Dental professionals' experience with and handling of suspicion of child maltreatment in a small-scale society, the Faroe Islands.

The aims of the present study were to describe how frequently dental professionals in a small-scale society like the Faroese Islands, experience suspicion on child maltreatment, and how they handle their suspicion. Furthermore, we wanted to investigate the hypothesis that the special interpersonal characteristics of small-scale societies like the Faroese, influence how dental professionals handle suspicion of child maltreatment compared to how their colleagues in larger societies handled such suspicion. The design of our study was cross-sectional using a non-probability purposive sampling method. A translated and slightly modified version of the Danish questionnaire regarding suspicion on child maltreatment was sent to all 71 dental professionals (44 dentists and 27 dental hygienists) in the Faroe Islands. 51 (72%) returned a valid questionnaire. Of these, 61% experienced suspicion of child maltreatment at some point in their career, 33% within the last 6 months, and 10% percent were certain of child maltreatment during the last six months. Of those respondents who had experienced suspicion at some point of their career, 39% had reported their suspicion. The main reasons for withholding a suspicion were: uncertainty as to whether the suspicion was reliable, fear of the consequences for the child, and lack of procedural knowledge. Faroese dental professionals suspected child maltreatment much more frequently (61%) than their Danish (38%), Scottish (29%), and Croatian colleagues (26%) did. Child maltreatment raises concern among the Faroese dental professionals more frequently than among their colleagues in larger societies. They also seem to report their concern more frequently than their Scottish colleagues do. Thus, the present study indicates that the social structure in small-scale societies may affect dental professionals' suspicions, and handling of child maltreatment.

Dentoalveolar oral surgery in children and adolescents: organization and surgical treatment in a large, Danish municipal dental service.

OBJECTIVE: To describe a population-based organization of dentoalveolar surgical service for 0 to 18-year old subjects in a Danish municipal dental service, and analyze the type of dentoalveolar surgical interventions needed. MATERIAL AND METHODS: The study was conducted in the Municipality of Aarhus, Denmark during five consecutive school-years. An internal referral system was established within the municipality where patients could be referred to colleagues with a higher level of competencies and more experiences with paediatric dentoalveolar surgery. The analysis includes a total of 1812 children and a total of 2854 surgical interventions. RESULTS: Almost 80% of the patients, representing more than 80% of the dentoalveolar surgical interventions needed, were referred internally. Denudations were the most frequent treatment type (40.3%) carried out, followed by removal of third molars (18.0%). Furthermore, 22 odontomas and 100 supernumerary teeth were removed. CONCLUSIONS: The need of dentoalveolar surgery in children and adolescents is relatively low, but includes a wide range of interventions. An organizational system, where dentists can refer to colleagues who have developed special competencies in this field, results in most of these surgical patients being referred and treated internally.

A placebo-controlled, double-blind, crossover trial on analgesic effect of nitrous oxide-oxygen inhalation.

BACKGROUND: The sedative effect of nitrous oxide-oxygen (N2 O/O2 ) inhalation is relatively well established. Less in known about its analgesic effect. AIM: To determine the analgesic effect of N2 O/O2 inhalation on pulp sensitivity and jaw muscle pressure pain threshold in children. DESIGN: A placebo-controlled, double-blind, crossover trial with random allocation to two sequences: atmospheric air at the first session and N2 O/O2 at the second; or N2 O/O2 at the first session and atmospheric air at the second. Measurements included reaction time, pulp pain sensitivity, jaw muscle pressure pain thresholds and a VAS score of overall discomfort from the pain tests. RESULTS: Fifty-six children (12-15 years) completed the study. N2 O/O2 inhalation increased reaction time (P < 0.001). Pulp pain sensitivity was reduced during N2 O/O2 inhalation (P < 0.001), but no effect was found after adjustment for the increased reaction time. Pressure pain threshold on the jaw muscle was also reduced during N2 O/O2 inhalation (P < 0.001), also after adjustment for reaction time (P < 0.005). An effect was still found 10 min after the mask had been removed (P = 0.03). No effect on VAS scores of discomfort from the tests could be found. CONCLUSIONS: No analgesic effect of N2 O/O2 inhalation on pulp pain sensitivity was found, whereas an increased pressure pain threshold of jaw muscles was found.

