Oral Health of Children One to Six Years after Dental Treatment under General Anaesthesia.

(1) Background: The aim of this study was to assess oral health in children following dental treatment under general anaesthesia and to obtain information about oral health measures in both the children and their parents. (2) Methods: Children were scheduled for regular dental re-examination one to six years after dental treatment under general anaesthesia. Scores for mixed dmft/DMFT, the plaque control record (PCR), and the gingival bleeding index (GBI) were determined. Information about children's/parents' oral hygiene habits and frequency of dental visits was obtained. Scores for mixed dmft/DMFT as assessed before dental treatment under general anaesthesia/at re-examination were compared (Wilcoxon test). (3) Results: From the 134 parents initially contacted, 35 attended regular dental control visits (response rate: 26%) with their children (median age 6 years). Of the 35 children (20 female, 15 male), 18 (51.4%) were healthy and 17 (48.6%) had a pre-existing condition. Mixed dmft/DMFT scores determined at the recall visit differed significantly from the earlier visit (p = 0.006). Children had 1.74 ± 3.64 teeth newly affected by caries. Four children (11.4%) needed dental treatment under general anaesthesia again. Oral hygiene was mediocre (median PCR: 32%). The GBI was high (median: 14%). Children with a high PCR also had a high GBI. (4) Conclusions: Children who had received dental treatment under general anaesthesia still had a high caries risk. Further prophylaxis programs are necessary to prevent caries and further use of general anaesthesia.

Oral health of children and adolescents with or without attention deficit hyperactivity disorder (ADHD) living in residential care in rural Rhineland-Palatinate, Germany.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is defined as childhood neurobehavioural disorder. Due to short attention span, oral hygiene and dental treatment of such individuals can be challenging. Aim of this study was to evaluate the oral health of children and adolescents with and without ADHD living in residential care in rural Rhineland-Palatinate, Germany. METHODS: Included in the study were 79 participants (male/female:58/21, age 9-15 years) living in residential care: 34 participants with ADHD and 45 participants without ADHD (control). Oral examination included the following parameters decayed, missing, filled teeth in the primary dentition (dmft), decayed, missing, filled surfaces/teeth in the secondary dentition (DMFS/DMFT), approximal plaque index (API), bruxism and orthodontic treatment. Additionally, oral hygiene, last dental visit and treatment performed, and dietary habits were assessed by questionnaire. RESULTS: There were no significant differences in dmft, API, bruxism and oral hygiene habits between groups. However, participants with ADHD tended to have higher DMFS/DMFT values than the control group. Ongoing orthodontic treatment was found more often in the control group. The ADHD group tended to consume acidic/sugary beverages and sweet snacks more often than the controls. Different treatments (control visit/prophylaxis, dental therapy, orthodontic treatment) were performed at the last dental visit in the two groups. CONCLUSIONS: Within the limitations of this study, oral health was similar in children and adolescents with or without ADHD from the same residential care setting. Parents/guardians need instructions for better supervision of oral hygiene and dietary habits to improve the poor oral health of children with or without ADHD.

One-year Clinical Performance of Flowable Bulk-fill Composite vs Conventional Compomer Restorations in Primary Molars.

PURPOSE: To evaluate the clinical performance of a flowable bulk-fill composite vs a compomer in Class II cavities of primary molars. MATERIALS AND METHODS: In a clinical study, 100 restorations were placed in two randomly assigned comparable Class II cavities in 32 children (aged 6.7 ± 1.2 years) with at least one bulk-fill composite (Venus Bulk Fill, Heraeus Kulzer) and one compomer (Dyract eXtra, Dentsply). After caries excavation, the adhesive Scotchbond Universal (3M Oral Care) was applied in self-etching mode. According to the manufacturer's instructions, Venus Bulk Fill was used for the entire Class II cavity of primary molars without a cover layer. After visible-light curing, both restorations were finished and polished. Both restorative materials were evaluated at baseline and after one year, including esthetic, functional, and biological parameters, using the FDI criteria. The Mann-Whitney U-test was used to determine the difference in the complete scores at baseline and after one year (p < 0.05). RESULTS: After one year, 99 restorations were reevaluated; one tooth had exfoliated physiologically. Concerning the esthetic parameters, Dyract eXtra showed slightly higher scores than Venus Bulk Fill. Both materials showed similar scores regarding functional and biological parameters. No severe postoperative sensitivities or side-effects were reported. There was no statistically significant difference between the performance of Venus Bulk Fill and Dyract eXtra for primary molars. CONCLUSION: The flowable bulk-fill composite Venus Bulk Fill can be considered as an alternative material for clinical use in primary teeth, but longer-term studies might still be needed.

