Psychometric and biohormonal indices of dental anxiety in children. A prospective cohort study.

The stress of dental treatment often elicits negative emotions in children, expressed as dental fear or anxiety. Highly anxious children obstruct treatment and avoid therapy, further amplifying oral health problems. The aim of this study was to examine the neuroendocrine and autonomic nervous system responses to dental treatment and their possible interactions and associations with psychometric indices of anxiety, caries, previous dental experience, anesthesia, age and gender in school children. Upon informed consent, saliva was obtained from 97 children (59% males, mean age ± SD: 89.73 ± 15 months) in the Clinic of pediatric dentistry before treatment, immediately post-treatment and at the recall visit to determine cortisol and salivary alpha-amylase (sAA) levels. Dental and general anxiety was assessed through specific questionnaires completed by the children. Compared to pre-treatment, cortisol levels were increased following treatment, while sAA levels were higher at the recall. Pre- and post-treatment cortisol and sAA responses were positively correlated. Dental and general anxiety questionnaire scores were also significantly correlated with each other. The integrated autonomic and neuroendocrine responses prior to treatment were correlated with state anxiety and those following treatment with dental anxiety. However, univariable and multivariable linear regression analysis associated post-treatment cortisol, but not sAA, levels with dental anxiety. No associations of cortisol or sAA responses with caries, age, gender, previous dental experience or anesthesia were detected. These data provide some evidence that both sAA and cortisol levels are altered in children in anticipation or during dental treatment, but only cortisol levels are associated to dental anxiety.

Decomposition of Ag-based soldering alloys used in space maintainers after intra-oral exposure. A retrieval analysis study.

OBJECTIVE: The aim of this study was to evaluate the elemental alterations of Ag soldering alloys used in space maintainers after intra-oral exposure. MATERIALS AND METHODS: Twenty devices were fabricated by using two different soldering alloys; US (Dentaurum Universal Silver Solder, n = 10) and OS (Leone Orthodontic Solder, n = 10). All devices were manufactured by the same technician. Surface morphology and elemental quantitative analysis of the soldering alloys before and after intra-oral placement in patients was determined by scanning electron microscopy and energy-dispersive X-ray microanalysis (SEM/EDX). Statistical analysis was performed by t-test, Mann Whitney tests and Pearson's correlation. For all tests a 95% confidence level was used (α = 0.05). RESULTS: Both soldering alloys demonstrated substantially increase in surface roughness after intra-oral aging. Statistical analysis illustrated a significant decrease in the Cu and Zn content after treatment. OS demonstrated higher Cu release than US (p < 0.05). The remaining relative concentrations of Cu and Zn after the treatment did not show any correlation (p > 0.05) with intra-oral exposure time, apart from Zn in OS (r = 0.840, p = 0.04). CONCLUSIONS: Both soldering alloys demonstrated a significant Cu and Zn reduction after intra-oral exposure that may raise biocompatibility concerns.

Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece.

BACKGROUND: The abuse and neglect of children constitutes a social phenomenon that unfortunately is widespread irrespective of geographic, ethnic, or social background. Dentists may be the first health professionals to recognize signs of child maltreatment (CM) and have an important role in dealing with such incidents. AIM: To describe the training, experience, and personal views of dentists practicing in the Prefecture of Attica regarding the recognition and referral of abused and neglected children. DESIGN: A random sample was drawn from a target population of dentists registered with two of the largest dental associations in Greece. The dental practitioners were interviewed by two paediatric dentists using a specially designed questionnaire. Information was collected regarding their awareness on child maltreatment, the frequency of suspected incidents as well as the reasons for not reporting them. RESULTS: With a response rate of 83%, findings are reported from 368 interviews (54% male, mean age 43 years). Only 21% of respondents had received training on child protection at undergraduate level. Suspected abuse was 13% and suspected neglect was 35%. Only six of the 368 respondents made an official report of a suspected case of child maltreatment. The most common reason that might prevent a dentist from reporting a case was doubt over the diagnosis (44%). Ninety-seven per cent of dentists believed that recognition and referral of incidents should be part of undergraduate training. CONCLUSIONS: Dental practitioners did not feel adequately informed on recognizing and referring child abuse and neglect cases. The low percentage of reported incidents and the lack of legislation indicate a great need for continuously educating dentists on child maltreatment as well as for setting up an organized system in Greece for reporting such incidents to protect the dentist referring the case as well as the child being victimized.

Effect of sealants on laser fluorescence caries detection in primary teeth.

The aim of this study was to investigate in vitro the effects of clear or opaque sealants, on the laser fluorescence readings for occlusal caries detection in primary molars. For this reason, 427 occlusal sites in 199 teeth were clinically examined by one dentist, and their laser fluorescence (LF) was measured locally with the DIAGNOdent™ device, both before and after the teeth had been sealed with Delton Clear LC or Delton Opaque LC. For 29 of these teeth, we also measured the laser fluorescence by scanning the fissures before and after sealant application. We used Wilcoxon's signed ranks sum test and Spearman's rho correlation to compare and correlate the LF readings before and after sealing, while we used the Mann-Whitney U test to compare the two materials. Finally, we used the Kruskal-Wallis test to compare readings taken locally with those taken by the scanning technique. The results showed that there was an LF increase by a mean of 6 units after sealing with the clear material, while there was a 15 units decrease after sealing with the opaque one. LF readings before and after sealing correlated better for the clear material (rho = 0.826) than for the opaque one (rho = 0.507). LF readings were statistically significantly affected by both clear and opaque sealants (P < 0.001). However, this effect was statistically significantly less pronounced for the clear material (P < 0.001). There was also no difference between the LF readings taken by the fissure scanning technique or locally (P > 0.05). In conclusion, LF readings for occlusal caries detection in primary molars were significantly affected by both the clear and the opaque materials. However, the effect for the opaque material was more pronounced.

