socio-cultural factors and variations in educational curriculums at both dental faculties.

II. Risk factors for crown fractures of permanent incisors in children from Plovdiv.

AIM: The present study considers gender, age, overjet and lip competence as risk factors for children to sustain crown fractures to their permanent incisors. MATERIAL AND METHODS: A total of 2572 children aged 7-11 years were included in the epidemiological study. They were randomly recruited from the schools in Plovdiv. A modified WHO classification for reporting crown fractures was used. The examiners collected data about children's age, gender, and age at sustaining the trauma; the overjet size was measured and the lip competence assessed. The obtained information was entered into a specially designed statistical proforma. The incisor overjet, lip competence, gender, age, and age at sustaining the fracture were encoded as variables as follows: overjet: 1 = normal (< 3 mm), 2 = increased (3-5 mm), 3 = highly increased (> 5mm); lip competence: 1 = adequate lip competence, 2 = lip incompetence; gender: 1 = male, 2 = female; fractures: 0 = no evidence of fractures, 1 = presence of fractures. On the basis of the obtained regression coefficients we developed a logistic regression model to determine the likelihood of sustaining crown fractures to the incisors. RESULTS: The results clearly suggest that boys are twice more likely to sustain crown fractures of the incisors. The calculated ratio of boys to girls affected by crown fractures of incisors was 1.79:1 (odds ratio = 1.88). The greatest number of children with crown fractures of incisors were in the age range of 7-9 years (86.10 +/- 2.32%). These data suggest that there is a greater risk of experiencing crown fractures of the permanent incisors when the overjet exceeds 3 mm. The children with inadequate lip coverage were statistically significantly more at risk of sustaining crown fracture of the incisors in comparison with the children with normal lip competence (P < 0.001, chi2 = 122.54). CONCLUSIONS: Children with inadequate lip coverage and overjet greater than 3 mm are significantly more at risk of sustaining crown fracture of the incisors. Boys are twice more likely to experience incisor crown fracture. The age period between 7 and 9 years is the most risky for fractures.

I. Prevalence of crown fractures of permanent incisors in schoolchildren aged 7-11 years from Plovdiv.

UNLABELLED: The aim of the study was to determine the prevalence of crown fractures of permanent incisors in schoolchildren aged 7-11 years from the town of Plovdiv. MATERIAL AND METHODS: The present study included 2572 children (1287 boys and 1285 girls) at the age of 7 to 11 years from Plovdiv. A modification of the WHO classification for reporting crown fractures was used. Examinations were performed only of the upper and lower incisors, in the classrooms at daylight. Treatments of the fractured teeth after the trauma were also registered. The results were analysed statistically by calculating the chi-square to determine if there was any significant difference between the variables. RESULTS: The prevalence of crown fractures of permanent teeth in children aged 7-11 years from Plovdiv was 8.67 +/- 0.55%. The crown fracture prevalence in boys was significantly higher than that in the girls for all examined children. Most of the children had only one fractured tooth (82.96 +/- 2.52%). The prevalence of the incisor crown fractures by teeth was 1.28 +/- 0.08%. The greatest number of fractured teeth were located in the maxilla (88.20 +/- 1.99%). Most often the fractures involved only the enamel or the enamel and dentine while complicated crown fractures with pulpal exposure were found in 5.32 +/- 1.38%. Most of the fractured teeth were left untreated (84.79 +/- 2.40%). CONCLUSIONS: The prevalence of permanent incisor crown fractures in children aged 7-11 years from Plovdiv was 8.67 +/- 0.55%; and by teeth--1.28 +/- 0.08%. Children with only one fractured tooth were the greatest part of all injured children in the study. There were significantly more maxillary teeth fractures, with predominance of uncomplicated crown fractures in the permanent teeth. Treated fractured teeth were very few. Treatment was needed for 78.92 +/- 2.73% of all registered fractured incisors.

Eruption of first permanent molars in 4- to 8-year-old children in Plovdiv.

