Heterozygous COL17A1 variants are a frequent cause of amelogenesis imperfecta

BACKGROUND

Collagen XVII is most typically associated with human disease when biallelic COL17A1 variants (>230) cause junctional epidermolysis bullosa (JEB), a rare, genetically heterogeneous, mucocutaneous blistering disease with amelogenesis imperfecta (AI), a developmental enamel defect. Despite recognition that heterozygous carriers in JEB families can have AI, and that heterozygous COL17A1 variants also cause dominant corneal epithelial recurrent erosion dystrophy (ERED), the importance of heterozygous COL17A1 variants causing dominant non-syndromic AI is not widely recognised.

METHODS

Probands from an AI cohort were screened by single molecule molecular inversion probes or targeted hybridisation capture (both a custom panel and whole exome sequencing) for COL17A1 variants. Patient phenotypes were assessed by clinical examination and analyses of affected teeth.

RESULTS

Nineteen unrelated probands with isolated AI (no co-segregating features) had 17 heterozygous, potentially pathogenic COL17A1 variants, including missense, premature termination codons, frameshift and splice site variants in both the endo-domains and the ecto-domains of the protein. The AI phenotype was consistent with enamel of near normal thickness and variable focal hypoplasia with surface irregularities including pitting.

CONCLUSION

These results indicate that COL17A1 variants are a frequent cause of dominantly inherited non-syndromic AI. Comparison of variants implicated in AI and JEB identifies similarities in type and distribution, with five identified in both conditions, one of which may also cause ERED. Increased availability of genetic testing means that more individuals will receive reports of heterozygous COL17A1 variants. We propose that patients with isolated AI or ERED, due to COL17A1 variants, should be considered as potential carriers for JEB and counselled accordingly, reflecting the importance of multidisciplinary care.

Molar incisor hypomineralisation: Teaching and assessment across the undergraduate dental curricula in the UK

BACKGROUND

No consensus exists on how molar incisor hypomineralisation (MIH) should be covered by the undergraduate dental curricula.

AIM

To assess the current teaching and assessment of MIH in the UK.

DESIGN

A piloted questionnaire regarding the teaching and assessment of MIH was disseminated to paediatric, restorative and orthodontic teaching leads in each UK dental school (n = 16). Data were analysed using descriptive statistics, chi-squared and Kruskal-Wallis tests.

RESULTS

Response rates from paediatric, restorative and orthodontic teams were 75% (n = 12), 44% (n = 7) and 54% (n = 8), respectively. Prevention of caries, preformed metal crowns, anterior resin composites and vital bleaching were taught significantly more by paediatric teams (p = .006). Quality of life and resin infiltration were absent from restorative teaching. Orthodontic teaching focussed on the timing of first permanent molar extractions. Paediatric teams were mainly responsible for assessment. Risk factors, differential diagnoses for MIH and defining clinical features were more likely to be assessed by paediatric teams than by others (p = .006). All specialities reported that students were prepared to manage MIH.

CONCLUSION

Molar incisor hypomineralisation is primarily taught and assessed by paediatric teams. No evidence of multidisciplinary or transitional teaching/assessment existed between specialities. Developing robust guidance regarding MIH learning in the UK undergraduate curricula may help improve consistency.

Dental professionals' views on motivational interviewing for the prevention of dental caries with adolescents in central Norway

BACKGROUND

Establishing positive oral health behaviours during adolescence should be a key priority to improve lifelong oral health. However, changing adolescent behaviours is known to be a challenge. Motivational interviewing (MI) is a method of working with patients to activate their motivation for change and has shown promising results within the dental setting. Yet, little is known about the actual experiences and perspectives of Norwegian dental health professionals in delivering motivational interviewing as part of routine care to their young patients. The overall aim of the present study was to explore the implementation of motivational interviewing by dentists and dental hygienists, employed by the Norwegian Public Dental Service, for their adolescent patients.

METHODS

As part of the larger #Care4YoungTeeth <3 project, a Norwegian Research Council funded four-year Collaborative Project to Meet Societal and Industry-related Challenges, an online survey was developed and administered to dental personnel (n = 168) in one region of Central Norway. Data were analysed by descriptive statistics and two-sample tests of proportions at the 95% confidence level.

RESULTS

A total of 98 dental personnel responded to the survey (response rate 58.3%), of which 37 were dental hygienists (response rate 72.5%) and 61 were dentists (response rate 52.1%). A greater proportion of hygienists reported implementing this intervention compared to dentists (78.4% versus 50.8%; p = 0.007). Similarly, a greater proportion of hygienists (83.8%) stated that they had received training in MI compared to dentists (65.6%; p = 0.051). About 80% of dentists and 90% of dental hygienists felt that they understood the principles of MI. However, only about 45% and 60%, respectively, felt confident in its use. Dental hygienists found MI more usable in their work (p = 0.052), to a greater extent want to use MI (p = 0.002) and found that using MI works well (p < 0.001), as compared to dentists.

CONCLUSIONS

A high proportion of dental professionals working within a Norwegian public dental service have received training in MI. However, barriers to implementation for adolescent patients and differences in practice between dentists and hygienists warrant further enquiry.

An International Investigation of Molar Incisor Hypomineralisation (iMIH) and Its Association with Dental Anomalies: Development of a Protocol

BACKGROUND

Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations.

METHODS

Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7-16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics.

CONCLUSION

This large-scale study has the potential to improve understanding about MIH with benefits for patient management.

Making white spots disappear! Do minimally invasive treatments improve incisor opacities in children with molar-incisor hypomineralisation?

BACKGROUND

Children with molar-incisor hypomineralisation (MIH) frequently seek aesthetic treatment for incisor opacities. Surprisingly, few studies have evaluated the clinical success of such interventions.

AIM

To quantify the effectiveness of minimally invasive treatments in reducing enamel opacity visibility in children with MIH.

DESIGN

This in vitro study used digital clinical images of 23 children aged 8-16 years with MIH who underwent microabrasion and/or resin infiltration for the management of incisor opacities. Standard images were taken pre-treatment and 6 months post-treatment. Image software (Image-Pro Plus^® V7) was employed to convert 24-bit RGB images to 16-bit greyscale and 145× magnification. Measurement repeatability was assessed using intra-class correlation coefficients (ICCs). Post-treatment changes in visible opacity area (mm² ) and brightness (greyscale value) were tested using the Wilcoxon signed-rank test for related samples.

RESULTS

The mean total opacity surface area significantly reduced from 14.3 mm² (SD = 7.5) to 9.4 mm² (SD = 9.0) post-treatment. The proportion of tooth surface affected by the opacity also significantly reduced from 22.5% (SD = 10.5) to 14.7% (SD = 12.7). The mean maximum opacity brightness significantly reduced from 53 066 greyscale value (SD = 4740) to 49 040 (SD = 3796). ICC was good/excellent (0.75-1.0).

CONCLUSION

Minimally invasive treatment is effective in reducing the size and brightness of discrete incisor opacities. Future research should compare objective findings with patient-reported outcomes.

Adolescent valuation of CARIES-QC-U: a child-centred preference-based measure of dental caries

Objectives

This study develops an adolescent value set for a child-centred dental caries-specific measure of oral health-related quality of life (OHRQoL) based upon CARIES-QC (Caries Impacts and Experiences Questionnaire for Children). This study develops a new approach to valuing child health by eliciting adolescent preferences and anchoring these onto the 1–0 full health-dead QALY (quality adjusted life year) scale using ordinal adult preferences.

