Undergraduate experience of clinical procedures in paediatric dentistry in a UK dental school during 1997-2001.

Abstract The aim of this study was to determine the clinical experience of undergraduate students in paediatric dentistry. This was a prospective study in a clinic teaching paediatric dentistry to undergraduates within a UK dental school. Students who graduated between 1997 and 2001 at King's Dental Institute, London, were required to complete a quantitative record of their clinical activity. The mean undergraduate intake for the 5-year period was 58. Thirty-six (36) sessions each of 2-2 1/2 h duration were available in the course for the clinical treatment of children (one half day per week), a total of 81 h. The undergraduates assessed and planned treatment for 13.4 patients, 3.6 emergency patients and administered 10.4 local analgesics. The mean number of inhalation sedation administrations increased (1.5-3.3) per student during the 5-year period. The mean number of procedures performed by undergraduates for primary teeth was 8.1 restorations in glass ionomer or compomer and 1.9 in amalgam, 1.6 pulpotomies and 0.2 preformed crowns. The mean number of procedures for permanent teeth was 24.5 fissure sealants, 2.6 preventive resin restorations, 1.5 amalgams, 1.7 composites, 1.4 incisal edge restorations and 0.8 root canal treatments. For permanent teeth, the trend was towards an increase in the number of preventive resin restorations (1.9-2.8) and composite restorations (1.4-1.9) but a decrease in the number of amalgam restorations (2.1-0.9) during the 5-year period. Individual students' clinical experience was very variable. Procedures that were performed more than 10 times were experienced by every student. A procedure performed on average two to four times within a year group would be experienced by only 80-90% of the group and less frequently performed procedures would only have been experienced by a minority of graduates. A large number of patients failed to attend or cancelled appointments representing a loss of 21 h of clinical treatment time per student, about 25% of the total time available for the treatment of children in the clinical course.

Iatrogenic damage to approximal surfaces in contact with Class II restorations.

OBJECTIVES: This study investigated the frequency of iatrogenic damage to approximal surfaces in contact with Class II restorations. METHODS: Patients (n = 28) with a Class II restoration in contact with an unrestored surface had elastic separators fitted interproximally. Contralateral (unrestored) control surfaces were also separated. Impressions (light body polyvinylsiloxane) of the separated surfaces were taken 3-6 days later. Interproximal impressions (28 paired, seven unpaired) were examined by binocular microscope and scanning electron microscope (SEM) for iatrogenic damage, attrition and cavitation due to caries. RESULTS: 49-60% of surfaces adjacent to Class II restorations had been iatrogenically damaged. The most frequent types of damage were vertical grooves (26%), extensive damage (17%), indentations (6%) and scratches (6%). Damage was more frequent in maxillary teeth (61%) than mandibular teeth (25%), in permanent teeth (60%) more than deciduous teeth (20%). Qualified dentists produced more iatrogenic damage (64%) than undergraduate students (23%). CONCLUSION: The frequency of iatrogenic damage to approximal surfaces following Class II preparations was 49%, and possibly as much as 60% when questionably damaged surfaces were included. Protection of the adjacent enamel is of paramount importance during Class II cavity preparation.

Concomitant intrusive luxation and root fracture of a central incisor--report of a case.

A case of a 9-year-old boy who presented with intruded maxillary central incisors, one of which had also sustained a middle third root fracture, is reported. The root fracture was diagnosed after orthodontic extrusion was started, which resulted in separation of the apical and coronal fragments. The hypermobile coronal fragment was stabilised by passing a K file through a palatal access cavity into the root canal of the apical fragment. Orthodontic alignment was completed and the fractured incisors were restored with the file left in situ. At a 10-year follow-up, the incisors were clinically healthy and continued to satisfy aesthetic and functional demands.

Mesiodentes in twins: a case report and a review of the literature.

This report describes 7-year-old Afro-Caribbean monozygotic twin boys who both presented with bilateral unerupted mesiodentes palatal to the central incisors. There have been two previous similar reports. From this case and previous reports it was concluded that mesiodentes in monozygotic twins are likely to be concordant with respect to the number of supernumerary teeth. Unilateral mesiodens usually have been mirror imaged in each twin. Minor discordance between monozygotic twins is common with respect to the shape (conical, incisiform or tuberculate) and orientation (inverted or normal) of individual mesiodens within and between each twin.

Early arrested development and coronal resorption of an impacted maxillary canine: report of case.

Coronal resorption of maxillary canines is a possible complication of long standing impaction. Degeneration of the enamel epithelium allows the connective tissues to come into direct contact with enamel. Irregular replacement of the pericoronal tissues and resorbed enamel by bone characterizes the histological picture. Inflammatory changes are rare. Resorption of enamel is slow and usually symptomless so that reported cases have usually been incidental radiographic findings in older patients. This report presents the early arrested development, ankylosis and resorption of the crown of a maxillary canine in a child 7.7-years-old. Arrest of crown development occurred between three and four-years-of-age. Radiographically the crown of the canine was incompletely formed and showed irregular resorption. Serial radiographs taken over a five-year period showed movement of the canine superiorly in relation to the hard palate which was taken as radiographic evidence for ankylosis of the resorbing maxillary canine in a growing child.

Caries inhibition by a resin-modified and a conventional glass ionomer cement, in vitro.

OBJECTIVES: The aim of this study was to compare inhibition, in vitro, of a resin-modified and a conventional glass ionomer cement. METHODS: Standardized Class V cavities were prepared in extracted human molar teeth and restored with Fuji II LC (n = 14) or Chemfil II (n = 14) according to manufacturers' guidelines. The teeth were submerged in an acid gel (lactic acid, gelatin, thymol, pH 4.5) for 14 days and resin embedded. Photomicrographs of ground sections were examined for enamel surface lesions, dentine surface lesions, wall lesions and evidence of caries inhibition. RESULTS: There was no significant difference between the depths of enamel or dentine surface lesions between the two materials. No wall lesions were found. CONCLUSIONS: Fuji II LC proved more acid resistant than Chemfil II and both materials inhibited caries in vitro.

Dentigerous cysts involving permanent incisors: four case reports.

Four cases of dentigerous cysts involving permanent incisors are reported. In each case the primary predecessor had been traumatized, was discoloured and suspected of being non-vital. Epithelial proliferation of the follicular tissues induced by chronic periapical inflammation of the predecessors is suggested as the most likely pathogenesis of cystic transformation in these cases. Regular radiographic review of discoloured primary incisors is recommended.

The detection of cavitation in carious approximal surfaces in vivo by tooth separation, impression and scanning electron microscopy.

Bitewings are the most effective method of detecting approximal lesions but correlation with surface integrity is poor. In this study teeth were separated using orthodontic elastic separators allowing impressions, taken in a vinyl polysiloxane impression material, to be viewed by scanning electron microscopy. Case reports demonstrate the effectiveness of this technique in assessing in vivo, and in detail, the extent of cavitation of lesions usually assessed by their radiographic image alone.