[Clinical aspects of Atraumatic Restorative Treatment]

The objective of Atraumatic Restorative Treatment is to prevent carious lesion development and to stop its progression. This can be achieved, among other ways, by placing high-viscosity glass-ionomer cement sealants in pits and fissures in the enamel. A second area of utilisation is the treatment of dentine carious lesions. The weakened demineralised dentine can effectively be removed using hand instruments only. An accurately placed sealant-restoration prevents remaining cariogenic bacteria from reigniting the process of decay and allows the residual carious dentine to remineralise. To achieve good results using Atraumatic Restorative Treatment, an oral healthcare provider should complete a programme of instruction and have command of sufficient knowledge of cariology, the principles of treatment and the available restorative materials. High-viscosity glass-ionomer cement is the material of first choice for the prevention of enamel caries and the treatment of dentine carious lesions, but there is a constant search for improvements to this material and for a qualitatively better alternative.

Caries preventive measures in orthodontic practice: the development of a clinical practice guideline

OBJECTIVES

White spot lesions (WSLs) are a side effect of orthodontic treatment, causing esthetic problems and a risk of deeper enamel and dentine lesions. Many strategies have been developed for preventing WSLs, but great variability exists in preventive measures between orthodontists. This study developed statements on which a clinical practice guideline (CPG) can be developed in order to help orthodontists select preventive measures based on the best available evidence.

MATERIALS AND METHODS

A nominal group technique (RAND-e modified Delphi procedure) was used. A multidisciplinary expert panel rated 264 practice- and evidence-based statements related to the management of WSLs. To provide panel members with the same knowledge, a total of six articles obtained from a systematic review of the literature were read by the panel in preparation of three consensus rounds. According to the technique, a threshold of 75% of all ratings within any 3-point section of the 9-point scale regarding a specific statement was accepted as consensus.

RESULTS

After the first and second consensus rounds, consensus was reached on 37.5 and 31.1% of statements, respectively. For the remaining 31.4% of statements, consensus was reached during a 4-h consensus meeting.

CONCLUSIONS

Statements on the management of WSLs derived from a systematic literature review combined with expert opinion were formally integrated toward consensus through a nominal group technique. These statements formed the basis for developing a CPG on the management of WSLs before and during orthodontic treatment.

[Atraumatic restorative treatment in relation to pain, discomfort and dental treatment anxiety]

Dental treatment anxiety usually develops during childhood due to a bad experience and the dental drill as well as the injection needle are the most common causes. The Atraumatic Restorative Treatment provides the opportunity to provoke little or no dental treatment anxiety because only hand instruments are used and local anaesthesia is seldom required. Several scientific studies have indicated that the Atraumatic Restorative Treatment causes less pain, discomfort and anxiety by comparison with conventional treatments. Therefore, the Atraumatic Restorative Treatment is considered to be promising for the treatment of carious lesions in anxious children and adults, and potentially also for patients suffering from dental treatment phobia. Furthermore, the Atraumatic Restorative Treatment may be indicated as the primary treatment method in children to prevent dental treatment anxiety and treatment under general anaesthesia. These conclusions must still be confirmed with responsible scientific research.

Prevalence, distribution and background variables of smooth-bordered tooth wear in teenagers in the hague, the Netherlands

The purposes of the study were: (1) to assess the prevalence and distribution of smooth-bordered tooth wear in teenagers, and (2) to investigate the relationship between smooth-bordered tooth wear and social background, dietary pattern, drinking habits, oral hygiene practices and caries prevalence. In The Hague, The Netherlands, a sample of 345 10- to 13-year-olds and 400 15- and 16-year-olds was clinically examined. The criteria for the assessment of smooth-bordered tooth wear ('smooth wear') were in line with the diagnostic criteria for erosion developed by Lussi (1996). In the age group 10-13 years, the percentage of subjects with visible smooth wear (SW1 threshold) was 3% and in 1 subject (0.3%), deep smooth enamel wear was found. Due to the low prevalence, the results for this age group were not analysed further. In the age group 15-16 years, the proportion of subjects with visible smooth wear (SW1 threshold) was 30% and that with at least deep smooth enamel wear (SW2 threshold) 11%. Smooth wear into dentine was found in 1 subject. First molars and upper anterior teeth were affected predominantly. A significant effect on visible smooth wear (SW1 threshold) was found for gender and social background. At mouth level, no significant influence was found for dietary patterns, drinking habits or oral hygiene practices. The caries prevalence was similar in subjects with and without smooth wear.