Reliability and Validity of Scales for Assessing Child Dental Fear and Anxiety.

INTRODUCTION: Children with high dental anxiety display uncooperative behavior during dental procedures. Different self-assessment questionnaires are in use to estimate the prevalence of dental fear and anxiety (DFA) in children but they need to be tested for reliability and validity in different populations. OBJECTIVES: The aim of this study was to test the reliability and validity of two scales for the assessment of child dental fear and anxiety in a sample of Croatian children. MATERIAL AND METHODS: The sample comprised 202 pairs consisting of children and their mothers (97 boys and 105 girls) aged 5 - 12 years. Two scales were used to assess children's DFA: the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) and the Modified Child Dental Anxiety Scale - face version (MCDAS-f). The Corah's Dental Anxiety Scale (CDAS) was used in the sample of children's mothers. The average scores of cooperative children and children with behavior management problem (BMP) were compared. RESULTS: Cooperative children displayed significantly lower CFSS-DS scores than children with BMP (M = 28. 46 vs. M = 39. 36; P < 0.001). The average MCDAS-f score was significantly higher in children with BMP than in cooperative children (M = 28. 07 vs. 20. 01; P < 0.001). The CFSS-DS showed high internal consistency (Cronbach's α = 0. 90), while internal consistency of MCDAS-f was good (α = 0. 73). The maternal CDAS showed good internal consistency (α = 0, 89). The correlations with other self-report measurements of DFS show good validity of all scales. The correlations between CFSS-DS and MCDAS-f were highly significant (r = 0.482; P < 0. 01) as well as the correlations of CFSS-DS and MCDAS-f with CDAS scores (r = 0.223; P < 0. 01 and r = 0.198; P < 0. 01, respectively. CONCLUSION: The obtained results suggest that both the CFSS-DS scale and the MCDAS-f scale are reliable and valid scales for measuring dental fear and anxiety in children in a sample of Croatian children. The MCDAS-f scale has shown slightly lower internal consistency but it is suitable for use in young children. In addition, the MCDAS-f scale is simple to administer.

Lobodontia: Genetic entity with specific pattern of dental dysmorphology.

A characteristic pattern of dental anomalies including cone-shaped premolars, multitubercular molar crowns, pyramidal molar roots with single root canals, shovel-shaped incisors with palatal invaginations and hypodontia usually described as lobodontia was recognised as a separate entity. Only a few family reports on this condition have been published until now. The prevalence of the condition is estimated to be less than 1:1000,000. In the present paper we tried to delineate and clarify some additional aspects of this rare genetic entity in three families with 17 affected members. This represents the largest number of cases recorded since now. The analyses of dental morphology, crown-size profile patterns, pedigree analyses, and analyses of digitopalmar dermatoglyphics were performed in 7 examined patients. Crown-size profile pattern was calculated for seven patients and compared with standards for the Croatian population. The most striking features of the condition are conical premolars, tritubercular canines, single pyramidal molar roots, multitubercular molar crowns and invaginated upper incisors. A considerable reduction of crown-size was observed for all premolars, particularly in mandible. The alveolar process in the premolar region was hypoplastic and thin in all patients studied. Gender ratio of affected individuals was approximately M1:F1. Our data suggest that the prevalence of this condition is less than 1:300,000 in the Croatian population, which is considerably higher than previously reported in the literature. The analysis of the anomaly in all the families showed a slight variability in the clinical picture and autosomal dominant (AD) mode of inheritance. It could be concluded that this rare condition described as lobodontia represents a true genetic entity which follows AD mode of inheritance and displays variability in its expression.

The effect of petroleum jelly, light-cured varnish and different storage media on the flexural strength of glass ionomer dental cements.

