[Preventive dentistry 9. Non-Restorative Cavity Treatment: advanced insight or controversial?] / Preventieve tandheelkunde 9. Niet-Restauratieve Caviteitsbehandeling: voortschrijdend inzicht of controversieel?

Non-Restorative Cavity Treatment (NRCT) is not as popular in paediatric dentistry as it should be. Substantial quantitative and qualitative evidence concerning the treatment has now been published that testifies to the success of the treatment. Some healthcare providers apply the method successfully, while others have no trust in this non-invasive cavity treatment and continue to favour the restoration of carious lesions. Reasons given for this are, among others, that NRCT is too bothersome, the patient's (or the patient's parents') compliance is low and the reimbursement is inadequate. Children, however, benefit from oral healthcare providers who take the position that a child has a right to an etiological treatment that addresses the source of the caries process and that NRCT offers a uniquely viable treatment option for this purpose. This approach fits within the parameters established by professional ethics and the law. Apart from oral healthcare providers, all agencies involved in the profession and beyond have the moral and social obligation to do justice to the implied question of the child regarding this shift in oral healthcare.

[Role of the oral care provider to call attention to child abuse]. / De rol van de mondzorgverlener bij het signaleren van kindermishandeling.

The focus on child abuse has increased in recent years. In 2015, the Royal Dutch Association of Dentists (KNMT) revised the Sign Code 'child abuse and domestic violence'. The core of the Sign Code is formed by the compulsory 5-step action plan for the signalling of, among other things, (a suspicion of) child abuse that must be followed. Dealing professionally with child abuse places high demands on the knowledge and communication skills of the health care provider. If the demands are met, the health care provider is by law adequately protected against complaints. Many health care providers are still uncomfortable about applying the Sign Code. The number of contacts with Safe at Home for advice and reports coming from oral care amounts to only a few one-thousandths of the total number of contacts. In dealing with the neglecting of oral care, the most common form of child abuse in the area of dental care, professional action is usually still limited to symptom relief. Organised care via chain formation offers possibilities for the coordination of targeted action on child abuse.

[A paradigmatic change in the management of caries in children: 'Gewoon Gaaf']. / Een omslag in cariësbehandeling bij kinderen: 'Gewoon Gaaf'.

This is a position paper about 'Gewoon Gaaf' ['Just Smooth'], a paradigmatic change in the management of caries in children with a special focus onprevention. Caries is now considered a disease related to behaviour. Behavioural changes are essential in the prevention of caries because only patient's self care can keep caries under control. It is the task of the oral care provider to alert parents and child to their own influence on the development of caries and particularly on how to keep this process under control. Evaluations have revealed that the traditional form of preventive care has hardly improvedoral health. In contrast, various studies have shown the good results of the 'Gewoon Gaaf' approach. Moreover it fits in well with the public debate, which puts more and more attention on efficiency and transparency in the care.

[Dissertations 25 years after date 30. Oral hygiene and dental hygienists]. / Proefschriften 25 jaar na dato 30. Mondzorg en mondhygiënisten.

In 1986 the thesis entitled 'Choosing for dental hygienists' was published in The Netherlands. It provided the scientific basis for the further development of the profession of dental hygienists in The Netherlands. Since then, the profession has developed very strongly. In the intervening years, qualified dental hygienists have come to be considered capable of taking over simple restorative treatments from dentists. As a result, treatment, especially in children, can largely be carried out by one person. Nevertheless, recent developments, such as the sharp increase in the number of new dental students, suggest that the re-allocation of responsibilities is proceeding slowly. This suggests that policy makers have not yet unambiguously opted for dental hygienists and prevention.

[Involvement of dental hygienists in pedodontics. A recommendation]. / Inzet van mondhygiënisten in de pedodontie. Een aanbeveling.