Methods

Two online surveys were created to elicit preferences for the CARIES-QC classification system. The first comprised best–worst scaling (BWS) tasks for completion by adolescents aged 11–16 years. The second comprised discrete choice experiment tasks with a duration attribute (DCE_TTO) for completion by adults aged over 18 years. Preferences were modelled using the conditional logit model. Mapping regressions anchored the adolescent BWS data onto the QALY scale using adult DCE_TTO values, since the BWS survey data alone cannot generate anchored values.

Results

723 adolescents completed the BWS survey and 626 adults completed the DCE_TTO survey. The samples were representative of UK adolescent and adult populations. Fully consistent and robust models were produced for both BWS and DCE_TTO data. BWS preferences were mapped onto DCE_TTO values, resulting utility estimates for each health state defined by the classification system.

Conclusion

This is the first measure with predetermined scoring based on preferences to be developed specifically for use in child oral health research, and uses a novel technique to generate a value set using adolescent preferences. The estimates can be used to generate QALYs in economic evaluations of interventions to improve children’s oral health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-01918-w.

A missense variant in specificity protein 6 (SP6) is associated with amelogenesis imperfecta

Amelogenesis is the process of enamel formation. For amelogenesis to proceed, the cells of the inner enamel epithelium (IEE) must first proliferate and then differentiate into the enamel-producing ameloblasts. Amelogenesis imperfecta (AI) is a heterogeneous group of genetic conditions that result in defective or absent tooth enamel. We identified a 2 bp variant c.817_818GC>AA in SP6, the gene encoding the SP6 transcription factor, in a Caucasian family with autosomal dominant hypoplastic AI. The resulting missense protein change, p.(Ala273Lys), is predicted to alter a DNA-binding residue in the first of three zinc fingers. SP6 has been shown to be crucial to both proliferation of the IEE and to its differentiation into ameloblasts. SP6 has also been implicated as an AI candidate gene through its study in rodent models. We investigated the effect of the missense variant in SP6 (p.(Ala273Lys)) using surface plasmon resonance protein-DNA binding studies. We identified a potential SP6 binding motif in the AMBN proximal promoter sequence and showed that wild-type (WT) SP6 binds more strongly to it than the mutant protein. We hypothesize that SP6 variants may be a very rare cause of AI due to the critical roles of SP6 in development and that the relatively mild effect of the missense variant identified in this study is sufficient to affect amelogenesis causing AI, but not so severe as to be incompatible with life. We suggest that current AI cohorts, both with autosomal recessive and dominant disease, be screened for SP6 variants.

Molar Incisor Hypomineralisation: Current Knowledge and Practice

BACKGROUND

Molar incisor hypomineralisation (MIH) is a common developmental dental condition that presents in childhood. Areas of poorly formed enamel affect one or more first permanent molars and can cause opacities on the anterior teeth. MIH presents a variety of challenges for the dental team as well as functional and social impacts for affected children.

OBJECTIVES

Here, we provide an up-to-date review of the epidemiology, aetiology, diagnosis and clinical management of MIH.

MATERIALS AND METHODS

A review of the contemporary basic science and clinical literature, relating to MIH, was undertaken using information obtained (up to 10 April 2020) from the electronic databases PubMed, Scopus, Web of Science and the Cochrane Library.

RESULTS

There is a growing body of evidence relating to the aetiology, presentation and clinical management of MIH. Current knowledge appears to be focused on potential genetic aspects, as well as the development and validation of indices for the diagnosis and management of MIH. There has also been increasing recognition of the global and individual burden of this common condition.

CONCLUSIONS

Dental health professionals should regularly appraise the basic science and clinical MIH literature to ensure that they provide the best possible short- and long-term care for their young patients.

A rapid review of variation in the use of dental general anaesthetics in children

Introduction The use of dental general anaesthetics (DGAs) remains a cause for concern due to additional strains placed on health services. There are numerous factors influencing the prevalence and use of DGAs, and understanding these is an important first step in addressing the issue.Aim Conduct a rapid review of current peer-reviewed and grey literature on the variation in the use of DGAs in children.Methods Electronic searching using Medline via Ovid covering DGA articles from 1998 onwards, written in English. Publication types included primary and secondary sources from peer-reviewed journals and reports, as well as grey literature.Results From 935 results, 171 articles were included in the final review. Themes emerging from the literature included discussions of DGA variation, variations in standards of service provision by health services, and the socio-demographic and geographical characteristics of children. Prominent socio-demographic and geographical characteristics included age, other health conditions, ethnic and cultural background, socioeconomic status and deprivation, and geographical location.Conclusions This review identified numerous variations in the patterns associated with DGA provision and uptake at both a health service and individual level. The findings demonstrate the complicated and multifaceted nature of DGA practices worldwide.

Selection and validation of a classification system for a child-centred preference-based measure of oral health-related quality of life specific to dental caries

Background

Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) is a child-centred caries-specific quality of life measure. This study aimed to select, and validate with children, a classification system for a paediatric condition-specific preference-based measure, based on CARIES-QC.

Methods

First, a provisional classification system for a preference-based measure based on CARIES-QC was identified using Rasch analysis, psychometric testing, involvement of children and parents, and the developer of CARIES-QC. Second, qualitative, semi-structured ‘think aloud’ validation interviews were undertaken with a purposive sample of children with dental caries. The interviewer aimed to identify whether items were considered important and easily understood, whether any were overlapping and if any excluded items should be reintroduced. Interview recordings were transcribed verbatim and thematic analysis conducted.

Results

Rasch analysis identified poor item spread for the items ‘cross’ and ‘school’. Items relating to eating were correlated and the better performing items were considered for selection. Children expressed some confusion regarding the items ‘school’ and ‘food stuck’. Parent representatives thought that impacts surrounding toothbrushing (‘brushing’) were encompassed by the item ‘hurt’. Five items were selected from CARIES-QC for inclusion in the provisional classification system; ‘hurt’, ‘annoy’, ‘carefully’, ‘kept awake’ and ‘cried’. Validation interviews were conducted with 20 children aged 5–16 years old. Participants thought the questionnaire was straightforward and covered a range of impacts. Children thought an item about certain foods being ‘hard to eat’ was more relevant than one about having to eat more carefully because of their teeth and so the ‘carefully’ item was replaced with ‘hard to eat’.

Conclusion

Following child-centred modification, the preliminary five-item classification system is considered valid and suitable for use in a valuation survey. The innovative child-centred methods used to both identify and validate the classification system can be applied in the development of other preference-based measures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-020-00268-9.

National patterns in paediatric hospital admissions for dental extractions in England

OBJECTIVES

Paediatric hospital admissions for dental extractions remain a cause for concern, despite decreasing levels of dental diseases in some areas of the country. While local investigations have taken place, little is known about national patterns, and how the relationship between the number of hospital admissions and key independent variables differs across England. The aim of this study was to examine spatial differences in the number of paediatric hospital admissions for extractions in relation to four key independent variables: dental caries, deprivation, units of dental activity and child access to dentists.

