"Setting the scene in early childhood" - an MID approach for life.

This article presents a discussion paper for both consideration and implementation of Minimal Intervention Dentistry (MID) principles by the general dental practitioner. It argues that if these concepts can be adopted in early childhood by both the community and the profession, "Teeth for Life" can become a reality for all. Oral Health promoting behaviours can be nurtured and supported from infancy and developed into everyday living practice for a lifetime thereby maintaining an optimal quality of life. MID techniques have become more refined and supported by scientific research in the recent times and should be considered an essential clinical guideline for the future disease management.

The application of caries risk assessment in minimum intervention dentistry.

Caries risk assessment forms the cornerstone for the successful application of a minimum intervention dentistry philosophy in the management of dental caries. Patients, particularly those with evidence of active dental caries at baseline, require a caries risk assessment to identify those risk factors that will most likely contribute to the progression of the carious disease process. Once identified, these factors should be eliminated or at least moderated to ensure the disease progression is stabilized before conservative and rehabilitative dental procedures are undertaken. Each individual will present with a slightly different caries risk profile and the principles of a patient centred approach to manage each case should be applied to the individual diagnostic and treatment planning phases of dental care. Current chairside technologies such as caries susceptibility and activity tests can be utilized to provide baseline and follow-up data to assist the dental practitioner in this task. However, clinician intuition or 'gut feeling' has been found to be a better prognostic indicator for future dental caries experience than present caries prediction instruments in most cases. As caries risk data are accumulated and refined at a population, community and individual level, the sensitivity and specificity of the caries risk assessment modelling will improve as will the positive predictive power of the final statistical model algorithm. It is likely that online caries predictive tools will be available for general dental practitioners in the not too distant future to help clinicians formulate accurate caries risk profiles for their patients.

Consensus statement by hospital based dentists providing dental treatment for patients with inherited bleeding disorders.

Avoidance of dental care and neglect of oral health may occur in patients with inherited bleeding disorders because of concerns about perioperative and postoperative bleeding, but this is likely to result in the need for crisis care, and more complex and high-risk procedures. Most routine dental care in this special needs group can be safely managed in the general dental setting following consultation with the patient's haematologist and adherence to simple protocols. Many of the current protocols for dental treatment of patients with inherited bleeding disorders were devised many years ago and now need revision. There is increasing evidence that the amount of factor cover previously recommended for dental procedures can now be safely reduced or may no longer be required in many cases. There is still a need for close cooperation and discussion between the patient's haematologist and dental surgeon before any invasive treatment is performed. A group of hospital based dentists from centres where patients with inherited bleeding disorders are treated met and, after discussions, a management protocol for dental treatment was formulated.

Caries experience in preschool children referred for specialist dental care in hospital.

BACKGROUND: Increasing numbers of preschool children are being referred for specialist dental management in a paediatric hospital. Most cases have severe early childhood caries and require comprehensive management under general anaesthesia. The present study investigated risk factors for disease presence at initial consultation. METHODS: A convenience sample of 125 children under four years of age from the north Brisbane region were examined and caries experience recorded using dmft and dmfs indices. A self-administered questionnaire obtained information regarding social, demographic, birth, neonatal, infant feeding and dental health behaviour variables. The data were analysed using the chi-square and one-way analysis of variance procedures. RESULTS: Ninety-four per cent of referred children had severe ECC with mean dmft of 10.5 +/- 3.8 and mean dmfs of 27.1 +/- 15.1. Prevalence of severe ECC was significantly higher in children allowed a sweetened liquid in the infant feeding bottle (99 per cent) and allowed to sip from an infant feeding bottle during the day (100 per cent). Mean dmfs was significantly higher in children allowed to sleep with a bottle (28.7) and sip from a bottle during the day (29.9), children from a non-Caucasian background (31.8), those children that commenced regular toothbrushing between 6 to 12 months of age (28.1), had no current parental supervision of daily tooth-brushing (34.2) and had not taken daily fluoride supplements (27.8), vitamin supplements (27.8) or prescription medicine previously (27.6). CONCLUSIONS: The behavioural determinants for severe early childhood caries presence in hospital-referred children were similar to those identified in the regional preschool population.

Social and behavioural determinants of early childhood caries.

BACKGROUND: To investigate the association between selected social and behavioural (infant feeding and preventive dental practices) variables and the presence of early childhood caries in preschool children within the north Brisbane region. METHODS: A cross sectional sample of 2515 children aged four to five years were examined in a preschool setting using prevalence (percentage with caries) and severity (dmft) indices. A self-administered questionnaire obtained information regarding selected social and behavioural variables. The data were modelled using multiple logistic regression analysis at the 5 per cent level of significance. RESULTS: The final explanatory model for caries presence in four to five year old children included the variables breast feeding from three to six months of age (OR=0.7, CI=0.5, 1.0), sleeping with the bottle (OR=1.9, CI=1.5, 2.4), sipping from the bottle (OR=1.6, CI=1.2, 2.0), ethnicity other than Caucasian (OR=1.9, CI=1.4, 2.5), annual family income dollars 20,000-dollars 35,000 (OR=1.7, CI=1.3, 2.3) and annual family income less than dollars 20,000 (OR=2.1, CI=1.5, 2.8). CONCLUSIONS: A statistical model for early childhood caries in preschool children within the north Brisbane region has been constructed using selected social and behavioural determinants. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Dental caries experience of preschool children from the North Brisbane region.

