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.

Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document

Purpose

The European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth.

Methods

Three expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified.

Results

There is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates.

Conclusion

The management of deep carious lesions in primary teeth can be challenging and must consider the patient’s compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.

A questionnaire study on perception and clinical management of molar incisor hypomineralisation (MIH) by Irish dentists

AIM

Molar incisor hypomineralisation (MIH) is a significant global health problem frequently encountered by dentists. The aim of this questionnaire-based study was to gain a better understanding of how dentists in the Republic of Ireland perceive and manage MIH. In addition, to compare these findings with results of existing international studies.

METHODS

Following ethical approval, an online survey was created consisting of 16 questions based on previous surveys regarding perception and treatment of MIH. Photographs and information regarding three specific cases were also included. The questionnaire was distributed by email and the data were analysed using SPSS statistical software.

RESULTS

The total number of respondents was 230, of which 204 were general dentists. The majority of dentists (58%) reported that they observe MIH on a weekly basis. Those dentists exclusively in private practice and respondents aged 36 and older were less likely to note frequent MIH (p = 0.042). The vast majority of respondents felt either confident or very confident in diagnosing MIH (91%). Overall, 71% reported to feel comfortable managing MIH; however, those in private practice only (p = 0.023) and those aged 36 and older (p = 0.011) were less likely to report being comfortable managing MIH. The most commonly cited barrier to care was the child's behaviour, followed by difficulty in achieving local anaesthesia. Composite resin was the most commonly selected material used to restore teeth affected by MIH (84%). In the scenario on cavity design, the results showed a similar number of dentists selected the most conservative and the most aggressive preparation indicating a disparity among choices.

CONCLUSIONS

MIH is frequently encountered by Irish general dentists. The overall wide disparity of responses is in line with other studies, and further highlights the need for the development of strong treatment guidelines and continuing dental education to assist dentists in treatment planning for MIH.

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.

Communication between dentists and laboratory technicians

A questionnaire was sent to 29 laboratory technicians regarding prescription writing by dentists for single anterior maxillary unit metal ceramic prostheses. Sixty nine per cent of the technicians responded and of these 40 per cent included copies of the typical prescriptions they receive. The results clearly showed that the standard of communication between dentist and laboratory technician is inadequate, although it has improved over recent years. The effectiveness of the Medical Devices Directive legislation was considered by reviewing the prescription sheets. It was concluded that many technicians still rely on contacting the prescribing dentist by telephone to clarify instructions and are often forced to make decisions without the necessary information. The finer details of prosthesis construction were found to be the weakest area of prescription writing. Time pressure was deemed the single greatest impediment to a harmonious working relationship. The recommendations of this paper are based on improving the levels of communication between these two members of the dental team. It is proposed that dentists should increase their awareness of the laboratory environment by maintaining closer links with their technicians. This would not only expand their understanding and appreciation of the laboratory environment, but also give the opportunity for discussing new developments in dental technology. Further undergraduate training in the area of laboratory prescription writing is also recommended.