Global overview on current paediatric dentistry teaching: A survey of National Member Societies of the IAPD.

BACKGROUND: Published information on the teaching and recognition of paediatric dentistry (PD) is limited worldwide. AIM: The aim of this study was to investigate the status of current teaching of undergraduate and postgraduate training in PD and identify differences by country-level economic development. DESIGN: Representatives from 80 national member societies of the International Association of Paediatric Dentistry (IAPD) were invited to complete a questionnaire on undergraduate and postgraduate PD curricula, types of postgraduate education offered, and recognition of the specialty. Country economic development level was classified according to the World Bank criteria. The chi-squared test and the Spearman correlation coefficient were used for data analysis (α = 0.005). RESULTS: Response rate was 63%. Teaching of PD at the undergraduate level was present in all countries, but PD specialization, master's, and Doctor of Philosophy (PhD) coursework were offered in 75%, 64%, and 53% of surveyed countries, respectively. Postgraduate specialization courses were offered in a significantly larger proportion of high-income countries than in upper-middle- or lower-middle-income countries (p < .01). In 20% of participating countries, PD was not an officially recognized specialty with no difference in recognition of the specialty by country's economic development level (p = .62). CONCLUSION: Paediatric dentistry is taught at the undergraduate level universally, but at the postgraduate level, significantly fewer courses are available, especially in lower-income countries.

Staining Outcomes of Silver Diamine Fluoride as an Adjunct in Caries Risk Assessment: A Case Series Evaluation.

OBJECTIVE: To investigate the staining outcomes of Silver Diamine Fluoride (SDF) after its application on healthy enamel and its implications on patient's caries risk assessment. STUDY DESIGN: A review of dental and photographic records of 61 caries-free subjects under age 3, who received SDF application as part of a prevention protocol in a private pediatric dental clinic was performed. The age, gender, caries risk assessment and resulting staining were analyzed. RESULTS: Three groups of staining outcomes after SDF application were found: Group 1: no staining (32.8%). Group 2: removable staining (31.1%). Group 3: permanent staining (36.1%). The patterns of the staining were similar to initial lesion distributions in Early Childhood Caries (ECC). The deft scores for all subjects were zero before treatment and remained so at the end of this study except one subject from Group 3 who showed clinical signs of caries at follow-up visits. CONCLUSIONS: There are three possible staining outcomes following SDF application on clinically healthy enamel for children under age three without previous caries history; no staining, removable staining and permanent staining. The patterns of the staining were similar to initial lesion distributions in ECC. SDF application may be of use in identifying previously undetected young children with high caries risk. Further research is needed to elucidate the mechanism and cause of staining and to examine the association of the staining outcomes with the future caries incidence of the subject.

Parental and Dentist Satisfaction with Primary Anterior Zirconia Crowns: A Case Series Analysis.

This retrospective cohort study evaluated overall parental satisfaction of zirconia crowns (ZC) placed on primary maxillary anterior teeth with that of two independent, blinded dentists. 131 ZC placed in 37 children, aged 24.8-62.2 months (mean = 42.8), who had at least one recall visit a minimum of 6 months after placement were rated (average = 13.3). Crown colour match, crown contour and crown durability were evaluated by parents and compared to photographic evaluations of two independent raters. Overall parental satisfaction was also evaluated. The overall retention rate was 99.7% and parental satisfaction was 100%. Colour match was rated excellent by 84% of parents and 36% of dental evaluators. Crown contour was rated excellent by 97% of parents and 55% of dental evaluators. The length of follow-up had no effect on colour match or crown contour. ZC comprises an aesthetic and durable option for restoring carious primary maxillary incisors and were well-accepted by parents. Parents were less critical than dental evaluators of crown appearance.

Books on Children's Dental Health and Their Authors.

