The effect of vibration on pain during local anaesthesia injections.

BACKGROUND: The "gate control" theory suggests pain can be reduced by simultaneous activation of nerve fibres that conduct non-noxious stimuli. This study investigated the effects of vibration stimuli on pain experienced during local anaesthetic injections. METHODS: In a preliminary study, subjects were asked to rate anticipated and actual pain from regional anaesthetic injections in the oral cavity. A second study compared, within subjects, pain from injections with and without a simultaneous vibration stimulus. Both infiltration and block anaesthetic injection techniques were assessed. In each subject, two similar injections were given and with one, a vibration stimulus was randomly allocated. Injection pain was assessed by visual analogue scale and McGill pain descriptors. RESULTS: Both infiltration and block injections were painful (mean anticipated intensity: 31.25, actual: 17.82 mm on 100 mm scale). Pain intensity with and without vibration was 12.9 mm (range 0-67) and 22.2 mm (range 0-83) respectively (p = 0.00005, paired T-test), and this effect was seen with both infiltration (p = 0.032) and block anaesthetic (p = 0.0001) injection subgroups. Furthermore, compared to no vibration-stimulus injections, injections with vibration resulted in less pain descriptors chosen (p = 0.004), and the descriptors had a lower pain rating (p = 0.001). CONCLUSIONS: The results suggest that vibration can be used to decrease pain during dental local anaesthetic administration.

Water fluoridation in the Blue Mountains reduces risk of tooth decay.

BACKGROUND: In April 1992, the fluoride concentration in the Blue Mountains water supply was adjusted to 1 mg/L. Baseline dmft/DMFT has been determined in children attending schools in the region and in the adjacent reference region of Hawkesbury, fluoridated since 1968. The aim of this study was to evaluate the effect of the water fluoridation programme in the Blue Mountains. METHODS: In 2003, children attending the same schools were sampled. Residential history data were obtained by questionnaire and caries experience was assessed according to WHO guidelines. The analysis was restricted to lifelong resident children aged 5-11 years. RESULTS: The baseline and follow-up dmft scores for Blue Mountains children aged 5-8 years were 2.36 and 0.67, respectively. The age-adjusted decrease in odds of experiencing one or more dmft due to fluoridation was 0.26 (CI(95) 0.19, 0.37). The corresponding DMFT scores for Blue Mountains children aged 8-11 were 0.76 and 0.21 and the corresponding decrease in odds of experiencing one or more DMFT due to fluoridation was 0.25 (CI(95) 0.16, 0.40). CONCLUSIONS: Tooth decay reduction observed in the Blue Mountains corresponds to high rates reported elsewhere and demonstrates the substantial benefits of water fluoridation.

The Caries Management System: an evidence-based preventive strategy for dental practitioners. Application for children and adolescents.

The application of the Caries Management System (CMS) for children and adolescents follows the rationale underlying the application of the CMS for adults. Briefly, the CMS is a 10-step, risk-based, non-invasive strategy to arrest and remineralize early lesions and to enhance caries primary prevention. The method for assessing each patient's diet, plaque distribution, and signs of caries as shown in bitewing radiograph images, follows the protocols for adults. Protocols presented here relating to caries risk assessment, lesion diagnosis and management, and patient recall are specific for children and adolescents. Fundamentally, non-cavitated lesions in primary and especially permanent teeth are managed: (1) professionally by preservative non-invasive means, including fluoride varnish and sealants; and (2) daily home toothbrushing using fluoride toothpaste where the aim is to arrest lesion progression so that restorations will not be necessary. Monitoring of lesions through the review of clinical signs and bitewing images is the means for assessing caries activity. For those who fail to respond to advice to reduce cariogenic exposures and continue to develop new lesions at a steady or increased rate, a more intensified programme is required; their higher risk status is confirmed and treatment follows the corresponding protocol.

The Caries Management System: an evidence-based preventive strategy for dental practitioners. Application for adults.

In the absence of effective caries preventive methods, operative care became established as the means for caries control in general practice. Water fluoridation resulted in a declining caries incidence which decreased further following the advent of fluoridated toothpaste. The challenge today is to develop a non-invasive model of practice that will sustain a low level of primary caries experience in the younger generation and reduce risk of caries experience in the older generations. The Caries Management System is a ten step non-invasive strategy to arrest and remineralize early lesions. The governing principle of this system is that caries management must include consideration of the patient at risk, the status of each lesion, patient management, clinical management and monitoring. Both dental caries risk and treatment are managed according to a set of protocols that are applied at various steps throughout patient consultation and treatment. The anticipated outcome of implementing the Caries Management System in general dental practice is reduction in caries incidence and increased patient satisfaction. Since the attainment and maintenance of oral health is determined mainly by controlling both caries and periodontal disease, the implementation of the Caries Management System in general practice will promote both outcomes.

Were NZ's structural changes to the welfare state in the early 1990s associated with a measurable increase in oral health inequalities among children?

OBJECTIVE: To test the hypothesis that the 1990-91 social and economic policy changes in New Zealand were associated with a subsequent increase in socioeconomic and ethnic inequalities in the dental caries experience of five-year-old children. METHOD: Dental caries data from the School Dental Service treating the greater Wellington area were analysed for the period 1995-2000. Multivariate models were developed for deciduous caries prevalence (logistic regression) and severity (negative binomial regression). RESULTS: In the years 1995, 1996, 1997, 1998, 1999 and 2000, complete data were available for 2,627, 3,335, 4,404, 4,155, 3,154 and 2,804 children, respectively. Ethnic and socio-economic differences in caries prevalence and severity were substantial and persistent during the observation period. Where caries severity was concerned, there was a significant interaction between time and Maori ethnicity, indicating that (on average) the oral health of Maori children deteriorated in comparison to their European counterparts. CONCLUSIONS: The early-1990s social and economic policy changes were associated with an apparent widening of ethnic inequalities in caries severity among five-year-old children. IMPLICATIONS: Economic rationalism appears to have oral health disadvantages for non-European children. Before implementation of proposed major social and economic policy changes, policymakers should consider their health implications.

The use of a neoprene "thumb-sock" to prevent trauma in a thumb-sucking child with intractable epilepsy.

A nine-year-old girl with spastic quadriplegia, mental retardation, poor vision, a gastrostomy, and intractable epilepsy was referred by her pediatrician for a dental assessment with a view to extracting her anterior teeth as a means of preventing repeated damage to the skin over the proximal phalanx of her left thumb, which she sucked at night. This was the time of day when the frequency of her epileptic seizures was highest. A simple solution to the problem was developed by a dentist and an occupational therapist in which nylon-coated 3-mm neoprene sheeting (wet-suit material) was formed into a "thumb-sock" with a simple Velcro fastening around the wrist. No trauma to the thumb from epileptic seizures has occurred since the "thumb-sock" was fitted 24 months ago.