Appraisal of the IADT fellowship - A member survey

BACKGROUND/AIM

The International Association of Dental Traumatology (IADT) is considered the foremost authority in Dental Traumatology. Fellowship status was introduced in 2015 and is considered an international standard of excellence. The Fellowship Committee of the IADT believed it was essential to survey members seeking information on the benefits of the IADT Fellowship and potential considerations for future development. This survey aimed to explore the perceptions of members of IADT surrounding the fellowship process in terms of interest, accessibility, equality, perceived prestige, and value to the membership.

MATERIAL AND METHODS

The survey was sent to 546 IADT members, of whom 89 were fellows (as of 31 July 2022) from 74 countries via an email invitation. Answers were analysed using the Chi2 and Fisher's exact test (p < .05).

RESULTS

The response rate to the survey was 20.69% (n = 113), including 28 fellows (24.78%). Forty-six respondents (40.71%) were female, and 67 (59.30%) were male. Dentists identified as specialists were significantly more likely to be involved in teaching dental trauma (p = .000008). A majority of respondents (87.76%; 86/98) expressed interest in obtaining fellowship, with increased interest from more recent graduates. Learning opportunities, obtaining expertise, networking and a sense of community and prestige, were key factors in considering fellowship. There was interest in alternate pathways other than examination alone, with 60.2% of 98 respondents suggesting a combination of publications /service to IADT/ reviewer for Dental Traumatology, 57.14% suggesting the submission of case reports, and 42.86% suggesting Honorary Fellowship. Respondents (73%) were willing to participate in online discussion forums and other professional development opportunities. This preference was more notable among non-fellows (75.29%) than fellows (67.85%).

CONCLUSIONS

The survey indicates the diverse motivations and perceptions regarding the IADT Fellowship, despite the low participation of IADT members. Achieving fellowship status is desired by 87.7% of non-fellows. The majority of respondents were aware of the process, but main concerns were identified as eligibility criteria and examination difficulty. Options for alternate pathways and other initiatives promoting engagement were identified. Further exploration of these issues is required to be representative of the entire IADT membership. Addressing these obstacles could significantly enhance fellowship participation and overall member satisfaction within the IADT community.

Dental photography for children: A global survey

BACKGROUND

Clinical photographs are now considered an essential element for accurate and objective dental records. Very little information exists on dental photography in children and the factors that can influence the dentist's decision to take dental photographs.

AIM

This study aimed to assess the current use, attitude and confidence of paediatric dentists using clinical dental photography of children worldwide.

DESIGN

This was a cross-sectional questionnaire-based study distributed online to paediatric dentists around the globe.

RESULTS

The survey was completed by 390 dentists. The majority of participants (82.3%, n = 321) took dental photographs of their patients, and over 74% of the participants were confident in taking dental photographs. Sixty-nine dentists (17.7%) did not take photographs. Seventy-four per cent (n = 240) of those who take dental photographs and 47.8% (n = 33) of those who do not take dental photographs reported an effect on the child's behaviour. The majority of participants expressed interest in receiving further training.

CONCLUSION

Most paediatric dentists take dental photographs of their patients and value their role in the behavioural management of the child patient. Paediatric dentists need further training in children's dental photography, including guidance on proper image recording, storage and transfer.

International teaching practices in dental trauma education

BACKGROUND/AIM

Several publications highlight the insufficient knowledge possessed by dentists and dental students regarding the management of traumatic dental injuries (TDIs). A lack of clinical experience during Undergraduate (UG) education could explain the reported deficits in managing dental trauma post-graduation. Despite its importance in dentistry, there are very few reports on how, where and who teaches Dental Traumatology (DT) in the UG curriculum. The aim of this study was to investigate teaching practices in DT around the world in UG education.

MATERIALS AND METHODS

UG educators involved in DT teaching activities were invited to complete an online questionnaire hosted on Qualtrics®. The survey consisted of close-ended and open-ended questions on their teaching practices in DT. Only one answer per institution was included in the final descriptive analysis.

RESULTS

A total of 203 responses from 164 institutions were obtained from 69 countries. All institutions reported that DT is included in their UG curriculum, and is mainly taught within Paediatric Dentistry and Endodontics. Most teaching and evaluation was delivered in traditional format. The number of contact hours dedicated to DT teaching activities ranged from 2 to 185 h (median = 10). Only 35% of institutions had a unified approach across disciplines. DT was taught as a separate course/module in 23% of the universities. Insufficient exposure to emergency care and the lack of formal clinical exposure to TDI was highlighted by many institutions. The need for a core curriculum was supported by 84% of the institutions with agreement on essential topics required at UG level.

CONCLUSIONS

Teaching practices in DT varied internationally. Very few teaching hours were devoted to DT and many institutions identified a need for increased clinical exposure. There was a desire for a standardised coherent approach to DT in the UG education with suggestions to improve educational resources.

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 10: First aid education

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 4: Faceshields for the prevention of dental and oral trauma

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 6: Education

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 2: Primary prevention of dental trauma across the life course

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 3: Mouthguards for the prevention of dental and oral trauma

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 8: ToothSOS app

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 5: Secondary prevention of dental injuries

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

The International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD) guidelines for prevention of traumatic dental injuries: Part 1: General introduction

The Guidelines for Prevention of Traumatic Dental Injuries were reviewed and approved by the Board of Directors of the International Association of Dental Traumatology (IADT) and the Academy for Sports Dentistry (ASD).