METHODS

Hospital admissions data (for all dental-related reasons) were taken from the Hospital Episode Statistics (HES) for England (2017/18) for children and adolescents aged up to 19 years. All data were collected at local authority level. Geographically weighted regression was used to examine associations between the number of hospital admissions and the independent variables, as well as the strength of these associations and how they differed spatially.

RESULTS

Geographically weighted regression revealed considerable differences in the associations between the number of paediatric hospital admissions and the independent variables across England, with distinct regional clusters identified in the data. Some areas exhibited positive associations between independent variables and the number of hospital admissions, such as in Yorkshire and areas of south-west, south-east and north-west England, where greater mean dmft scores were associated with greater numbers of hospital admissions. Negative associations were also found, such as in south-west, north-west and North East England, where higher deprivation scores were associated with lower admission numbers. Despite the patterns found, a much smaller sample of the associations between the independent variables and the number of hospital admissions was statistically significant.

CONCLUSIONS

This analysis allows for a better understanding of the spatial associations between the number of hospital admissions and key independent variables, as well as how changes to these independent variables may affect the number of admissions in each local authority. These findings should be considered in the context of the limitations of HES dataset.

What children say and clinicians hear: accounts relating to incisor hypomineralisation of cosmetic concern

AIM

To explore the range of impacts relating to incisor opacities as described by children, their general dental practitioners and paediatric dentists.

METHODS

Participants included 50 children, aged 7-16 years, referred to a UK hospital paediatric dentistry service for management of incisor opacities. All children were subsequently diagnosed with molar incisor hypomineralisation. Following ethical approval, data were recorded as follows: patient demographics, distance travelled, waiting times, nature of any impacts relating to incisor opacities documented in referral letters and/or in subsequent paediatric dentistry assessment records. Additionally, children completed the short form Child Oral Health Impact Profile questionnaire (COHIP-SF19) as a self-report measure of their oral health-related quality of life (OHRQoL).

RESULTS

Nearly, half (48%, n = 24) of the referral letters mentioned that the child was experiencing one or more negative social and/or functional impacts. Mean COHIP score was significantly lower (indicating poorer OHRQoL) for children whose referring dentist had identified a negative impact (COHIP = 42.9) compared to those with no documented impact (COHIP = 50.5; p = 0.018, independent t test). At the hospital consultation, negative impacts were elicited by a paediatric dentist in 86% (n = 43) of cases. Again, mean COHIP score was significantly lower for children whose assessment records noted a negative impact (COHIP = 44.5) compared to those with no recorded impact (COHIP = 60.2; p = 0.001). Families travelled a mean distance of 57 km (range 3-218 km) to the hospital service, with an average waiting time of 75 days from referral.

CONCLUSION

It is encouraging that dental professionals seem to be aware of the negative psychosocial impacts experienced by some children with enamel opacities, and that children feel able to describe them.

A systematic review of the quality and scope of economic evaluations in child oral health research

BACKGROUND

Economic evaluations provide policy makers with information to facilitate efficient resource allocation. To date, the quality and scope of economic evaluations in the field of child oral health has not been evaluated. Furthermore, whilst the involvement of children in research has been actively encouraged in recent years, the success of this movement in dental health economics has not yet been explored. This review aimed to determine the quality and scope of published economic evaluations applied to children's oral health and to consider the extent of children's involvement.

METHODS

The following databases were searched: CINAHL, Cochrane Library, Econlit, EThOS, MEDLINE, NHS EED, OpenGrey, Scopus, Web of Science. Full economic evaluations, relating to any aspect of child oral health, published after 1997 were included and appraised against the Drummond checklist and the Consolidated Health Economic Evaluation Reporting Standards by a team of four calibrated reviewers. Data were also extracted regarding children's involvement and the outcome measures used.

RESULTS

Two thousand seven hundred fifteen studies were identified, of which 46 met the inclusion criteria. The majority (n = 38, 82%) were cost-effectiveness studies, with most focusing on the prevention or management of dental caries (n = 42, 91%). One study quantified outcomes in Quality Adjusted Life Years (QALYs), and one study utilised a child-reported outcome measure. The mean percentage of applicable Drummond checklist criteria met by the studies in this review was 48% (median = 50%, range = 0-100%) with key methodological weaknesses noted in relation to discounting of costs and outcomes. The mean percentage of applicable CHEERS criteria met by each study was 77% (median = 83%, range = 33-100%), with limited reporting of conflicts of interest. Children's engagement was largely overlooked.

CONCLUSIONS

There is a paucity of high-quality economic evaluations in the field of child oral health. This deficiency could be addressed through the endorsement of standardised economic evaluation guidelines by dental journals. The development of a child-centred utility measure for use in paediatric oral health would enable researchers to quantify outcomes in terms of quality adjusted life years (QALYs) whilst promoting child-centred research.

Development and evaluation of CARIES-QC: a caries-specific measure of quality of life for children

BACKGROUND

Existing paediatric oral health-related quality of life (OHRQoL) measures are generic instruments designed to evaluate a range of oral conditions. It has been found that disease-specific measures may be more adept at detecting subtle changes which occur following treatment of the condition in question. Furthermore, existing self-report OHRQoL measures have not involved children at all stages of development of the measure. The aim of this study was to develop a caries-specific measure of quality of life for children.

METHODS

The first stage of the study involved a qualitative enquiry with children, aged 5-16 years, to inform the development of the measure. Children generated the potential items, contributed to item reduction and questionnaire design and participated in the testing of face and content validity. The resulting measure was evaluated in a cross-sectional validation study. Ethical approval was granted for the study.

RESULTS

The qualitative study found that children discussed a number of caries-related impacts which affected their daily lives. These were incorporated into a draft measure which was further refined following testing of face and content validity. This resulted in the production of the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC), comprising 16 items and one global question. Two hundred participants with a mean (range) age of 8.1 (5-16) years took part in the further evaluation of CARIES-QC. Four items, which did not fit the Rasch model, were removed from further analysis. The remaining 12 items demonstrated good internal consistency (alpha = 0.9) and the total score showed significant correlations with the number of decayed teeth, presence of pain, pulpal involvement, the Child Perceptions Questionnaire (16-item short form) and the global score (p < 0.01, Spearman's rho).

CONCLUSION

In conclusion, children's input allowed the development of a valid and reliable child-centred caries-specific quality of life measure. CARIES-QC can now be used to evaluate which interventions for dental caries are most effective in reducing impacts from the child's perspective.

Failed Attendances at Hospital Dental Clinics among Young Patients with Cleft Lip and Palate

Objective:

To determine the frequency of missed dental appointments among children with a cleft lip and/or palate (CL/P).

Design:

A prospective study of failed appointments over a 12-month period.

Setting:

Three different CL/P clinics within a British dental hospital.

Patients:

Forty-five CL/P children (mean age of 8.8 years) and 45 age-matched, gender-matched, and postal code–matched noncleft patients.

Main outcome measures:

The overall percentage of missed appointments at three different clinics by CL/P patients and the difference in attendance rates at the pediatric dentistry clinic between CL/P and non-CL/P children.

Results:

Pediatric dentistry had the highest rate of missed appointments (22.4%), followed by the multidisciplinary cleft clinic (9.2%) and the orthodontic clinic (8.8%). CL/P patients missed a significantly greater proportion of their pediatric dentistry appointments than noncleft children (22.4% versus 11.9%). Patients with a bilateral CL/P were significantly more likely to miss an appointment than patients with a unilateral CL/P. Age, gender, medical history, and distance traveled had no significant effect on attendance rates.

