Castillo Morales Appliance Therapy in the treatment of drooling children.

OBJECTIVE: To evaluate the efficacy of Castillo Morales Appliance Therapy (CMAT) in reducing the severity and frequency of problematic drooling in children. METHODS: A de-identified extraction of all hospital morbidity records belonging to patients with drooling who underwent treatment with CMAT was performed between June 22, 2000 and April 12, 2016. Data were obtained from Starship Children's Hospital clinical records department. Demographic, diagnostic, and procedural data were included. Severity and frequency of drooling was quantified using the Thomas-Stonell and Greenberg classification method. RESULTS: There were fifty-three children less than 17 years of age who were treated with CMAT for the indication of problematic drooling between June 22, 2000 and April 12, 2016. 72% (n = 38) of patients had a reduction in the severity and frequency of drooling with CMAT. Mean follow up was 51 months. These patients did not require further treatment for drooling with botulinum toxin or surgery. Within this group, 63% (n = 24) of patients had significant improvement in drooling as per the Thomas-Stonell and Greenberg classification method (p = 0.024). CONCLUSIONS: Children who underwent CMAT for drooling were less likely to require further treatment with botulinum toxin or surgery. This result suggests that the use of CMAT in children with problematic drooling confers benefit.

Comparison of the ECOHIS and short-form P-CPQ and FIS scales.

BACKGROUND: The development of short-form versions of child oral-health-related quality of life (OHRQoL) scales has resulted in two closely related sets of measures. We set out to compare the properties and responsiveness of the Early Childhood Oral Health Impact Scale (ECOHIS--both "child" and "family" versions) and short-form Parental-Caregiver Perceptions Questionnaire (P-CPQ) and the Family Impact Scale (FIS) measures among New Zealand children with early childhood caries who underwent treatment under general anaesthesia (GA). METHODS: Secondary analysis of data from pretest/post-test clinical studies of consecutive clinical convenience samples undertaken in Wellington in 2005 and Auckland in 2010/11, with cross-sectional analyses using the former, and longitudinal analyses using the latter. RESULTS: Cronbach's α values for the ECOHIS-Child, P-CPQ-16 and P-CPQ-8 were 0.80, 0.88 and 0.80 respectively, and 0.83 and 0.68 (respectively) for the FIS-8 and the ECOHIS-Family. All scales showed acceptable cross-sectional construct validity, although that of the ECOHIS-Family was not as marked as that observed with the FIS-8. Responsiveness was acceptable, with the three child-focused measures showing similar effect sizes. The two family-focused measures were also similar. CONCLUSIONS: The ECOHIS-Child and the P-CPQ scales are very similar in their properties, but the ECOHIS-Family falls short of the FIS-8 in some important ways. The ECOHIS scales may be better deployed in epidemiological survey work rather than in health services research, whereas the P-CPQ-8, P-CPQ-16 and the FIS-8 seem to be well suited for the latter (particularly with children suffering from severe caries), but their epidemiological utility remains to be demonstrated.

Short-form versions of the Parental-Caregivers Perceptions Questionnaire and the Family Impact Scale.

OBJECTIVE: To develop short-form versions of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and Family Impact Scale (FIS). METHODS: Pretest/post-test clinical studies involved parent-completed questionnaires (the P-CPQ and the FIS) before and some weeks after dental care (under general anaesthesia) for early childhood caries (ECCs) in consecutive clinical samples from Wellington and Auckland. Deriving the short-form versions used only the baseline data from the Wellington sample (N = 195), whereas their evaluation used both baseline and follow-up data from the Auckland sample (N = 144 followed up). Item impact analysis was used to identify the 8 and 16 items with the greatest impact. An eight-item short-form FIS version was obtained in the same way. RESULTS: In the Wellington sample, Cronbach's α for the full, 16- and 8-item P-CPQ scales was 0.92, 0.89 and 0.82, respectively, and it was 0.88 and 0.85 for the full and eight-item FIS. Cross-sectional concurrent validity in the Wellington sample was acceptable for all short forms. Examining their responsiveness in the Auckland sample, large decreases post-treatment were observed in the short-form P-CPQ scores which were similar in relative magnitude to those seen with the full version. The full and short-form FIS scale scores showed moderate decreases. CONCLUSIONS: The reliability, validity and responsiveness of the short-form versions were acceptable in these settings with children suffering from severe ECC; however, before they can be treated as definitive measures for use in health services research to determine the effects of clinical interventions for ECC, their test-retest reliability should be examined and further validation undertaken.

Bilateral radicular cysts of mandibular deciduous teeth: a case report.

While common in adult teeth, radicular cysts are uncommon in deciduous teeth. When they do occur, they are associated with non-vital teeth and typically present 6 months to 5 years after vitality is lost. They cause swelling, bone-loss and permanent tooth bud displacement. Often, they are incidental findings. A case involving radicular cysts on the left and right sides of the mandible is presented. If non-vital deciduous teeth receive pulp therapy, regular post- operative reviews are recommended.

Changes in young children's OHRQoL after dental treatment under general anaesthesia.

OBJECTIVE: To use the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and Family Impact Scale (FIS) to determine whether dental treatment of young Auckland children under general anaesthesia (GA) improved oral-health-related quality of life (OHRQoL) for them and their families. DESIGN: A pretest/post-test design, with a consecutive clinical sample of parents/caregivers of children (10 years or younger) treated under GA. More than half of the children were Maori or Pacific Islanders. RESULTS: Of the 157 children in the baseline sample, 144 (91.7%) were followed up. The overall P-CPQ score showed a large decrease following treatment, along with an increase in the number scoring 0 (no impact). Similar relative changes were observed in the oral symptoms and emotional well-being subscales, whereas the other two subscales showed moderate decreases. All post-treatment FIS scores were lower than pre-treatment ones; all showed moderate effect sizes. The greatest relative changes were seen in the parental/family activity and parental emotions subscales. CONCLUSIONS: The dental treatment of young children under GA is associated with considerable improvement in their OHRQoL. The P-CPQ and the FIS are valid and responsive to treatment-associated changes in young children with early childhood caries (ECC).

Dens evaginatus--how does it present and how should it be managed?

Dens evaginatus is a developmental dental anomaly predominantly affecting premolars in people of Mongolian origin. It is likely to become more prevalent in New Zealand due to the increase in immigration of Asians. The formation of dens evaginatus is postulated to be an abnormal evagination of the internal enamel epithelium and dental papilla into the stellate reticulum during morphodifferentiation. An important complication resulting from damage to the evagination is periapical abscess. When considering treatment options, the long-term prognosis of the tooth, its root length, the general alignment of the teeth, and overall arch length should be reviewed. Management options include composite resin placed at the base of the tubercle, excision of the tubercle followed by direct or indirect calcium-hydroxide pulp capping and composite-resin restoration, and apexification procedures followed by conventional endodontic therapy. Grinding of the intact tubercles of newly erupted evaginated premolars may contribute to secondary infection of the pulp, and is not recommended.