Self-perceived oral health and orofacial aesthetics of cleft patients.

PURPOSE: To evaluate the self-perceived oral health and aesthetics of the dentition and jaw in patients with different types of oral cleft, measured by patient-reported outcome measures (PROMs). Additionally, to compare the results of the PROMs between cleft lip and or/palate (CL/P) patients and non-affected controls. METHODS: 420 CL/P patients treated at the cleft team of the Erasmus Medical Center, Rotterdam, The Netherlands, were included, and 138 non-cleft patients were recruited as control-group. Patient's perceptions were retrospectively evaluated using the CLEFT-Q Teeth for dental aesthetics at ages 8, 12 and 22, CLEFT-Q Jaw for jaw aesthetics at ages 12 and 22, and the Child Oral Health Impact Profile-Oral Symptoms Subscale (COHIP-OSS) for oral health at ages 8 and 12. One-way ANOVA was used to compare differences in oral health and aesthetic perceptions among age-groups, cleft types, as well as between cases and controls. RESULTS: CL/P patients were significantly less satisfied than controls with their dental aesthetics (p = 0.001). CL/P patients reported significantly lower satisfaction on CLEFT-Q Teeth scores at ages 8 and 12, than at 22 years (p < 0.001). Patients with the most extensive cleft phenotype, Cleft Lip and Palate (CLAP), reported lowest satisfaction on the CLEFT-Q Teeth. No differences in perceptions of oral health nor in aesthetics of the jaw were found in the different cleft types, ages, nor in study versus control group. CONCLUSION: This study found differences in self-perceived dental aesthetics: CL/P patients are less satisfied than non-affected controls. CLAP patients are least satisfied, but satisfaction increases with age.

Are parents of high caries risk Dutch children motivated to brush their children's teeth? An assessment using the health action process approach questionnaire.

PURPOSE: To assess the social cognitive constructs of the Health Action Process Approach (HAPA) of parents of high caries risk children to be treated under intravenous sedation (IVS) or with behavioural guidance techniques (BGT), and to assess the changes in these constructs for each treatment group after treatment. DESIGN: In this cohort study, 160 children aged 3-10 years were allocated by their paediatric dentist to either IVS (77.4%) or BGT. Their parents filled out a HAPA questionnaire, before (T1, n = 160), immediately (T2, n = 108) and three months (T3, n = 71) after their children's dental rehabilitation. RESULTS: Before treatment, all parents had high scores on all social cognitive constructs. There were no differences in mean HAPA scores between the treatment groups (p > 0.05). After treatment, mean scores changed in both groups. In the BGT group, action self-efficacy changed from 3.64 (T1) to 3.36(T2) (p = 0.027) and to 3.13 (T3) (p = 0.021) and coping self-efficacy changed from 3.63 (T1) to 3.23 (T2) (p = 0.015). In the IVS group, action planning changed from 3.25 (T1) to 3.05(T3) (p = 0.036) and action control changed from 2.58 (T1) to 2.82 (T2) (p = 0.012) and to 2.87 (T3) (p = 0.006). CONCLUSIONS: High scores on social cognitive constructs of parents of children referred to a paediatric dentist showed that they seem to be motivated to brush their children's teeth, irrespective of the treatment group. Small changes were observed in the HAPA constructs, however, these are not considered clinically relevant.

Is silver diammine fluoride effective in arresting dental caries in cavitated primary molars?

CLINICAL QUESTION: To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dental caries in cavitated caries lesions in primary molars. DATA SOURCES: A systematic search was carried out in PubMed, Scopus, and Embase. Furthermore, cross-referencing was performed using the references lists of full-text articles and grey literature was also retrieved for eligible studies. Two independent reviewers were responsible for study selection and data extraction. STUDY SELECTION: Randomized and non-randomized clinical studies that evaluated the caries arrest rate of SDF compared to no treatment or any other type of non-invasive or minimally-invasive treatment were included. Only publications in the English, Italian and French language and with a minimum follow-up of 6 months were considered for study eligibility. DATA EXTRACTION AND SYNTHESIS: The characteristics of the included studies-age, sex, type of study, sample size, caries at baseline, setting, operator, blinding, intervention, outcomes and assessment of any confounders-were extracted from the included papers. The quality assessment was carried out using the Cochrane risk of bias tool. The success rate and odds ratios were chosen to calculate the effect size for the meta-analysis. RESULTS: A total of nine publications were included for qualitative review and five of them were included in the meta-analysis. Around half of lesions that received annual or biannual application SDF ≥ 38% were arrested. CONCLUSIONS: SDF 38% application was found to be effective in arresting dental caries progression in cavitated primary molars.