Books relating to dental care of children go back many years. This includes care by mothers and the rise of good clinical treatments and prevention by dentists. Most early books were written by a single author. As dentistry developed it became necessary to bring in writers with specialist knowledge, for example on dental materials. In 1952 Walter McBride wrote that children were sometimes described as being "temperamental and hysterical, notional and incorrigible". Many practitioners saw them as small adults and offered little treatment. Often they had no idea how to comfort children (Fig. 1). Some dental offices displayed notices that children under the age of 12 years would not be seen. Advice on handling was needed. Books were needed to encourage more dentists to treat children and to raise standards amongst practitioners already treating them. This paper documents and discusses early books that have appeared since 1853. Although of course much care advanced with increased knowledge and skills, it is fascinating to see how much we might still recognize today from the earliest publications.

History of the International Association of Paediatric Dentistry: A 50-year perspective.

This paper demonstrates how the International Association of Paediatric Dentistry (IAPD) arose from small beginnings in 1967. What started as an International Forum on Child Dental Health in London grew to become first the International Association of Dentistry for Children and then the outstanding IAPD with biennial Congresses, regional meetings, cooperation with other children's organizations, Teach the Teachers programmes, a wonderful website, and this International Journal of Paediatric Dentistry. There are now 70 national member societies worldwide representing over 16 000 members with a single interest: to further the oral health care of children. It is a truly remarkable achievement.

The Keeper of the Meaning and the Era of Evidence Based Dentistry.

The AAPD has stated that the clinical practice of pediatric dentistry has to be driven by science and evidence-based dentistry (EBD). However, our specialty must recognize the need for both EBD and age proven clinical experience. An amalgam of art and science is required, each respecting the other's important contribution and recognizing that neither alone is as good as the whole. Being a Keeper of the Meaning means handing on the values of the past to the future. The foundations of patient care are composed of both EBD and past clinical experience. Over time the clinician develops clinical intuition based on these foundations which results in optimum patient care. Pediatric dentistry will remain as much an art form as a science for the foreseeable future. There are clinical techniques and approaches successfully used for scores of years that the scientific method might never be able to validate but that doesn't necessarily mean that they don't have great value. The greatest weakness of the EBD movement is that there is no measure for clinical skill and experience. And yet, clinical success equals clinical skill and experience.

Clinical Performance of Heat-Cured High-Viscosity Glass Ionomer Class II Restorations in Primary Molars: A Preliminary Study.

OBJECTIVES: The present preliminary study evaluated the clinical and radiographic performances of heat-cured high viscosity glass ionomer (HCHVGI) in class II restorations of primary molars. STUDY DESIGN: A retrospective study on a cohort of patients who had dental caries restored at a private practice was conducted. Restorations were evaluated radiographically and photographically by two separate examiners. RESULTS: Ninety-three Class II restorations in 44 patients (average age: 108 months ± 25.3, 24 males, 20 females) were examined. Average recall time was 22.2 months ± 4.2. All but three restorations (96.8%) were present and intact, with no incidents of secondary caries. Three additional restorations had occlusal defects that required retreatment, resulting in an overall success rate of 93.5%. Ninety-seven percent of the restorations were rated optimal for marginal integrity with no staining of the restoration surfaces. No patients complained of post-operative sensitivity. The most common flaw found was a concavity on the proximal wall of the cavity box (27%, mean age 16 months ± 3.9). CONCLUSION: The findings in this preliminary study suggest that heat cured high viscosity glass ionomer cement may be an effective restorative material for Class II restorations in primary molars that are a year or two from shedding.

Report on the clinical technique of thermo-curing glass-ionomer sealant.

Controversy exists regarding the general safety of resin sealants and in particular their use in children, due to the possible leaching of non-polymerized monomers including bisphenol A. A thermally cured high-viscosity glass-ionomer cement (GIC) is suggested as a first-choice sealant material. An innovative approach of thermo-curing the GIC during placement is presented. The step-by-step clinical procedure and rationale for the biomimetic thermo-cured glass-ionomer fissure sealant are introduced and described. A thermally cured GIC sealant may provide long-term caries protection to fissures and pits without the need to maintain and reseal. GICs are both biocompatible and biomimetic resulting in formation of fluorapatite, the ultimate protection against dental caries.