Developmental enamel defects in children born preterm: a systematic review.

The purpose of this review was to evaluate the association between developmental enamel defects and children born preterm. An identical search was performed in PubMed and Embase and was limited to human studies and studies written in English, German, Danish, Swedish, or Norwegian. Reviews, case studies, and case series were excluded. A total of 283 articles were identified. Twenty-three publications, of which 19 were follow-up studies, two were case-control studies, and two were cross-sectional surveys, were enrolled in the review. The majority of the studies (n = 17) dealt with enamel hypoplasia of the primary teeth. Thirteen studies reported an association between preterm birth and enamel hypoplasia, and, in addition, few studies reported an increased risk of enamel opacities in the primary teeth, in children with a birth weight <1500 g. Seven studies dealt with enamel disturbances of the permanent teeth, four of which suggested an increased risk of enamel opacities. This systematic review suggests an increased risk of enamel hypoplasia in primary teeth of children born preterm and enamel opacities in very-low birth-weight children. A larger number of well-designed studies are, however, needed in order to increase the validity of the studies.

Microdontia and hypodontia of premolars and permanent molars in childhood cancer survivors after chemotherapy.

BACKGROUND: Adverse long-term general and dental health effects of cancer and cancer therapy during childhood have been reported. AIM: To examine the association between chemotherapy before the age of 8 years and (1): microdontia; (2): hypodontia of premolars and permanent molars. MATERIAL AND METHODS: In The Danish Registry of Childhood Cancer (DBCR), we identified 203 children who met the following inclusion criteria: (1) age below 8 years at the start of treatment; (2) age between 12 to 18 years upon dental examination; (3) had received chemotherapy The exclusion criterion was radiotherapy to the head and neck. A total of 150 children fulfilled the inclusion criteria. As controls, a random sample of 193 age-matched unexposed children was included. RESULTS: Microdontia was found in a total of 88 teeth in 29 (19.3%) of the 150 children who had been exposed to chemotherapy, while none of the controls had microdontia of premolars or permanent molars (difference: 19.3%; 95% CL: 13.5%; 26.4%). The earlier the exposure, the more frequent was microdontia. We found a total of 27 missing premolars and permanent molars in 14 (9.3%) of the exposed children and a total of 18 missing premolars and permanent molars in 8 (4.1%) of the controls (difference: 5.2%; 95% CL: -0.1%; 11.3%). CONCLUSION: The present study confirms findings from previous studies that chemotherapy, especially in very young children, causes microdontia and hypodontia of premolars and permanent molars.

Craniofacial morphology in patients with hypophosphatemic rickets: a cephalometric study focusing on differences between bone of cartilaginous and intramembranous origin.

Hypophosphatemic rickets (HR) are diseases characterized by deficient mineralization of bone due to abnormal renal wasting of phosphate. Deformation of bony structures of cartilaginous origin has been described as a major characteristic in patients with HR, but little is known about the impact on bony structures of intramembranous origin. The aim of the present study was to describe the osseous morphology of the craniofacial structures in patients with HR compared to healthy controls, and to investigate the impact of different bone origin on the osseous morphology. Fifty-three patients with HR (17 males, 36 females), aged 3-74 yrs, were included. Fifty HR patients had dominant X-linked disease, and in three patients no mutations were identified. A total of 79 healthy individuals (37 males, 42 females), aged 6-79 yrs, with normal occlusion served as controls. Significant cephalometric differences were found between HR patients and controls. In HR patients, the cranial base was flattened and the depth of the posterior cranial fossa was decreased. The anterior height of the cranium, the angle nasion-sella-frontale, and the thickness of theca were increased. The length of the nasal bone and the height of the maxilla were reduced. In contrast, the vertical as well as the sagittal relation between the jaws were unaffected in HR patients compared to controls. In conclusion, we found that the cranial structures of cartilaginous origin as well as the structures of intramembraneous origin were affected in patients with HR.

Limited phenotypic variation of hypocalcified amelogenesis imperfecta in a Danish five-generation family with a novel FAM83H nonsense mutation.