A retrospective clinical study on the resin infiltration of proximal caries lesions: the operator's effect.

PURPOSE: This retrospective university-based study investigated the effect of operators' training and previous experience on the success of resin infiltration (RI) in arresting proximal non-cavitated caries lesions in primary and permanent teeth. METHODS: Information was collected regarding RI of proximal non-cavitated caries lesions in primary and permanent teeth with a follow-up period up to 32 months. Factors investigated were: operators' clinical experience and training, patient's age, tooth, arch, mouth-side, surface treated, tooth separation, and baseline lesion depth. Kaplan-Meier survival and Cox regression analysis with shared frailty were used (α = 5%). RESULTS: A total of 130 proximal surfaces treated on 115 teeth of 43 children (11 ± 4.4 years) were evaluated. Survival of RI was 46% up to 32 months. Lesions treated by non-trained dentists were more likely-to-present progression than those performed by non-trained dental students under supervision (HR 2.41, 95% CI: 1.00-5.80); conversely, no difference was found between non-trained dental students under supervision and trained dentists (HR 0.52, 95% CI: 0.16-1.70). Additionally, dentin lesions were 59% more-likely-to-present progression than enamel lesions (HR 0.41, 95% CI: 0.17-0.99). CONCLUSION: The operator's experience and training could influence the success of RI on proximal non-cavitated caries lesions and it should be taken into consideration when choosing this treatment modality.

[Child-friendly restorations of primary molars using the Hall technique]. / Kindvriendelijke restauraties van tijdelijke molaren met de Hall-techniek.

Minimally invasive dentistry is being used increasingly often, especially in paediatric dentistry. It involves replacing traditional 'drilling and filling' with treatment modalities that are tissue-saving and minimally burdensome to the patient. One of these techniques for treating carious dentine lesions is the Hall technique. A stainless-steel crown is cemented onto the primary molar without the use of anaesthesia or any form of preparation. The molar is 'sealed' under the crown and this stops the carious process in the cavity. Usually, the procedure requires 2 sessions. The Hall technique is well tolerated by children and provides the primary molar with a durable restoration. Together with this technique, the patient is also guided in an individual prevention process. The survival rates of Hall crowns are very high.

Parents' satisfaction on dental care of Dutch children with Autism Spectrum Disorder.

PURPOSE: To assess if Dutch children with Autism Spectrum Disorder (ASD) regularly visit a dentist and to evaluate parent's satisfaction on the care provided. METHODS: Parents of ASD children (2-18 years) were invited to fill out a survey. The survey consisted of questions regarding ASD severity, frequency of dental visits, history of dental pain, type of dental practice and parents' satisfaction. Results were analysed using Chi square and Mann-Whitney U tests (α = 5%). RESULTS: Of the 246 returned questionnaires, 19 were excluded (incomplete or unconfirmed ASD diagnosis). All children visited a dentist at least once and 5% of them had their last visit more than 12 months ago. According to parents, 15% of the children did not receive the needed care when they had toothache and 21% of the parents were unsatisfied with the current dental care provided. No difference was found between satisfied and unsatisfied parents in type of dental practice visited (p > 0.05). The children of unsatisfied parents reported more often pain during the last year (p = 0.013) and had a more severe type of ASD (p = 0.016). CONCLUSIONS: The majority of Dutch ASD children investigated regularly visit a dentist and 21% of the parents is unsatisfied with the dental care provided.

The Hall Technique 10 years on: Questions and answers.