General dentists' perceptions and clinical management of hypomineralised second primary molars (HSPM) in Ireland

PURPOSE

This questionnaire aimed to explore how general dentists in the Republic of Ireland perceive and manage hypomineralised second primary molars (HSPM).

METHODS

Following ethical approval, a validated structured questionnaire containing 19 questions was sent to Irish dentists using Survey Monkey. Questions on awareness, dentist's experience, barriers to care and clinical scenarios with different treatment options were included. Binary outcomes and independent variables were compared using logistic regression analysis (α = 5%).

RESULTS

Responses from 279 general dentists were analysed. The majority of dentists were aware of HSPM (72%) and most dentists felt confident in diagnosing HSPM (71%). Dentists who had practiced for ≥ 15 years were significantly more likely to document HSPM frequently compared to those with less experience (OR 0.29; p = 0.012). No significant association was found between confidence in HSPM diagnosis and other variables, such as age group, years of practice and workplace. Dentists not working in private practice reported to be less comfortable in the management of HSPM (OR 0.49; p = 0.030). The most cited barrier to management of HSPM was child's behaviour. A broad variation was observed in the clinical scenarios, in particular when treatment planning more severe HSPM.

CONCLUSIONS

In general, Irish dentists are aware of HSPM and are confident in diagnosis and management. Variation existed in treatment options reflecting the disparity that exists in clinical management.

Clinical experience of undergraduate dental students in paediatric dentistry: A 5-year cross-sectional study

INTRODUCTION

The clinical experience of undergraduate dental students in Paediatric Dentistry has a profound influence on their future confidence. The purpose of this study was to evaluate the clinical experience of undergraduate students in Paediatric Dentistry over five consecutive years and to determine whether changes in teaching practices are reflected in the clinic.

MATERIALS AND METHODS

In total, 196 records submitted at the end of the Paediatric Dentistry training from the last 5 years (2016-2020) were evaluated. The variables analysed included the number of patients treated per student, the year, and the numbers and types of procedures performed individually across the years. The data were grouped into two categories; pre and post implementation of an electronic portfolio and a change in teaching practices (2016-2017 and 2018-2020 respectively). Data were analysed using Student's t-test or Mann-Whitney for two group comparison, depending on data distribution (α = 5%).

RESULTS

There was a significant reduction in the number of radiographs exposed (p = .013) between the two groups. The number of fissure sealants had increased in recent years (p < .001). Although the number of stainless steel crowns performed remained unchanged (p = .98), there was an increase in the number of crowns placed using the Hall technique (p < .001) and a concurrent decrease in the number of conventional crowns placed (p < .001).

CONCLUSION

The clinical experience of undergraduate students has changed in line with evolving teaching practices. The use of objective measures such as patient numbers and range of procedures can be used as a method of evaluating student clinical experience. Other assessment tools are still required to evaluate additional aspects of clinical learning in paediatric dentistry.

Prevalence of hypomineralised second primary molars (HSPM): A systematic review and meta-analysis

AIM

To evaluate the prevalence of HSPM worldwide on a child and a tooth level and investigate the influence of diagnostic criteria on the prevalence of HSPM.

DESIGN

A comprehensive literature search was performed through MEDLINE/PubMed, Scopus, and Web of Science databases. The grey literature was also screened as were the reference lists of included studies. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of HSPM.

RESULTS

The search strategy identified 1,988 articles, 487 were retrieved for full-text evaluation, and 37 studies were included in the meta-analysis (32 for child and 23 for tooth level prevalence), providing data from 26,805 individuals and 81,107 molars. The prevalence of HSPM was 6.8% (95% CI 4.98%-8.86%) on a child level and 4.08% on a tooth level (95% CI = 2.80%-5.59%). The diagnostic criteria used did not seem to influence the prevalence results (P > .05). The majority of the papers (75%) showed a low-to-moderate risk of bias.

CONCLUSION

There was a broad variation in the prevalence reported that may be attributed to differences in the study population. The present meta-analysis showed a HSPM prevalence worldwide of 6.8% on a child level and 4.1% on a tooth level.

Cross-sectional cohort study on the use of mouthguards by children playing Gaelic football in Ireland

BACKGROUND/AIMS

Up to 40% of dental injuries in children occur during sports and may be prevented by using mouthguards (MG). The use of mouthguards is mandatory in some sporting organizations. Knowledge of the benefits of protection does not always result in mouthguard use. The aim of this observational cross-sectional cohort study was to measure and compare knowledge of 9-16-year-old Gaelic football players and their parents on MG use and compliance with MG rules.

MATERIALS AND METHODS

A convenience sample of players and their parents was identified and were assessed at their sports facility. Parents completed a questionnaire while children were asked standardized questions and MG type was verified by a dentist. Data were analysed using descriptive statistics and binary logistic regression analysis for comparison.