The proportion of dental hygienists in oral health care for children is not consistent with the potential of the profession. Developments in cariology point in a direction that fits the profile of the dental hygienist. Stimulation of a re-allocation of jobs in paediatric dentistry in relation to dental hygienists is therefore desirable. Moreover, tackling the causes of oral diseases should be an objective to a greater degree than has been the case in the past. For caries treatment this would mean giving priority to a plaque-related treatment. That amounts to: a non-invasive approach to non-cavitated caries lesions in permanent and temporary dentition and a non-restorative approach to cavitated caries lesions in temporary dentition.

[Non-Restorative Cavity Treatment. Managing rather than masking caries activity]. / Niet-Restauratieve Caviteitsbehandeling. Cariësactiviteit beteugelen in plaats van maskeren.

UNLABELLED: The traditional restorative approach to active dentin caries in the temporary dentition is questioned. This paper argues in favour of a causal approach. The causal approach focuses on caries management. Restoration is of secondary importance. Delay or replacement of invasive restorative treatment by a causal approach decreases discomfort for children and promotes oral health over time. A form of causal treatment is the so called Non-Restorative Cavity Treatment. This approach requires that some measures be taken for managing cavitated caries lesions: 1. written informed consent; 2. making the cavity accessible for plaque removal; 3. treating carious dentition with anti-cariogenic agents and/or applying a protective layer to the carious dentition; 4. monitoring the caries process; 5. effective communication about dental health education. Some diagnostic criteria are important for the risk assessment of cavitated lesions: 1. activity of the caries lesion; 2. accessibility of the caries lesion for plaque control; 3. depth of the cavity; 4. condition of the pulp. CONCLUSION: the causal approach can arrest the caries process even in advanced stages of decay.

[Endodontic treatment of primary teeth. Pulp exposure and pulp necrosis]. / Endodontische behandeling van tijdelijke gebitselementen. Pulpa-expositie en pulpanecrose.

With management of the deep caries in primary teeth we have to take account into the coping strategies of the patient and the state of the development of the dentition. That's why in most cases a root canal treatment of primary incisors or even a pulpotomy is not indicated. Often Intellectual Decision Not To Restore is a good alternative for treatment of deep caries in primary incisors. In deep caries lesions of primary canines and molars preferably minimal invasive techniques as indirect pulp capping are performed. In case of a exposure, the dentist can choose between several types of treatment. Improved techniques have lead to clinical satisfying results of the calcium hydroxide pulpotomy. A partial pulpotomy is if possible the treatment of choice. A resin modified glass ionomer cement is used to cover the pulp wound because it has good sealing properties and it is easy to handle. To limit the burden in young children a root canal treatment in primary teeth is seldom indicated. Overfilling with calcium hydroxide in root canal treatment of primary teeth never causes problems.

The effect of 6-monthly application of 40% chlorhexidine varnish on the microflora and dental caries incidence in a population of children in Surinam.

This study is aimed at determining whether a commercially available varnish, containing 40% chlorhexidine, is able to reduce the numbers of mutans streptococci and lactobacilli in saliva, in a moderately caries-active population in Surinam. 238 children, ages 13-14 years, were selected from different schools in Paramaribo, Surinam. From these children, total dental status was recorded and saliva samples were taken. At baseline and every 6 months, a 40% chlorhexidine varnish (EC40) was applied. The control group received a neutral gel that did not contain chlorhexidine. The numbers of salivary mutans streptococci and lactobacilli were calculated by standard methods, and the caries status was recorded every 12 months. The study lasted 30 months. The results indicate that chlorhexidine varnish did not decrease the numbers of cariogenic bacteria, nor did it decrease caries progression. Moreover, in this population with a low dental health care, children with lactobacilli present in the saliva above our detection level, the chlorhexidine varnish even tended to increase caries progression, possibly due to selection of aciduric and acidogenic oral bacterial species. We therefore conclude that 40% chlorhexidine varnish is not likely to decrease caries in children in a high-treatment-need population without treatment of the sources of infection.