Cross sectional: use of coolant for high-speed tooth preparation: a survey of pediatric dentist members of the American Academy of Pediatric Dentistry.

PURPOSE: To report the findings of a survey to determine the educational experiences, opinions and clinical practices relative to the use of coolant during cavity preparation of pediatric dentist members of the American Academy of Pediatric Dentistry (AAPD) and to determine whether teaching policies influenced the type of coolant used in private practice. METHODS: Four thousand fifty surveys were emailed to AAPD members and included questions regarding demographics and predoctoral, graduate, and current practice policies for the use of dry cutting. RESULTS: Returned survey numbered 1730 for a response rate of 43%. Fifteen percent were taught the concept of dry cutting in their predoctoral programs and 34% in their specialty, programs. Sixty percent never or rarely prepare teeth without water coolant. Slightly more than 40% prepared teeth with air coolant alone. Patient behavior (25%) and sedation (21%) were reported as determining factors for cutting dry. Thirty-one percent of private practice clinicians and 34% of part time academics use dry cutting, while only 15% of full time academicians use the technique (P<0.0001). CONCLUSIONS: Respondents tend to use the technique they were taught during their residency. Use of dry cutting was more likely to be utilized during sedations or general anesthesia to avoid airway compromise.

Parental cooperation scale in the pediatric dentistry setting: reliability and criteria.

OBJECTIVE: The purpose of this study was to provide reliability and criteria data on a newly defined parental cooperation scale (PCS) and in addition correlate between parent scores and their child's behavior in the dental setting. STUDY DESIGN: 244 parents accompanying their child to a dental visit were evaluated by two independent pediatric dentist evaluators. 150 parents were designated to be revaluated at least two weeks following the initial evaluation by the same examiner. Children's dental behavior was previously evaluated using the Frankl rating scale. RESULTS: A majority of the parents were found to be highly positive and positive (40% of the parents were evaluated as being PCS rating 4, 26% were rated 3). 35% of the parents were rated as being negative or extremely negative (27%, 8% respectively). 139 parents were re-evaluated at least two weeks following their initial assessment. 64% were rated as highly cooperative and cooperative; 36% were negative or extremely negative. 244 children participated in the study (mean age +/- SD, 6.8 years +/- 2.86). 67% were rated as Frankl scale extremely cooperative and cooperative (31%, 35.5% respectively). 33% were negative or extremely negative (26.1%, 7.3% respectively). When comparing the Frankl behavior of each child to their parent's PCS a significant association was found (McNemar test value 17.668, p = 0.007). CONCLUSION: The PCS was evaluated and found to be a reliable tool to evaluate parental dental behavior. Parents with negative behavior were more likely to present with children who also exhibit negative dental behavior and vice versa.

Use of coolant for high-speed tooth preparation: a survey of pediatric dentistry residency program directors in the United States.

PURPOSE: To determine current teaching policies regarding the use of coolant type during tooth preparation with high-speed hand-pieces in pediatric dental residency programs in the US. METHODS: A 17-question survey was electronically mailed to 63 program directors with one follow-up. Multiple-choice questions asked about school and program teaching of cavity preparation with or without water coolant, including hypothetical clinical situations. RESULTS: Fifty-two (83%) program directors returned the survey. Fifty-two percent taught both dry and water coolant methods, 6% taught dry cutting exclusively, and 42% did not teach the dry method and always used water coolant. Dry techniques were used primarily for special needs patients with poor swallow reflexes (50%) and for young children undergoing sedation (41%). Air coolant was taught more frequently in programs in the Midwest (77%) and South (85%) vs. the Northeast (32%) and West (50%) (P<.01). Forty-four percent of combined programs and 60% of hospital programs taught water spray use exclusively, while all university programs taught the dry cutting technique (P<.01). CONCLUSIONS: A majority of program directors teach the use of air coolant alone for high-speed preparation of teeth. University and combined programs were more likely to teach the method compared with hospital based ones.

