Changes in dentists' attitudes and practice in paediatric dentistry.

AIM: The purpose of the study was to determine if there had been any changes in the clinical practice and attitudes to the care of children by general dental practitioners over a ten year period from 1986 to 1996, following the introduction of a system of capitation payments in the United Kingdom. METHODS: A questionnaire was mailed to 1,290 general dental practitioners practicing in Yorkshire (UK) in an identical way to a previous survey ten years before. Practitioners were asked questions concerning their practice of dental caries prevention, behaviour management, restoration of primary teeth and pulp therapy. Responses were compared with the results of the 1986 survey. RESULTS: Of the total of 687 replies (53.2% response) 61% practiced, or said they practiced, diet evaluation and gave dietary advice. Oral hygiene instruction was reported by 87% and 57% used fissure sealants. The routine use of amalgam, previously 80%, had declined to 35% in favour of glass ionomer cements (57%). There had been a significant improvement in the use of pulp therapy for primary teeth at 35% compared with previous 3%. The use of rubber dam also increased, but only from 0% before to 9% in the present study. The usage of stainless steel crowns had changed from 2% over ten years to 8% and strip crowns from 1% to 5%. CONCLUSION: The use of paediatric dental techniques by general dental practitioners had generally increased, particularly in preventive measures and pulp treatment. Restorative techniques had marginally changed, but a dramatic shift away from amalgam had occurred. There was still a very low usage of stainless steel crowns and rubber dam was also not used to the extent that it should be.

The influence of restorative material on the survival rate of restorations in primary molars.

The survival rates of restorations in primary molars were calculated after a retrospective examination of patients' dental records from a study population of 1,065 children. A random sample of 128 records showing information for 604 dental restorations was examined, coded, and analyzed by the life table method of survival analysis. The order of the survival rate of restorations from higher to lower success was preformed crowns, amalgam, composite resin, and glass ionomer restorations. A highly statistically significant difference (P = 0.0001) was found among the survival success rates of different material restorations. For preformed crowns and amalgam restorations, the median survival time was more than 5 years. The 5-year survival estimate for preformed crowns was 68% and for amalgam restorations was 60%. For composite resin the median survival time was 32 months and the 4-year survival estimate was 40%. For glass ionomer restorations, the median survival time was 12 months and the 4-year survival estimate was 5%.

Limiting factors in the site distribution of dental caries.

From records of 32 067 dentate persons from low fluoride communities in South Yorkshire, England, clinical dental caries has been scored at the distal and mesial sites of permanent canines, first and second premolars, and first and second molars, in relation to age. For those teeth with distal or mesial caries or both, the average number of distal and mesial sites attacked per DF tooth is calculated. The ratio observed generally reaches a stable value as age increases and is lowest for mandibular canines (1.10 from 15 years of age and above) and highest for mandibular first molars (1.46 from 30 years and above). For second premolars--both maxillary and mandibular--the ratio reaches a maximum at 30-39 years, and then falls with increasing age. Because the ratio generally attains an effective ceiling with increasing age at a level well below 2, and because it is characteristic of the tooth-type, host factors would seem to be implicated. The data corroborate the authors' hypothesis that the site-specificity of dental caries is genetically-determined and that the timing of attacks in a given environment is governed largely by endogenous factors.

A new method of direct computer entry for dental epidemiological data using an X-Y digitiser.

A method has been devised for obtaining a rapid and accurate transfer of dental epidemiological data directly from survey sheets or dental charts to computer records by using an X-Y digitiser. The technique involves modification of the conventional 'menu' approach to data entry via a digitiser.

The problem of determining twin zygosity for epidemiological studies.

The use of epidemiological studies of twins as a means of determining the existence of genetic factors in various conditions is well known. To be of value, the zygosity of the twin pairs must be identified with as great a degree of confidence as possible. A method of determining twin zygosity, using concordance in general likeness, hair colour, hair type, eye colour, ear form, tongue roll and phenylthiocarbamide (PTC) taste sensitivity, was developed for use in a survey of 244 pairs of like-sexed twins aged 5 to 15 years. The results obtained and the problems raised when applying this method are discussed. The method was sinple to apply to a large group of twin pairs, and monozygotic pairs were identified with a degree of confidence greater than 95%.

Pulsed electromagnetic energy therapy in third molar surgery.

Pulsed electromagnetic energy is being increasingly employed to reduced symptoms and enhance the healing process following tissue injury. A double-blind placebo-controlled trial has been carried out to assess the value of electromagnetic energy in third molar surgery, but no significant benefit has been found.