Parental knowledge, attitude and practice regarding paediatric dental trauma. A systematic review.

AIM: Dental trauma is one of the major oral health problems faced during the developmental ages. Most of the traumatic events occur at home; therefore, parents are frequently required to provide appropriate first aid measures. This systematic review aimed to synthesize the available evidence parents have regarding the topic of dental trauma, with a focus on their level of knowledge, attitude, and practice. METHODS: The systematic review was performed according to PRISMA guidelines. The research question was structured using the PICO framework (PROSPERO ID: CRD42023397318). CONCLUSION: Parents' knowledge about dental trauma management is quite limited, and this has a negative impact on the long-term prognosis of traumatised teeth. It is crucial to increase parents' knowledge and awareness about the importance of dental traumas in paediatric age.

Clinical effectiveness of inhalation conscious sedation with nitrous oxide and oxygen for dental treatment in uncooperative paediatric patients during COVID-19 outbreak.

AIM: The aim of this study was to evaluate the features of inhalation conscious sedation for urgent dental treatments in uncooperative paediatric patients during COVID-19 outbreak. MATERIALS AND METHODS: Forty-two uncooperative patients, attending primary and secondary schools, were submitted to emergency dental treatments with inhalation conscious sedation using nitrous oxide and oxygen during COVID-19 pandemic. Collected data included: number of working sessions, success/failure, adverse events, side effects, number of teeth treated; type of dental procedure. Parents filled in an e-mailed questionnaire on post-discharge children status to evaluate: pain; crying; fever; vomiting; headache; drowsiness; excitability; irritability; ability to eat; need for drugs. RESULTS: One working session was carried out in 29 patients, 2 working sessions were carried out in 6 patients and 3 working sessions were carried out in 7 patients. Success rate was 87.1%. In relation to success, there was no statistically significant difference between males and females, healthy and disabled patients, respectively; while there was a statistically significant difference between patients attending primary and secondary schools (p=0.023). No adverse events occurred. The most frequent side effect was nausea. In relation to side effects, there was no statistically significant difference between males and females, healthy and disabled patients, patients attending primary and secondary schools, respectively. In relation to e-mailed questionnaires on post-discharge children status, 29.6% of the patients had pain, 22.2% vomited, 14.8% had headache, 18.5% experienced drowsiness, 29.6% failed to eating normally, 35.2% needed to take drugs. None of the patients cried, had a fever, exhibited irritability and excitability. CONCLUSION: Inhalation conscious sedation is a safe, practical and effective procedure with minimal side effects to perform emergency dental treatments in uncooperative paediatric patients during COVID-19 outbreak.

Oral health conditions in Wilson's disease patients: A clinical diagnostic study.

AIM: The aims of this study were: To evaluate oral health conditions, oral health behaviours and eating habits in Wilson's disease (WD) patients; to assess the possible relationship between oral health status and long-term pharmacological therapies undertaken. METHODS: Sixty WD patients were selected and their data were compared to those of an age-matched control group of 62 subjects. Clinical examinations were carried out and a questionnaire on oral health behaviours and eating habits was submitted to both groups. WD patients were interviewed on long-term pharmacological therapies undertaken. Statistical analysis was performed. RESULTS: The mean DMFT value was 3.75±4.65 in the WD group and 2.81±4.65 in the control group. The difference in the mean DMFT value between the two groups was not statistically significant. Modified Dental Enamel Defects (DDE) Index showed significantly higher values in WD group than in control group. No statistical differences in Visible Plaque Index (VPI), Gingival Bleeding Index (GBI) and malocclusions were observed between groups. In relation to the questionnaire, the differences between groups were statistically significant for: dental visits in a year; brushing teeth after a snack; drinking soft beverages; using mouthwash. For WD patients no statistical correlation between oral health status and long-term pharmacological therapies undertaken was observed. CONCLUSION: WD patients did not show worse oral health conditions than the control group, despite worse oral health behaviours and eating habits. Nerveless, WD patients showed higher presence of dental enamel defects. Finally, for WD group oral health status was not correlated to the long-term pharmacological therapies.

Autism spectrum disorders and oral health status: review of the literature.

