Biomineralization of Dental Tissues Treated with Silver Diamine Fluoride

Silver diamine fluoride (SDF) is a dental biomaterial used to arrest dental caries. To better understand SDF's mechanism of action, we examined the localization of silver within the tissues of SDF-treated teeth. Carious primary teeth fixed within 2 min of SDF application (SDF-minutes, n = 3), at 3 wk after SDF application in vivo (SDF-weeks, n = 4), and at 2 y after multiple SDF applications in vivo (SDF-multiple, n = 1) were investigated in this study. Carious primary teeth without SDF application (no-SDF, n = 3) served as controls. Mineral density and structural analyses were performed via micro-X-ray computed tomography and scanning electron microscopy. Elemental analyses were performed through X-ray fluorescence microprobe and energy-dispersive X-ray spectroscopic techniques. SDF-treated teeth revealed higher X-ray-attenuated surface and subsurface regions within carious lesions, and similar regions were not present in no-SDF teeth. Regions of higher mineral density correlated with regions of silver abundance in SDF-treated teeth. The SDF penetration depth was approximated to 0.5 ± 0.02 mm and 0.6 ± 0.05 mm (mean ± SD) for SDF-minutes and SDF-weeks specimens, respectively. A higher percentage of dentin tubular occlusion by silver or calcium phosphate particles was observed in primary teeth treated with SDF-weeks as compared with SDF-minutes. Elemental analysis also revealed zinc abundance in carious lesions and around the pulp chamber. SDF-weeks teeth had significantly increased tertiary dentin than SDF-minutes and no-SDF teeth. These results suggest that SDF treatment on primary teeth affected by caries promotes pathologic biomineralization by altering their physicochemical properties, occluding dentin tubules, and increasing tertiary dentin volume. These seemingly serendipitous effects collectively contribute to the cariostatic activity of SDF.

The influence of medical history on restorative procedure failure rates following dental rehabilitation

PURPOSE

This study evaluated the association between patient medical history and the outcomes of restorative procedures performed under general anesthesia.

METHODS

The dental records of patients who had dental rehabilitation under general anesthesia at Children's Hospital in Boston (1990-1992) and Children's National Medical Center in Washington, DC (1994-1998) were examined. Data regarding restorative outcomes and the association between patient medical history and restorative failures were assessed using chi-square tests with correction for continuity. T-tests were performed on parametric data.

RESULTS

Significantly higher stainless steel crown failure rates were found in young patients diagnosed with developmental disabilities when compared to patients without such disabilities (p<0.025, x2 = 5.50). However, there was no difference in the failure rates of SSCs in young patients with significant medical histories compared to patients without significant medical histories. Regarding amalgam and composite restorations, there were no differences in failure rates among patients with and without significant medical histories, including developmental disabilities.

CONCLUSIONS

SSC failures were higher in young children with developmental disabilities compared to children without these disabilities.

Perceived outcomes and parental satisfaction following dental rehabilitation under general anesthesia

PURPOSE

The objective of this study was to evaluate parents' perceptions of their child's quality of life following dental rehabilitation under general anesthesia and to assess their satisfaction with that treatment modality.

METHODS

A survey was sent to 400 parents of patients who had undergone dental rehabilitation. Quality of life outcomes, such as continued presence of pain and inability to eat or sleep, were assessed. Additionally, parental satisfaction with outcomes and processes was evaluated, as was outcome expectation. Descriptive statistics were collected on outcome measures. Contingency testing was employed to compare outcomes by medical or developmentally compromising conditions, gender, or continued use of the initial treatment facility for routine care.

RESULTS

Fifty seven percent of parents returned surveys. A descending hierarchy of improved treatment outcomes was noted, with improvement in pain the predominant outcome, followed by improved abilities to eat and sleep, reported by 86, 69, and 41% of parents, respectively, 72% perceived an improvement in their child's health. Children with medically or developmentally compromising conditions were significantly more likely to have improved abilities to eat and sleep, and had a significantly improved overall health status. Satisfaction and expectations were consistently achieved and were not related to continued use of the initial treatment facility.

CONCLUSIONS

Children with early childhood caries receiving comprehensive treatment under general anesthesia achieved improvements in their quality of life as well as overall health. A hierarchy of improvement was noted, with the greatest improvement noted in pain experience followed by improved abilities to eat and sleep. Parents were overwhelmingly satisfied with outcomes and the process of care, and reported that their expectations had been met.

A 20-year perspective on the changing use of hand over mouth (HOM) and restraint in postdoctoral pediatric dental education

PURPOSE

This study assessed the current teaching and utilization of the hand over mouth technique in advanced educational programs in pediatric dentistry and compared these results to previous surveys.

METHODS

A survey, identical to those used in 1979 and 1989, was sent to pediatric dentistry program directors. Descriptive and comparative statistics evaluated the use of HOM, HOMAR, and restraint. Additionally, changing patterns of responses for programs and directors that responded to both the 1989 and 1999 surveys were assessed.

RESULTS

Eighty-seven percent of directors returned surveys. There was a significant decrease in the number of programs utilizing the HOM technique in the past 10 years (P< 0.0001). Among respondents that returned surveys in 1989 and 1999, 50% of the previous HOM users discontinued its use (P<0.03). Technique non-users were significantly less likely to describe the technique consistent with AAPD guidelines (P<O.0001). Although the 1989 respondents expressed significantly decreased certainty that restraint techniques were free of psychological sequealae compared to 1979 respondents, the continuing decreasing trend observed between the 1989 and 1999 groups was not significant.

CONCLUSIONS

With continuing uncertainty regarding psychological sequealae associated with HOM, there was a significant decrease in the number of programs advocating its use.

The effect of dental rehabilitation on the body weight of children with early childhood caries

PURPOSE

The purpose of this study was to determine the effect of comprehensive dental rehabilitation on the percentile weight and percentile growth velocity of children with early childhood caries (ECC).

METHODS

The percentile weight categories of children with noncontributory medical histories and ECC were compared to caries free comparison patients, before and after comprehensive dental treatment under general anesthesia.

RESULTS

Prior to dental rehabilitation, test subjects' percentile weight categories were significantly less than that of comparison counterparts (P < 0.001). Of the ECC patients, 13.7% weighed less than 80% of their ideal weight, thereby satisfying one of the criteria for the designation of failure to thrive, while none of the comparison patients did so (P < 0.05). Following therapeutic intervention, ECC children exhibited significantly increased growth velocities through the course of the follow-up period (P < 0.001), reflecting the phenomenon of catch up growth. The average length of follow-up for the test and comparison groups were 1.58 and 1.36 years, respectively. At the end of the follow-up period there were no longer any statistically significant differences noted in the percentile weight categories of the test and comparison groups.

CONCLUSION

Comprehensive dental rehabilitation resulted in catch-up growth, such that children with a history of nursing caries no longer differed in percentile weights from comparison patients.