Influencing factors of paediatric dental anxiety levels in an undergraduate dental clinic.

AIM: To examine the nature of dental anxiety in paediatric patients, and to identify factors relevant to paediatric dental anxiety in a sample of 5 to 17 year-old children residing in Cairns, Australia. MATERIALS AND METHODS: A convenient sample of 125 children, their parents and corresponding student practitioners were selected. Each was assessed with questionnaires. RESULTS: A higher level of dental anxiety was seen in children who were subject to radiographic examination as part of their treatment (b=0.462; p=0.012). Similarly, children of Asian ethnicity showed higher dental anxiety levels than their Caucasian counterparts (b=1.187; p=0.010). Finally, the childrens' overall dental anxiety levels decreased after being treated by student practitioners (t=2.311;df=124; p=0.022). CONCLUSION: Children experienced greater anxiety before receiving dental treatment than after. Treatment involving radiographic examination exacerbated dental anxiety and children of Asian descent were more anxious prior to receiving treatment. Further investigation is indicated.

Attitude of general dental practitioners toward root canal treatment procedures in India.

OBJECTIVE: The percentage of general dental practitioners is very common in India, so the purpose of this study was to assess attitude of general dental practitioners toward root canal treatment (RCT) procedures. MATERIALS AND METHODS: In a cross-sectional study, 178 dentists (96 males and 82 females) were surveyed using a selfadministered, structured questionnaire pretested through a pilot survey. The questionnaire collected information regarding RCT procedures among participants. Data were analyzed using SPSS version 15. Frequency and percentage distributions were calculated. RESULTS: In the present study most of the participants, i.e. 86.4% reported that they perform (RCT) procedures in posterior teeth. Isolation is mainly done with cotton rolls only (74.6%) and very few are using rubber dam in their practice (3.2%). Radiographs were not taken after every step in most of the cases. Rotary instruments were used in less number of cases and K-files were the most popular instruments (66.2%). Also single sitting RCT was not commonly seen. CLINICAL SIGNIFICANCE: This study indicates that most of the general dental practitioners' do not comply with quality standards guidelines such as use of rubber dam as isolation. So dentist should update their knowledge and practices with current techniques and materials through CDE programs.

Pediatric bitewing film holder: preschoolers' acceptance and radiographs' diagnostic quality.

PURPOSE: The purpose of this study was to evaluate a modified bitewing film holder based on preschoolers' acceptance and the diagnostic quality of radiographic images. METHODS: Sixty-six 3- to 5-year-old children were radiographed with the modified device. Acceptance was assessed according to their behavior during the radiographic examination and to their perception of the procedure. In only the 4- and 5-year-olds, the children's perception was assessed using a faces scale. Evaluation of the images' diagnostic quality for each quadrant (considering pairs of radiographs) was based on anatomic structures usually present on bitewing radiographs. RESULTS: During radiographic examination, 73% of the children were cooperative. As to the patients' perceptions (N = 43), 74% showed satisfaction with the radiographic examination. The diagnostic quality of radiographic images (N = 66) was adequate in more than 90% of the cases for all evaluated parameters, except for the visualization of alveolar bone crests (54%) and the absence of proximal overlapping (86%). CONCLUSIONS: The modified bitewing film holder produced adequate radiographs for almost all parameters and was well accepted by preschoolers.

Caries development in a young population managed by a restrictive attitude to radiography and operative intervention: I. A study at the patient level.

