An Assessment of the Knowledge of Dentists on the Emergency Management of Avulsed Teeth.

OBJECTIVE: to investigate the knowledge and attitudes of general dental practitioners (GDPs) on the emergency management of avulsed teeth.The management of the avulsed teeth is well outlined in the latest trauma guideline. However, little information is available about the level of knowledge of the management of avulsed teeth among young dentists in Turkey. MATERIAL AND METHODS: A cross-sectional questionnaire was completed to assess the knowledge of GDPs on the emergency management of avulsed teeth. The questionnaire asked questions to 142 dental practitioners about whether they have received information about the emergency management of dental trauma, whether they have intervened in cases of avulsed teeth following a dental trauma, and, finally, whether they have given treatment of avulsed teeth. RESULTS: The majority of GDPs had received training to treat avulsed teeth. The findings of the study showed that only 35% of GDPs recalled the critical time for treatment. The number of GDPs who had incorrect knowledge on this topic was higher and statistically significant (p<0.001). The rates of the correct answers according to the relevant information fields were as follows: optimal storage medium (78%), type of splint (56%), splinting period (58.5%), and systemic medication after avulsion (32%). CONCLUSION: The results show that many GDPs had limited experience in treating avulsed teeth. However, in the study, it was stressed that the knowledge of GDPs related to the factors affecting the successful treatment of avulsion cases should be improved by using continuing education programs.

Effectiveness, Costs and Patient Acceptance of a Conventional and a Biological Treatment Approach for Carious Primary Teeth in Children.

BACKGROUND: Over the last years, conventional restorations for the treatment of active carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves less invasive techniques that alter the environment of the CL isolating it from the cariogenic biofilm and substrate. AIM: To investigate the cost-effectiveness and patient acceptance of 2 treatment approaches for the treatment of deep CLs in primary teeth in children. METHODS: This was a retrospective/prospective cohort study carried out in 2 UK specialist hospital settings. Data on cost-effectiveness was extracted retrospectively from clinical dental records of 246 patients aged 4-9 years. A prospective study design was used to explore patient acceptance of the 2 treatment approaches. One hundred and ten patients aged 4-9 years and their carers completed 2 questionnaires on treatment acceptance. RESULTS: In total, 836 primary teeth that had received treatment with either approach were included. More than 2 thirds (75.7%) of the restorations in the conventional approach were of non-selective removal to hard dentine followed by pulpotomy (24.3%). In the biological approach, most of the restorations were stainless steel crowns placed with the Hall Technique (95%) followed by selective removal to firm dentine (5%). The majority of the primary teeth remained asymptomatic after a follow-up period of up to 77 months; 95.3% in the conventional and 95.8% in the biological arm. When the treatment costs were analysed, a statistically significant difference was found between the mean costs of the 2 approaches with a mean difference of GBP 45.20 (Pound Sterling; p < 0.001), in favour of the biological approach. The majority of the children and carers were happy with the conventional or biological restorations. CONCLUSION: Although both approaches had similar successful outcomes, the biological approach consisting mainly of Hall Technique was associated with reduced treatment costs. Both approaches were accepted favourably by the children and carers.

The impact of dental caries and its treatment by conventional or biological approaches on the oral health-related quality of life of children and carers.

BACKGROUND: The effect of untreated dental caries and the approaches taken to its treatment have not been extensively elucidated in children. AIM: To investigate the impact of untreated dental caries on children aged 4-9 years and whether its treatment with either a conventional or a biological approach influenced the oral health-related quality of life (OHRQoL) of the children and their carers. DESIGN: Children (n = 110) and their carers attending two specialist centres for treatment of carious primary teeth completed the Early Childhood Oral Health Impact Scale and the Self-reported Scale of Oral Health Outcomes for 5-year-old Children at baseline prior to dental treatment and at 3-6 months following completion of dental care. Dental treatment was provided using either a conventional or a biological approach. RESULTS: Dental caries showed a negative impact on the child and family's OHRQoL (P = 0.001). Children reported difficulty eating (55.5%), sleeping (40%), and avoiding smiling because of how the teeth looked (27.3%). More than half of the parents reported their child had toothache. Parents perceived difficulty eating (40.9%), being irritable (38.2%), and difficulty drinking (30.9%) as being impacts of caries on their child's OHRQoL. In addition, approximately half the parents reported feeling a sense of guilt because of their child's dental disease. Following dental treatment, participants reported significant improvement in their overall health status (P = 0.001). Children's age, gender, or the treatment approach were not statistically significantly associated with changes in OHRQoL of the child or carer. Children and parents who initially reported greater impacts of untreated dental caries demonstrated greater improvements in their overall oral health status (P < 0.0001). CONCLUSION: Dental caries was associated with negative impacts on children and parents' quality of life. Treatment of caries improved the quality of life of children and families significantly, irrespective of whether the treatment was provided by a conventional or a biological approach.