RESULTS

One hundred and twenty-one children with 118 parents participated in the study. According to players, MG use during competition (N = 119, 99.2%) was greater than during training (N = 97, 80.8%). As age increased, children were less likely to comply with MG rules during training (OR =0.18, p < .001). Children played a median of 2 contact sports (IQR = 1). Only 32 parents (27.1%) and 17 children (14%) reported that the child wore a MG for all sports. Only four children (3.8%) had a custom MG even though most parents (N = 87, 73.7%) believed that they provided superior protection. Knowledge of players and their parents on how to care for the MG was variable.

CONCLUSION

Compliance with the Gaelic Atheletic Association's MG rules was lower during training than competition. Children were less likely to comply with MG rules during training as they grew older. Most parents believed a custom MG would best protect their child's teeth, yet few children had a custom MG. Players and parents had variable knowledge in relation to MG hygiene.

Parental perception on oral health-related quality of life and dental features of ectodermal dysplasia and isolated hypodontia in children

Background

Children missing 6 or more permanent teeth often present with complex dental care needs and significant impacts on their oral health related quality of life (OHRQoL). The most important facet in the overall care for these children is the child’s own experience, but parents primarily make the decisions regarding their child’s dental management. Understanding the parental perspective could have a positive impact on planning and provision of care for these patient groups in the future. The study compared the parental perspectives on OHRQoL impact and dental experience for children with ectodermal dysplasia (ED), severe isolated hypodontia (IH), and matched controls following assessment of their dental features.

Design

A cross-sectional study of 172 children (mean age: 12.4 years old) was conducted; 86 with severe hypodontia (≥ 6 missing teeth; ED: 29; IH: 57) and 86 age and gender matched controls. The Parental-Caregiver Perceptions Questionnaire (P-CPQ), Family Impact Scale (FIS) and a supplemental questionnaire were used to gather information on parental perceptions of OHRQoL and dental experiences, respectively. Clinical examinations were used to assess and compare the dental features between children with ED, IH and their respective controls.

Results

Higher scores (p < 0.05) were found in P-CPQ and FIS scores between the children with ED, IH and their respective controls. P-CPQ scores for males with ED had a moderate correlation with functional limitations (R_s = 0.576; p = 0.001*), oral symptoms (R_s = 0.444; p = 0.016*) and overall QoL (R_s = 0.499; p = 0.006*). The ED group reported earlier awareness of issues, the youngest attendance (3.24 years) and highest perceived number of appointments (“20 or more”; 58.6%). The mean number of missing teeth in the ED group was almost twice that of the IH group (ED: 20.17; IH: 10.68) and the median number of missing teeth (Radiographically: ED = 21; IH = 9; Clinically: ED = 11; IH = 6), was significantly greater in the ED group when compared to the IH group (p < 0.001*).

Conclusion

Parents of children with ED and IH perceive a greater impact on QoL, for both the child and their family. Children with ED need earlier intervention and more extensive treatment than children with IH and their controls.

Extension of a novel diagnostic index to include soft tissue injuries: Modified Eden Baysal Dental Trauma Index

AIM

Accurate records of traumatic dental injuries are important for clinical management and data collection for research. Soft tissue injuries often accompany dental trauma and should be appropriately recorded. The Eden Baysal Dental Trauma Index (EBDTI) provides an easy recording system of useful information about traumatic dental injuries on a tooth basis. The aim of this study was to extend the EBDTI index to record soft tissue injuries in a concise format and to approve the face and content validity of this version as the modified EBDTI (MEBDTI).

MATERIALS AND METHODS

An extension to EBDTI was developed by adding superscript numbers from 0 to 8 to represent soft tissue injuries related to dental trauma. The Rand e-Delphi method was used to evaluate this version of the index. A definition and two statements about the index were sent to 15 international panel experts to be assessed independently on a 9-point Likert scale where 1 represented "total disagreement," and 9 indicated "total agreement." The panel needed to reach a 75% consensus for validation. A numerical code was suggested using zero to depict no soft tissue injury; 1-4 to record extra-oral injuries; and 5-8 to record intra-oral injuries (for example, gingiva, frenulum, and palate). Traumatic dental injury of the tooth/teeth is recorded using EBDTI in square brackets, and soft tissue codes are used as superscript numbers outside the brackets on a patient basis.

RESULTS

The panel reached a consensus on the definition (86.7%) and two statements (86.7% and 93.3%) in one round. Various cases are presented to demonstrate the application of the index.

CONCLUSION

The Modified Eden Baysal Dental Trauma Index was developed to record soft tissue. injuries on a patient basis and was approved for face and content validity.

