Indirect pulp capping versus pulpotomy for treating deep carious lesions approaching the pulp in primary teeth: a systematic review.

AIM: To assess dental practice regarding the use of indirect pulp capping or pulpotomy in children with deep carious lesions approaching the pulp in primary teeth and to compare the efficacy of the two pulp treatments. STUDY DESIGN: Systematic review. We searched the Cochrane Library, PubMed via MEDLINE, and EMBASE as well as the reference lists of included reports and ClinicalTrials.gov (for ongoing trials). Eligible studies were surveys of dental practice sent to dentists regarding the use of indirect pulp capping and pulpotomy in children with deep carious lesions approaching the pulp in primary teeth and any type of clinical study. Two review authors independently extracted data and assessed risk of bias in duplicate. RESULTS: Of the 481 potentially eligible articles, 11 were included in the review: 8 described surveys of dental practice, 1 a non-randomised study, and 2 ongoing randomised trials. The surveys of dental practice showed an overall increase in the teaching and practice of indirect pulp capping in primary teeth. The non- randomised study found a statistically significant difference in favour of indirect pulp capping for clinical and radiological success at 3 years but with high overall risk of bias. CONCLUSIONS: Despite the success rate of indirect pulp capping for treating deep carious lesions approaching the pulp in primary teeth, practitioners still hesitate to practice this technique because of lack of evidence and studies on this topic. Thus, for strong evidence, investigators are encouraged to conduct randomised trials comparing the efficacy of indirect pulp capping and pulpotomy for treating deep carious lesions approaching the pulp in primary teeth.

Dental caries and enamelin haplotype.

In the literature, the enamelin gene ENAM has been repeatedly designated as a possible candidate for caries susceptibility. Here, we checked whether ENAM variants could increase caries susceptibility. To this aim, we sequenced coding exons and exon-intron boundaries of ENAM in 250 children with a severe caries phenotype and in 149 caries-free patients from 9 French hospital groups. In total, 23 single-nucleotide polymorphisms (SNPs) were found, but none appeared to be responsible for a direct change of ENAM function. Six SNPs had a high minor allele frequency (MAF) and 6 others were identified for the first time. Statistical and evolutionary analyses showed that none of these SNPs was associated with caries susceptibility or caries protection when studied separately and challenged with environmental factors. However, haplotype interaction analysis showed that the presence, in a same variant, of 2 exonic SNPs (rs7671281 and rs3796704; MAF 0.12 and 0.10, respectively), both changing an amino acid in the protein region encoded by exon 10 (p.I648T and p.R763Q, respectively), increased caries susceptibility 2.66-fold independent of the environmental risk factors. These findings support ENAM as a gene candidate for caries susceptibility in the studied population.

Common SNPs of AmelogeninX (AMELX) and dental caries susceptibility.

Genetic approaches have shown that several genes could modify caries susceptibility; AmelogeninX (AMELX) has been repeatedly designated. Here, we hypothesized that AMELX mutations resulting in discrete changes of enamel microstructure may be found in children with a severe caries phenotype. In parallel, possible AMELX mutations that could explain resistance to caries may be found in caries-free patients. In this study, coding exons of AMELX and exon-intron boundaries were sequenced in 399 individuals with extensive caries (250) or caries-free (149) individuals from nine French hospital groups. No mutation responsible for a direct change of amelogenin function was identified. Seven single-nucleotide polymorphisms (SNPs) were found, 3 presenting a high allele frequency, and 1 being detected for the first time. Three SNPs were located in coding regions, 2 of them being non-synonymous. Both evolutionary and statistical analyses showed that none of these SNPs was associated with caries susceptibility, suggesting that AMELX is not a gene candidate in our studied population.

Clinical decision on pit and fissure sealing according to the occlusal morphology. A descriptive study.

BACKGROUND: The objective of this descriptive study was to evaluate the clinical decision on sealing pits and fissures according to the occlusal morphology in patients with low individual caries risk (ICR). MATERIALS AND METHODS: A total of 222 dentists, 86 affiliated to the French Society of Paediatric Odontology (SFOP) and 136 general practice dentists (GPs), answered the same questionnaire with illustrations of 4 occlusal surfaces of permanent molars: they indicated firstly if these were at risk and secondly the corresponding decision regarding sealing. This questionnaire assessed the decision on widening pits and fissures before sealing and the type of sealant material used. Multivariate logistic regression analyses were performed to identify the factors associated with the clinical decision to widen pits and fissures. RESULTS: Sealing of at-risk teeth was indicated by 89% of dentists, whereas sealing of not at-risk occlusal surfaces was recommended by 46%. SFOP dentists were more prone to recommend pit and fissures sealants. The multivariate analyses demonstrated that only the type of material was associated with the clinical decision to widen pits and fissures. Forty eight percent of dentists choose the same material in all clinical situations. CONCLUSION: The wide variations in sealant use and placement technique implies there is no apparent consensus among GP and SFOP dentists. Although the criteria are similar in numerous scientific societies, not all dentists are acting upon these recommendations.