Outcomes of the conventional and biological treatment approaches for the management of caries in the primary dentition.

BACKGROUND: In the last few years, conventional restorations including complete removal of carious tissue (CT) with or without pulp therapy for the treatment of carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves the use of less invasive techniques which alter the environment of the CL isolating it from the cariogenic biofilm and substrate. Two of these treatment approaches that are becoming increasingly widely accepted and used in paediatric dentistry are the Hall Technique and indirect pulp capping (IPC). AIM: To investigate the outcome of the conventional versus the biological approaches for the treatment of deep CL in the primary teeth in children, delivered in a specialist paediatric dentistry training environment. DESIGN: This was a retrospective cohort study of 246 children aged 4-9 years, treated with either approach, conventional and biological, in two UK specialist hospital settings. Data were extracted from clinical dental records and post-operative radiographs of patients treated during the period 2006-2012. The outcome of the treatment in this study was categorised into three main categories: clinical, radiographic, and final outcome. Clinical and final outcomes were further described as success, minor, and major failure. RESULTS: In total, 836 primary teeth were included. In the conventional approach, 324 teeth had complete CT removal and 104 teeth had a pulpotomy. In the biological approach, 388 teeth had Hall Technique preformed metal crowns (PMC) placed and 20 teeth received indirect pulp capping. PMC were the restoration of choice for most of the cases where a pulpotomy had been carried out, and resin composite was most frequently used restorative material for the complete CT removal group. The majority of the primary teeth treated with either approach remained asymptomatic after a follow-up period of up to 77 months, 95.3% in the conventional and 95.8% in the biological. No significant association was found between the final outcome and the approach used for treatment, age of the patient, gender and number of carious surfaces or tooth type. CONCLUSION: Both the conventional and biological treatment approaches had similar final outcomes and were equally successful for management of CL in the primary dentition.

The prevalence of molar incisor hypomineralisation in Northern England and its relationship to socioeconomic status and water fluoridation.

BACKGROUND: Molar incisor hypomineralisation (MIH) is a condition which has significant implications for patients and service provision. AIMS: The aim of this survey was to determine the prevalence of MIH in 12-year olds in Northern England and to consider the relationship with socioeconomic status and background water fluoridation. DESIGN: Twelve-year-old children were examined for the presence of MIH. Participating dentists were trained and calibrated in the use of the modified Developmental Defects of Enamel index. Children were examined at school under direct vision with the aid of a dental mirror. A diagnosis of MIH was attributed to a child if they had a demarcated defect in one or more of their first permanent molars. RESULTS: Of 4795 children that were selected, 3233 (67.4%) were examined. Overall prevalence of MIH was 15.9% (14.5-17.1%). There was an association between prevalence of MIH and deprivation quintiles with a positive correlation in the first 4 quintiles (P < 0.05). There was no difference in prevalence between fluoridated Newcastle and other areas. CONCLUSION: Prevalence of MIH is equivalent to other European populations. Prevalence was related to socioeconomic status but not to background water fluoridation.

Bite force measurement in children with primary dentition.

OBJECTIVES: To determine the magnitude of the biting forces in young children aged 3-6 years in the primary dentition and analyse the potential effects of caries and malocclusion on maximum bite force. METHODS: Children aged 3-6 years of age attending primary schools within a major city in the UK were recruited to participate in this study. The magnitude of the bite force in Newtons (N) was measured bilaterally corresponding with the 1st and 2nd primary molars and central incisors using a new specifically designed single tooth bite force gauge. RESULTS: Two-hundred and five children were included in the study. The prevalence of dental caries and malocclusion was found to be 30.4% and 17.1% respectively. The levels of bite force recorded showed comparatively wide intra- and inter-individual variation with the maximum of the three bite force measurements ranging from 12.61 (N) to 353.64 (N) (M=196.60, SD=69.77). CONCLUSION: Bite forces of young children show comparatively wide intra- and inter-individual variation with some similarities with those found in the limited number of previous primary dentition studies undertaken elsewhere. The results will serve to provide key reference values for use both in paediatric dental clinical practice and wider research community.