This study determined the influence of coating with either petroleum jelly or light-cured varnish and storage medium on the flexural strength of glass-ionomer cements (GIC). The flexural strength of two glass-ionomer cements (Fuji Equia Fil and Ketac Molar Aplicap) was measured. Specimens (2 × 2 × 25 mm) were prepared in three groups: uncoated, coated with petroleum jelly, or coated with light-cured varnish (EquiaCoat) cured for 20 s using a cure lamp (Bluephase G2, Ivoclar Vivadent, Schaan, Liechtenstein). Specimens were stored for 1 week at 37 °C in water, artificial saliva or 20 mmol dm-3 lactic acid, then flexural strength was determined in 3-pont bend. Data were analyzed by ANOVA and Tukey HSD post hoc test (p < 0.05). In addition, the mold was filled with water and the temperature change caused by the cure lamp was measured with a thermocouple. For both materials, storage in water gave the lowest flexural strength. It was slightly higher in either saliva or lactic acid, and was improved by coating in petroleum jelly. Specimens coated with light-cured varnish, that also involved heating with a cure lamp, gave the highest flexural strength. The heating effect of the lamp was demonstrated by the temperature rise in the water in the mold after light exposure from 21.9 (± 1.0) °C to 26.8 (± 1.0) °C. hence, sealing of GIC from aqueous media improves flexural strength. The cure lamp emitted heat, which may enhance the flexural strength of specimens coated with light-cured varnish.

Influence of Dentifrices pH on Enamel Microhardness In Vitro.

Purpose was to evaluate the effect of toothpastes pH on enamel remineralization. Six fluoride toothpaste and one without fluoride were applied to the enamel slabs. Twenty eight enamel slabs were divided into seven groups and subjected to a daily cycling regimen with brushing treatments, demineralization and remineralization in artificial saliva. The surface microhardness (SMH) was calculated from the mean values obtained from six indentations (Vickers hardness number (VHN)) on the enamel surface at baseline and after 12 days. pH of the dentifrices was determined in a slurry with deionized water (1:3). Changes of the enamel surface microhardness at baseline and after remineralization stage were measured and analyzed using the Student t-test and one-way ANOVA. All groups treated with fluorides showed higher SMH values compared to control group. Toothpastes with lower pH (Pronamel, Sensodyne F, Sensodyne Rapid) were statistically superior to other fluoride dentifrices and control group after 12 days pH-cycling regimen (p < 0.001). Obtained results showed that slightly acidified fluoridated toothpastes may have a positive influence on enamel remineralization process.

Taekwondo coaches knowledge about prevention and management of dental trauma.

The aim of this study was to assess level of knowledge about prevention and dental trauma management among taekwondo coaches in Croatia. The questionnaire submitted to the taekwondo coaches contained 16 items about dental trauma prevention and management. The questionnaires were filled in by 131 taekwondo coaches; 28 females and 103 males. Descriptive statistics was used to describe and analyze the obtained data. The coaches were familiar with dental injuries in high percentage: 41 (31.3%) have observed dental injury and 36 (27.5%) have experienced a dental injury themselves. Eight of them had tooth avulsion, fourteen crown fracture, and eight had tooth luxation. About half of all interviewed coaches 68 (52.7%) were aware of the possibility of replanting avulsed teeth. Twenty six (19.8%) were familiar with the tooth rescue kit. Only 99 out of 131 coaches (75.6%) have used a mouthguard. The obtained results show low knowledge about possibilities for prevention of dental trauma. Insufficient use of mouthguards in this contact sport requires more attention of dentists and coaches education about dental trauma prevention.

Minor physical anomalies in children with hearing impairment and normal controls.