BACKGROUND. Autosomal dominant hypocalcified amelogenesis imperfecta (ADHCAI) is a disease with severe dental manifestations. OBJECTIVES. The aims were by means of a genome-wide linkage scan to search for the gene underlying the ADHCAI phenotype in a Danish five-generation family and to study the phenotypic variation of the enamel in affected family members. RESULTS. Significant linkage was found to a locus at chromosome 8q24.3 comprising the gene FAM83H identified to be responsible for ADHCAI in other families. Subsequent sequencing of FAM83H in affected family members revealed a novel nonsense mutation, p.Y302X. Limited phenotypic variation was found among affected family members with loss of translucency and discoloration of the enamel. Extensive posteruptive loss of enamel was found in all teeth of affected subjects. The tip of the cusps on the premolars and molars and a zone along the gingival margin seemed resistant to posteruptive loss of enamel. We have screened FAM83H in another five unrelated Danish patients with a phenotype of ADHCAI similar to that in the five-generation family, and identified a de novo FAM83H nonsense mutation, p.Q452X in one of these patients. CONCLUSION. We have identified a FAM83H mutation in two of six unrelated families with ADHCAI and found limited phenotypic variation of the enamel in these patients.

An analysis of pattern of dental injuries after fall accidents in 0- to 2-year-old children - does the use of pacifier at the time of injury make a difference?

AIM: To assess the relation between type of traumatic injury and use of pacifier at the time of a fall accident in 0- to 2-year olds. MATERIAL AND METHODS: The study draws on data from the database on traumatic dental injuries at the Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital. RESULTS: The study includes 1125 patients ≤ 2 years of age, representing a total of 1886 injuries. A total of 176 patients had fallen while using a pacifier, whereas 949 children suffered a fall without using a pacifier. In the pacifier group, 11.9% had crown fractures compared with 20.0% of children who had fallen without a pacifier (P = 0.012). Tooth displacement (lateral luxation, extrusion or avulsion) was relatively more frequent in children falling with a pacifier compared to children falling without a pacifier (64.8%vs 54.8%; P = 0.014). Furthermore, soft tissue injury was less frequent among the former (28.4%vs 38.3%; P = 0.013). CONCLUSIONS: Injuries occurring while using a pacifier tend to be tooth displacement rather than fractures. This is in accordance with the theoretical consideration that a blunt impact tends to favour displacement, whereas a sharp impact tends to favour fractures of the hard dental tissues.

Peripheral ameloblastic fibro-odontoma or peripheral developing complex odontoma: report of a case.

BACKGROUND. Peripheral (extraosseous) odontogenic tumors are rare. CASE REPORT. This report describes a case which illustrates the clinical and histopathological features of a lesion in an 8-year-old, healthy Caucasian girl that on purely morphological grounds would seem to be an ameloblastic fibro-odontoma, but may represent a case of a peripheral developing complex odontoma. CONCLUSION. Conservative surgical enucleation of the lesion was followed by unbcomplicated healing and no recurrence was seen.

Available evidence does not support use of oxalates for dentine hypersensitivity.

DATA SOURCES: Medline, CENTRAL, LILACS, TRIP Database, National Guideline Clearinghouse, OPENSigle and a number of other medical / dental databases and websites, as well as reference lists. STUDY SELECTION: Randomised controlled trials and controlled clinical trials in any language that compared oxalates with placebo or no treatment were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS: Three reviewers extracted data with two people assessing quality independently using the Cochrane risk of bias domains. Standardized mean differences (SMD) were estimated by random-effects meta-analysis and heterogeneity between studies was quantified with the I2-statistic. RESULTS: 12 reports were included. Interventions were diverse and included: monohydrogen-monopotassium oxalate, ferric oxalate, di-potassium oxalate, or oxalate containing pre-polymerized resin, and combinations of monohydrogen-monopotassium and di-potassium oxalate. Follow up intervals varied between immediate to 1 year. Hypersensitivity was elicited by tactile, evaporative or thermal stimuli, and a number of outcomes used to measure pain. Risk of bias was high in a number of studies and statistical heterogeneity high. Based on 187 and 179 units (patients or teeth) in the intervention and placebo groups from seven studies, the summary SMD for 3% monohydrogen-monopotassium oxalate was -0.71 (95% Confidence Interval (CI):-1.48, 0.06), which suggests it may not be beneficial. There was no improvement with the other interventions. CONCLUSIONS: The review identified no evidence to indicate benefit from treating dentine hypersensitivity with oxalates beyond a placebo effect.

