Maternal vitamin D status in pregnancy and molar incisor hypomineralisation and hypomineralised second primary molars in the offspring at 7-9 years of age: a longitudinal study.

PURPOSE: The study aimed to investigate associations between maternal vitamin D status during pregnancy and molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) among children. METHODS: The study had a longitudinal design using prospectively collected data from 176 mother and child pairs. Mothers were initially recruited in a randomised controlled trial to assess a pregnancy exercise programme. Along with the 7-year follow-up, we invited the children to a dental examination. The exposure variable was maternal serum 25-hydroxyvitamin D in gestational weeks 18-22 and 32-36, categorised as insufficient (< 50 nmol/l) and sufficient (≥ 50 nmol/l). Negative binomial hurdle models were used to analyse potential associations between the exposure variables and MIH or HSPM. The models were adjusted for potential confounders. RESULTS: Among the children (7-9 years old), 32% and 22% had at least one tooth with MIH or HSPM, respectively. A significant association was found between insufficient maternal vitamin D measured in gestational weeks 18-22 and the number of affected teeth among those with MIH at 7-9 years (adjusted RR = 1.82, 95% CI 1.13-2.93). CONCLUSION: Considering any limitations of the present study, it has been shown that insufficient maternal serum vitamin D at mid-pregnancy was associated with a higher number of affected teeth among the offspring with MIH at 7-9 years of age. Further prospective studies are needed to investigate whether this finding is replicable and to clarify the role of maternal vitamin D status during pregnancy and MIH, as well as HSPM, in children.

Extraction of first permanent molars severely affected by molar incisor hypomineralisation: a retrospective audit.

AIM: The aim of this study was to evaluate possible spontaneous space closure after extraction of first permanent molars in children and their eventual need for orthodontic treatment. METHODS: Twenty-seven children with at least one first permanent molar planned for extraction were enrolled in the study. The children were referred to the Department of Paediatric Dentistry, University of Oslo, between 2009 and 2017. All extracted teeth were severely affected by Molar Incisor Hypomineralisation and/or caries. The children and their parents had consented to extraction and follow-up. Data were analysed with SPSS 26. RESULTS: The age of the children was between 5.5 and 12.1 years (mean 8.7) at extraction. The mean follow-up time was 3.2 years (range 1.1-6.3). Sixteen children (59.3%) had all four molars extracted, five (18.5%) had three, five had two and one had one molar extracted. In the maxilla, the second permanent molar had erupted in the place of the first molar in all the children, and none of them needed orthodontic space closure. In the mandible, eight children (29.6%) needed orthodontic treatment to close the spaces after extraction. In three children, the second molar was not yet erupted and treatment need was not settled. CONCLUSION: Extraction of severely affected first permanent molars before the eruption of the second molar is a treatment option causing little additional treatment in the majority of cases.

Knowledge, experience and perception regarding molar incisor hypomineralisation (MIH) among dentists and dental hygienists in Oslo, Norway.

AIM: The aim of this study is to gather baseline information on knowledge, perceptions, clinical experience and treatment options regarding MIH among dental care providers in Oslo, Norway, before a larger epidemiological study. METHODS: An electronic questionnaire was distributed to dentists (n = 88) and dental hygienists (n = 47) working in the Public Dental Service (PDS) in Oslo. The questionnaire consisted of five sections related to sociodemographic, clinical experience, perceptions, clinical management and preferences for further training. Descriptive statistics with chi-squared test was used, and level of statistical significance was set to 5%. RESULTS: Replies were obtained from 74.1% (n = 100) after two reminders. All respondents encountered MIH in their practice. The respondents' perception of the prevalence of MIH in Oslo varied. The majority felt confident when diagnosing MIH (86%). The clinicians qualified in the last 10 years felt more confident than those who had qualified earlier (p = 0.016). Most were self-confident when treating these patients (68.3%), however, nearly all (88%) agreed that MIH was a clinical problem. The clinician's treatment of MIH varied. Difficulties achieving adequate local anaesthetic (71.4%) and the child's behavioural problems (84.1%) were treatment barriers for the dentists. Approximately two thirds (69%) would like further training, in particular on the aetiology (70%), diagnosis (57%) and treatment (77%) of the developmental disorder. CONCLUSION: All clinicians were familiar with the diagnosis of MIH and experienced the condition to be a clinical problem. Continuing education on aetiology, diagnosis and treatment of MIH is requested by dental health personnel.