The aim of this research was to assess differences in the frequency of individual minor physical anomalies (MPA) between healthy controls and children with hearing impairment (HI) and to find out whether some MPAs are more informative in discriminating between two groups than cumulative Waldrop's scores. The aim was also to investigate the influence of gender on MPA in children with HI and those with normal hearing (NH). The study was carried out on a sample of 424 children (121 children with hearing impairment (82 boys and 39 girls) aged from 5 to 18 and 303 healthy schoolchildren with normal hearing (152 boys and 151 girls) aged from 8 to 16). In HI children, the mean value of MPA was 2.2 times higher than in the controls. Binary Logistic Regression Model is entirely (with all 18 predictors) statistically significant, that is, it recognizes partial deafness. The comparisons between the studied groups of boys and girls HI and boys and girls NH showed a higher relative involvement of MPA in boys than in girls. MPA comparison of HI boys versus NH boys and HI girls versus NH girls according to topographic regions revealed that for HI children there were higher mean scores than for the same-sex controls from all regions, but differences are particularly pronounced in the ear and tongue region. However and that the difference is statistically significant for the majority of regions but this difference tended to be more pronounced in girls with relatively better expressed peripheral dysmorphia in the former and craniofacial dysmorphia in the latter. From the obtained results, it can be seen that in HI children, common etiological factors were probably in effect leading to physical anomalies and hearing impairments. Given the present findings of increased MPAs in HI children, further investigations are necessary to determine whether these developmental abnormalities arise from genetic factors or as a consequence of environmental influences.

The effect of heating and ultrasound on the shear bond strength of glass ionomer cement.

The aim of this study was to compare the influence of externally applied "command set" methods (heat, ultrasound) on shear bond strength to enamel of several glass ionomer cements (GIC). The vestibular surfaces of 180 extracted premolars were wet ground until a flat enamel surface was created, and divided into three groups. Three restorative GICs (Fuji IX GP Fast, Fuji Triage, Ionofil Molar AC) were cured in three ways: standard (SC), ultrasonic excitation (UC) and by an external heat source (HC). In each group, teeth were conditioned in two ways: 30 with 10% polyacrylic acid and 30 without conditioning. The GIC were used to fill teflon molds (3 x 4 mm). The samples were loaded in a Universal testing machine (Lrx Material Testing Machine) at a 1 mm/min crosshead speed. Results showed that heat cured Fuji IX on conditioning enamel had significantly greater shear bond strength (13.3 MPa) than all other tested groups (8.6-10.8 MPa) (p < 0.001). The mean shear bond strength in GIC with SC and without enamel conditioning was 3.6-5 MPa and had significantly lower bond strength. Heating of GIC increase bond strength, improves the properties of GIC restoration and can be recommended for use as a "command set" method.

Optoelectronic pantography diagnostics of temporomandibular disorders in patients with bruxism.

Temporomandibular disorders (TMD) is a joint term that encompasses a number of clinical symptoms that involve the teeth, masticatory musculature and temporomandibular joints (TMJ). They are a frequent cause of orofacial medical conditions. The aetiology of disorders is complex and individual etiologic factors are not sufficiently defined. Bruxism, in its centric or eccentric form, is becoming a frequent problem for dentists. The purpose of this study is to show factors of the condyle leading in patients with bruxism by optoelectronic pantography, and to establish the possibility of using optoelectronic pantography in the diagnostic procedure of TMD. Patients were selected (N = 42), with incomplete sets of teeth, without prosthodontic appliances and with traces and symptoms of TMD. After completing the history questionnaire a clinical check up and plaster cast analysis patients with bruxism were selected (N = 22) and without bruxism (N = 20). During the study optoelectronic String-condylocomp LR3, Dentron, D-Höchberg (software JAWS 30) was used. This study showed the possibility of applying optoelectronic pantography in TMD diagnostics and compares history, clinical and condylographic parameters in TMD patients with and without bruxism. Optoelectronic pantography enables us, by using relatively easy methods, to determine a more accurate diagnosis, highly important when choosing therapeutic methods and control of the aforementioned disorders.

Dental anxiety in relation to emotional and behavioral problems in Croatian adolescents.