INTRODUCTION: The eruption age of the first permanent molars is one of the milestones by which the normal physical development of the child is evaluated. AIM: The need of current data about M1 eruption in 4- to 8-year-old children determines the aim of the present study. MATERIAL AND METHODS: The study includes 928 children from 4 to 8 years of age, from randomly selected kindergartens and schools in Plovdiv. The initial, mean and the latest age of eruption were determined. RESULTS: The data show that there is no statistically significant difference in the eruption age of first permanent molars between the two genders, as well as between the upper and lower jaw. Statistically significantly higher percentage of 4-5 and 5-6 year-old children have had first permanent molars in 1985 compared to their pairs in 2001. CONCLUSIONS: In 4- to 8-year-old children from Plovdiv the initial eruption age of first permanent molars is 5-6 years, the mean age--6-7 years, and the latest age--7-8 years.

Comparison of caries epidemiology of the primary teeth in 3- to 6-year-old children from Plovdiv and Karlovo/Sopot.

INTRODUCTION: Dental caries is affected by multiple factors, including socioeconomic conditions and the presence or absence of anticaries prevention programs. AIM: The aim of the present study was to conduct comparative study of caries epidemiology of the primary teeth in 3- to 6-year-old children from Plovdiv and Karlovo/Sopot. MATERIAL AND METHODS: The study includes 1250 children from 3 to 6 years of age--830 from Plovdiv and 420 from Karlovo/Sopot, from randomly selected kindergartens. The following indicators were determined: prevalence of caries per persons (Ep); prevalence of caries per teeth (Et); incidence of caries (It); incidence of untreated and treated caries (Id, If). RESULTS: The results show that the caries indicators are higher in the children from Karlovo and Sopot than in their pairs in Plovdiv. Inadequacy of the children dental care system and stomatological treatment was found in both studied groups.

Incidence of caries of the primary teeth (IT) in 3- to 8-year-old children in Plovdiv.

INTRODUCTION: There is a recognized trend of a decrease of the caries incidence of primary teeth (It) in Europe and worldwide. AIM: The need for updated data for the indicator It, as well as the need to study the trends of its development determine the aim of the present study. MATERIAL AND METHODS: The study includes 1124 children from 3 to 8 years of age--536 girls and 588 boys, from randomly selected kindergartens and schools in Plovdiv. The carious and filled primary teeth were registered (df). The following indicators were determined: incidence of caries of primary teeth (It), total and by jaws; incidence of the untreated caries (Id); incidence of the treated caries (If). RESULTS: The obtained data suggest that It increases with age. No statistically significant difference was found between the values of the two genders, as well as in the comparison by jaws. A marked trend of decrease of the values of It in the last 5 years is outlined, as well as of distribution of the predominant percentage of carious and filled teeth into an increasingly smaller group of children.

Caries epidemiology of the primary teeth in children from 3- to 8-years of age in Plovdiv.

INTRODUCTION: The need of current data on the epidemiology of caries of the primary teeth in 3- and 8-year-old children and establishing the trends in the prevalence of this disease in the last 18 years in Plovdiv determines the aim of the study. MATERIAL AND METHODS: The study includes 1124 children--536 girls and 588 boys from randomly selected kindergartens and schools in Plovdiv. The carious and filled primary teeth were registered (df). The following indicators were determined: prevalence of caries per persons (Ep), prevalence of caries per teeth (Et) and incidence of caries per teeth (It). RESULTS: The results show that the values of caries indicators increase with age: Ep in 3-year-old children is 23.13%, while in 8-year olds--83.22%. Et in 3-year-old children is 3.09%, while in 8-year olds--29.43%. The percentage of caries-free individuals in the target age group of WHO--5-year-old children is 47.32%. CONCLUSIONS: A trend of decrease of the prevalence and incidence of caries of the primary teeth is ascertained in children from 3 to 8 years of age in Plovdiv in the last 18 years. The disease is limited to an increasingly narrower children group.