A form of 'parental presence/absence' (PPA) technique for the child patient with dental behaviour management problems.

AIM: This paper reports on the use of early introduction of a specific parental presence/absence (PPA) behavioural technique to manage the initially uncooperative child. METHODS: Using a prospective design, 440 healthy children aged 3 to 10 years visited a paediatric dental practice within 33 months. Children exhibiting initially Frankl 'negative' and 'definitely negative' behaviour were empathically offered parental presence only if they were cooperative. Otherwise, the parent stepped out until behaviour improvement. STATISTICS: t-tests and Chi-square tests were used to compare characteristics of initially cooperative and uncooperative children, as well as proportions of parents who were asked to leave the surgery. The technique's success was assessed by a one sample binomial test. RESULTS: 75 of the children presented as Frankl either 'negative' (30) or 'definitely negative' (45) at their first visit; 70 (93.3%, p<0.001) responded to the PPA technique by displaying positive behaviour as their first visit progressed. 38 responded without the need to ask the parent to exit the practice room, while the other 32 responded only after their parent exited. 52 children had additional appointments, and 8 required an application of PPA at a second appointment; all children cooperated in all subsequent appointments. CONCLUSION: Early and empathic application of the PPA technique appears very successful in managing initially uncooperative child patients, suggesting that a randomised controlled trial of the technique is warranted.

FGF signaling in mandibular skeletogenesis.

OBJECTIVE: To examine the functions of FGF/FGFR signaling during mandibular skeletogenesis in ovo. DESIGN: We examined the effects of inhibition of FGF signaling during mandibular skeletogenesis by overexpressing replication-competent RCAS virus encoding a truncated form of FGFR3 in the chicken mandibular process between stages 17 and 26. RESULTS: Injection of RCAS-dnFGFR3 into the developing mandible resulted in abnormalities in a stage- and region-dependent manner. Injection at early stages of development resulted in the truncation of Meckel's cartilage, severely reduced outgrowth of the mandibular process and absence of five of the mandibular bones. Injection at later stages did not affect the outgrowth of the mandibular process and Meckel's cartilage but resulted in abnormalities in mandibular osteogenesis in a region-specific manner. The bones in the more caudal region were frequently truncated whereas bones in the more rostral regions such as dentary and splenial bones were frequently absent. CONCLUSION: Together these experiments have revealed essential roles for FGF/FGFR signaling in the elongation of Meckel's cartilage, development of osteogenic condensations and appositional growth of mandibular bones.