AIM: Autism Spectrum Disorder (ASD) is characterised by impairments in communication and social relationships and by a narrow, repetitive and stereotyped repertoire of activities, behaviours and interests. The aim of this work is to evaluate how these characteristics have an impact on oral health. MATERIALS AND METHODS: A search was conducted through MEDLINE/PubMed and Web of Science in order to evaluate the oral health status of children with ASD and the correlation between ASD and dental caries, periodontal disease, dental injuries, oral microbiota, as well as the different strategies, approach and treatments in ASD patients. Forty-six articles were selected. RESULTS: Children with ASD are at higher risk of caries, alteration of the periodontal status, alterations of the oral microbiota and increased risk of traumatic injuries. CONCLUSION: Since ASD is a haeterogeneous disease with a wide range of expressions in individuals, adapted and specific strategies are needed. ASD children represent a challenge for the dental community.

OSAS in developing age: Screening of a Southern Italy population.

AIM: The aim of this study was to determine the prevalence of OSAS' risk in children of the province of Catanzaro, Italy. MATERIALS AND METHODS: A sample of 2445 scoolchildren aged 6 to 12 years of the province of Catanzaro (Italy) were administered the Pediatric Sleep Questionnaires (PSQs) in its validated Italian version. A total of 1772 questionnaires were collected; however, 130 of them were excluded, and 1642 questionnaires were accepted and scored. RESULTS: According to final scores of questionnaires, 172 children (10.47%) were considered at risk for OSAS. No statistically significant association between sex and risk of OSAS was found (p = 0.189). The risk of OSAS was equally distributed in all ages (p = 0.984). It was found that the most common habits in children with risk of OSAS were: snoring, heavy or noisy breathing, oral breathing, xerostomia, difficulty waking up in the morning, behavioural disturbances during the day and excess weight. CONCLUSION: The study showed a high risk of OSAS, suggesting the importance of first-level screening and the need to pay special attention to the diagnosis of this syndrome.

Assessing changes in oral health-related quality of life and body growth in 3-5 years old children following dental treatment under general anaesthesia due to severe dental caries.

AIM: To evaluate the impact of oral treatment under general anaesthesia (GA) on oral health-related quality of life (OHRQoL) in children with severe dental caries; to assess the effect of dental treatment under general anaesthesia on children's weight (Wt), height (Ht) and Body Mass Index (BMI). METHODS: One hundred uncooperative 3-5 years old children were selected. OHRQoL, assessed with the Early Childhood Oral Health Impact Scale (ECOHIS), Ht, Wt and BMI were measured at baseline and after 1 year from dental treatment under general anaesthesia. STATISTICS: All statistical procedures were performed using the Statistical Package for the Social Sciences (SPSS for Windows). ANOVA analysis was made to assess the effect of GA procedures on oral health quality of life in uncooperative children. RESULTS: After 1 year, the reductions for the ECHOIS components were statistically significant (P < 0.0001). Children showed a significant improvement in relation to pain, eating, sleeping and behavioural problems. At follow-up, there was a significant improvement in the anthropometric measures: 55% of children increased the percentile curves for weight and BMI; 44% for height. CONCLUSIONS: One year after a complete treatment under GA, both the OHRQoL and the growth improved.

Oral health status and Unmet Restorative Treatment Needs (UTN) in disadvantaged migrant and not migrant children in Italy.

AIM: Despite a global decline in caries experience in children, dental caries remains a common and persistent public health problem, being more prevalent among socioeconomically disadvantaged groups. The aim of this survey is to evaluate DMFT index, caries prevalence and Unmet Restorative Treatment Needs (UNT) index in migrant and not migrant children with low income, in Campania region (Italy), in order to plan and build up strategies for promoting dental health in children and adequate health care for vulnerable groups. MATERIALS AND METHODS: A sample of 553 children (age range: 12-14 years old) were recruited from volunteer patients at a charitable foundation in Naples (Italy) and were categorised into 2 subgroups, according to their status of "migrant" or "not migrant". Parents completed a questionnaire in order to investigate demographic and oral health behaviour. The participants were healthy and from low family income levels. DMFT scores and caries prevalence were calculated; UNT index was also calculated [D?(D + F)]%. The mean DMFT values related to the examined variables were calculated using one-way ANOVA. RESULTS: Mean DMFT and UTN index were 3.92±2.92 and 86.3% for migrants, and 3.29±3.21 and 68.4% for not migrants, respectively. The difference in the mean DMFT between the two groups was statistically significant (p=.027). Caries prevalence was 77.5% and 55.9% in the migrant group and in the not migrant group, respectively. High DMFT values were statistically associated to history of previous dental visit, sugar intake, brushing teeth once a day, and low mothers' educational level for both groups. CONCLUSION: Economically disadvantaged children showed high levels of dental caries. Furthermore, DMFT values, caries prevalence and unmet restorative treatment needs index among migrant children were higher than that of not migrant. In order to reduce inequalities in dental caries experience, there is a need to design policies aimed at primary prevention through health promotion programmes.