Conclusions:

Further work is needed to identify risk factors for poor attendance and to develop strategies to reduce the frequency of missed appointments in this vulnerable group.

Development of a decision aid for children faced with the decision to undergo dental treatment with sedation or general anaesthesia

BACKGROUND

Decision aids are tools used to help individuals faced with difficult healthcare decisions. They help patients further understand the treatment options available and encourage the sharing of information between patients and clinicians.

AIM

To develop a decision aid for young patients faced with the decision to undergo dental treatment with inhalation sedation, intravenous sedation, or general anaesthesia (GA).

DESIGN

Qualitative interviews with dental patients (aged 10-16 years), and their parents/guardians were used to inform the content of a draft decision aid. Following further revisions, a pilot evaluation of the decision aid was conducted. Patients referred for dental treatment with sedation or GA were recruited from a UK dental hospital. Patients (n = 15) and parents/guardians (n = 13) assigned to the intervention group received the decision aid and routine clinical counselling, whereas patients (n = 17) and parents/guardians (n = 13) in the control group only received routine clinical counselling. Participants completed measures of knowledge, decisional conflict, and dental anxiety.

RESULTS

Knowledge scores were significantly higher for participants who received the decision aid when compared to standard care. There were no other significant differences between groups.

CONCLUSIONS

A decision aid was successfully developed, and initial findings suggest such tools could be beneficial to dental sedation or GA patients and their parents/guardians. Further research is required on the use of such tools in primary care settings, with particular attention to the impact of the decision aid on attendance and completion rates of treatment.

Change in children's oral health-related quality of life following dental treatment under general anaesthesia for the management of dental caries: a systematic review

BACKGROUND

Dental caries has significant impact on children and their families and may necessitate treatment under general anaesthesia (GA). The use of oral health-related quality-of-life (OHRQoL) measures enables evaluation of dental treatment from a patient's perspective.

OBJECTIVE

This systematic review aimed to assess change in OHRQoL in children following treatment under GA for the management of dental caries.

METHODS

A comprehensive search was conducted to identify articles which were assessed against inclusion criteria before data extraction. Studies involving children under 16 years, having treatment for dental caries under GA, were considered eligible. Included studies were quality assessed.

RESULTS

Twenty studies were included, which demonstrated significant heterogeneity. Most studies employed a pre-test-post-test design. All but one study relied on proxy reports of OHRQoL. Only half the studies used instruments validated in the study population. Whereas all studies reported improved OHRQoL overall, some subscales showed changes which were not significant or worsened OHRQoL. The scientific quality of the studies varied considerably.

CONCLUSION

Heterogeneity of included papers limited the conclusions which could be drawn. Treatment under GA appears to result in overall improvements in proxy-reported OHRQoL; however, there is a need for further high-quality studies employing validated, child-reported measures of OHRQoL.

Children's experiences of dental anxiety

BACKGROUND

Dental anxiety is common among children. Although there is a wealth of research investigating childhood dental anxiety, little consideration has been given to the child's perspective.

AIM

This qualitative study sought to explore with children their own experiences of dental anxiety using a cognitive behavioural therapy assessment model.

DESIGN

Face-to-face, semi-structured interviews were conducted with dentally anxious children aged 11-16 years. The Five Areas model was used to inform the topic guide and analysis. Data were analysed using a framework approach.

RESULTS

In total, 13 children were interviewed. Participants described their experiences of dental anxiety across multiple dimensions (situational factors and altered thoughts, feelings, physical symptoms, and behaviours). Participants placed considerable value on communication by dental professionals, with poor communication having a negative influence on dental anxiety and the dentist-patient relationship.

CONCLUSIONS

This study confirms the Five Areas model as an applicable theoretical model for the assessment of childhood dental anxiety. Children provided insights about their own dental anxiety experiences that have not previously been described.

Traumatic dental injury research: on children or with children?

BACKGROUND AND AIM

It is widely acknowledged that children should participate in healthcare decisions, service development and even setting research agendas. Dental traumatology is a major component of paediatric dentistry practice and research. However, little is known about young patients' contribution to new knowledge in this field. The aim of the study was to establish the extent to which children are involved in contemporary dental trauma research and to evaluate the quality of the related literature.

MATERIAL AND METHODS

A systematic review of the dental trauma literature was conducted from 2006 to 2014. The electronic databases, MEDLINE and Scopus, were used to identify relevant studies. The selected papers were independently examined by five calibrated reviewers. Studies were categorized by the degree of children's involvement and appraised using a validated quality assessment tool.

RESULTS

The initial search yielded 4374 papers. After application of the inclusion and exclusion criteria, only 96 studies remained. Research on children accounted for 87.5% of papers, and a proxy was involved in 4.2%. Children were engaged to some degree in only 8.3% of studies, and there were no studies where children were active research participants. In the quality assessment exercise, papers scored, on average, 57% (range = 14-86%).

CONCLUSION

There is scope to encourage more active participation of children in dental trauma research in the future. Furthermore, there are some areas where the quality of research could be improved overall.

How do children view other children who have visible enamel defects?

BACKGROUND

Facial and dental appearance influences how individuals are perceived by others.

AIM

This study aimed to determine whether young people make judgements about other young people with visible enamel opacities.

DESIGN

Focus group findings were used to develop a social attribute questionnaire to capture young people's dental appearance-related judgements. 547 pupils (aged 11-15 years), from two different schools, participated in the study. Half the participants were given full-face photographs of a boy and girl without an enamel defect, and the other half were given the same two photographs with the subjects' incisors digitally modified to show enamel opacities. Participants completed the attribute questionnaire to rate the photographic subjects according to six positive and five negative descriptors using a four-point Likert scale. The total attribute score (TAS) could range from 11 (most negative) to 44 (most positive).

RESULTS

TAS was significantly lower for photographic subjects with enamel defects compared to the same subject with normal enamel appearance (P < 0.001, one sample t-test). Gender had a significant impact on TAS, with boys making more negative judgements than girls. Age and socio-economic status did not have an effect.

CONCLUSION

Young people may make negative psychosocial judgements on the basis of enamel appearance.

Seen and heard: towards child participation in dental research

BACKGROUND

There has been an increasing emphasis in many countries worldwide to capture the views of children on health services and research. A previous systematic review found that most oral health research from 2000 to 2005 was conducted on children and highlighted the need for greater research with children.

AIM

To describe the extent to which oral health research between 2006 and 2014 has been conducted with or on children.

DESIGN

Systematic review. Electronic databases were searched for the literature on child dental health. Each identified paper was examined by two researchers and categorised based on the extent to which children were involved in the research, the type of study (evaluative or otherwise), the country of origin, and the clinical discipline.

RESULTS

The search included 2950 papers after application of the exclusion criteria. Of these, 17.4% were with children, 18.3% involved the use of proxies (parents or clinician), and 64.2% were on children.

CONCLUSIONS

The proportion of studies from 2006 to 2014 involving research with children has increased from 7.3% in 2000-2005. This systematic review provides evidence for movement towards children's involvement in dental research over the last 10 years. Future dental research must focus on incorporating children's perspectives into the evaluation of dental treatments to improve outcomes for children.

