A multi-site service evaluation of silver diamine fluoride use for children

Introduction The use of silver diamine fluoride (SDF) is relatively new to the UK. It is unknown how it is being used and for what indications in UK paediatric dental services.Aim To: 1) establish how SDF is being used across different paediatric dental settings in the UK; and 2) consider parental and patient views on the treatment experience and side effect of discolouration.Method A multi-site service evaluation was carried out across six paediatric dentistry units covering hospital and community services. Data were collected prospectively from 17/02/2020 to 02/03/2022. Simple descriptive statistics were used to analyse the data.Results Data were collected for 54 patients. The included patients had an age range of 2-13 years, with a mean of 4.9 years. The reason SDF was chosen was reported as: to avoid general anaesthetic (n = 25); to avoid extractions (n = 8); stabilisation (n = 25); acclimatisation (n = 24); and insufficient cooperation for other treatment (n = 17). In total, 42 cases had SDF applied to the primary dentition. This was in the anterior dentition for 18 patients and the posterior dentition for 15, with nine patients having SDF applied both anteriorly and posteriorly. The majority of children and parents were accepting of the technique and immediate aesthetic outcome.Conclusion In the services involved in this multi-site service evaluation, SDF is used for young patients in the primary dentition for the purpose of caries arrest. The technique was viewed positively by the majority of parents and children.

The interaction and interference of preformed metal crowns on magnetic resonance imaging: a scoping review with a systematic methodology

Purpose

Preformed metal crowns are widely used to restore primary and permanent teeth. Children may require magnetic resonance imaging (MRI) for diagnosis and monitoring of diseases in the head and neck region. Metallic objects, in the field of view, may compromise the diagnostic value of an MRI. The impact on the diagnostic quality of an MRI in children who have had preformed metal crowns placed has not been assessed. The aim of this systematic review was to evaluate the impact that PFMCs have on MRI imaging quality and thus the overall diagnostic value.

Methods

Electronic searches of the following databases were completed: MEDLINE, EMBASE, Cochrane Library, Web of Science and Open Grey. Primary in vivo studies on children who had at least one preformed metal crown placed and required an MRI investigation were to be included. PRISMA guidelines were followed and screening/data extraction was carried out by two independent calibrated reviewers.

Results

A total of 7665 articles were identified. After removing duplicates, 7062 were identified for title and abstract screening. Thirty-four articles underwent full-text review, of which none met the inclusion criteria. Most common reasons for exclusion were not placing preformed metal crowns (n = 16) or in vitro studies (n = 12).

Conclusion

No in vivo studies were identified to establish the hypothetical impact preformed metal crowns would have on the diagnostic quality of an MRI in the head and neck region. Decision making needs to be guided on a case by case basis. Further high-quality clinical studies are required.

Primary Care Dentists' management of permanent dentition traumatic dental injuries in 7- to 16-year-olds: A sequential mixed-methods study

BACKGROUND/AIMS

Primary care dentists play a pivotal role in the management of traumatic dental injuries in children, despite little evidence on the barriers they face in providing care. The aim of this study was to explore and contextualize the knowledge and attitudes of general dental practitioners regarding their management of permanent dentition traumatic dental injuries in children aged 7-16 years old.

MATERIAL AND METHODS

A two-phase sequential mixed-methods study included a questionnaire that was disseminated to all 619 primary care dentists, identified via a triangulated sampling strategy, based across the north-east of England (Phase I). Statistical analyses were performed using Mann-Whitney U- and Kruskal-Wallis tests, Spearman's correlation and chi-square test. Multivariate factor analysis, with principal components extraction, was used to test between multiple ordinal variables. Respondents were invited to a face-to-face or telephone semi-structured interview (Phase II). Interviews were transcribed verbatim and analysed using inductive thematic analysis.

RESULTS

Primary care dentists were less confident in managing complex dental trauma. Inadequate financial remuneration was the main reason for not providing care, often prompting a referral to the local dental hospital. This was more apparent for those who qualified before 2000. More recently qualified dentists felt the long-term costs, related to traumatic dental injuries, were insufficiently remunerated. Most still provided emergency management, irrespective of remuneration, as long as they had the requisite knowledge and skills. Four major themes arose: impact of traumatic dental injuries on patients, parents and primary care dentists; barriers to providing treatment; educational opportunities for primary care dentists; and interactions between primary and secondary care services.

CONCLUSIONS

There is high confidence in managing simple traumatic dental injuries but less for complex injuries. A lack of sufficient financial remuneration associated with the long-term management of dental trauma was the main barrier for dentists to manage these cases.

Plant-based milks: the dental perspective

Background Consumption of plant-based milk in the UK is increasing at the expense of cow's milk. Cow's milk consumption has traditionally been advocated by the dental profession as 'good for teeth'.Aims To identify the range of plant-based milks available in the UK and compare their nutritional benefits with cow's milk. A secondary aim was to explore reasons behind the increase in popularity of plant-based milks and discuss dental relevance.Methods Branded plant-based milks available in UK supermarkets were identified and nutritional data collected. Data were obtained from product labelling and manufacturer websites. The sample was collected in December 2019.Results Eighty-two products were identified. Differences were observed between plant-based and cow's milk, in particular regarding calcium, iodine, vitamin B12 and sugar content. Sugar content varied from 0-7.6 g/100 ml.Conclusions Dairy is a key source of dietary iodine and many plant-based milks contain much lower levels. Many plant-based milks contain free sugars which are cariogenic. Dentists should be aware of this emerging market and be able to advise patients accordingly.

Everyone else is using it, so why isn't the UK? Silver diamine fluoride for children and young people

INTRODUCTION

Silver diamine fluoride (SDF) is used to prevent and arrest caries across the globe, particularly in the developing world. Whilst its use in the Western World is increasing, it is not yet routinely used in the United Kingdom, nor is it advocated by our national guidelines.

OBJECTIVES

To explore the literature surrounding the use of SDF, and consider the reasons why SDF has not yet been widely adopted in the United Kingdom (UK).

DISCUSSION

There is a growing evidence base for the use of SDF for the arrest and prevention of dental caries in the primary and permanent dentition. Potential side effects include staining of carious tooth structure, but in some cases this is acceptable to parents. There is no evidence for the cost effectiveness of SDF, although it may be a reasonably cost-effective option.

CONCLUSION

SDF is perhaps not yet widely adopted in the UK due to a perceived parental concern about its staining effect. With a growing evidence base and reportedly higher efficacy than fluoride varnish for caries prevention and arrest, SDF has the potential to play an important role in managing dental disease in children and young people in both primary and secondary care.