Country and gender differences in the motivation of dental students-An international comparison.

PURPOSE: The objective of this study, conducted in Germany, Finland and Turkey, was to identify whether motivations to study dentistry varied by country, gender or year of study. METHODS: The multicentre pilot study was conducted in English language in 2014. Participants (n = 469 dental students) were either in the first or last year of study. The response rate was 91%. RESULTS: The sample comprised 63% females and 37% males, reflecting the common gender distribution in dental education. A total of 236 first year students (50.3%) and 233 final year students (49.7%) took part in the study. The participants were aged 21-25 years and of 15 different nationalities, mostly from Turkey, Germany and Finland. Considering who motivated them most to become a dentist, the most common answer was "self-motivated" (49.5%). 23.4% of the students stated having been motivated by a "family member or friend, who is a dentist," while 24.3% said they had been motivated by a "family member or friend, who is not a dentist." -Very few students (2.8%) recorded having been motivated by a "high school or college counsellor." Motivations for choosing dentistry as a career included "ability to help people," "self-employment," "income potential," "working with hands" and "status and prestige," all of which were rated as highly important. "Time management" and "career variety" were rated as moderately important. Significant statistical differences were observed by country and gender. For the German students, a dental relative was significantly more often relevant than for the Finnish and Turkish students, who were more often influenced by family members or friends not working in the dental field. "Time management" seemed to be significantly more important to female than to male students. CONCLUSION: In line with a feminisation of the workforce in dentistry, a well-structured working environment and well-thought-out time management may play an increased role in future work force planning (Gender dentistry: International vergleichende Studie zu Karrierewahl und Spezialisierungswünschen von Zahnmedizinstudenten. Ulm: Universität Ulm).

Survey of midwives' knowledge of caries prevention in perinatal care.

PURPOSE: To assess midwives' knowledge about oral health and early caries prevention during perinatal care for mothers and babies. STUDY DESIGN AND METHODS: A survey developed by the investigators was conducted among midwives to assess their knowledge about caries etiology, their attitude toward their role in early caries prevention, and prophylactic measures recommended during pregnancy, and after birth, for their babies. Self-administered questionnaires were sent to 180 midwives in hospitals and 323 midwives from a midwives' association in Hesse, Germany. RESULTS: Response rates were 46% (83/180) and 56% (181/323); a total of 264 questionnaires were evaluated. Most midwives were familiar with the term Early Childhood Caries (ECC), over 90% knew the role of acidic bacteria, carbohydrates, and insufficient oral hygiene in caries etiology. A vast majority of the midwives considered caries prophylaxis as essential, and saw this topic as part of their core area of competence. Only 60% informed the pregnant women in their care about pregnancy gingivitis. Almost all midwives gave recommendations about caries prophylaxis. The risk for developing ECC was explained to the pregnant women and mothers/parents by 92% of the midwives. Recommendations concerning regular dental visits for small children were given by 80% of the midwives. CLINICAL IMPLICATIONS: The time-intensive medical care of families through advanced practice nurses or midwives offers opportunities for better education about caries prophylaxis. A consensus of all the involved healthcare professional groups, including dentists, obstetricians, advanced practice nurses, midwives, pediatric nurses, and pediatricians, is needed to provide uniform recommendations for prophylaxis and prevention of ECC.

Influence of bleaching agents on surface roughness of sound or eroded dental enamel specimens.