Orofacial granulomatosis: a questionnaire study among Norwegian dental clinicians.

AIMS: To evaluate awareness on orofacial granulomatosis (OFG) and oral Crohn disease (oral CD) among Norwegian dental clinicians. METHODS: A precoded questionnaire (QuestBack) was sent electronically to dentists and dental hygienists treating children and adolescents in the public dental service (PDS) in Norway. Data on the clinicians' knowledge of OFG and oral CD related to working experience were analysed by Chi square tests and bivariate logistic regression analyses. RESULTS: A total of 1097 clinicians were invited to participate, 778 dentists and 319 dental hygienists; 48.2% returned the completed form. Fifty-four percent of the participants had ≥ 10 year experience of clinical practice. Two-thirds (68.4%) of the dentists and all but one of the dental hygienists graduated in Norway. Approximately half of the respondents were aware of OFG (41.2%) and oral CD (57.8%). One-quarter (24.6%) reported that they most likely had seen a patient with OFG and 20.6% with oral CD. Recently graduated dentists (≤ 10 years ago) were more aware of OFG and oral CD than those who graduated > 10 years ago (p ≤ 0.001). Regarding dental hygienists, this difference was observed for OFG only (p < 0.05). Country of education did not affect the clinicians' reported knowledge. Approximately 90% would refer a patient suspected of having OFG or oral CD either to a dental specialist or to a physician. CONCLUSION: The high prevalence of clinicians observing OFG and oral CD in this study may indicate that OFG and/or oral CD are under-reported and that OFG in particular is more common than hitherto believed. The high frequency of awareness was promising for the benefit of the patients.

Treatment decisions regarding caries and dental developmental defects in children - a questionnaire-based study among Norwegian dentists.

BACKGROUND: Current knowledge on treatment strategies and choice of restorative materials when treating deep caries or severe dental developmental defects (DDDs) in young individuals is scarce. Therefore, the aim was to investigate Norwegian dentists´ treatment decisions and reasons for treatment choice when treating deep caries in primary teeth and severe DDDs in permanent teeth in children. METHODS: A pre-coded questionnaire was sent electronically to all dentists employed in the Public Dental Service (PDS) in Norway (n = 1294). The clinicians were asked about their background characteristics and how often they registered DDDs. Three clinical cases were presented to the dentists and asked to prioritize treatment options and reasons for their choice. RESULTS: After three reminders, 45.8% of the dentists answered. Most clinicians were general practitioners (96.3%), females (77.9%), under 41 year-olds (59.4%), graduated in 2001 or later (61.1%), and representing all regions of Norway. The respondents registered molar incisor hypomineralisation (MIH), other DDDs and dental fluorosis (DF) frequently, 523 (91.1%), 257 (44.8%) and 158 (27.5%), respectively. In case 1a with severe dental caries in a primary molar, the preferred treatment was resin-modified glass ionomer cement (RMGIC) (58.3%), followed by glass ionomer cement (GIC) (17.9%) and zinc oxide-eugenol (ZOE) (13.2%). Extraction, compomer or stainless steel crowns (SSC) were preferred by 0.9, 0.7 and 0.4%, respectively. In case 1b, which was identical to case 1a, but treated under general anaesthesia, the preferred treatment alternatives were RMGIC (37.1%), resin composite (RC) (17.6%) and GIC (17.2%). Extraction and SSC were chosen by 15.1 and 7.2%, respectively. In case 2, showing a severely hypomineralised and symptomatic first permanent molar, the dentists preferred RC (38.4%), followed by RMGIC (26.6%) and GIC (19.0%). Extraction and SSC were chosen by 8.7 and 5.4%, respectively. The treatment choices were not significantly affected by the dentists' background characteristics. The reasons for dentists' treatment decisions varied for each patient case; patient cooperation, prognosis of the tooth and own experience were the dominant reasons. CONCLUSIONS: A notable disparity in treatment choices was shown indicating that Norwegian dentists evaluate each case individually and base their decisions on what they consider best for the individual patient.