Casein phosphopeptide-amorphous calcium phosphate products in caries prevention

Data sourcesMedline, Embase, PreMedline and Cochrane Central Register of Controlled Trials.Study selectionClinical trials, investigating only clinical caries outcomes on participants of any age comparing the use of Tooth Mousse(®) or Tooth Mousse Plus(®) to a routine oral care regimen for the prevention of dental caries with or without comparison to additional preventive products. Studies that used other formulations of CCP-ACP were excluded. Trials using split-mouth design were also excluded. Only English language papers were considered.Data extraction and synthesisPapers were assessed independently by both authors using the Cochrane Collaboration tool for assessing risk of bias in randomised trials.1 Meta-analysis was not possible due to study heterogeneity.ResultsTwelve studies were available for the final review; three studies on caries prevention were assessed as having low risk of bias. The remaining nine studies, with high risk of bias, reported on treatment or regression of early carious lesions. Two RCTs reported no significant benefits in the use of Tooth Mousse(®) over brushing with a fluoride toothpaste, a third study demonstrated a statistically significant increase in enamel microhardness for the Tooth Mousse(®) group compared to control group but no difference to the group who had fluoride gel treatment. Overall the authors concluded that Tooth Mousse(®) performs no better than fluoride in the prevention of carious lesions.Seven of nine studies evaluated caries lesion severity in orthodontic patients, with four demonstrating statistically significant white spot regression. Two trials in non-orthodontic patients showed statistically significant remineralising potential of Tooth Mousse(®) over fluoride mouthrinse or the regular use of fluoride toothpaste in 14-30 days.ConclusionsThe authors found no evidence to support the use of Tooth Mousse(®) over brushing with a fluoride toothpaste for the prevention of early caries. ToothMousse(®) appeared to benefit regression of white spot lesions associated with orthodontic treatment but the evidence is limited. Effectiveness of Tooth Mousse(®) was not significantly increased by the addition of fluoride in Tooth Mousse Plus(®) and evidence is still lacking to support the use of one over another. High quality randomised clinical trials are needed before these products can be recommended for the prevention and treatment of early carious lesions in the general population.Source of fundingThe publication was funded by Colgate Palmolive, Australia.

A randomised clinical trial on the use of intermediate bonding on the retention of fissure sealants in children

OBJECTIVE

To assess whether an adhesive bonding agent increases the retention of resin fissure sealants on first permanent molars (FPMs) and to determine any difference in sealant retention on occlusal, buccal, or palatal surfaces. The effect of the child's behaviour on the retention of the sealants was also assessed.

METHODS

One hundred and twelve children were recruited (age range 5-15 years). One operator placed sealants (Helioseal, Ivoclar Vivadent) on 390 FPMs using a split-mouth design. The study group, (n = 195), had an ethanol-based adhesive bond (ExciTEF, Ivoclar Vivadent) placed prior to sealant application, and no bond was used in the control group (n = 195). The sealants were reviewed after 12 months and analysed using Fisher's exact test.

RESULTS

The addition of a bonding agent significantly increased sealant retention (P = 0.0005). Retention of bonded sealants on occlusal surfaces was higher (98%) than non-bonded sealants (93%) (P = 0.08). Bonded sealants placed on buccal/palatal surfaces were retained (92%) more successfully than non-bonded sealants (82%) (P = 0.0005). The behaviour of the patient significantly affected the retention of fissure sealants (P = 0.0001).

CONCLUSIONS

The addition of an ethanol-based bonding agent significantly increased the retention of sealants at 12 months particularly on palatal fissures of maxillary first permanent molar teeth.

Chairside repair of preveneered primary molar stainless steel crowns: a pilot study

PURPOSE

To evaluate the success of a direct chairside method for repair of esthetic facings in NuSmile® and Kinder Krowns® pediatric crowns.

METHODS

A rapid direct chairside technique was developed for repair of fractured facings of preveneered primary molar crowns using the Co-Jet system to pretreat the exposed metal subsurface and composite resin (Herculite XRV). A total of 19 posterior crowns were included in the pilot sample. The loss of veneer was categorized as less than 50 percent and over 50 percent of the surface area. All clinical repairs were completed by one operator and evaluated by one examiner after three months.

RESULTS

Clinically, all patients accepted the repair process achieved within 15 minutes. The repair was either fully intact (N=5) or completely lost (N=14) by three months. No crowns showed partially lost repairs. This protocol had a low success rate of 26 percent. The two successfully repaired Kinder Krowns® had the greatest occlusal surface area rebonded, exposing more fenestrations of the metal subsurface.

CONCLUSIONS

Due to poor retention of the repaired composite, this protocol cannot be recommended routinely for in vivo repair of preveneered stainless steel crowns with fractured facings. It could be considered as an interim procedure in selected cases.

A randomized clinical trial investigating the performance of two commercially available posterior pediatric preveneered stainless steel crowns: a continuation study

PURPOSE

This study aimed to compare the clinical and radiographic success of preveneered posterior NuSmile® and Kinder Krowns® over one year and to assess the level of parental satisfaction with their esthetics.

METHODS

Three trained operators placed 120 crowns in a split-mouth design with a random allocation for 36 participants (mean age: 5.8 years) who received two, four, six, or eight crowns. Blind assessment of the clinical and radiographic performance of the restorations was performed by four calibrated examiners after one year. Results were analyzed by Fisher's exact test and McNemar test. Examiner reliability was determined by Cohen's kappa score. Visual analogue scale (VAS) was used to assess the level of parental satisfaction.

RESULTS

All crowns but one were retained, and the majority (83 percent) had no facing fractures. Parental satisfaction was high (9.4/10 on the VAS). Primary maxillary first molar crowns had more occlusal facing fractures than their mandibular counterparts (P=.02). Primary mandibular second molar crowns showed more facing fractures than their maxillary counterparts (P=.008). Both types showed no statistical difference in most categories, but Kinder Krowns had more facing fractures (P<.02).

