Diagnostic dilemma of an ulcer in a child.

UNLABELLED: Careful history-taking and examination are important in diagnosing self-inflicted injuries, which are often very difficult to diagnose and manage. We describe a case of a misdiagnosed traumatic ulcer in a 9-year-old boy which meant that he went through months of pain and discomfort, missed school, was admitted to hospital and had a series of unnecessary investigations. CLINICAL RELEVANCE: This case highlights the importance of dental referral, careful history and examination in managing unusual oral ulceration.

A comparison of paracetamol, ibuprofen or their combination for pain relief following extractions in children under general anaesthesia: a randomized controlled trial.

OBJECTIVE: This study was designed to compare the effectiveness of different oral analgesics for relieving pain and distress in children following the extraction of teeth under general anaesthesia (GA). The analgesics included paracetamol alone, ibuprofen alone, and paracetamol and ibuprofen in combination. METHODS: Two hundred and one subjects were randomly allocated to one of four groups. Forty-seven children were included in the ibuprofen alone (5 mg kg(-1)) group, 51 in the paracetamol/ibuprofen combination (15/5 mg kg(-1)) group, 48 in the high-dose paracetamol (20 mg kg(-1)) group, and 55 children were included in the usual-dose paracetamol (15 mg kg(-1)) group (control group). Evaluation of distress for children was made immediately pre-operatively, on recovery from anaesthesia and again after 15 min by using a five-point face scale. Furthermore, each child was observed immediately postoperatively and 15 min postoperatively for signs of pain using the Children's Hospital of Eastern Ontario Pain Scale. RESULTS: There were significant decreases in the mean pain and distress scores for both the ibuprofen alone and paracetamol/ibuprofen combination groups compared to the control group (usual-dose paracetamol) at 15 min postoperatively. CONCLUSIONS: This study provides evidence to support the oral administration of ibuprofen alone or in combination with paracetamol for postoperative analgesia in children who are having teeth extracted under GA.

The effects of a long wait for children's dental general anaesthesia.

OBJECTIVES: The purpose of this study was to monitor the effect of an interruption in a service for children who were scheduled to have dental extractions under general anaesthesia (GA). The reasons for offering GA and the treatment given while the service was not available, together with the history of the pain, antibiotic usage and alterations to the number of teeth extracted were recorded. METHODS: When the GA extraction service stopped, the children who were scheduled to have their teeth extracted were placed on a waiting list. When the service recommenced 6 months later, the children were invited to attend a reassessment. Relevant data were collected at this visit using a proforma. RESULTS: A total of 321 children had their extractions delayed. Only 249 of these attended for a reassessment. During the waiting period, 102 parents (41.0%) reported that their children required analgesics, 71 (28.5%) stated that their children's sleep was disturbed and 82 (32.9%) recorded problems with eating. One hundred and twenty-three children (49.4%) had received antibiotics, with 49 (19.6%) having been prescribed two or more courses. The majority of treatment plans (85.5%) remained unchanged. CONCLUSIONS: Many children who had had their extractions delayed suffered further pain and disruption to their life.

Service quality implications of dental undergraduate outreach teaching for Primary Care Trusts in England, UK.

OBJECTIVE: Primary Care Trusts (PCTs) assumed new responsibilities for dentistry in 2005. In dental education it has been suggested that more emphasis is made of primary care outreach schemes. The paper considers the service quality implications of dental outreach teaching for PCTs with particular reference to access and acceptability. RESEARCH DESIGN AND CLINICAL SETTING: A pilot of outreach teaching for Manchester undergraduates in relation to adult dental care began in 2001. Six groups of eight students, working in pairs, spent one day per week in one of three community dental clinics in socially deprived areas. The evaluation of the first year used data from 908 patient treatment summaries, 139 patient questionnaires, and records of patient attendance. MAIN OUTCOME MEASURES: Access and acceptability measured by patients' demographic characteristics, patients' attendance at the clinics; patients' reasons for attendance, use of services and satisfaction with the service. RESULTS: In terms of access, the new service was used by local patients. Their main reasons for attending were convenience, a dental problem, free treatment, lack of access to a dentist, and lay referral. Some 41 percent attended initially because of an emergency, 30 percent said that if they had not attended the clinic they would have gone nowhere or did not know where they would have gone, and 49 percent had not attended a dentist for more than two years. In terms of acceptability most patients were positive about being treated by a student, 96 percent thought the quality of care excellent or good, and the same percentage said they would return to the clinic. The main areas of criticism were waiting times and appointments. CONCLUSIONS: Students can provide an accessible and acceptable local primary care dental service for adult patients in socially deprived areas as part of their undergraduate learning, and in a way that complements the existing services.

Management of a non-vital central incisor tooth with three root canals.

A macrodont permanent central incisor tooth with unusual root canal morphology became non-vital 18 months following trauma. Two root canals were initially identified and filled, but the patient continued to have symptoms and radiographic examination indicated apical periodontitis. Careful radiographic and clinical examination revealed a third root canal, which was subsequently treated, resulting in the resolution of symptoms and periapical healing.

Management of the immature apex--a clinical guide.

The production of an apical barrier prior to the placement of a permanent gutta percha root filling in a non-vital immature incisor tooth with an open apex is a well researched and documented technique. The technique is successful and a very satisfactory root filling can be placed in the tooth. However, dentists seem to have difficulty in achieving satisfactory outcomes.

Splinting of traumatized teeth in children.

Different types of splints have been used to stabilize traumatized teeth in children. Some of these splints have compromised healing of the teeth and associated dental tissues. This article considers the ideal properties for a splint and describes a method of splinting traumatized teeth in children that meets most of the requirements of an ideal splint.