Paediatric oral surgery: endoscopic approach in ameloblastic fibroma management. A preliminary report.

AIM: Ameloblastic fibroma (AF) is a rare benign odontogenic tumor of slow-growing behaviour characterised by proliferation of both epithelial and mesenchymal odontogenic tissues. Treatment of AF is usually conservative by means of enucleation, curettage and long term follow-up. CASE REPORT: This report describes a case of AF in a 12-year-old boy. Examination of the oral cavity revealed absence of tooth 3.7 and mild swelling in the same mandibular area. Orthopantomography and Cone Beam Computed Tomography (CBCT) showed a wide multilocular radiolucent lesion at the left mandibular angle, extending from the first molar to the lower part of the mandibular branch; agenesis of tooth 3.7 and displacement of tooth 3.8. Surgical excision was performed under general anaesthesia. A fiberscope was used to perform a more conservative bone removal and extraction of tooth 3.8. Furthermore, an accurate curettage of the bone site was performed. The histological investigation showed an AF pattern: an epithelial cell component arranged in nests and tubules immersed in a stroma of low differentiated mesenchymal tissue. No sign of recurrence has been observed during the 6-month follow-up period. CONCLUSION: Although AF is a rare tumor, it is more prevalent in children's jaw. A new intra-operative visual technique could provide a conservative treatment by minimising bone deformities and permitting an accurate bone curettage.

Is there an association between various aspects of oral health in Southern Italy children? An epidemiological study assessing dental decays, periodontal status, malocclusions and temporomandibular joint function.

AIM: To describe the current oral health status of primary school children in Southern Italy, to investigate if there is an association between malocclusions and temporomandibular disorders (TMDs), and to investigate if there is an association between dental caries and periodontal disease. MATERIALS AND METHODS: Study design: Transversal epidemiological study. We examined 1086 children, considering them of the same socioeconomic status (medium). The Decayed, Missing, Filled (DMF) index and the Community Periodontal Index (CPI) were used to assess decay and periodontal status. Moreover, orthodontic and gnathologic evaluations were performed. RESULTS: Children had a mean age of 10.3±0.72 yrs, 41.6% had active dental caries in permanent teeth and 54.8% experienced periodontal problems. The 54.3% of patients had Angle Class I, 40.1% Class II and 5.5% Class III. The 13.8% of children had a deviated opening pattern of the mandible, and 2.2% of them had TMJ pain. DMF indices greater than 0 were associated with positive CPI. Males were more susceptible to periodontal disease, compared to females. TMJ pain was found associated with a decreased overbite. STATISTICS: Descriptive statistics for continuous data, and frequencies and percentages for categorical and ordinal data were calculated. Univariate linear and logistic regression model, with ? calculations, was used to assess associations between dental caries status and CPI, and between malocclusions and gnathologic aspects. CONCLUSIONS: This study found a noticeable prevalence of oral diseases among children of Southern Italy and an association between malocclusions and TMDs, periodontal disease and dental decay. Thus, a higher number of preventive interventions are recommended in the area.

Multidisciplinary approach to the treatment of double bilateral upper permanent incisors in a young boy.

BACKGROUND: A double tooth is a rare developmental anomaly referring to the fusion of two adjacent tooth buds or the gemination of a single bud. CASE REPORT: This case report describes the multidisciplinary approach to an 11-year-old patient with two double upper permanent incisors. The clinical intraoral examination showed a mixed dentition with bilateral double maxillary central incisors, molar Class I malocclusion and palatal ectopy of two lateral upper incisors. Computed tomography of the upper dental arch revealed the presence of double central incisors with two distinct roots. The clinical choice consisted of an innovative treatment including surgical, endodontic, orthodontic and restorative treatments. This management protocol produced good aesthetic, healthy and functional results that were stable also two years post-treatment.

In vitro performance of ultrasound enamel preparation compared with classical bur preparation on pit and fissure sealing.