CONCLUSION

Posterior preveneered crowns have predictable durability at 12 months while offering natural appearance to restored teeth.

Assessment of occlusion after placement of stainless steel crowns in children - a pilot study

Many stainless steel crowns (SSCs) disrupt the occlusion in children, but stabilisation appears to occur within a short period post-placement. The extent and mechanism of these short-term occlusal changes in children are unknown. This study sought to determine whether placement of a SSC changes the maximum intercuspation position (MIP) in children, whether the MIP returns to normal within 4 weeks and whether local anaesthesia had an effect on the child's ability to achieve MIP. The T-Scan(®) III was used for the measurement of occlusal contacts. Reliability and reproducibility of the system was determined using a calibration exercise where MIP recordings were taken of eleven children not undergoing any dental treatment. For the main study, the percentage of total occlusal force on each tooth was recorded in 20 children preoperatively, after local anaesthesia, after SSC placement and 4 weeks postoperatively. There was no significant difference in MIP (P = 0·435) preoperatively and post-administration of local anaesthesia. There was a significant difference between the preoperative force on a tooth and the reading after crown placement (P = 0·0013, Wilcoxon test). By 4 weeks, there was no significant difference overall between post-SSC placement and the preoperative value for the tooth (P = 0·3). Administration of local anaesthesia did not affect the ability of a child to attain MIP. Maximum intercuspation position was disturbed by the placement of a SSC in seven of 20 cases. When MIP was disturbed, in most cases, it returned to preoperative status within 4 weeks of crown placement.

Posterior preveneered stainless steel crowns: clinical performance after three years

PURPOSE

The purpose of this study was to evaluate the clinical performance of posterior preveneered stainless steel crowns after three years.

METHODS

NuSmile crowns and Kinder Krowns were randomly allocated on paired molars using a split-mouth design. Variables such as fracture, wear, gingival health, and esthetics were recorded. (P<.05).

RESULTS

Statistical analysis was completed on 34 paired crowns in 14 children. After three years, 53 percent of crowns were fracture free compared to 81 percent at one year. There was minimal esthetic impact for most fractures due to the location of the veneer fracture, but five crowns had extensive fracture. No difference was reported in the clinical performance between the two crown types. Fracture was more likely to occur where the adjacent tooth was missing. Parents reported a satisfaction rating of 8.3 out of 10.

CONCLUSIONS

Clinical performance of both crown types was similar and successful for three years. Facing fracture occurred in 47 percent of crowns but had minimal impact on the esthetic value or parental satisfaction in the majority of cases. These crowns offer an esthetic alternative to the traditional stainless steel crown, but parents should be alerted to the possibility of veneer loss over time.

A foreign body in disguise

BACKGROUND

Young children habitually place objects in their mouths to discover and learn about the world and it is considered a normal stage of early childhood development. Ingestion and aspiration of foreign objects predominantly occurs in preschool toddlers with a peak incidence at age three years, and can have serious consequences.

CASE REPORT

A 2-year-old boy presented to the Dublin Dental University Hospital with a tooth-coloured mass tightly adherent to a lower primary incisor. The lesion surrounded the cervical third of the crown on the lower right primary central incisor and extended subgingivally. The tooth was mobile but with minimal inflammation.

TREATMENT

The tooth was subsequently extracted under general anaesthesia to reveal that the mass was in fact a foreign body, although this was originally thought unlikely as a cause.

FOLLOW-UP

The patient underwent an unremarkable recovery.

CONCLUSION

The case of a foreign body disguised as a tooth-like abnormality was only identified under general anaesthesia, and even then it was impossible to prise the object from the tooth in situ. Misdiagnosis of impacted foreign bodies in young children presents complicated diagnostic problems.

Treatment of open apex teeth using two types of white mineral trioxide aggregate after initial dressing with calcium hydroxide in children

BACKGROUND

The clinical and radiographic success of two types of white mineral trioxide aggregate (MTA) as apical barriers in non-vital immature permanent incisors in children was investigated.

MATERIALS AND METHODS

Following an initial dressing with calcium hydroxide, MTA apical barriers were placed in 22 non-vital traumatized, permanent incisors with open apices in 21 children (mean age 10years). Teeth were alternately assigned to either white MTA ProRoot(®) or white MTA Angelus groups and treated by two operators. Clinical and radiographic reviews took place at baseline, 3 months and every 6months thereafter. Two other calibrated, blinded examiners evaluated all radiographs. Examiner agreement was assessed using Kappa-Cohen tests. Results were analysed using Fisher's exact tests and repeated measures anova.

RESULTS

The mean follow-up time was 23.4months. There were no statistically significant differences in clinical or radiographic outcomes between the two groups. The overall clinical success and relative radiographic success rate was 95.5%. Statistically significant reduction in periapical pathosis was shown over time in both groups (P<0.05). A significant relationship was identified between non-divergent apical anatomy and ideal positioning of the MTA plug in all teeth (P=0.04). Interestingly, coronal discolouration was observed in 22.7% of teeth following white MTA placement.

CONCLUSIONS

Apical barrier placement using both white MTA ProRoot(®) and white MTA Angelus after an initial calcium hydroxide dressing showed similar favourable clinical and radiographic outcomes.