Bond strengths of nine current dentine adhesive systems to primary and permanent teeth.

The aim of this study was to compare the shear bond strength (SBS) of nine dentine bonding systems (DBS) of different classes to human primary and permanent dentine. Flat dentine occlusal surfaces were produced on human molars (100 primary, 100 permanent) by wet grinding on a 800-grit SiC paper. Nine DBS were applied following the manufacturers' instructions: One total etch multi-step system: Scotchbond Multipurpose Plus (3M/ESPE); Four total etch one-bottle system: Prime &Bond 2.1 (Dentsply), One Step (Bisco), Scotchbond 1 (3M/ESPE), and OptibondSolo Plus (Kerr); Three two-step self-etching primer systems: Clearfil Liner Bond 2 (Kuraray), Clearfil SE Bond (Kuraray), and Prime &Bond NT with NRC (Dentsply); An 'all-in-one' self-etching system: Prompt L-Pop (3M/ESPE). Composite (Z100; 3M/ESPE) cylinders (2 mm diameter, 3 mm high) were polymerized on the treated dentine surfaces and the specimens were stored at 37 degrees C for 24 h prior to testing. Twenty experimental groups were produced and tested. Statistical analysis revealed both a substrate and a bonding system effect. Two adhesive systems (One Step, Prime &Bond NT) had significantly higher bond strengths on permanent than on primary dentine. There was an effect of dentine bonding system on the mode of fracture. Although eight of the 10 DBS tested exhibited higher median SBS values on permanent dentine than on primary dentine, the dependent pairwise comparison identified a significant difference only for two groups. The use of simplified bonding systems does not necessarily result in improved bond strength to primary or to permanent dentine.

[Compliance with the vaccination recommendations for 0- to 24-month-old infants in general or paediatric practice]. / Suivi des recommandations vaccinales des nourrissons de 0 à 24 mois: à propos d'une enquête en médecine libérale.

PURPOSE: To describe the vaccine practice of general practitioners and paediatricians for the 0-24-month-old infants and their deviations to the official recommendations. RESULTS: One thousand three hundred and fifty-five practitioners, 46 +/- 8-year-old took part in the survey. Among them 42.7% were general practitioners and 57.3% were paediatrician. Only one third of them, strictly complied with the official vaccination recommendation (33.1%). This percentage was higher for the general practitioners (43.4%) than for the paediatricians (25.5% P < 0.001). When practitioners adapted the vaccination program, their modifications essentially concerned the first administration of the DTCP Hib vaccine, which was delayed of 1 or 2 months. Some vaccines were specifically concerned by the modifications. The ROR was delayed and the vaccination coverage reached only 75% at 18 months. General practitioners adapted the vaccination calendar more often than paediatricians (16.9 vs. 9.0%: P < 0.05). The B Hepatitis vaccination schedule was the most frequently adapted one by general practitioners as well as paediatricians to deal with multiple injections (53.5%), and the age of the infants (39.1%). CONCLUSION: The availability of hexavalent vaccination containing B Hepatitis should contribute to increase the vaccination coverage of the population against B Hepatitis and could allow an antipneumococcal vaccination through an heptavalent vaccine without increasing the number of injections. On the other hand, general practitioners and paediatricians must actively contribute to increase the ROR vaccination coverage.

Advice from the butt nanny: the compulsive end user's guide to anal-rectal procedures.

AIDS: A synopsis of the procedures used to diagnose and treat maladies of the rectum is outlined. A description of the functions of the muscle group involved and its interaction with other body activities is detailed. It is advised that following any procedures, a patient should take the necessary time to recuperate, in order to encourage healing. A patient should get plenty of sleep and eat properly. Muscle and nerve pain should be expected within a day or two after a procedure and can be eased with warm baths and pain killers. Moving around will be more strenuous and should be done slowly. A list of supplies that can be gathered prior to surgery is provided.^ieng