BACKGROUND: To report the dental caries experience of preschool children within the north Brisbane region and to investigate the association between selected social and demographic variables and disease presence. METHODS: A cross-sectional sample of 2515 children aged four to six years was examined in a preschool setting using decayed, missing, filled teeth/surface (dmft/dmfs) and percentage caries free indices. A self-administered questionnaire obtained information regarding selected social and demographic variables. The data were analysed using the chi-square and one way analysis of variance procedures at the 5 per cent level of significance. RESULTS: Overall, 1668 (66.3 per cent) children were disease free at the examination and mean dmft was 1.4+/-2.77 and dmfs was 2.28+/-6.00. Dental caries occurred more frequently and severely in children from non-Caucasian background (p<0.000), family language other than English (p=0.001) and lower socio-economic status (p<0.000). CONCLUSIONS: Significant associations between child ethnicity, language spoken at home, socio-economic status and caries presence have been identified. Epidemiological data can be used for improved public oral health service planning and resource allocation within the region.

Submandibular gland aplasia and progressive dental caries: a case report.

When severe caries occurs in mandibular permanent incisor teeth, the clinician should consider the possibility of associated submandibular gland aplasia or salivary hypofunction. Early diagnosis of submandibular gland disease is essential, as operative problems involving restoration of mandibular incisor teeth are considerable. Furthermore, progressive severe dental caries can present a dilemma for the clinician in affected individuals, despite intensive preventive and restorative therapy. A case report describing severe progressive dental caries and enamel demineralization of the permanent mandibular incisor teeth in a young girl is presented. Further investigation revealed absence of functional bilateral submandibular salivary glands contributing to the rapid breakdown of the teeth despite intensive preventive measures.

Early childhood caries--a new name for an old problem.

Early childhood caries (ECC) is one the most prevalent diseases of infants and toddlers from low income, immigrant and ethnic minority backgrounds. Yet, scant research and health care resources have been allocated to allow a better understanding this disease process. Since rampant dental caries in young children cannot be exclusively blamed on known risk factors such as poor oral hygiene and diet control, other models for disease initiation and progression need to be explored. Furthermore, evidence-based recommendations are critical for dissemination of consistent and effective preventive strategies to health care providers and government agencies. To accomplish this objective, organizations concerned with children's health issues need to seek additional resources to meet this challenge and overcome this inequity.

Dental health of children with cerebral palsy following sialodochoplasty.

Drooling occurs commonly in children with cerebral palsy (CP). Surgical procedures, known as slalodochoplasties, are often performed for the control of drooling. These include major salivary gland excision, parasympathetic nerve section, duct ligation, and duct re-routing. Alterations in saliva amount, flow, and consistency occur following sialodochoplasty, and the resultant effect on dental homeostasis requires further investigation. This controlled study investigated 19 children with CP following sialodochoplasty (surgery group) and 75 children with CP treated nonsurgically (control group) who attended our hospital. Dental caries experience-including dmft, DMFT, and partial DMFS scores of mandibular incisors and canines only-plaque index, and enamel developmental defects index were recorded. Saliva buffering capacity and bacterial counts were assessed. The surgical group (median DMFT = 5.00) had significantly more dental caries when compared with the control group (median DMFT = 0.00), Wilcoxon Signed-rank Test, P < 0.0001. This study has shown that children with CP following sialodochoplasty have increased risk of dental caries when compared with those treated nonsurgically for drooling. Although no caries predictors were identified, alterations to the caries-protective role of saliva are considered the likely cause. Children who undergo this procedure should receive intensive pre- and postsurgical preventive dental therapy.

Gingival fibromatosis and Klippel-Trénaunay-Weber syndrome. Case report.

A case of a young male with the Klippel-Trénaunay-Weber syndrome is described. Typical features of hemihypertrophy, hemangiomata, macrodactyly, and macrocephaly were present. The most striking oral feature was generalized severe gingival hypertrophy confirmed histologically, ultrastructurally, and by collagen analysis. In the absence of other known systemic causes of gingival enlargement, a diagnosis of familial gingival fibromatosis in association with Klippel-Trénaunay-Weber-syndrome is concluded. The combination of gingival fibromatosis and Klippel-Trénaunay-Weber syndrome has not been reported to our knowledge, it is uncertain whether this occurrence is significant or coincidental.