A clinical study evaluating success of 2 commercially available preveneered primary molar stainless steel crowns

PURPOSE

To evaluate the success of posterior NuSmile(®) and Kinder™Krown and to determine the level of parental satisfaction with this treatment option.

METHODS

Forty-eight crowns were placed in 18 children with a mean age of 5 years. A split mouth design was used. Each participant randomly received each crown type on 2 or 4 pair matched molars. Two trained operators completed all treatments. Two additional trained and calibrated clinicians blindly re-evaluated crowns according to specified variables. A visual analogue scale was used to determine parental satisfaction. Examiner reliability was determined by Cohen's kappa scores and results were analysed statistically using Fisher's exact test.

RESULTS

All crowns were retained after 12 months with no statistical difference in the clinical and radiographic success of posterior NuSmile(®) and Kinder™Krowns. Overall success was high with 81% of facings intact and 83% free of gingival inflammation after 12 months. Radiographically, 81% were successful. Veneer facing wear was significantly more likely to occur with opposing crowns (P=.02). Parental satisfaction was excellent with a mean score of 9.3 out of 10.

CONCLUSIONS

These crowns combine the durability of conventional stainless steel crowns with improved esthetics and are proposed as a suitable alternative where esthetic demand is increased.

Incisor reduction: a provisional aesthetic technique for traumatised teeth

Patients in the mixed dentition who have suffered severe extrusion or avulsion injuries often present with difficult treatment decisions, especially when the initial emergency care has been compromised. Here we describe a well-tolerated, aesthetically acceptable and conservative method for treating such patients until a definitive treatment plan is possible.

Oral health of children born small for gestational age

We sought to evaluate the oral health status of children born small for gestational age (SGA). Children now aged 4-8 years who were born SGA (birth weight < -2 SDS) were examined using standardised criteria. The parents completed a structured oral health questionnaire. Twenty females and 25 males, mean age 72.1 months, and mean birth weight 2.1 kg, participated in the study. Poor appetite was a concern; 32 (71%) children snacked between meals and 14 (30%) used carbonated beverages more than 3 times daily. Erosion was present in 9 (20%) children. Dental decay occurred in 22 (47%) children with 92% being untreated. Eight children had more than 5 decayed teeth. It is essential that clinicians working with children born SGA include oral health within the general health surveillance and refer these children for a dental assessment within the first 2 years to support parents in establishing safe feeding patterns for their children.

Orthodontic extrusion in the transitional dentition: a simple technique

Extrusion of teeth may be necessary in cases of delayed eruption, primary retention, traumatically intruded teeth, or subgingivally fractured teeth. Removable appliances are advantageous, as anchorage is not as tooth-dependant as in the case of fixed appliances. They are cost-effective, operator friendly, and a valuable treatment option to consider in cases where extrusion of anterior teeth in the transitional dentition is necessary. The purpose of this paper was to describe a simple, cost-effective technique using a removable appliance for extrusion of incisors in the transitional dentition.

An effective bleaching technique for non-vital, discoloured teeth in children and adolescents

Discolouration of a permanent incisor may have a significant social impact on children and adolescents. Intervention should be minimally destructive of tooth tissue and should not compromise future restorative options. This paper reviews the technique of inside/outside bleaching, and proposes it as an efficient, effective and acceptable method for use in the compliant younger patient with an unaesthetic non-vital tooth.

Paediatric dentistry experience of the first cohort of students to graduate from Dublin Dental School and Hospital under the new curriculum

AIM

To assess undergraduate clinical experience in Paediatric Dentistry in students graduating under a new curriculum.

METHODS

An audit using logbooks completed by 34 students for all patients for whom they had provided treatment in the university paediatric dentistry clinic.

RESULTS

A total of 177 child patients had received treatment from the students, age range 2-8 years. Students had performed an average of 13 restorative techniques. Sixty-eight percent had provided stainless steel crowns and 71% at least one pulpotomy for a primary tooth. All students had provided fissure sealants. Eighteen had carried out extractions and 8 had provided treatment for fractured incisors on this clinic.

CONCLUSIONS

The cohort of students included had a wide range of experience of paediatric dentistry which compared favourably with accepted guidelines. A relative lack of experience of dental extractions currently remains a problem.

Natural history and prevention of radiation injury

Radiation therapy for cancers of the head and neck can irreversibly damage the salivary glands. Xerostomia (subjective oral dryness) develops within the first week of therapy and is progressive, with devastating effects on the quality of life of the individual. The xerostomia does not correlate with the degree of salivary gland hypofunction. The mechanism of tissue injury in humans is still unclear, but much progress has been made with animal models. This paper reviews the natural history of radiation damage to human salivary glands and highlights the inter-individual variations in the responses to and recovery from therapeutic radiation. The degree of salivary gland damage is correlated to the dose of radiation delivered and the volume of gland included in the field of radiation. The molecular mechanism of acute radiation damage is not fully understood; however, long-term salivary gland dysfunction is associated with both loss of gland weight and loss of acinar cells. Various strategies have been used to prevent or alleviate the problem of salivary gland hypofunction following therapeutic radiation. This paper reviews the progress made to date and the possibilities for future interventions to prevent radiation damage.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) targets myeloid leukocytes in the uterus during the post-mating inflammatory response in mice