The impact of dental caries on children and young people: what they have to say?

BACKGROUND

Dental caries affects 60-90% of children across the world and is associated with a variety of negative impacts. Despite its ubiquity, there has been surprisingly little exploration of these impacts from the child's perspective.

AIM

The aim was to allow children to describe the impact of dental caries on their daily lives and to describe the terminology they used.

DESIGN

Children, aged 5-15 years, with caries experience were purposively sampled from primary and secondary care dental clinics. Focus groups (n = 5) and in-depth interviews (n = 16) were recorded and transcribed verbatim. Data analysis took a narrative approach, and themes were derived from the data using framework analysis.

RESULTS

Pain was the main theme to emerge. Within this, three subthemes were identified: impacts related to pain, strategies adopted to reduce pain, and emotional aspects resulting from pain. A second theme was also identified relating to the aesthetic aspects of caries.

CONCLUSION

Children as young as 5 years of age were able to competently discuss their experiences of dental caries. Participants reported a number of impacts affecting various aspects of their lives. These will be incorporated into the future development of a caries-specific measure of oral health-related quality of life.

Childhood dental injuries: a resiliency model of adaptation

BACKGROUND

There is a paucity of research examining how children and their families adapt to traumatic dental injuries.

AIM

This study examined how clinical and psychosocial factors influence adaptation to this oral stressor using a theoretical framework of resiliency and adaptation.

DESIGN

Children with traumatised permanent teeth, who were attending a UK dental hospital, completed questionnaires at baseline and at a 6 month follow-up. Child questionnaires assessed coping styles, social support, and quality of life outcomes. Parents were also asked to complete questionnaires, which assessed previous stressors/strains on the family, social support, healthcare satisfaction, and family impacts. Data related to the child's dental injury were collected from clinical notes. Structural equation modelling and regression analyses were employed to analyse data.

RESULTS

One hundred and eight children and 113 parents participated at baseline. Children's gender, coping style, social support, and family functioning significantly predicted children's oral health-related quality of life. Parents' satisfaction with their children's dental care significantly predicted parental quality of life outcomes. Children's close friend support and healthcare satisfaction remained significant predictors of positive outcomes at follow-up.

CONCLUSIONS

The findings revealed important psychosocial factors that influence child and family adaptation to childhood dental trauma.

Pulpal status of human primary molars with coexisting caries and physiological root resorption

AIM

This study sought to investigate the effect of caries, in association with physiological root resorption, on the pulpal status of human primary molars.

DESIGN

Fifty-three mandibular primary molars were obtained from children requiring extractions under general anaesthesia. Following extraction, teeth were split longitudinally and placed in Zamboni's fixative. Teeth were categorised according to i) the depth of caries (less than or greater than halfway through dentine thickness) and ii) the degree of physiological root resorption (<33%, 34-66% or >67% of the root length). Ten-micrometre pulp sections were subject to indirect immunofluorescence using a combination of PGP 9.5 (a general neuronal marker), CD45 (a general neuronal marker), and Ulex europaeus agglutinin I (a marker of vascular endothelium). Image analysis was used to determine the percentage area of staining (PAS) for innervation and immune cells.

RESULTS

Marked differences were seen between different samples, but there were no significant differences in mean PAS for PGP 9.5 or CD45 according to the degree of caries or extent of physiological root resorption (two-way anova, P > 0.05).

CONCLUSION

Findings suggest that even if primary molars are undergoing exfoliation, they show comparable caries-induced changes to teeth without physiological root resorption, thus retaining potential for healing and repair.

Video diaries to capture children's participation in the dental GA pathway

AIM

To explore children's experiences of having teeth extracted under general anaesthetic, with a focus on opportunities to participate in their care pathway.

STUDY DESIGN

Qualitative study where analysis was informed by a narrative approach.

METHODS

Ten fit and healthy children, aged 6-11 years, who required multiple dental extractions under general anaesthesia at a UK Children's Hospital, participated in the study. Participants were invited to keep a video diary of their thoughts and experiences leading up to, and following, their hospital admission. Data collection was supported by two semi-structured home interviews.

RESULTS

Three themes emerged relating to participation: (i) children's prior knowledge and expectations of the dental general anaesthetic (DGA); (ii) their role in decision-making about the DGA and (iii) opportunities identified by children to actively participate in their care pathway. Children's feedback suggested that they did not feel fully informed or involved in decisions about the procedure and were upset about not being able to keep their extracted teeth.

CONCLUSIONS

Child-centred resources and decision-aids may be helpful in providing greater opportunities for children to participate in their DGA pathway. However, considerable challenges lie in engaging children without increasing pre-DGA anxiety or conflicting with parents' views about what is best for their child.

Impact of the Hall technique for preformed metal crown placement on undergraduate paediatric dentistry experience

The Hall technique, a novel method of placing preformed metal crowns (PMCs) without local anaesthesia or tooth preparation, was introduced to our undergraduate dental curriculum in 2009. This study aimed to describe student experience of, and attitudes towards, PMCs before and after exposure to this new technique. Clinical data were extracted from student logbooks to determine the number of PMCs placed for cohorts graduating in 2005 (n = 55), 2009 (n = 61) and 2010 (n = 75). Five focus groups were also conducted with 29 final-year dental students. Students graduating in 2005, 2009 and 2010 had placed a mean (range) of 0.03 (0-1), 0.63 (0-5) and 1.15 (0-9) PMCs, respectively. The proportion of students who had placed a PMC increased significantly from only 1.9% in 2005 to 75% in 2010 (P < 0.05, ANOVA). Students reported some positive experiences of the Hall technique. However, concern over perceived lack of future clinical support, an anticipated increase in time and financial pressures, and the ease of use of glass-ionomer cement as an alternative were described as potential barriers to PMC use. Findings suggest that the introduction of the Hall technique has had a marked impact on the use of PMCs as a treatment modality for carious primary teeth.

Ectopic eruption of first permanent molars: A preliminary report of presenting features and associations

AIM

To investigate presenting features of ectopically erupting first permanent molars and associations with other dental anomalies.

STUDY DESIGN

Prospective convenience study.

METHODS

28 panoral radiographs were collected, over a 24-month period, of 7-11 year-old children with radiographic evidence of ectopic eruption of first permanent molars who presented to a Dental Teaching Hospital in the North of England. A further 20 radiographs were collected of matched patients with no evidence of ectopic molar eruption. All radiographs were analysed under standard conditions to record the distribution and type of ectopic eruption (if present). In addition, the presence of the following dental anomalies was noted: cleft lip and/or palate; supernumerary teeth; hypodontia, and infraocclusion of primary molars. Chi-squared analysis was performed to determine any significant differences in the frequency of these dental anomalies between ectopic molar and control groups.

RESULTS

For patients with ectopic molar eruption, the majority demonstrated ectopic eruption of either one or two first permanent molars (32% and 57% of subjects respectively). There were a similar proportion of 'jumps' and 'holds'. 92% of these were maxillary teeth and there was equal left and right distribution. Interestingly, a positive record of ectopic eruption was only documented in the dental records of 35.7% of these subjects. Children with ectopic eruption were significantly more likely to have at least one additional dental anomaly than was the case for the control group (60.7% versus 25%). Notably, primary molar infraocclusion and cleft lip/palate were significantly more frequent in the ectopic group.