AIM: Fissure sealants are effective in preventing caries. The aim of this in vitro study was to evaluate the effects of two different enamel surface preparation techniques for pit and fissure sealing. MATERIALS AND METHODS: Sixty extracted sound third molars were used. For each tooth, the mesial half of the occlusal fissures was treated with ultrasound diamond tip T1 mounted on an ultrasonic handpiece, while the distal half with conventional diamond bur. The teeth were randomly divided into 2 groups (n = 30/each). Group 1 samples were stored in distilled water at 4 °C. For group 2 samples, sealing of occlusal fissures was performed according to standard procedures. Bucco-lingual cuts parallel to the long axis of the tooth were made in order to separate the two different types of preparations. The effects of the executed procedures were assessed with SEM. RESULTS: Surfaces prepared with ultrasound system showed the presence of residual debris and appeared more irregular than surfaces prepared with traditional bur system. Furthermore, images showed the presence of cracks on the bottom and on the walls of the ultrasound prepared fissures. CONCLUSION: Conventional bur surface treatment showed a better performance when compared to ultrasound preparation and could probably ensure superior sealant retention.

An experimental in vivo procedure for the standardised assessment of sealants retention over time.

AIM: The elaboration of an experimental system to obtain reproducible and comparable photographs of the occlusal surface to monitor sealants retention. MATERIALS AND METHODS: An intraoral camera connected to a computer was used to obtain photos of the occlusal surfaces. A specific software was utilized to perform measurements on archived pictures. An experimental two-part system, consisting of a dental arch support and a camera support, connected to each other through holes and pins, was made to obtain a standardised and reproducible placement of the camera in the mouth. In the first part, to test the degree of reliability of the procedure and the percentage of image distortion, 120 first molars were sealed and for each molar ten photographs were taken, using the intraoral camera connected with the dental arch support, the camera support and the dedicated software. In the second part, 165 first molars were sealed and photographed, as above described, immediately after sealing (T0), 6 months (T1) and 1 year later (T2). With the software, the sealed areas were measured. The comparison of the selected sealed areas between T0 and T1, T0 and T2, T1 and T2 determined the percentage of sealant loss. RESULTS: In the first part, the experimental procedure showed a reliability of 96.85%. In the second part, the difference in the rate of lost sealant between T0-T1 and T1-T2 was statistically significant (p <0.001). STATISTICS: ANOVA analysis was made. CONCLUSIONS: Photographs, obtained through the experimental two-part system, allowing a reproducible positioning of the intraoral camera in oral cavity, could represent a standardised and useful method to monitor sealants retention over time.

New approach in paediatric dentistry: ultrasonic nondestructive evaluation of restorative dental materials. Experimental study.

AIM: The ultrasonic inspection is a non invasive method which is very developed in the industrial field, for the non-destructive evaluation of materials, and in the medical field, for the ultrasound diagnostic analysis. In paediatric dentistry the most widely used non- destructive evaluation is the X-ray technique. Radiographs are valuable aids in the oral health care of infants, children, adolescents, allowing dentists to diagnose and treat oral diseases that cannot be detected during a visual clinical examination. The aim of this in vitro study was to analyse the ultrasonic non-destructive evaluation (UT-NDE) technique to inspect both dental materials internal structure and the form and position of internal defects in order to obtain a diagnostic method, free of ionising radiations, in paediatric dentistry. Moreover the ultrasonic inspection (UT) could be a rapid method of diagnosis in uncooperative paediatric patients. MATERIALS AND METHODS: Study Design: Experimental samples were manufactured with the characteristics of a large composite or glass ionomer cement paediatric dental restoration, in terms of either size or operative technique used. Characteristics of the common restorations were analysed and reproduced in vitro, using the same operative conditions, also adding operative defects into some samples. All the samples were subjected to an innovative UT test using the pulse echo immersion scanning technique. Both C-scans and full volume scans were carried out during the experimental programme. To enhance the data obtained from the UT scan, a digital system (Ecus Inspection software) for signal detection, archiving, processing and displaying was used. RESULTS: UT images showed the presence of internal defects in the dental materials. It was also possible to inspect very thin discontinuity such as the one represented by the fluid resin. STATISTICS: In order to execute the statistical analysis, the values of electric voltage measured in five higher white points and in five higher grey points of the pictures pixels, were measured for each sample. Then, the average values and the standardised data were calculated. CONCLUSION: n In conclusion, the ultrasonic test could be a diagnostic non-invasive method in paediatric patients, capable to evaluate the quality of the restorative teeth filling, showing internal little defects. In vivo application of this diagnostic method should be developed.