Oral health-related quality of life among survivors of childhood cancer.

BACKGROUND. Childhood cancer survivors may have experienced a high number of invasive medical and dental procedures, which may affect their oral health-related quality of life (OHRQoL). AIM. To compare children who have survived cancer and children without cancer with respect to OHRQoL. DESIGN. In a cross-sectional study, we compared the OHRQoL of children treated for cancer at Aalborg Hospital with the OHRQoL of classmates without cancer. All children answered The Danish version of the Child Perceptions Questionnaire (CPQ). Children aged 8-10 (n = 95) answered CPQ(8-10) , with 27 questions, and children aged 11-14 (n = 138) answered the CPQ(11-14,) with 39 questions. RESULTS. Children with cancer rated their OHRQoL better or equal to those without cancer. The mean overall CPQ(8-10) score was 5.6 (95% CI: 2.5-8.6) among 18 children who have survived cancer and 8.8 (95% CI: 7.3-10.3) among those without cancer (n = 77); the mean difference was -3.3 (95% CI: -6.5 to 0.1). The overall mean CPQ(11-14) score was 12.5 (95% CI: 6.8-18.2) among 24 children who have survived cancer and 11.8 (95% CI: 10.3-13.3) among those without cancer (n = 114); the mean difference was -0.7 (95% CI: -4.9 to 6.3). CONCLUSION. Cancer and cancer treatment during childhood was not associated with a decreased OHRQoL.

Marginal adaptation of a low-shrinkage silorane-based composite: 1-year randomized clinical trial.

The aim of the present study was to examine the marginal adaptation of a new low-shrinkage silorane-based composite material (Filtek™ Silorane, 3M-Espe) by comparing it with a methacrylate-based composite material (CeramX™, Dentsply DeTrey). In particular, we wanted to test the hypothesis that reduced polymerization shrinkage would improve the marginal adaptation. Seventy-two patients participated in the study. A total of 158 restorations were placed in 80 premolars and 78 molars. Only Class II restorations were included, and each patient could contribute with more than one tooth. The restorations were scored at baseline and after one year. While statistical comparison of marginal adaptation at follow-up indicated better performance of CeramX™ both occlusally and approximally (p = 0.01 and p < 0.01), the low kappa value (32%) reflects the difficulty to assess marginal adaptation clinically. The reduction in polymerization shrinkage demonstrated in the laboratory was not clinically significant in the present study.

Danish dentists' and dental hygienists' knowledge of and experience with suspicion of child abuse or neglect.

BACKGROUND: Studies from several countries have shown that knowledge of child protection matters among the dental team is inadequate. No such data are available from Denmark. AIM: To describe dental teams perception of their role in child protection matters. DESIGN: A previously used questionnaire regarding the role of the dental team in child protection was adopted to Danish terminology, and mailed to a sample of Danish dentists and dental hygienists. RESULTS: A total of 1145 (76.3%) returned a questionnaire with valid data; 38.3% reported to have had suspicion of child abuse or neglect. Of those who reported a suspicion, 33.9% had reported their suspicion to social services. This was more frequent for dentists than for dental hygienists, and more frequent for respondents working in the municipal dental service than in private practice. Most frequently reported barriers towards referring suspicion to social services were uncertainty about observations, fear of violence in the family towards the child, and lack of knowledge regarding referral procedures. The majority of the respondents expressed a need for further education. CONCLUSIONS: Members of the dental team in Denmark do not seem to fill their role sufficiently in child protection matters, and perceive a need for undergraduate and continuing postgraduate training.

Phenotype presentation of hypophosphatemic rickets in adults.

