Time to complain about pain: Children's self-reported procedural pain in a randomised control trial of Hall and conventional stainless steel crown techniques.

BACKGROUND: Children's pain in dentistry has undesirable short- and long-term consequences; therefore, less invasive treatments merit consideration. AIM: To investigate procedural pain scores for two treatments for carious primary molars in New Zealand primary care. DESIGN: This study was a split-mouth randomised control trial, with secondary outcome analysis. Children (4-8 years) with proximal carious lesions on matched primary molars had one tooth treated with the Hall technique (HT) and one treated with a conventional stainless steel crown (CT); treatment type and order of treatment were randomly allocated (allocation concealment). The Wong-Baker self-report pain scale measured pretreatment dental pain, procedural pain at each treatment and post-operative pain. RESULTS: Data were analysed for 103 children: 49 children had the HT first and 54 children had the CT first. Procedural pain scores did not differ by treatment type, with 71.8% and 76.7% of children reporting low pain for the HT and the CT, respectively. Fewer children reported low procedural pain for the second treatment than the first (p = .047). Most children reported low procedural pain for both treatments (58.3%), although 41.7% experienced moderate-high procedural pain with at least one treatment. CONCLUSIONS: The HT caused pain for as many children as the CT. There is an opportunity for better dental pain management in this setting.

Bonding Universal Dental Adhesive to Developmentally Hypomineralised Enamel.

PURPOSE: To investigate the effect of pretreatment protocols involving Papacarie Duo gel and Scotchbond Universal (SU) on the microshear bond strength (µSBS) of resin composite (RC) to hypomineralised enamel (HE). MATERIALS AND METHODS: Specimens of normal enamel (NE) and HE were derived from extracted hypomineralised first permanent molars (FPMs). Based on the colour of demarcated opacities, HE specimens were classified as creamy/white (CW) or yellow/brown (YB). The specimens were randomly allocated into eight groups (n = 20). Each group involved pretreatment with Papacarie Duo gel or no pretreatment, and SU applied in etch-and-rinse (E&R) or self-etch (SE) mode. All specimens were bonded with RC and subjected to µSBS testing. Failure modes were analysed using an optical microscope and SEM. RESULTS: Comparing NE with HE, the following factors were found to be significant (p < 0.001): type of enamel substrate, deproteinising pretreatment, and etching mode. Comparing CW HE with YB HE, a significant interaction between "deproteinising pretreatment" and "etching mode" was demonstrated (p = 0.028). When subjected to the concurrent use of Papacarie Duo gel and phosphoric acid etching, HE specimens showed a significant increase in µSBS (p < 0.001). CONCLUSION: Deproteinising pretreatment using Papacarie Duo gel followed by the application of SU in E&R mode led to increased µSBS of resin composite to HE.

Ultrastructure and properties of primary carious molars treated using the Hall Technique.

BACKGROUND: The Hall Technique (HT) is a method of restoring decayed primary teeth using stainless steel crowns (SSCs) without tooth preparation, caries removal, or local anaesthetic. AIM: To investigate the ultrastructural, biomechanical, and chemical characteristics of teeth managed with the Hall Technique in comparison with conventional SSC (controls). DESIGN: Twelve HT-treated primary molars and four controls were analysed. Teeth were dehydrated in ethanol, embedded in methylmethacrylate, mesio-distally sectioned, X-rayed, mounted, and polished. Biomechanical, ultrastructural, and chemical characterisation was performed for carious lesion and sound areas of each specimen. RESULTS: Pre-treatment and post-treatment X-rays showed evidence of little to no caries progression over time. In carious lesions, mean hardness and elastic modulus values were lower in HT-treated teeth than in controls. In both controls and HT-treated teeth, carious lesions had the lowest %wt of Ca and P of all tissues sampled. CONCLUSIONS: Although the retained carious tissue was biomechanically more compromised in HT-treated teeth, the Ca and P values were higher than reported elsewhere for carious lesions in primary molars, suggesting remineralisation may have occurred in caries in HT-treated teeth. Future investigations will help elucidate the processes involved with carious lesion arrest under SSC.

The Hall Technique and conventional restorative treatment in New Zealand children's primary oral health care - clinical outcomes at two years.

BACKGROUND: New Zealand children's oral health care is mostly provided in primary care oral health clinics. Little is known about treatment outcomes. HYPOTHESIS/AIM: To investigate different treatment outcomes of primary molar carious lesions in a sample of children in primary care. DESIGN: Quasi-experimental study of 180 5- to 8-year-old children. Each child had one carious primary molar treated by a dental therapist with a plastic restorative material (PRM) or a pre-formed stainless steel crown placed with the Hall Technique (HT). After 2 years, restorative outcomes were categorised as success, minor failure, or major failure. Data were analysed using Chi-square tests. RESULTS: A total of 147 (82%) children were followed up; mean follow-up period 25 months (range: 21-35 months). Failure was observed significantly more in the PRM group (32%) than the HT group (6%). When baseline carious lesions were radiographically deep with marginal ridge breakdown (MRB), there was a higher proportion of major failures than when they were shallow without MRB (33% and 1%, respectively; P < 0.001). Among the deep lesions, those treated with the HT showed better success than PRM. CONCLUSIONS: There was a much higher success rate in the children treated with HT than PRM. Deep carious lesions responded better to HT than PRM.

Acceptability of the Hall Technique to parents and children.

OBJECTIVE: To investigate the acceptability of stainless steel crowns placed by dental therapists on children's primary molars using the Hall Technique. DESIGN: Mixed methods approach, using qualitative inductive analysis and quantitative analysis. SETTING: Hawke's Bay Community Oral Health Service METHODS: One focus group was conducted and ten thirty-minute phone interviews were undertaken with parents of children who had previously had a stainless steel crown placed using the Hall Technique (over the period 1 December 2011 to 31 May 2012). An inductive approach was used to analyse the qualitative research data, and the information was arranged into several categories based on the key themes which arose. Children treated with the Hall Technique were asked immediately after treatment whether they had enjoyed their visit to the clinic that day. RESULTS: Common themes were found with regard to appearance, pain, the procedure, and general opinions on acceptability. Nearly all (90%) of the children responded positively about their visit to the clinic. CONCLUSION: There was a high degree of acceptance among both parents and children for stainless steel crown placement using the Hall Technique in this group.

Antifungal drug susceptibilities of commensal Candida isolates.

Two hundred and forty-two oral commensal yeast isolates were obtained from a convenience sample of 134 healthy 7- and 8-year-old children (65 males and 69 females). The isolates were initially tested for their susceptibilities to the antifungal azole drug fluconazole, using an agar diffusion method (Etest), which was suitable for screening large numbers of yeast isolates, and confirmed as equivalent to the broth microdilution reference method. Eighteen isolates from 7 children were found to have low fluconazole susceptibility according to guidelines published by the United States National Committee for Clinical Laboratory Standards (NCCLS). The isolates with low susceptibility were identified as either Candida tropicalis (n = 9 of 34 strains tested) or Candida glabrata (n = 9 of 13 strains tested). Selected isolates (6 susceptible and 7 with lower susceptibility to fluconazole) were also tested by a reference broth microdilution method for susceptibility to fluconazole and to a related over-the-counter azole antifungal, miconazole. A positive correlation between susceptibility to fluconazole and to miconazole was observed. The high rate (38 percent) of reduced susceptibility in commensal C tropicalis and C glabrata strains may represent a future treatment problem if the use of over-the-counter azole drugs increase.