Factors in seminal plasma elicit a surge of GM-CSF expression in uterine epithelial cells after mating in mice. This study investigates the nature of the endometrial cell populations targeted by epithelial GM-CSF. In quantitative RT-PCR studies, expression of the alpha-subunit of the GM-CSF receptor (GM-CSF-R) parallelled GM-CSF expression, being maximal during the 48 h period after mating and declining thereafter. Expression of mRNA encoding beta-common chain (AIC2B) also increased after mating and remained high until the time of embryo implantation on day 4 of pregnancy. Cells expressing GM-CSF receptors were identified in sections of uterus on the day after mating using 125I-GM-CSF, and were located predominantly in the endometrial stroma subjacent to the luminal epithelium, co-localising with abundant populations of myeloid leukocytes. Cells expressing GM-CSF receptor were identified as macrophages, granulocytes and putative dendritic cells by flow cytometric analysis using lineage and receptor subunit specific antibodies. Recombinant GM-CSF injected into the uterine lumen of ovariectomised mice was found to elicit a dose-dependant accumulation of macrophages and granulocytes in the endometrium, in a pattern of distribution comparable to that seen in uteri after natural mating. Together, these data indicate a role for epithelial cell-derived GM-CSF in mediating the recruitment and potentially in modifying the behaviour of uterine leukocytes during the post-mating inflammatory response in mice.

Delayed eruption of permanent teeth in hyperimmunoglobulinemia E recurrent infection syndrome

OBJECTIVE

To determine the incidence of abnormal tooth eruption in patients with hyperimmunoglobulinemia E (hyper-IgE) syndrome.

STUDY DESIGN

This study evaluated 34 individuals with hyper-IgE syndrome (age range, 2-40 years). A comprehensive dental history and a head and neck evaluation were performed on all patients. Dental age was assessed in patients younger than 17 years by 2 methods: (1) clinical assessment of tooth eruption and (2) a radiographic method. Relationships between the chronologic age, dental developmental age, and age at tooth eruption were determined. Other oral or dental anomalies were recorded.

RESULTS

Of patients older than 7 years, 75% reported problems with permanent tooth eruption, as evidenced by retained primary teeth or the need for elective extractions of primary teeth to allow eruption of permanent teeth. None of the patients experienced problems with eruption of primary teeth. Eruption of the first and second permanent molars also occurred on time. Dental maturity scores were established for 14 patients 17 years of age or younger. In each case, the difference between chronologic age and the estimated dental developmental age was less than 12 months; however, we found a significant discrepancy between the chronologic age and the mean age of tooth eruption in 80% of these patients when using a particular set of standardized values. Persistence of Hertwig's epithelial root sheath was observed on histologic examination. Chronic multifocal oral candidiasis was a consistent feature in patients with hyper-IgE recurrent infection syndrome. Other oral anomalies were also noted.

CONCLUSION

We confirmed that a disorder of tooth eruption is part of the hyper-IgE syndrome. This problem occurs because of delayed primary tooth exfoliation rather than a developmental delay in the formation of the permanent dentition. The persistence of Hertwig's epithelial root sheath is unusual and may be associated with the lack of resorption of the primary teeth. Dentists should be aware of this feature of hyper-IgE syndrome because timely intervention will allow normal eruption to occur.

Safety and efficacy of adenovirus-mediated transfer of the human aquaporin-1 cDNA to irradiated parotid glands of non-human primates

This study evaluated the safety and efficacy of a single administration of a recombinant adenovirus encoding human aquaporin-1 (AdhAQP1) to the parotid glands of adult rhesus monkeys. In anticipation of possible clinical use of this virus to correct irradiation damage to salivary glands, AdhAQP1 was administered (at either 2 x 10(9) or 1 x 10(8) plaque-forming units/gland) intraductally to irradiated glands and to their contralateral nonirradiated glands. Radiation (single dose, 10 Gy) significantly reduced salivary flow in exposed glands. Virus administration resulted in gene transfer to irradiated and nonirradiated glands and was without untoward local (salivary) or systemic (sera chemistry, complete blood count) effects in all animals. However, the effect of AdhAQP1 administration varied and did not result in a consistent positive effect on salivary flow rates for all animals under these experimental conditions. We conclude that a single adenoviral-mediated gene transfer to primate salivary glands is well-tolerated, although its functional utility in enhancing fluid secretion from irradiated parotid glands is inconsistent.

Primary failure of tooth eruption: a unique case

Primary failure of tooth eruption rarely occurs. This case represents a rare clinical situation and appears to reflect a generalized disturbance in the eruptive process, inasmuch as (1) deciduous and permanent dentition are affected, (2) incisors, molars, and premolars are involved in all quadrants, (3) skeletal and craniofacial growth are within normal limits, and (4) no systemic/genetic anomalies were detected. This is the first such case reported in the literature; diagnosis and management are discussed.