OBJECTIVES: To assess, in a young population (age 6-19) managed by a restrictive attitude to radiography and operative intervention, prevalence of patients with posterior caries and/or fillings, probabilities of new proximal dentine lesions given different caries experience, correlation between radiographic intervals and caries experience, and prevalence of endodontic treatment. METHODS: Bitewing radiographs, taken between age 6 through 19 in 285 patients, were analysed in succession. Occlusal and proximal surfaces were coded for caries depth (0-4) and presence of fillings (5). Simple regression analysis was used to determine relations between radiographic intervals and caries experience. Significance testings of probability estimates were made with chi(2)- and t-tests, when applicable adjusted by the Bonferroni-Holm correction for mass-significance. RESULTS: The prevalence of patients with >/ or =1 fillings/dentine lesions in occlusal surfaces increased from 6-78% and in proximal ones from 1-38%. The probability of developing new proximal dentine lesions/fillings over different time periods was significantly lower among caries-free patients than among those with enamel or dentine lesions. There was a poor correlation between radiographic intervals (mean=16 months, range=6-33) and accumulated caries experience. Endodontic treatment had been made in a total of six teeth in six patients. CONCLUSIONS: A restrictive attitude both to the frequency with which radiographs are taken and to operative treatment of proximal caries seems to be possible in young populations with low caries prevalence.

Caries development in a young population managed by a restrictive attitude to radiography and operative intervention: II. A study at the surface level.

OBJECTIVES: To longitudinally assess the distribution of fillings and carious lesions in permanent posterior tooth surfaces, caries states fillings were made, and survival time of proximal lesions in different states in a young population managed by minimal operative treatment and a restrictive attitude to radiography. METHODS: Bitewing radiographs from age 6-20 in 285 patients were analysed. Proximal and occlusal surfaces were coded for caries depth and fillings. Start and end dates for different caries states in proximal surfaces were assigned and survival times in these states calculated by means of survival statistics. RESULTS: The frequency of carious/filled occlusal surfaces in the population increased from 6 to 19% and that of proximal surfaces from 1 to 26%. At age 19, 86% of the occlusal and 7% of the proximal surfaces affected by caries were filled. An overwhelming majority of unfilled carious proximal surfaces had enamel lesions only. Of all fillings, 81% were placed in surfaces with dentine lesions. The occlusal and proximal surfaces of the first molar and the distal surface of the second premolar accounted for most lesions and fillings among the 19-year-olds. The average survival time of lesions in the enamel was 8.0 years and in the outer half of the dentine 3.4 years when right-censored data were taken into account. CONCLUSION: In a young population exposed to optimal levels of fluoride with a caries preventive programme, a restrictive attitude towards operative treatment can be combined with longer average intervals between radiographic examinations than those prescribed by current guidelines.

Radiographic techniques for the pediatric patient.

Obtaining quality radiographs on pediatric patients can be a challenge. Suggestions for communicating with patients about radiation safety and the need for radiographs can facilitate the process. Guidelines for radiographic exposure intervals for young patients are key elements in the reduction of exposure to ionizing radiation and are presented in this paper. The child patient presents unique challenges for the dental professional and special techniques are presented in this article that may be helpful in the conducting radiographic examinations for this patient population.

Taking bitewing radiographs in preschoolers using behavior management techniques.

Radiographs are essential diagnostic tools to enable dentists to make adequate decisions and treatment plans. Treatment plans for young children, however, are quite often based on no or less than ideal radiographs. Getting successful bitewing radiographs from young children demands both behavior management techniques and adequate equipment. This report reviews the literature, and presents a modified technique of taking radiographs in young children. The technique was successfully used with 156 three-to-five-year-old children from Yakima County, Washington. Behavioral management of the children employed several techniques: building rapport, tell-show-do, modeling, positive reinforcement and increasing the child's sense of control. The equipment and placement technique were designed to be as atraumatic as possible. Positive experiences in the dental office often enhance a child's future cooperation. The techniques presented are simple to learn and use in treating very young children.

Factors affecting the diagnostic quality of bitewing radiographs: a review.

The bitewing radiograph (BWR) has been used in dental practice for over 90 years and is a widely used technique. This paper outlines the ideal technique for producing reproducible BWR of good diagnostic quality. In particular, it reviews the technical errors that may occur while exposing and processing BWR and the psychological errors that may result when radiographs are viewed. The consequences of these errors, (unnecessary patient exposure to radiation, poor diagnosis and potentially inappropriate treatment) are outlined in detail. Steps to improve the quality of BWR and decrease patient exposure to radiation are given in line with recent recommendations.