An impacted central incisor due to supernumerary teeth: a multidisciplinary approach.

BACKGROUND: Hyperdontia is a disorder of odontogenesis characterised by excess teeth. Many complications can be associated with supernumerary teeth, such as crowding, tooth displacement, diastema, deep caries, retention or impaction, delayed eruption or ectopic eruption of adjacent teeth, aesthetic problems, neuralgic manifestations, root resorption of adjacent teeth, and dentigerous cyst formation with significant bone destruction. Treatment of hyperdontia depends on the area and number of supernumerary teeth, and also on the presence of pathologic processes that can affect them and/or the teeth of the normal series that could be erupted, retained or impacted. CASE REPORT: The present case report describes the clinical management of two impacted supernumerary teeth, which impeded the eruption of the maxillary right central incisor in a paediatric patient. A multidisciplinary treatment approach was planned, including the surgical removal of the supernumerary teeth and the orthodontic correction of the unerupted permanent maxillary right central incisor. Combined surgical and orthodontic treatment resulted in an aesthetically pleasant and balanced occlusion. Thus, early multidisciplinary treatment is required for greater hard and soft tissue preservation.

Oral health status in liver transplant Italian children.

AIM: The aim of this study was to assess the oral health status in children submitted to liver transplantation in order to evaluate the need to promote suitable dental caries prevention programmes. MATERIALS AND METHODS: Thirty-eight children submitted to liver transplantation (4-5 years) were selected and their data were compared to those of an age-matched control healthy group of 78 children. Clinical examinations were carried out and X-ray bitewings were taken, in order to record caries prevalence, caries experience, periodontal health and dental enamel defects. A questionnaire investigating demographic and oral health behaviour data was completed by parents. RESULTS: Caries prevalence was 78.9% in the liver transplantation group and 39.7% in the healthy control group. The dmft mean value was 2.26±2.25 in the liver transplantation group and 0.69±1.51 in the healthy group. The difference in the mean dmft between the two groups was statistically significant (p<0.0001). From the elaboration of the data on periodontal health it resulted that 23.7% of the liver transplantation subjects and 48.7% of controls had a healthy periodontal status, respectively; 39.5% of the liver transplantation children and 23.6% of the controls had plaque and calculus. In addition, 44.7% of the liver transplantation patients and 28.2%% of the control subjects showed bleeding on probing. In the liver transplantation subjects there was a higher prevalence (65.8%) of dental enamel defects with respect to the healthy group (21.8%). CONCLUSION: The high prevalence of caries and gingival diseases showed the need to promote specific dental caries prevention programmes in liver transplant children.

SEM investigation on casein phosphopeptides capability in contrasting cola drinks enamel erosion: an in vitro preliminary study.

AIM: Erosion of dental hard tissues induced by acidic dietary components is a high-prevalence finding, especially among children and adolescents. Acidic soft drinks are frequently implicated in dental erosion. The aim of this in vitro study was to assess if CPP-ACP preparation is capable of reducing enamel erosion caused by a cola-type drink. MATERIALS AND METHODS: Twenty-five sound human permanent premolars, extracted for orthodontic reasons in patients of 12-16 years old, were used. The roots were removed and the crowns were sectioned in order to obtain 3 enamel sections from each tooth. The specimens were immersed in: (A) cola-type drink; (B) cola-type drink plus CPP-ACP; (C) deionised water (control) for: 48 h, 24 h, 12 h, 6 h and 3 h, respectively. pH values were constantly monitored. Statistical analysis was performed using ANOVA. The enamel samples were evaluated for surface changes using scanning electron microscopy (SEM). RESULTS: Specimens subjected to cola-type drink (treatment A) showed wide areas of enamel dissolution, while the treatment B specimens showed a few areas of little enamel erosion, different from control samples. Adding CPP-ACP to the cola-type drinks influenced pH levels of the solutions, but always in the acidity range. CONCLUSION: CPP-ACP provides protection against dental erosion from cola-type drinks in vitro. Therefore, further studies are necessary to evaluate if adding casein phosphopeptide-stabilised amorphous calcium phosphate complex to acidic cola drinks could reduce their erosive potential in vivo as well.