CONCLUSIONS

This study, the first in a British population, has identified a significant association between ectopic eruption of first permanent molars and other dental anomalies. A multifactorial aetiology is thus supported and clinicians should be alert to the co-existence of ectopic eruption and other dental anomalies.

Understanding children's dental anxiety and psychological approaches to its reduction

BACKGROUND

Dental anxiety is a common problem, which can affect people of all ages, but appears to develop mostly in childhood and adolescence. Childhood dental anxiety is not only distressing for the child and their family but is also associated with poor oral health outcomes and an increased reliance on costly specialist dental services.

AIM

This article will consider the prevalence, development, and implications of children's dental anxiety. It will also discuss the opportunities for and challenges of psychological approaches such as cognitive behavioural therapy aimed at the reduction of dental anxiety in children.

Children's experiences of participation in the cleft lip and palate care pathway

AIM

This qualitative study sought to explore children's perspectives on their participation in the cleft lip and palate care pathway.

DESIGN

Eight boys and nine girls (aged 8-17 years), with a range of cleft types and who were patients at a British dental hospital each took part in two child-centred interviews which incorporated participatory activities. An initial interview focused on children's general life stories, and these often encompassed a discussion about cleft lip and/or palate. A follow-up interview explored specific aspects of the condition and its related treatment.

RESULTS

Data revealed the varying roles that young people can play in decision-making, which can be described as active or passive. In addition, the dynamic degree of participation was highlighted with patients occupying different roles throughout the care pathway.

CONCLUSION

The research provides an insight into treatment decisions, and how young people, their families, and clinicians interact to arrive at these. Findings provide further evidence to support the important contribution young patients can make in their own treatment choices.

Children's and adolescent's perspectives on cleft lip and/or palate

OBJECTIVE

Children's voices are being increasingly acknowledged in health care research. The aim of this study was to explore children's and young people's perspectives of being born with a cleft lip and/or palate.

DESIGN

The research took a qualitative approach that consisted of two interviews with each child, drawing on child-centered methodologies and techniques. The initial interview focused on children's general life stories, and these often encompassed a discussion about cleft lip and/or palate. The follow-up interview explored specific aspects of the condition and related treatment.

PARTICIPANTS

The self-selected sample consisted of 17 children and young people (eight boys, nine girls) with cleft lip and/or palate, aged 8 to 17 years, who received treatment at a dental hospital in the U.K.

RESULTS

Children's and young people's accounts identified a number of themes including how they became aware that they had been born with the condition, their views of the treatment pathway, and how it related to who they are.

CONCLUSIONS

This study highlights the value of including young people's perspectives in oral health-related research. It has allowed a deeper insight into cleft lip and palate and shows that young people can contribute their views and experiences about services which demonstrate that these could be incorporated into service evaluations.

Seeking children's perspectives in the management of visible enamel defects

AIM

To undertake a child-centred evaluation of treatment provision for visible enamel defects.

DESIGN

Postal questionnaires, developed with children, were sent to 88 patients, aged 7-16 years, with visible enamel defects of permanent incisors and who had received microabrasion, with/without additional composite restoration at Sheffield Dental Hospital, UK. The questionnaires sought children's perceptions about their teeth before and after the intervention, as well as their evaluation of how they had been treated. Anonymised responses were graded using a 10 cm visual analogue scale (VAS) where a score of 10 indicated the most negative response, and zero the most positive response.

RESULTS

Sixty three questionnaires were returned (72% response). Prior to treatment, children reported high levels of worry (VAS=6.8), embarrassment (VAS=6.9) and a perception that their teeth looked yellow and discoloured (VAS=7.3). Following treatment, children thought their teeth looked much better (VAS=1.6), felt happier (VAS=2.2) and more confident (VAS=1.6). They also felt very positive about their clinical experiences, rating the staff as extremely friendly and kind (VAS=0.4) and reporting that procedures were clearly explained (VAS=0.6).

CONCLUSIONS

Simple non-invasive dental treatment can have a positive effect on appearance-related satisfaction. The use of child-centred approaches offers an invaluable insight into patient perspectives.

The success of fissure sealants placed by dentists and dental care professionals

OBJECTIVE

To obtain preliminary data on the effectiveness of fissure sealants placed by dentists and dental care professionals (DCPs).

RESEARCH DESIGN

Case-note review of fissure sealants provided for paediatric patients within primary dental services in South Yorkshire.

PARTICIPANTS

Records were retrieved for 1,100 fissure sealants, placed on first and second permanent molars of 312 children by 25 participating dentists and 25 DCPs during 2001-2003.

MAIN OUTCOME MEASURES

Independent variables included operator details and patient-related factors including: caries experience at baseline, age, gender, and socio-economic status. The outcome variables were sealant retention and progression to caries at three years. Bivariate analyses were used to explore the role of potential factors associated with the success of fissure sealant survival. Kaplan-Meier survival analysis and Cox's regression models were used to estimate the probability of sealant success for both operator groups.

RESULTS

Retention rates at three years for fissure sealants placed by dentists and DCPs were 62.4% (SD = 22.1) and 58.1% (SD = 21.5) respectively. After three years, 87.1% (SD = 9.8) and 84.2% (SD = 11.6) of teeth sealed by dentists and DCPs remained sound. Exploratory analysis found no significant difference in sealant retention or caries transformation rates according to operator type.

CONCLUSIONS

On the basis of these preliminary findings, delegation of fissure sealants to DCPs would seem to be justified in view of the comparable sealant success rates achieved by dentists and DCPs. These data can now be used to inform future randomised controlled trials on the effectiveness of fissure sealants by different operator groups.

Are social judgements made by children in relation to orthodontic appliances?

OBJECTIVE

There is evidence to suggest that social judgements are made on the basis of dental appearance. This study sought to determine how children view other children with fixed orthodontic appliances.

DESIGN

Cross-sectional, self-completion questionnaire.

SUBJECTS AND METHODS

Year 7 (aged 11-12 years) and year 10 (aged 14-15 years) school children (the participants) were invited to look at colour photographs of one girl and one boy (the subjects) and to make a social judgement about these children. Participants were randomly allocated either pictures of the two children without fixed orthodontic appliances or pictures of the same children with fixed orthodontic appliances. Using a previously validated child-centred questionnaire, participants rated subjects using a four-point Likert scale for three negative and six positive attributes. Multivariate analysis of variance was used to determine whether participant year group or gender and the presence of the orthodontic appliance had a significant effect on total attribute score.

RESULTS

Three hundred and twenty-two children completed the questionnaires, giving a response rate of 69%. There was a significant effect of year group (P = 0.003) and gender of the participant (P = 0.031) on the attribute score. There was no effect according to the presence or absence of an orthodontic appliance (P = 0.791). Female participants gave more positive ratings than their male peers.

CONCLUSION

This study has found that children do not make social judgements about other children purely on the basis of wearing a fixed orthodontic appliance, suggesting that they are viewed as part of a normal dental appearance in adolescence.

The psychosocial impact of oral conditions during transition to secondary education

AIM

Transition to secondary education is a significant life event. Little is known about the impact of oro-facial conditions during this time and how concerns may contribute as a risk factor to negative adaptation. The aim of the study was to explore experiences of young people with oro-facial conditions as they undergo the transition to secondary education.