PURPOSE: The aim of the present in vitro study was to assess the effect of bleaching agents on eroded and sound enamel specimens. MATERIALS AND METHODS: Enamel specimens prepared from human permanent anterior teeth were incubated with different bleaching agents containing active ingredients as 7.5 or 13.5% hydrogen peroxide or 35% carbamide peroxide, ranging in pH from 4.9 to 10.8. The effect of the tooth whitening agents on surface roughness was tested for sound enamel surfaces as well as for eroded enamel specimens. To provoke erosive damage, the enamel specimens were incubated for 10 hours with apple juice (pH = 3.4). Afterwards, pretreated and untreated dental slices were incubated with one of the bleaching agents for 10 hours. The surface roughness (R(a)) of all enamel specimens (N = 80) was measured using an optical profilometric device. A descriptive statistical analysis of the R(a) values was performed. RESULTS: The study demonstrated that exposure to an acidic bleaching agent (pH = 4.9) resulted in a higher surface roughness (p = 0.043) than treatment with a high peroxide concentration (pH = 6.15). If the enamel surface was previously exposed to erosive beverages, subsequent bleaching may enhance damage to the dental hard tissue. CONCLUSION: Bleaching agents with a high concentration of peroxide or an acidic pH can influence the surface roughness of sound or eroded enamel.

Accuracy of a chair-side test for predicting caries risk compared with established methods. A pilot study.

PURPOSE: The aim of this study was to determine the prognostic accuracy of a new chair-side test, determination of lactic-acid production on the tongue, for caries-risk assessment according to caries increment within two years. METHODS: 35 children (6-8 years old) participated in the study. The past caries experience (df-t1, DF-T1), caries at second deciduous molars (df-2.mol), approximal plaque index (API) were the clinical, and salivary counts of mutans streptococci (MS)/lactobacilli (LB) and lactic-acid production on the tongue (LAP) the subclinical predictors recorded at baseline. Two years later, the dental examination was repeated (df-t2/DF-T2). According to the increase in DF-T (delta DF-T), caries-risk groups (delta DF-T = 0 versus delta DF-T > or = 0) were built. To assess the prognostic accuracy sensitivity and specificity were calculated. Statistical analysis was performed using Spearman's test for nonparametric correlations. RESULTS: The DF-T increased from 0.3 +/- 0.8 to 1.2 +/- 1.6. 20 children were in the no-caries-risk and 15 in the caries-risk group. The p-value for the correlation of delta DF-T to API was 0.007 and to LB counts 0.069. The highest sensitivity and specificity levels were found for LB (65%/70%), LAP reached a maximum sensitivity of 33% with a specificity of 55%. CONCLUSION: According to the results, because of its insufficient prognostic accuracy the LAP test is not suitable as a sole screening-tool for an accurate caries-risk assessment.

Prolonged in vitro exposure to white wines enhances the erosive damage on human permanent teeth compared with red wines.

The aim of this in vitro study was to determine and compare the erosive potentials of red and white wines, exerted on enamel surfaces prepared from extracted human permanent teeth. European wines (50 red, 50 white wines) from different regions were purchased, and the pH values were measured. Eight wines with different pH values were selected. Enamel samples with an average surface area of 25 mm(2) were prepared from 25 extracted permanent teeth from male and female patients aged 40 to 65 years and incubated with wines for up to 24 hours; the amounts of released calcium were determined colorimetrically, and mean surface roughness was measured with a profilometer. A quantitative elemental analysis for Ca was carried out in various depths (5-50 microm), using an electron probe microanalyzer. Incubation of the enamel surfaces with different wines caused a time-dependent release of calcium. After 24 hours, white wines caused a significantly higher (P = .003) Ca release (range: 8.74-28.56 mg dL(-1) 25 mm(-2)) than red wines (range: 4.85-19.43 mg dL(-1) 25 mm(-2)), whereas the values for surface roughness were similar (white wines: 2.67 +/- 0.92 microm; red wines: 2.64 +/- 0.66 mum). Incubation with white wines resulted in a higher loss of Ca down to a depth of 60 microm. In this study, it was demonstrated that white wines have higher erosive potentials than red wines. Within the limits of this in vitro study, it can be predicted that a frequent consumption of white wines might lead to severe dental erosion.

