Specialist paediatric dentistry in Sweden 2008 - a 25-year perspective.

International Journal of Paediatric Dentistry 2010; 20: 313-321 Background. Paediatric dentistry in Sweden has been surveyed four times over the past 25 years. During this period postgraduate training, dental health, and the organization of child dental care have changed considerably. Aim. To investigate services provided by specialists in paediatric dentistry in Sweden in 2008, and to compare with data from previous surveys. Design. The same questionnaire was sent to all 30 specialist paediatric dental clinics in Sweden that had been used in previous surveys. Comparisons were made with data from 1983, 1989, 1996 and 2003. Results. Despite an unchanged number of specialists (N = 81 in 2008), the number of referrals had increased by 16% since 2003 and by almost 50% since 1983. There was greater variation in reasons for referrals. The main reason was still dental anxiety/behaviour management problems in combination with dental treatment needs (27%), followed by medical conditions/disability (18%), and high caries activity (15%). The use of different techniques for conscious sedation as well as general anaesthesia had also increased. Conclusions. The referrals to paediatric dentistry continue to increase, leading to a heavy work load for the same number of specialists. Thus, the need for more paediatric dentists remains.

Ozone air levels adjacent to a dental ozone gas delivery system.

OBJECTIVE: Ozone (O3) has been suggested as an anti-microbial treatment in dentistry, with an ozone gas delivery system introduced for the treatment of fissure and root caries. The aim of this study was to investigate the sealing capacity of the novel delivery system and its re-suction capacity during accidental displacement of the cup at different stages of ozone delivery. MATERIAL AND METHODS: Ozone leakage was studied in vitro after application on a flat metal surface and on buccal and occlusal tooth surfaces. An ozone analyzer was used to measure ozone gas concentrations adjacent to the delivering cups when adapted to the target surfaces during and after 10-20 s application cycles. The measured levels were compared with the background concentrations in the room. Measurements were performed 1) after complete ozone application cycles, 2) within the cycle before the start of the suction period, and 3) after displacements of the cup during the cycles. RESULTS: Ozone air values varied between 8 and 166 microgram/meter-3 for the flat metal surface and between 0 and 108 microgram/meter-3 for the tooth surfaces. Ozone leakage levels were 7.6 microgram/m-3 for the flat and and 7.4 microgram/meter-3 and 5.6 microgram/meter-3 for the buccal and occlusal surfaces, respectively, and 5.2 microgram/meter-3 and 9.8 microgram/meter-3 for the premolar and molar surfaces, respectively. Cycles with displacement showed significantly higher leakage levels than continuous complete cycles (p=0.03). CONCLUSIONS: Ozone application cycles with displacements showed significantly higher leakage levels than continuous complete cycles. The largest ozone delivery cups showed the highest leakage values. A change in background levels was seen with similar change in adjacent ozone levels. The overall measured ozone leakage values were low after normally functioning delivery cycles and after repeated displacements. The delivery system can be considered safe.

Flowable resin composite as a class II restorative in primary molars: A two-year clinical evaluation.

OBJECTIVE: To evaluate the clinical durability of flowable resin composite and resin-modified glass ionomer cement when used as class II restoratives in primary molars. MATERIAL AND METHODS: A total of 190 restorations were placed in 61 children, age in the range of 5-11 years. The restoratives, Tetric Flow, in combination with the adhesives, Excite or Prompt-L-Pop and Vitremer, were used in class II cavities in primary molars. An intra-individual study design was used and the restorations were evaluated by modified USPHS criteria over a 2-year period. RESULTS: 146 of the restorations could be evaluated at 2 years. The cumulative failure rate was 10.6% for Vitremer and 13.6% for Tetric Flow. No statistically significant differences were found in failure rates between different materials or between bonding systems. The main cause of failure for Tetric Flow was secondary caries and for Vitremer wear and dissolution. CONCLUSIONS: Vitremer and Tetric Flow showed no significant difference concerning clinical durability at 2 years when used as class II restoratives in primary molars. Both materials demonstrated acceptable clinical results.

Durability of extensive Class II open-sandwich restorations with a resin-modified glass ionomer cement after 6 years.

PURPOSE: To evaluate the durability of a modified open-sandwich restoration utilizing a resin-modified glass ionomer cement (RMGIC) in large cavities. METHODS: 268, mostly extensive, Class II Vitremer/Z100 restorations were placed in 151 patients. 47% of the restorations were placed in patients considered as caries-risk patients. Six experimental groups, differing from each other in thickness of RMGIC layer and preconditioning, were evaluated at baseline and annually during 6-7 years according to modified USPHS criteria. RESULTS: After 6 years, 220 restorations were evaluated. 42 failures (19%) were observed. The most frequent reasons for failure were material fracture (n = 11), tooth fractures (n = 9) and secondary caries (n = 10). Non-acceptable proximal dissolution of the RMGIC was seen in six restorations. Significantly more failures, but similar dissolution of the RMGIC, were recorded in high caries risk patients. No differences were seen between the experimental groups or between restorations with thick or thin RMGIC layer. 160 restorations were also evaluated at 7 years. Another 13 failures were observed, eight with non-acceptable dissolution, three secondary caries and two fractures. It can be concluded that the modified open sandwich restoration showed an acceptable durability for the extensive restorations evaluated. An accelerating dissolution of the RMGIC was observed at the end of the study.

Modified Class II open sandwich restorations: evaluation of interfacial adaptation and influence of different restorative techniques.

The sandwich technique with resin-modified glass ionomer cement (RMGIC) has been proposed to relieve the contraction stresses of direct resin composite (RC) restorations. The aim of this study was to evaluate the interfacial adaptation to enamel and dentin of modified Class II open RMGIC/RC sandwich restorations and the influence of different light curing techniques and matrix bands. Forty box-shaped Class II fillings were placed in vivo in premolars scheduled for extraction after one month. In groups I and II, a metal matrix was used; RC was inserted with horizontal (group I) and diagonal (group II) increments and cured with indirect/direct light. Group III was performed as group II, but a transparent matrix was used. Group IV was as group II, but with a separating liner between RMGIC and RC. Group V was a closed sandwich restoration. Interfacial quality was studied using SEM replica technique. Gap-free interfacial adaptation to enamel was observed for RMGIC in 70%, for RC in 70% and to dentin for RMGIC in 81%, for RC in 56%. No significant differences were seen between the experimental groups. At the cervical margins, RMGIC showed significantly better adaptation to enamel than RC, 74% and 42%, respectively. In conclusion, the investigated restorations showed a high percentage of gap-free interfacial adaptation in vivo. Interfacial adaptation to dentin and to cervical enamel was significantly better for RMGIC than for RC.