STUDY DESIGN

Qualitative interview and diary study.

METHODS

Participants were children aged 11-12 years with a range of clinical conditions who attended a dental hospital. Participants completed a two-week diary during the transition and were interviewed about the diary and their experiences. The interviews were audio-taped and transcribed verbatim.

RESULTS

Seventeen participants returned the diary and were interviewed; they described both changes in school environment and social interactions. A key finding was the concerns about aspects of themselves that children developed during this time. For some young people these concerns were about their oro-facial condition. No links between gender, severity of condition and experiences of school were apparent.

CONCLUSION

Transition to secondary education affected young people to varying degrees. Timely treatment for those concerned about the condition of their teeth may improve the likelihood of positive adaptation.

Previous radiographic experience of children referred for dental extractions under general anaesthesia in the U.K

OBJECTIVE

To determine what proportion of children undergo radiographic assessment prior to referral to a dental hospital for extractions under general anaesthesia.

BASIC RESEARCH DESIGN

This prospective survey was conducted over a 6-month period. A data sheet was used to record the following information: patient's age; referrer's name and place of work (general dental practice or community dental service); teeth to be extracted (primary dentition and/or permanent dentition) and reported previous radiographic examination. Patients were excluded from the study if, following a clinical examination, radiographs were not actually deemed necessary for diagnosis and treatment planning purposes. Clinical setting A paediatric dentistry clinic within a dental hospital in the North of England. Participants 161 patients with a mean age of six years (SD = 2.2, range = 3-14 years) who were referred to the dental hospital for extractions under general anaesthesia.

RESULTS

Overall, 12.4% of children had reportedly undergone a previous radiographic assessment prior to hospital referral. A significantly greater proportion of children referred for permanent tooth extractions had been subject to radiographic examination compared to children referred for primary tooth extractions (46.2% as compared to 6.3%; P = 0.001 chi-squared test). Furthermore, patients referred from the community dental service were significantly more likely to have had previous dental radiographs than children referred from general dental practice (36.9% compared to 9.3%; P = 0.003 chi-squared test).

CONCLUSIONS

Radiographs do not appear to be routinely employed for caries diagnosis and treatment planning in young children within general dental practice in the U.K.

Changes in proteinase-activated receptor 2 expression in the human tooth pulp in relation to caries and pain

AIMS

To investigate the presence of proteinase-activated receptor 2 (PAR2) in the human tooth pulp and to determine whether there are any changes in receptor expression with caries and pain.

METHODS

Forty-four mandibular first permanent molars were collected from children (n = 36, mean age 9.96 years +/- 2.11) requiring dental extractions under general anesthesia. Teeth were categorized as either intact (n = 22) or carious (n = 22). Carious teeth were further subdivided into asymptomatic (n = 10) and painful (n = 12). The coronal pulp was removed and processed for indirect immunofluorescence by using antibodies raised against PAR2 and double labeled with either a neuronal marker (protein gene product 9.5) or both a smooth muscle cell (aSMA) and endothelial (UEIL) marker, in order to examine PAR2 presence in both neuronal and vascular tissue. In addition, hemotoxylin and eosin staining was performed to identify pulpal fibroblasts.

RESULTS

PAR2 expression was found to be present in pulpal nerve fibers, vascular tissue, and pulpal fibroblasts. PAR2 neuronal expression was not affected by the presence of caries (P > .05) but was significantly less in carious painful teeth than in carious asymptomatic teeth (P < .05). No changes in vascular PAR2 expression were found (P > .05); however, the number of PAR2-labeled fibroblast-like cells per mm2 was significantly greater in carious teeth (P < .05).

CONCLUSION

These findings indicate that PAR2 receptors and changes in their level of expression may have relevance and clinical importance in nociception.

Decision-making for children with traumatized permanent incisors: a holistic approach

Traumatic injury to permanent central incisors is a common occurrence in childhood and adolescence. It is of paramount importance that expedient and appropriate care is provided to ensure an optimum short- and long-term outcome for injured teeth and, importantly, the patients themselves. Treatment planning should thus adopt a holistic approach, taking into account a number of patient- and dental-related factors. Multidisciplinary care, involving paediatric dentistry, orthodontics or oral and maxillofacial surgery may be indicated. Decisions should also be informed by a sound understanding of the exact nature and prognosis of the presenting dental injury.

CLINICAL RELEVANCE

Poor primary management of dental trauma may have lifelong consequences for the young patient.

The case report in 21st century child dental literature

AIM

To review recent dental child case reports to determine: 1 the main focus of the paper; 2 perceived contribution to the dental literature and, 3 involvement of the child.

STUDY DESIGN

Systematic review.

METHODS

Case reports published between 2000 and 2005 were identified using Medline via Ovid and Embase databases. Papers were reviewed to determine: their perceived value; whether they related to a single case or case series; the main dental condition; how the child was referred to, and inclusion of any child-centred input within the report.

RESULTS AND STATISTICS

663 case reports, from 82 journal titles, were subject to review. The majority presented a single patient (82%) and discussed a type of intervention or treatment (58%). The most common themes related to oral pathology/medicine (28%), and orthodontics (26%). Most children were referred to as 'patients' (74%) with little use of personalised terms (4%). Few reports included any child-centred input or contribution from a proxy (10% and 2% respectively). Inter- and intra-examiner repeatability for categorisation was excellent.

CONCLUSIONS

The majority of child-related reports described a treatment or intervention which is surprising given the low level of case reports in the hierarchy of evidence. The child's perspective in the presenting complaint or outcome needs greater consideration.

Pulpal status of hypomineralized permanent molars

PURPOSE

Young patients with hypomineralized teeth frequently complain of symptoms suggestive of dentin hypersensitivity. It has been proposed that these symptoms may be exacerbated by an underlying pulpal inflammation. The purpose of the study was to determine the pulpal status of hypomineralized teeth.

METHODS

The experimental material comprised 25 sound and 19 hypomineralized permanent first molars obtained from children requiring dental extractions under general anesthesia. Pulp sections were processed for indirect immunofluorescence using combinations of: (1) protein gene product 9.5; (2) leukocyte common antigen; and (3) Ulex europaeus I lectin. Image analysis was then used to determine the percentage area of staining of each label.

RESULTS

Innervation density was significantly greater in the pulp horn and subodontoblastic region of hypomineralized teeth than in sound teeth. Immune cells were most abundant within pulps of hypomineralized teeth exhibiting enamel loss. Vascularity was found to be similar for both hypomineralized and sound teeth, but was significantly greater in hypersensitive hypomineralized samples.

CONCLUSION

This study provides biological evidence that inflammatory changes may be present within the pulpal tissue of these teeth.

Seen but not heard: a systematic review of the place of the child in 21st-century dental research

BACKGROUND

The position of children in society has changed with increasing emphasis on children's rights and child-centred services. This study aimed to describe the extent to which contemporary oral health research has been conducted with or on children.

DESIGN

A systematic review of the child dental literature from 2000-2005 was conducted. A purposive sample was used to develop categories describing the level of involvement of children in research. Four main categories were developed: children as the objects of research, proxies used on behalf of children, children as the subjects of research with some involvement and children as active participants with their perspectives explored. Electronic databases were searched and exclusion criteria applied. Each of the resulting papers was examined and categorised. The frequency distribution in each category and the distribution of these categories according to subject were calculated.