Hypophosphatemic rickets (HR) is a group of rare disorders caused by excessive renal phosphate wasting. The purpose of this cross-sectional study of 38 HR patients was to characterize the phenotype of adult HR patients. Moreover, skeletal and endodontic severity scores were defined to assess possible gender differences in disease severity in patients with genetically verified X-linked HR. Compared to normal reference data, i.e., z = 0, HR patients had significantly lower final height, with a mean difference in z-score of -1.9 (95% CI -2.4 to -1.4, P < 0.001). Compared to paired z-scores of final height, z-scores of leg length were significantly lower and those of sitting height were significantly higher (P < 0.001), resulting in disproportion as indicated by the significantly elevated sitting height ratio, mean difference in z-score of 2.6 (95% CI 2.1-3.1, P < 0.001). Z-scores of head circumference (median 1.4, range -0.4 to 5.5, P < 0.001) and z-scores of bone mineral density (BMD) of the lumbar spine (median 1.9, range -1.5 to 8.6, P < 0.001) were significantly elevated compared to normal reference data. The relative risk (RR) of fracture was reduced (RR = 0.34, 95% CI 0.20-0.57, P < 0.001). The skeletal severity score tended to be higher in males compared to females (P = 0.07), and no gender difference in endodontic severity was found. In conclusion, adult HR patients were characterized by short stature and were disproportioned. They had elevated BMD of the lumbar spine and a reduced risk of fractures. We found a tendency for males to be more severely affected than females.

The association between fluoride in drinking water and dental caries in Danish children. Linking data from health registers, environmental registers and administrative registers.

OBJECTIVES: To study the association between fluoride concentration in drinking water and dental caries in Danish children. METHODS: The study linked registry data on fluoride concentration in drinking water over a 10-year period with data on dental caries from the Danish National Board of Health database on child dental health for 5-year-old children born in 1989 and 1999, and for 15-year-old children born in 1979 and 1989. The number of children included in the cohorts varied between 41.000 and 48.000. Logistic regression was used to assess the correlations, adjusting for gender and taxable family income as a proxy variable for socioeconomic status. RESULTS: Fluoride concentration in drinking water varied considerably within the country from very low (<0.10 mg/l) to more than 1.5 mg/l. Only little variation was found over the 10-year study period. Dental caries in both 5-year-olds and 15-year-olds decreased over the study period. An inverse relation between the risk of dental caries and fluoride concentration in drinking water was found in both primary and permanent teeth. The risk was reduced by approximately 20% already at the lowest level of fluoride exposure (0.125-0.25mg/l). At the highest level of fluoride exposure (>1 mg/l), a reduction of approximately 50% was found. Similar findings were found if analysis was limited to children residing in the same place during the entire study period. CONCLUSIONS: The study confirmed previous findings of an inverse relation between fluoride concentration in the drinking water and dental caries in children. This correlation was found in spite of the extensive use of fluoridated toothpaste and caries-preventive programs implemented by the municipal dental services in Denmark. Linking Danish health registers with environmental and administrative registers offers an opportunity for obtaining sample sizes large enough to identify health effect, which otherwise could not be identified.

Hypocalcified type of amelogenesis imperfecta in a large family: clinical, radiographic, and histological findings, associated dento-facial anomalies, and resulting treatment load.

OBJECTIVE: The purpose of this study was to report on the clinical, radiographic, and histological dental findings and the resulting treatment load in a five-generation family with amelogenesis imperfecta (AI). MATERIAL AND METHODS: Thirteen affected and 15 unaffected individuals were examined clinically and radiographically. In addition, four exfoliated deciduous teeth were examined by scanning electron microscopy and microradiography. RESULTS: The mode of inheritance of AI was autosomal-dominant. At eruption, most of the tooth enamel was yellow, lacking translucency, and prone to gradual loss in subjects with AI. Post-eruptive breakdown of enamel was extensive in accordance with the histological observations of hypomineralized and porous enamel. Extensive enamel loss and discoloration were observed in older affected individuals. The treatment need had been extensive: 76.2% of the total number of teeth present in affected individuals had been treated with partial or full coverage compared to 1.7% of the teeth in unaffected relatives. Unaffected individuals had more endodontically treated teeth than AI-affected relatives. Adjunctive findings, e.g. tooth agenesis, tooth impaction, pulp stones, enlarged follicular space, and taurodontism, were rare in both groups. CONCLUSIONS: Affected family members had the hypocalcified type of AI, which is characterized by severe hypomineralization, extensive post-eruptive loss, and discoloration of the enamel. Adjunctive findings were rare. Individuals with the hypocalcified type of AI have an extensive restorative treatment load compared to unaffected relatives.