Variation in caries treatment proposals among dentists in Norway: the best interest of the child.

AIM: To explore variation in treatment-related-decisions for severe caries in children among dentists in the Public Dental Service (PDS) in Norway. It was also to evaluate the treatment choices in relation to the best interest of children and a child's rights to enjoy the highest standard of health care. METHODS: A pre-coded questionnaire was sent electronically to all general dental practitioners (GDPs) working in the PDS in eight counties in Norway (n = 611). The questionnaire included two case scenarios to reflect common dental conditions related to severe caries among 5-year-old children. Paediatric dentists and paediatric students were invited to validate the different treatment options. Frequency distributions and statistical analyses were carried out using Chi square statistics. RESULTS: The response rate was 65% (n = 391) among the GDPs. A majority of the GDPs preferred a new appointment with behaviour management techniques (BMT) to a child presenting pulpitis and pain. Dentists educated outside the Nordic region would use restraint more often as a treatment alternative when the child was in pain than Nordic-educated dentists (p\0.05). Dentists with less than 10 years of experience preferred BMT and sedation more often when the child was in pain than their older colleagues, who, however, preferred a waiting approach and no immediate treatment if the child was not in pain(p\0.05) [corrected]. CONCLUSIONS: Use of BMT and sedation is related to region of education and years of experience. Awareness of ethical principles with the child´s best interest in mind, should receive increased attention.

Dentists' self-perceived stress and difficulties when performing restorative treatment in children.

AIM: This was to explore factors associated with dentists' difficulties doing restorative treatment in children, in particular (1) stress, (2) clinical experience, (3) use of conscious sedation, and (4) use of local analgesia. METHODS: A precoded questionnaire (QuestBack) was sent electronically to all dentists working in the Public Dental Service (PDS) in eight counties in Norway. Chi-square statistics, McNemar's test and bivariate logistic regression analyses were used. RESULTS: A total of 611 dentists received the questionnaire and 391 (65 %) returned the completed form. Self-reported stress was most frequent among dentists when treating patients aged 3-5 years and was statistically significantly associated with the dentists' self-reported difficulties doing restorative treatment. Among dentists with ≤ 10 years experience about 60 % reported stress treating the youngest patients compared with 44 % among the more experienced dentists. Self-perceived stress and working experience was not associated with use of local analgesia and sedation. CONCLUSIONS: The frequency of self-perceived stress among dentists when undertaking restorative treatment decreased with increasing patient age from 3 to 18 years. When treating preschool children, a small group of dentists frequently or always experienced this as stressful work. The use of local analgesia or conscious sedation was not related to dentists' stress. Dentists reported less frequently use of local analgesia and conscious sedation in children younger than 10 years. Undergraduate and continuous education and support in the use of local analgesia and conscious sedation is essential to provide optimal dental care for this patient group.

Caries increment in primary teeth from 3 to 6 years of age: a longitudinal study in Swedish children.

AIM: To longitudinally follow and analyse caries prevalence and development in primary dentition in Swedish preschool children from 3 to 6 years of age. STUDY DESIGN: A longitudinal clinical study. METHODS: Three hundred 3-year-old children in the Public Dental Service were consecutively included. The children underwent annual clinical examinations at 3, 4, 5 and 6 years of age, performed by four calibrated dentists in clinical settings. Initial (d1-2) and manifest (d3-5) lesions were registered at surface and tooth level. Radiographs were taken when indicated and possible. STATISTICS: Chi-squared test was used for group comparisons. Friedman's test, Wilcoxon non-parametric test and logistic regression analyses explored caries development over the years. RESULTS: The parents of 271 children agreed to their children participating in the study (total dropout rate at 6 years, 10.3%). At baseline, 27.3% of the children had carious lesions (d1-5 mean 0.98, SD ± 2.44), and only 50.6% of the children were totally caries-free at 6 years (d1-5 mean 1.88, SD ± 2.81). Initial carious lesions made up the greater share at all ages. The greater part of the caries increment occurred between 3 and 4 years of age (p < 0.001). Having initial and/or manifest carious lesions at 3 years of age was a significant explanatory factor for new lesions at 6 years of age (OR 2.29; 95% CI 1.58-3.31). CONCLUSION: Children with an early caries experience had a high risk of further disease progression. Oral health promotion and prevention programmes should target small children and their carers.