Dental enamel defects in Italian children with cystic fibrosis: an observational study.

OBJECTIVE: The relationship between cystic fibrosis (CF) and caries experience has already been explored, but relatively little information is available on dental enamel defects prevalence among children affected by cystic fibrosis. The aim of this study was to investigate this issue in deciduous and permanent teeth of children with CF resident in southern Italy. BASIC RESEARCH DESIGN: This cross sectional observational study was undertaken between October 2009 and March 2010. PARTICIPANTS: 88 CF patients and 101 healthy age-matched participated in this study. METHODS: The prevalence of dental enamel defects was calculated using a modified Developmental Defects of Enamel (DDE) index. The comparison of dental enamel defects prevalence among groups was carried out using regression binary logistic analysis. RESULTS: In the CF subjects there was a higher prevalence (56%) of enamel defects in comparison to the healthy group (22%). The most prevalent enamel defect was hypoplasia with loss of enamel (23% of CF patients vs 1 1/2% of control group) in permanent teeth. CONCLUSION: This study confirms that children with cystic fibrosis are at increased risk of developing hypoplastic defects on their permanent teeth.

The effects of short-term consumption of commercial yogurt on salivary mutans streptococci and lactobacilli counts: an in vivo investigation.

The aim of this study was to evaluate in vivo whether short-term consumption of commercial yogurt modifies the levels of salivary mutans streptococci and lactobacilli in young subjects. A total of 84 volunteers were selected and divided into two groups (test and control). Subjects from the test group were asked to eat a pot of commercial yogurt twice a day for 2 weeks. No dietary restrictions, except a prohibition on eating yogurt and other fermented dairy products, were required to the subjects from the control group. The salivary colonisation of mutans streptococci and lactobacilli was investigated by chair-side kits at baseline, and after 1 and 2 weeks. Data were statistically processed. A statistically significant reduction in mutans streptococci counts was observed in the test group compared with the control group. No effects on the levels of lactobacilli were noted. Daily consumption of yogurt for 2 weeks may decrease the salivary levels of mutans streptococci.

Dental and periodontal health status in children affected by cystic fibrosis in a southern Italian region.

AIM: The aim of this study was to record the oral health status through the mean value of the DMFT/dmft index, the CPITN values and the DDE modified index in children affected by cystic fibrosis (CF). STUDY DESIGN: Observational study. METHODS: A group of 54 CF patients, aged 7 to 12 years, was selected and their data were compared to those of the same age healthy control group of 101 children. RESULTS AND STATISTICS: CF patients showed a mean DMFT (1.5 +/- 2.17) and dmft (0.42 +/- 0.9) significantly lower than control subjects (respectively 3.70 +/- 3.92 and 2.96 +/- 3.30). Moreover, in the CF subjects a high prevalence (55.6%) of enamel defects and a better periodontal health were found, despite the low presence of calculus in both groups. CONCLUSION: The low caries experience and the high prevalence of enamel defects in CF patients could be due to the metabolic disease, and above all to the long-term pharmacological therapies (antibiotics and pancreatic enzymes) that they take.

Effectiveness of a motivation method on the oral hygiene of children.

AIM: The aim of this study was to determine the influence of an oral hygiene motivation model on removing dental plaque in 57 subjects with an age range from 4 to 16 years, divided into three age categories on the basis of dentition phases, and to analyse the differences in behaviour between the three age groups and between sexes. MATERIALS AND METHODS Patients were instructed on how to carry out effective oral hygiene and were examined using the O'Leary plaque index at baseline (t0), 1 week, 1 month and 3 months later. At t0, examiners promised a present to the children if after 1 month they had better level of oral hygiene. After 1 month, the trainers gave a present to the children that had better level of oral hygiene. No gift was promised for the next visit at 3 months for evaluating if brushing teeth regularly had become an habit. Statistical analysis of the results was performed using ANOVA. RESULTS: At t0, the mean O'Leary plaque index was very high; after 1 week, this value had already decreased; after 1 month it slightly decreased; after 3 months, the mean O'Leary plaque index was still low. DISCUSSION: Children cleaned correctly their teeth both when examiners promised them a present, and when no gift was promised. Nevertheless, the mean value of the lower index of plaque was recorded after the first month, showing the children's susceptibility to the prizes. Females had better oral hygiene than males. CONCLUSIONS: This oral health motivation method was effective in establishing good oral health habits among children.