It is ten years since the first paper on the Hall Technique was published in the British Dental Journal and almost 20 years since the technique first came to notice. Dr Norna Hall a (now retired) general dental practitioner from the north of Scotland had, for many years, been managing carious primary molar teeth by cementing preformed metal crowns over them, with no local anaesthesia, tooth preparation or carious tissue removal. This first report, a retrospective analysis of Dr Hall's treatments, caused controversy. How could simply sealing a carious lesion, with all the associated bacteria and decayed tissues, possibly be clinically successful? Since then, growing understanding that caries is essentially a biofilm driven disease rather than an infectious disease, explains why the Hall Technique, and other 'sealing in' carious lesion techniques, are successful. The intervening ten years has seen robust evidence from several randomised control trials that are either completed or underway. These have found the Hall Technique superior to comparator treatments, with success rates (no pain or infection) of 99% (UK study) and 100% (Germany) at one year, 98% and 93% over two years (UK and Germany) and 97% over five years (UK). The Hall Technique is now regarded as one of several biological management options for carious lesions in primary molars. This paper covers commonly asked questions about the Hall Technique and speculates on what lies ahead.

Physical-mechanical properties of glass ionomer cements indicated for atraumatic restorative treatment.

BACKGROUND: This study evaluated mechanical properties of glass ionomer cements (GICs) used for atraumatic restorative treatment. Wear resistance, Knoop hardness (Kh), flexural (F(s)) and compressive strength (C(s)) were evaluated. The GICs used were Riva Self Cure (RVA), Fuji IX (FIX), Hi Dense (HD), Vitro Molar (VM), Maxxion R (MXR) and Ketac Molar Easymix (KME). METHODS: Wear was evaluated after 1, 4, 63 and 365 days. Two-way ANOVA and Tukey post hoc tests (P = 0.05) analysed differences in wear of the GICs and the time effect. F(s), C(s), and Kh were analysed with one-way ANOVA. RESULTS: The type of cement (p < 0.001) and the time (p < 0.001) had a significant effect on wear. In early-term wear and Kh, KME and FIX presented the best performance. In long-term wear, F(s) and C(s), KME, FIX and HD had the best performance. Strong explanatory power between F(s) and the Kh (r(2) = 0.85), C(s) and the Kh (r(2) = 0.82), long-term wear and F(s) of 24 h (r(2) = 0.79) were observed. CONCLUSIONS: The data suggested that KME and FIX presented the best in vitro performance. HD showed good results except for early-term wear.

Bonding effectiveness of different adhesion approaches to unground versus ground primary tooth enamel.

AIM: This study aims to evaluate the bonding effectiveness of self-etch and etch-and-rinse adhesive systems in on intact and ground primary tooth enamel. STUDY DESIGN: Sixty primary incisors were divided into 6 groups according to the adhesive system (etch-and-rinse - Adper Single Bond 2 - SB, 2 steps self-etch -Clearfil SE Bond - SE, and 1 step self-etch - One Up Bond F Plus OBF) and to the substrate (ground or intact enamel): G1-SB/intact enamel; G2-SE/intact enamel; G3- OBF/intact enamel; G4-SB/ground enamel; G5- SE/ground enamel and G6-OBF/ground enamel. METHODS: Microshear bond test specimens were prepared with microhybrid composite and after 24h of water storage the microshear test was performed. STATISTICS: Data were submitted to statistical analysis using two-way ANOVA and Tukey's tests (p<0.05). RESULTS: Comparing the enamel characteristics (ground or intact) only when SE was used a statistically significant difference was found, as G2 (21.12+/-4.52) was statistically lower than G5 (33.29+/-5.44). Among the intact enamel groups, SB (26.11+/-7.56) was statistically superior to SE (21.12+/-4.52) and OBF (17.01+/-3.96). However, when comparisons were made among groups of ground enamel, SE (33.29+/-5.44) was significantly higher than SB (26.35+/-8.18) and OBF (17.52+/-3.46). CONCLUSION: The two-step self-etch adhesive system is a reliable alternative to etch and rinse adhesive systems on both ground and intact primary enamel.