Morphological and compositional alterations of in vivo aged prefabricated pediatric metal crowns (PMCs).

OBJECTIVES: The purpose of the present study was to assess the morphological and elemental alterations of retrieved prefabricated metal crowns (PMCs) after intraoral exposure. METHODS: Seventeen in vivo aged stainless steel crowns (3M ESPE) were collected. The intraoral exposure time varied from 3 to 101 months. For every retrieved crown one new crown of the same type was used as a reference. The reference and in vivo aged crowns were examined by high-vacuum scanning electron microscopy and energy-dispersive X-ray microanalysis. The elemental composition between the as-received and in vivo aged crowns was statistically analyzed by t-test (a=0.05). RESULTS: In vivo aged crown surfaces demonstrated significantly morphological alterations with accumulation of amorphous intraoral integuments, biting imprints, wear and occlusal perforations. The results of microanalysis showed that there were no statistically significant differences in the elemental composition of the stainless steel crowns between the two conditions. SIGNIFICANCE: Under the conditions of the present study, retrieved prefabricated pediatric stainless steel crowns exhibit morphological changes mainly due to plastic deformation, without changes in elemental composition.

Development of caries in permanent first molars adjacent to primary second molars with interproximal caries: four-year prospective radiographic study.

PURPOSE: This study investigated the effect of the primary second molars' distal surface caries on the incidence of the permanent first molars' mesial surface caries in 613 paired tooth surfaces of children ages 6 to 8 years at baseline examination. METHODS: Proximal caries and its progression were diagnosed by bite-wing radiographs taken at a 1-year interval over a period of 4 years. The permanent first molars' mesial surfaces and primary second molars' distal surfaces were examined. Recorded were: (1) sound surfaces; (2) carious lesions on the enamel's external and internal half and on the dentin's external, middle, and internal third; (3) filled, extracted, and exfoliated teeth. The logistic model for panel data was employed to estimate the effect of proximal caries of the primary second molars' distal surfaces on the incidence of the permanent first molars' mesial surface caries. The 95% confidence interval probability was used. Sensitivity and specificity as well as the positive and negative predictive rates were computed. RESULTS: The results showed that the presence of proximal caries on each primary second molars' distal surfaces significantly affected the development of proximal caries on the corresponding permanent first molar's mesial surfaces. Age was estimated to exert a positive and highly significant impact, while gender had no effect. The odds ratio values ranged from 4.86 to 63.43. The values of sensitivity and specificity ranged from 45% to 97% and 80% to 89%, respectively, while the positive and negative rates ranged from 40% to 56% and 90% to 99%, respectively. CONCLUSIONS: Proximal caries present on the primary second molars' distal surfaces increases the risk of developing caries on the permanent first molars' mesial surfaces. This risk, however, is different among the paired surfaces studied.

In vivo vs in vitro anticariogenic behavior of glass-ionomer and resin composite restorative materials.

OBJECTIVE: To evaluate the in vivo vs the in vitro anticariogenic potential of glass-ionomer and resin composite restoratives, utilizing a standardized interfacial gap model. METHODS: (a) In vitro study. Box shaped cavities were prepared at the buccal surfaces of extracted premolars limited to enamel. The incisal cavity walls received no treatment and were covered with 40 microm-thick metal spacers. The cavities were restored with a glass-ionomer (Ketac-Fil, n=8) and a fluoride-free resin composite (Scotchbond MP Plus/Z100, n=8). After 4 weeks immersion in an acidic gel (pH 4), thin sections were produced and examined under polarized-light microscopy.(b) In vivo study. Four low caries activity volunteers, with first four premolars, each planned to be extracted for orthodontic reasons, participated in the study. Cavities were prepared as before and filled contralaterally per patient with glass-ionomer (n=8) and resin composite (n=8). After 6 months in vivo, the teeth were extracted, sectioned and investigated by polarized-light microscopy, Raman microspectroscopy and SEM-EDS X-ray microanalysis. Unpaired t-test (lesion dimensions) and one-way ANOVA and Newman-Keuls tests (Ca, P wt%, Ca/P ratios) were used to identify statistically significant differences in lesion analysis (alpha=0.05). RESULTS: (a) In vitro study. All restorations developed lesions at incisal and cervical margins. At gap-free regions glass-ionomers showed reduced lesion dimensions compared to those of composites (p<0.05). At regions with gaps, no significant differences were found in lesion depth between the restorative groups tested. Lesion length was increased in composite, and decreased in glass-ionomer, whereas lesion depth in both restorative groups was increased in comparison to gap-free regions (p<0.05).(b) In vivo study. No lesions were observed at gap-free regions. At gap regions, 75.5% of glass-ionomer and 62.5% of composite restorations developed lesions. The lesion dimensions were significantly greater in glass-ionomer (p<0.05). A reduction in PO4(3-), CO3(2-), Ca and P was found in lesions compared to intact tissues. No F was detected and no CaF2 lattice vibrations were found at the enamel margins facing the gap adjacent to glass-ionomers. SIGNIFICANCE: In the presence of a standardized interfacial gap, no preventive effect was exerted in vivo from the glass-ionomer to protect the adjacent enamel wall from secondary caries attack. The lack of any correlation between the in vivo and in vitro models tested implies that artificial caries experiments have a negligible clinical relevance in predicting the in vivo effect.