Comparison of a new chairside test for caries risk assessment with established methods in children.

PURPOSE: The aim of this study was to compare the results of a new method, measurement of lactic-acid production on the tongue (LAP), with established methods of caries risk assessment in children. METHODS: One hundred nineteen children (6-10 years old) participated in the study. Data collection included number of carious lesions (D-T) and filled teeth (F-T), approximal plaque index (API), LAP, buffering capacity (BC), counts of mutans streptococci (MS) and lactobacilli (LB) in stimulated saliva. According to caries presence, the children were divided into low risk (LR group; D-T = 0) and high risk (HR group; D-T > or = 1) groups. Statistical analysis was performed using Chi-square test, Spearman's test for nonparametric correlations, uni- and multivariate regression analysis. RESULTS: Seventy-two children (F-T = 0.4 +/- 1.4) were in the LR and 47 (D-T = 2.5 +/- 2.7; F-T = 1.5 +/- 1.9) in the HR group. The correlation analysis verified statistically significant correlations between D-T and the salivary counts of MS/LB and between D-T and F-T. API correlated with F-T and LB, while F-T and LB also correlated with each other significantly. The counts of MS and LB showed also a significant correlation. The LAP showed a significant correlation only to F-T. Significances in univariate regression analysis were found for F-T, counts of LB and MS in saliva, and for LAP. The multivariate regression analysis indicated significances only for F-T and LB in saliva, but not for LAP. CONCLUSION: LAP might be useful only as a supplementary screening tool for caries risk assessment, but not as a sole predictor.

Course of changes in salivary pH-values after intake of different beverages in young children.

PURPOSE: The aim of the study was to determine possible differences in decrease of pH-values of whole saliva, following the intake of different beverages. MATERIALS AND METHODS: Twelve boys and 13 girls (4.9 +/- 0.9 years old) participated in this study. A dental examination was performed (dmft). Orange juice (pH = 3.67), instant fennel tea (pH = 7.38), whole milk (pH = 6.84) and mineral water (pH = 5.88) were tested. All beverages were given at the same time of day. Salivary pH and buffering capacities of the beverages were determined with a portable pH-meter. Immediately after intake of a beverage, and 5, 10, 15 and 25 minutes later, whole saliva was collected, and the pH-value was measured again. The statistical evaluation was performed using the Wilcoxon test for paired samples. RESULTS: Fifteen children had healthy dentitions. Ten subjects had a mean dmft of 1.1 +/- 2.3. The mean base salivary pH was 7.09 +/- 0.07, without differences between the children with and without dental decay. Mineral water led over the whole period of measurements to a significant rise in salivary pH (P < 0.05). Orange juice caused a significant reduction in the salivary pH during the first 10 minutes. After intake of instant tea or milk, significant reductions were found in the period of 5 to 10 minutes. After the intake of instant tea, the reduction was still significant after 15 minutes. During the period of 5 to 10 minutes, the change in pH (deltapH) in whole saliva differed significantly only between consumption of mineral water and other beverages (P < 0.01). CONCLUSION: With regard to dental health, a regular consumption of orange juice or sweetened instant teas should be discouraged.

Usefulness of combining clinical and radiological dental findings for a more accurate noninvasive age estimation.

The aim of this study was to establish correlations of clinical and radiological dental findings, alone or in combination, with chronological age in adults. Dental findings and orthopantomograms of 984 patients (aged 20-60 years; 524 females/460 males) were analyzed. DMF-T index and distance (alveolar bone level, ABL) between cemento-enamel junction and alveolar bone margin were recorded. Additionally, clinical and radiological findings at each tooth crown and root were collected according to the actual status of destruction and restoration, and a total score for each dentition (TSD) was calculated. After univariate correlation analysis, correlation coefficients for ABL and TSD were improved by using square root (sqrt). However, the determination accuracy was still not satisfactory; 90% of the residuals were in the range of about +/-10. The present study showed that clinical and radiological dental findings could not be used, not even in combination, for accurate age estimation as a single method, but that they could support other methods.

Dystrophic epidermolysis bullosa: oral findings and problems.