The investigation was performed on 113 adolescents in the age between 15 and 18 years (63 boys, 50 girls). Corah Dental Anxiety Scale (CDAS) and Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) were used for evaluation of dental fear and Child Medical Fear Questionnaire (CMFQ) for evaluation of the fear of medical treatment. Achenbach Youth Self Report questionnaire (YSR) was used for evaluation of emotional and behavioral problems. The tests were filled in by children. The aim of the study was to evaluate the level of dental anxiety in adolescents and to assess a cause--consequence relationship between dental anxiety and emotional and behavioral problems in adolescents. The results of CDAS, CFSS-DS and CMFQ tests showed that dental anxiety scores and the total internalizing problems were higher in girls. Girls displayed more physical problems (p < 0.001) and were more prone to anxiety/depression disorders (p < 0.05). Both boys and girls were more aggressive, more prone to delinquent behaviour and had more externalizing problems in comparison with the average values obtained for the Croatian population. Significant correlation coefficients for boys were calculated for age and anxiety/depression, and delinquent behaviour and aggression (p < 0.05). Significant correlations were observed between physical problems and dental anxiety measured by the CFSS-DS test (p < 0.01), and between physical problems and the total internalizing problems (p < 0.05). In girls, the CMFQ scores showed significant correlations between dental anxiety and physical problems (p < 0.05), and anxiety/ depression (p < 0.01) and the total internalizing and externalizing problems (p < 0.05). Significant correlations were calculated for age and the total internalizing and externalizing problems for boys (p < 0.05). According to the results of both CDAS and CMFQ tests, anxiety in girls showed significant correlations with delinquent behaviour (p < 0.01). CDAS scores for girls showed significant correlations with aggression (p < 0.05) and the total externalizing problems (p < 0.01).

A comparison of methods for predicting the size of unerupted permanent canines and premolars.

The aim of this study was to examine the reliability of eight methods for determining the mesio-distal crown diameters (MDD) of the permanent canines and premolars (C, P(1), and P(2)). The study models of 120 children (60 boys and 60 girls) aged from 14 to 18 years treated in orthodontic clinics were measured using Seipel's method, with callipers accurate to 0.01 mm. The correlation coefficients were determined between the MDD of C, P(1), and P(2) measured on the study models and the sums calculated using various other methods. The correlation coefficients derived by comparison with the methods of Moyers, Tanka and Johnston, Droschl et al., Legovic and Hauz, and Berendonk-Nawrath showed a tendency to over-estimate the MDD of C, P(1), and P(2), while the regression methods of Gross and Hasund, Bachmann, and Tränkmann et al. under-estimated the values. Bachmann's method appeared to give the most reliable results.

Labial talon cusp on maxillary central incisors: a rare developmental dental anomaly.

Labial talon cusp, or dens evaginatus is a very rare dental anomaly of unclear etiology and significance. It can occur as an isolated finding or be associated with other dental anomalies or some syndromes. The present report describes two Caucasian males with labial talon cusp on maxillary permanent left central incisors. In both cases accessory cusp caused plaque accumulation and marginal gingivitis. One case displayed affected tooth to be in cross bite position causing occlusal trauma. No other dental anomalies in either case, neither association with some syndromes were noted. This rare anomaly requires careful dental and physical examination of the affected patient since its finding can be of clinical and genetic significance.

Palatal and dental arch morphology in Down syndrome.

The analysis of palatal vault morphology and maxillary dental arch shape was carried out in the sample of 42 Down syndrome (DS) patients with trisomy 21. The data were compared to those of healthy controls from the same population matched for age and sex. Palatal morphology and upper dental arch shape were studied on hard plaster casts of the patients and controls. No sexual dimorphism in palatal and dental arch shape was observed in DS and controls. Normal palatal shape was more frequent in controls than in DS subjects (52.38% vs. 28.57%; p < 0.05). DS patients displayed significantly higher frequency of shelf-like or "stair palate" (38.1%) than controls (11.9%) (p < 0.02). The younger age group (3-14 year) showed much higher frequency of "stair palate" than controls (26.19% vs. 2.38%; c2 = 9.72; p = 0.003). The older group of DS patients did not show increased frequency of such shape of the palatal vault. There was no significant difference in dental arch shape between DS patients and controls. High frequency of shelf-like palate in DS subjects is decreasing by age. The obtained results indicate that palatal vault morphology is subjected to the age related changes. These changes can be attributed to the growth of caraniofacial structures and increased tonus of tongue and other orofacial muscles.