Management of gingival overgrowth associated with generalized enamel defects in a child

Gingival overgrowth is usually associated with systemic conditions or treatment (e.g. blood dyscrasias, anti-epileptic or immunosuppressive agents). A child is presented, who had enlarged gingiva associated with a generalized enamel defect (amelogenesis imperfecta (AI), hypoplastic type) and document the periodontal and restorative management of this case.

Hyper-IgE syndrome with recurrent infections--an autosomal dominant multisystem disorder

BACKGROUND

The hyper-IgE syndrome with recurrent infections is a rare immunodeficiency characterized by recurrent skin and pulmonary abscesses and extremely elevated levels of IgE in serum. Associated facial and skeletal features have been recognized, but their frequency is unknown, and the genetic basis of the hyper-IgE syndrome is poorly understood.

METHODS

We studied 30 patients with the hyper-IgE syndrome and 70 of their relatives. We took histories, reviewed records, performed physical and dental examinations, took anthropometric measurements, and conducted laboratory studies.

RESULTS

Nonimmunologic features of the hyper-IgE syndrome were present in all patients older than eight years. Seventy-two percent had the previously unrecognized feature of failure or delay of shedding of the primary teeth owing to lack of root resorption. Common findings among patients were recurrent fractures (in 57 percent of patients), hyperextensible joints (in 68 percent), and scoliosis (in 76 percent of patients 16 years of age or older). The classic triad of abscesses, pneumonia, and an elevated IgE level was identified in 77 percent of all patients and in 85 percent of those older than eight. In 6 of 23 adults (26 percent), IgE levels declined over time and came closer to or fell within the normal range. Autosomal dominant transmission of the hyper-IgE syndrome was found, but with variable expressivity. Of the 27 relatives at risk for inheriting the hyper-IgE syndrome, 10 were fully affected, 11 were unaffected, and 6 had combinations of mild immunologic, dental, and skeletal features of the hyper-IgE syndrome.

CONCLUSIONS

The hyper-IgE syndrome is a multisystem disorder that affects the dentition, the skeleton, connective tissue, and the immune system. It is inherited as a single-locus autosomal dominant trait with variable expressivity.

Radiation-induced progressive decrease in fluid secretion in rat submandibular glands is related to decreased acinar volume and not impaired calcium signaling

The mechanism(s) of radiation-induced salivary gland dysfunction is poorly understood. In the present study, we have assessed the secretory function (muscarinic agonist-stimulated saliva flow, intracellular calcium mobilization, Na+/K+/2Cl- cotransport activity) in rat submandibular glands 12 months postirradiation (single dose, 10 Gy). The morphological status of glands from control and irradiated rats was also determined. Pilocarpine-stimulated salivary flow was decreased by 67% at 12 months (but not at 3 months) after irradiation. This was associated with a 47% decrease in the wet weight of the irradiated glands. Histological and morphometric analysis demonstrated that acinar cells were smaller and occupied relatively less volume and convoluted granular tubules were smaller but occupied the same relative volume, while intercalated and striated ducts maintained their size but occupied a greater relative volume in submandibular glands from irradiated compared to control animals. In addition, no inflammation or fibrosis was observed in the irradiated tissues. Carbachol- or thapsigargin-stimulated mobilization of Ca2+ was similar in dispersed submandibular gland cells from control and irradiated animals. Further, [Ca2+]i imaging of individual ducts and acini from control and irradiated groups showed, for the first time, that mobilization of Ca2+ in either cell type was not altered by the radiation treatment. The carbachol-stimulated, bumetanide-sensitive component of the Na+/K+/ 2Cl- cotransport activity was also similar in submandibular gland cells from control and irradiated animals. These data demonstrate that a single dose of gamma radiation induces a progressive loss of submandibular gland tissue and function. This loss of salivary flow is not due to chronic inflammation or fibrosis of the gland or an alteration in the neurotransmitter signaling mechanism in the acinar or ductal cells. The radiation-induced decrease in fluid secretion appears to be related to a change in either the water-handling capacity of the acini or the number of acinar cells in the gland.

Evaluation of oral problems in an osteogenesis imperfecta population

OBJECTIVE

The incidence of craniofacial and dental anomalies in children with the more severe nonlethal forms of osteogenesis imperfecta was evaluated.

STUDY DESIGN

The study evaluated 40 children (age range, 1-17.5 years) with types III and IV osteogenesis imperfecta. In each case, the dentition was evaluated for the presence of dentinogenesis imperfecta, attrition, and caries, as well as for radiographic appearance, dental development, and malocclusion.

RESULTS

The incidence of dentinogenesis imperfecta was greater than 80% in the primary dentition. Clinically, the color of the dentition was of predictive value in appropriate management of the primary dentition. Tooth discoloration and attrition did not occur to the same extent in the permanent dentition as in the primary dentition in either group. Class III dental malocclusion occurred in 70% to 80% of this osteogenesis imperfecta population, with a high incidence of anterior and posterior cross bites and open bites. A delay in dental development was observed in 21% of patients type III osteogenesis imperfecta, whereas accelerated development was noted in 23% of the patients with type IV. In addition, ectopic eruption occurred in 13 patients.

CONCLUSIONS

In addition to dentinogenesis imperfecta, significant oral problems occur in types III and IV osteogenesis imperfecta. Other features that impact the dental management of this population are highlighted.