Dystrophic epidermolysis bullosa (DEB) is one of the three major types of epidermolysis bullosa (EB), an inherited cutaneous disease with blister formation following minor trauma. A subtype of DEB is recessive dystrophic epidermolysis bullosa, Hallopeau-Siemens type (RDEB-HS), where marked scarring leads to deformities of extremities. In RDEB-HS the mucous membranes may also be involved and form adhesions with ankyloglossia and microstomia. Oral hygiene is difficult. A 7-year-old boy with RDEB-HS was brought to the Johannes Gutenberg University dental clinic with dental pain. He had multiple carious lesions, poor oral hygiene and gingivitis. Because he was noncompliant and had microstomia, he required dental therapy under general anesthesia. The recall visits over the past two years had demonstrated that the dental health of this patient with RDEB-HS could be maintained by means of improved oral home care, using antibacterial agents.

Effectiveness of a three-headed toothbrush in pre-school children.

PURPOSE: The aim of the study was to compare the effectiveness in plaque removal of a three-headed toothbrush with a conventional toothbrush in pre-school children. MATERIALS AND METHODS: Twenty-nine children (aged 4-5 years) participated in this study. Fourteen children (group A) used a three-headed toothbrush, and 15 children (group B) used a conventional toothbrush for 3 months. At the initial visit, the children brushed their teeth with their regular toothbrush, and at the final visit with the type of toothbrush they had used for the past 3 months. Plaque was recorded at 48 surfaces (molars: vestibular, oral, occlusal; front teeth: vestibular, oral). Plaque reduction was assessed on anterior and posterior areas of the dentition, and on the different tooth surfaces in sextants (I = 55/54; II = 53/63; III = 64/65; IV = 74/75; V = 73/83; VI = 84/85). Statistical evaluation was performed using Wilcoxon signed rank and Mann-Whitney tests. RESULTS: In group A, the median number of surfaces with plaque was reduced significantly after 3 months (p < 0.05). At final examination the number of surfaces with plaque in both groups differed significantly (p < 0.05). Significant decreases in plaque scores were recorded at maxillary and mandibular posterior and mandibular anterior teeth in group A (p < 0.05). The comparison of changes in plaque scores of both groups showed significant differences (p < 0.05) on the occlusal surfaces of molars, except in sextant IV. Significant differences between the groups were also noted on all surfaces of the left side and on the occlusal surfaces of the right side of the mouth (p < 0.05). CONCLUSIONS: This study indicates that the three-headed toothbrush could be an alternative to the conventional toothbrush.

Reduction of the pH-values of whole saliva after the intake of apple juice containing beverages in children and adults.

PURPOSE: The aim of the present study was to compare changes in salivary pH after intake of apple juice and its various dilutions with mineral water, in children and adults. MATERIALS AND METHODS: 15 children (mean age 4.4+/-0.9 years), and 15 adults (mean age 30+/-2.4 years) participated in this study. Carbonated mineral water, apple juice and its various dilutions with carbonated mineral water were tested. The pH-value of unstimulated whole saliva was measured at the same time of day. The pH-value was measured again immediately after intake of a beverage, and 5, 10, 15 and 25 min later. The flow rate and buffering capacity of stimulated saliva, and the buffering capacity, calcium and phosphorus contents of the beverages were measured. The statistical evaluation of the data was performed employing the Wilcoxon test for paired samples. RESULTS: The mean base value of the pH of whole saliva was 7.0+/-0.2 (children), and 6.8+/-0.3 (adults). The differences in the flow rates of stimulated saliva in children and adults were statistically significant (p = 0.0003). The intake of mineral water led to a statistically significant rise in the salivary pH-value (p < 0.05). Undiluted and diluted apple juice caused a reduction in the salivary pH-values. Within the first 10 min the changes of pH in saliva only differed significantly between mineral water and the other beverages (p < 0.01). In the pH range of 5.8 - 7.0, mineral water had a weak buffering capacity, while undiluted apple juice had a high buffering capacity. CONCLUSIONS: With regard to dental and general health, only mineral water can be recommended for children.