Registration of dental erosive wear on study models and intra-oral photographs.

BACKGROUND: Clinical photographs and study models may provide permanent records of dental erosion and be useful supplements to clinical registration. AIM: To assess the reliability and validity of registrations on clinical photographs and study models performed by a group of examiners. METHODS: Thirty tooth surfaces were selected and assessed clinically, using the visual erosion dental examination system. The chosen surfaces provided the whole range of dental erosions including sound surfaces. The tooth surfaces were photographed and impressions were obtained for preparation of study models. Thirty-three dentists examined and scored the selected surfaces both on photographs and study models. RESULTS: The quality of diagnosis (AUC, area under curve) was slightly higher using photographs as compared to study models. The difference was statistically significant when the validation criterion was erosion, assuming dentine exposure. The inter-method agreement on photographs and study models versus the clinical evaluation were approximately in the same range with a mean κw of 0.48 and 0.43, respectively. When comparing study models with photographs the mean κw was 0.52. The intra-examiner agreement was strong/substantial for both (photographs mean κw = 0.63 and study models mean κw = 0.60). STATISTICS: Linear weighted Cohen's kappa (κw) was used to evaluate inter-method and intra-examiner agreement. Receiver operating characteristic and area under the curves were used to express diagnostic quality according to a clinical examination. CONCLUSION: The results indicated that photographs were as good as study models for recording erosive lesions.

Reliability of two clinical scoring systems for dental erosive wear.

The aim of the study was to evaluate and compare two dental erosive wear scoring systems, the Visual Erosion Dental Examination (VEDE) and Basic Erosive Wear Examination (BEWE). Seventy-four tooth surfaces (photographs) and 562 surfaces (in participants) were scored by 5 (photographs) or 3 (in participants) clinicians using both scoring systems. The surfaces in the photographs were scored twice. The level of agreement was measured by weighted kappa (kappa(w)). Inter- and intraexaminer agreement showed small variations between the examiners for both systems when scoring the photographs. Slightly higher mean kappa(w) values were found for VEDE (kappa(w) = 0.77) compared with BEWE (kappa(w) = 0.69). When scoring the surfaces in the clinical examination the mean kappa(w) values for the two systems were equal (kappa(w) = 0.73). Interexaminer agreement using VEDE was calculated to see how differentiation between enamel and dentine lesions influenced the variability. The highest agreement was found for score 0 (sound, 86%) and score 3 (exposure of dentine, 67%), while the smallest agreement was shown for score 1 (initial loss of enamel, 30%) and score 2 (pronounced loss of enamel, 57%). The reliability of the two scoring systems proved acceptable for scoring the severity of dental erosive wear and for recording such lesions in prevalence studies. The greatest difficulties were found when scoring enamel lesions, especially initial lesions, while good agreement was observed when examining sound surfaces (score 0) and dentine lesions (score 3).

Caries patterns in an urban preschool population in Norway.

AIM: This was to describe the prevalence, severity and distribution of caries in a preschool population in Oslo, Norway, and to compare the findings in subgroups according to immigrant status and age. Furthermore, the present data should serve as a baseline for longitudinal studies. METHODS: The participating children (n = 775), chosen from 7 clinics in the Public Dental Health Service, were of various socioeconomic backgrounds and immigrant status (IM, immigrant group-mother of non-western origin or WN, western native group-mother of western background). The study design was descriptive cross-sectional. The caries examinations were carried out by calibrated examiners, and a detailed 5-graded caries diagnosis system including incipient caries was used. Radiographs (BW) were taken of the 5-year-old children. RESULTS: The percentage of caries free children, aged 3 years (mean 3.0) and 5 years (mean 4.8) were 80.1% and 48.0% respectively. The subgroup of immigrant children showed a considerably higher caries prevalence, it was more often affected by severe caries and experienced an earlier onset of the disease than the subgroup of western native children. The most marked skewness of the caries data was seen within the WN group, especially at 3 years of age. CONCLUSIONS: The present study has revealed disparities in dental health associated with ethnic origin seen at the age of 3. The disparities in dental health are still evident at 5 years of age, but then caries is more common for the whole population.