Mucopolysaccharidosis: MPS VI and associated delayed tooth eruption.

Eight cases of mucopolysaccharidosis Type VI (Maroteaux-Lamy syndrome) are reviewed and two cases are presented in detail. Developmental dental anomalies including unerupted and impacted permanent teeth and associated hyperplastic tooth follicles are seen frequently in MPS patients. The surgical implications and management are discussed. All patients reviewed had significant cardiovalvular disease. It is essential for the primary medical provider to establish early basic dental care and evaluation for delayed eruption of primary and permanent dentition. This will probably minimize the possibility of infective endocarditis and allow for early treatment of impacted teeth.

Congenital adrenal hyperplasia and enamel hypoplasia: case report.

A female with congenital adrenal hyperplasia and enamel defects involving the permanent maxillary incisors and all canines and premolars received composite veneer splint overlays under general anesthesia. Possible etiological factors involved in the formation of the enamel defects and overall case management is discussed.

Shear bond strength of a resin composite to enamel etched with maleic or phosphoric acid.

The purpose of this study was to evaluate the effect of 10 per cent maleic and 37 per cent phosphoric acid on the shear bond strength of Z100 composite resin with Scotchbond Multi-Purpose adhesive to primary and permanent tooth enamel. Four groups of 20 teeth each were established: 1, permanent teeth, 10 per cent maleic acid etched for 15 seconds; 2, permanent teeth, 10 per cent maleic acid etched for 30 seconds; 3, permanent teeth, 37 per cent phosphoric acid etched for 15 seconds; 4, primary teeth, 10 per cent maleic acid etched for 15 seconds. Five teeth from each group were randomly assigned for SEM examination of the etched enamel surface. Scotchbond Multi-Purpose primer and adhesive were applied to the etched enamel surface of the remaining 15 teeth and cured following the manufacturer's instructions. Z100 composite resin was placed in a nylon cylinder and cured for two 40 second intervals. Following thermocycling, the specimens were sheared on an universal testing machine and debonded areas were examined visually with a stereo microscope and with SEM. The mean shear bond strengths in MPa were: 1, 17.00; 2, 14.58; 3, 14.66; 4, 11.18. ANOVA and Student-Newman-Keuls analyses revealed no statistically significant difference among the groups. SEM examination showed the majority of specimens fractured at the adhesive-resin interface.

Neuropathological chewing: a dental management protocol and treatment appliances for pediatric patients.

Neuropathological chewing in hospitalized, comatose patients can occur from severe brain damage following a closed head injury, hypoxia, and septic shock. The dental management protocol developed by the Department of Dentistry at the Royal Children's Hospital, Melbourne, Australia, is presented. Treatment appliances utilizing a mandibular cast-silver cap splint with acrylic bite blocks and a maxillary mouthguard with acrylic bite blocks are discussed.

Microleakage of resin-modified glass ionomer cement restorations: an in vitro study.

Microleakage of two resin-modified glass ionomer cement (GIC) restorative materials was compared with that of two conventional GIC restorative materials. Forty-five noncarious extracted human molars were prepared with standardized Class V cavity outlines on the buccal and lingual surfaces. The occlusal margin was in enamel and the gingival margin was in dentin/cementum. All were restored according to the manufacturers' instructions. After thermocycling, 30 teeth were placed in 2% basic fuchsin dye for 24 h, sectioned and viewed with a stereomicroscope to assess microleakage. The other 15 teeth were sectioned, replicated and prepared for marginal gap evaluation using a SEM. Differences in microleakage scores between materials were compared using Kruskal-Wallis and Mann-Whitney U tests. One resin-modified GIC restorative material showed significantly less microleakage against enamel and dentin/cementum compared to the conventional GIC restorative (p < 0.01). Marginal gap formation for both resin-modified GIC restorations was limited to the axial wall of the restorations.

Oral health of children with congenital cardiac diseases: a controlled study.

Congenital cardiac disease (CCD) is one of the most common developmental anomalies in children. Affected children require special care in dentistry because of their susceptibility to infective endocarditis from oral infections, yet little information is available on the oral health of children with CCD. The present study, which investigated 39 children with CCD and 33 healthy control siblings, showed that CCD children generally suffered poorer oral health. In patients with primary dentitions, 52% of CCD children had enamel hypoplasia, compared with only 23% in the control group. In addition, CCD children had significantly more teeth with untreated dental decay (mean dmft 4.2 vs. 2.3), and more endodontically treated teeth. Children with CCD also had less than optimal professional and home dental care. Only 31% had professional advice regarding increased preventive dental health behavior, and only 15% used fluoride supplements, although the children resided in a nonfluoridated area. Furthermore, significantly fewer CCD children had parental help with tooth brushing compared to control children. This study shows that children with CCD should be targeted for vigorous preventive dental care.