RESULTS

The search revealed 3266 papers after application of the exclusion criteria. Of these, 87.1% were categorised as research where children were used as objects, 5.7% were found to involve proxies (parents or clinicians), 7.0% involved children to some extent and 0.3% involved children actively.

CONCLUSION

Most oral health research is conducted on children, in future research should strive to be conducted with children, involving them as fully as possible.

Who accompanies children to a dental hospital appointment?

AIM

To determine who accompanies paediatric dental patients to their appointments, in a teaching hospital setting.

STUDY DESIGN

Data were recorded prospectively for children attending the Paediatric Dentistry clinic of the Charles Clifford Dental Hospital, Sheffield, England, over 4 months which included two school holiday periods. The data were recorded on a standardised data collection sheet, which included age and gender of the patient; number/s of accompanying adults and children and their relationship to the patient; the appointment session and appointment type.

RESULTS

A total of 394 paediatric dental visits were recorded. Patients were of a mean age of 10 (range 1-17 years). Most visits were for treatment (44.7%) and review (39.8%), with a much smaller proportion being new patient assessments (8.9%) and emergency appointments (6.6%). The numbers of afternoon and morning sessions recorded were approximately similar and 35% of the visits were recorded in a school holiday day. The majority of patients attended with at least one parent (91.6%). A parent was most likely to attend a new patient assessment (97.1%) or review visit (94.3%). Parental presence was less likely for treatment (89%) and least likely for emergency visits (84%). Most patients attended with their mother (62.1%). Patients were less frequently accompanied by parents (13.1%), their father (12.1%) and one or both grandparents (4.3%). Smaller proportions were accompanied by older siblings, a step parent, other relatives or foster carers. Two patients attended unaccompanied. The time of day, or whether it was a school holiday period or not, did not influence parental presence or the numbers of adults accompanying patients. However the additional presence of other children (non patients) was more likely on morning sessions and during school holidays.

STATISTICS

One way analysis of variance (ANOVA), an independent sample t-test or chi-squared tests were undertaken as appropriate to determine whether there were any significant differences in parental or child accompaniment according to the patient's age; gender; type of appointment or time of appointment. Significance levels were set at p<0.05.

CONCLUSIONS

It was of concern that a parent was least likely to accompany a child for an emergency visit when a history and consent may assume the greatest importance.

Leukaemic infiltration of the mandible in a young girl

BACKGROUND

This report presents a case of leukaemic infiltration of the mandible in a 10-year-old female of Sudanese extraction.

CASE REPORT

The patient was in remission from acute lymphoblastic leukaemia when she presented with pain localized to the alveolar ridge overlying the unerupted lower right second permanent molar. Two days later, she developed right inferior alveolar nerve paraesthesia. Radiographic imaging demonstrated cortical line absence around the developing lower right second and third permanent molars, and distal displacement of the lower right third molar. In addition, the cortical outline of the right inferior dental canal lacked clarity. Biopsy confirmed leukaemia recurrence demonstrating the Philadelphia chromosome. Tailored chemotherapy was commenced, and a bone marrow transplant was carried out 12 weeks later. At 6-month dental review, the patient remained exceptionally well with no bone pain and normal sensation in the right lower lip.

CONCLUSION

The importance of regular and long-term dental examination of patients with leukaemia is discussed.

Management of postorthodontic demineralized white lesions with microabrasion: a quantitative assessment

INTRODUCTION

The aim of this study was to quantify changes in postorthodontic demineralized enamel lesion surface areas after microabrasion.

METHOD

The study group comprised 8 orthodontic patients (mean age,17.3 years) with multiple decalcified enamel lesions after fixed orthodontic therapy. Two demineralized areas were randomly selected for interventive treatment in each patient. Microabrasion was undertaken on these lesions by using a well-accepted 18% hydrochloric acid and pumice technique. Standardized intraoral images were taken of the lesions before and immediately after microabrasion. Image-processing software was used to quantify (mm2) the visible areas of the demineralized lesions before and after microabrasion. The total labial surface area of each tooth was also determined, and the area affected by demineralization was expressed as a percentage of total tooth surface. Images were reanalyzed a month later to determine the repeatability of the method.

RESULTS

Microabrasion significantly reduced visible enamel demineralization (P < .001, paired t test). The mean reduction in lesion size after treatment was 83% (SD, 8.2%; range, 61%-92%). The quantification methodology was found to be highly repeatable with an intraclass correlation coefficient of 0.98.

CONCLUSIONS

Microabrasion is an effective treatment approach for the cosmetic improvement of long-standing postorthodontic demineralized enamel lesions.

Immunocytochemical investigation of immune cells within human primary and permanent tooth pulp

AIM

The aim of this study was to determine whether there are any differences in the number and distribution of immune cells within human primary and permanent tooth pulp, both in health and disease.

DESIGN

The research took the form of a quantitative immunocytochemical study. One hundred and twenty-four mandibular first permanent molars and second primary molars were obtained from children requiring dental extractions under general anaesthesia. Following exodontia, 10-microm-thick frozen pulp sections were processed for indirect immunofluorescence. Triple-labelling regimes were employed using combinations of the following: (1) protein gene product 9.5, a general neuronal marker; (2) leucocyte common antigen (LCA); and (3) Ulex europaeus I lectin, a marker of vascular endothelium. Image analysis was then used to determine the percentage area of immunostaining for LCA.

RESULTS

Leucocytes were significantly more abundant in the pulp horn and mid-coronal region of intact and carious primary teeth, as compared to permanent teeth (P < 0.05, anova). Both dentitions demonstrated the presence of well-localized inflammatory cell infiltrates and marked aborization of pulpal nerves in areas of dense leucocyte accumulation.

CONCLUSIONS

Primary and permanent tooth pulps appear to have a similar potential to mount inflammatory responses to gross caries The management of the compromised primary tooth pulp needs to be reappraised in the light of these findings.

Content analysis of children's television advertising in relation to dental health

This paper provides some disturbing facts and figures about the amount of television being watched by children. In addition, it reports on the volume and type of television advertising aimed at young people, both in the United Kingdom and other developed countries. In view of recent public and professional concern as to the possible adverse effects of food advertising on children's health, this study set out to examine what proportion of television advertisements, directed at children, promoted products potentially harmful to dental health. Forty-one hours of children's television programming broadcast on ITV1, the main UK commercial channel, were recorded on to videotape for subsequent analysis. Almost 1,000 adverts were analysed; each was timed and broadly categorised as relating to a food/drink product or non food/drink product. Advertisements for food and drink were further subdivided according to their sugar and/or acid content. We found that, on average, 24 adverts were shown per broadcast hour, which accounted for 15.8% of the total schedule time. 34.8% of adverts related to food/drink products, and 95.3% of these promoted products that were deemed potentially cariogenic or erosive. The most frequently promoted food/drink products included breakfast cereals with added sugar (26.3%), confectionery (23.7%) and non-carbonated soft drinks (18.1%). It is very concerning that, despite recent specific codes of practice outlined by the Independent Television Commission for Children's Advertising, many food and drink products promoted during children's programming are potentially damaging to dental health.