The influence of triclosan, zinc or propylene glycol on oral mucosa exposed to sodium lauryl sulphate.

Previous studies on triclosan treatment of skin exposed to sodium lauryl sulphate (SLS) indicated a protective rôle of zinc and an irritant effect of propylene glycol (PG). The aim was hence to examine whether zinc or PG also may affect SLS-induced oral mucosal reactions, and also to test the influence of zinc in combination with triclosan. 15 healthy dental students participated in this double-blind crossover study performed in 2 experimental series. They were rinsing 2x daily with solutions containing (A) 1.5% SLS, (B) 1.5% SLS/0.5% zinc citrate and (C) 1.5% SLS/PG (1:8) in experiment 1, and (D) 1.5% SLS/0.15% triclosan/0.3% zinc citrate and (E) 1.5% SLS/0.15% triclosan in experiment 2. Clinical evaluation by 2 examiners of degree of erythema and oral mucosal desquamations was then performed. The critical micellar concentration was also determined. SLS and SLS/PG, which were not different in effect, evoked significantly more erythematous reactions than SLS/Tri/Zn. This solution was numerically but not statistically better than SLS/Tri, and the latter also did lead to significantly less erythema than SLS/PG. In conclusion, the present study revealed no irritation of the oral mucosa due to PG, whereas a protective effect of zinc as well as the anti-inflammatory effect of triclosan were confirmed.

Does the nature of the solvent affect the anti-inflammatory capacity of triclosan? An experimental study.

The anti-inflammatory properties of triclosan have been revealed in several recent studies, including an effect on histamine-induced inflammation. In other studies, the nature of the solvent has been shown to be of importance for the plaque inhibiting as well as the antibacterial potential of triclosan. This study was aimed at examining whether the nature of the solvent also may influence the anti-inflammatory capacity of triclosan and further to study a possible dose/ response relationship. The study was performed as 3 separate, double-blind experiments, comprising 10, 11 and 12 healthy females. In all 3 experiments, 5 sites on the lower part of the back of the volunteers were intradermally exposed to one drop of 1% histamine dihydrochloride for 15 min. The size of the resulting wheals was recorded before and after 40 min of triclosan treatment. In experiment 1, 4 different concentrations of triclosan in 2-fold dilutions in absolute alcohol (0.125%-1%) were applied on the histamine-induced wheals. In experiments 2 and 3, 4 different solutions containing 0.5% triclosan and a saline solution as negative control were used. The solvents in experiment 2 were as follows: (1) absolute alcohol (positive control), (2) propylene glycol (PG), (3) polyethylene glycol (PEG), (4) olive oil, and in experiment 3: (1) absolute alcohol (positive control), (2) Tween 80, (3) sodium carbonate, (4) soy oil. The results showed a dose/ response effect of triclosan and further that the solvent may be of importance for its anti-inflammatory potential.

Mouthrinses containing triclosan reduce the incidence of recurrent aphthous ulcers (RAU).

Triclosan, an antibacterial agent introduced in toothpastes and mouthrinses, has recently been shown to have anti-inflammatory and analgesic properties. The aim of the present double-blind cross-over study was to examine the effect of triclosan on the incidence of recurrent aphthous ulceration (RAU) when administered in mouthrinses. The study included 30 patients with a history of multiple recurrent aphthous ulcers. Three different triclosan-containing mouthrinses, differing only in their solubilizing agents were used and compared with a control rinse. The number of new ulcers, ulcer-free days and the severity of pain were recorded. The results showed that the patients experienced a significant decrease in the number of oral ulcers during the experimental period when the mouthrinses contained triclosan. It may thus be concluded that triclosan has the potential to reduce the number of aphthous ulcers presumably due to its anti-inflammatory properties.