A simplified isolation technique for preparation and placement of resin composite strip crowns.

Resin composite strip crowns (SCs) have been utilized for over 2 decodes to restore carious primary teeth. While SCs are the most esthetic anterior crowns, they also are the most technique sensitive. Restoration of a severely decoyed primary anterior tooth with a SC restoration is often complicated by hemorrhage in the operative site. Inflamed, bleeding gingiva may interfere with proper curing of the restorations, resulting in discolored crowns due to excessive bleeding during the curing process. Proper isolation and hemostasis is crucial for successfully completing the SC restoration. Traditionally, the routine use of ligature ties to deflect gingival tissue and retain the rubber dam in place has been recommended to address this problem. The purpose of this report was to describe a simple, relatively inexpensive, alternative technique for placing SCs by utilizing orthodontic elastomers.

Fasting state and episodes of vomiting in children receiving nitrous oxide for dental treatment.

PURPOSE: The purpose of this controlled-crossover study was to determine the frequency of vomiting during nitrous oxide / oxygen analgesia (NOA) and assess the relationship between fasting status and vomiting. METHODS: One hundred and thirteen children (64 male, 49 female), ranging in age from 24-160 months (mean = 74) and a mean weight of 23 kg (range 11-60 kg), participated in the study. At the initial examination, subjects were randomly assigned to be either fasting on the first appointment and non-fasting during the second appointment or alternatively be non-fasting for the first appointment and fasting for the second. RESULTS: The average time interval between eating and treatment in the fasting sessions was 6 hours and in the non-fasting group, 1 hour before treatment. Vomiting occurred in only one subject, immediately after cessation of treatment resulting in a frequency of 1% of subjects or 0.5% of sessions. No other differences were found between fasting and non-fasting subjects. CONCLUSION: During dental treatment with NOA using the rapid induction method, constant nonfluctuating concentration/ flow, and treatment time of under 35 minutes, the frequency of vomiting during NOA was found to be 0.5%.

Use of restraint and management style as parameters for defining sedation success: a survey of pediatric dentists.

PURPOSE: The purpose of this study was to identify factors that may influence current American Academy of Pediatric Dentistry (AAPD) members' definitions of a successful oral sedation. METHODS: Surveys were electronically mailed to all AAPD members with registered e-mail addresses, and printed surveys were sent via postal mail to all other members. The survey included: (1) items on demographic variables; and (2) questions on sedation methods and definition of success. RESULTS: The following response rates were recorded: (1) electronic survey = 26%; (2) printed = 45%; and (3) diplomate = 53%. The majority of members (55%) characterized their patient management style as being authoritarian. Sixty-seven percent agreed that the need to employ restraints when using sedation does not necessarily indicate that sedation is inadequate or unacceptable. When asked if such a sedation outcome could be defined as being successful, however, the agreement dropped to 47%. When defined as optimal, the respondents' agreement was further reduced to 36%. CONCLUSIONS: The practitioner's management style and use of restraint significantly influence how a dentist defines a successful sedation.

The transpalatal arch: an alternative to the Nance appliance for space maintenance.

The loss of multiple primary molars in the primary or transitional dentition will, in many instances, lead to disturbances of the developing dentition. To prevent this, an appliance can be constructed to maintain the relationship of the remaining teeth and to guide the eruption of the developing teeth. Traditionally, the treatment of choice for maxillary loss is the placement of a Nance appliance. An alternative appliance that may be considered for use is the transpalatal arch or bar. The purpose of this clinical report was to describe the transpalatal arch appliance and present its advantages over the more common Nance appliance, thus encouraging clinicians to prescribe its use in certain clinical situations.

Effects of video information on parental preoperative anxiety level and their perception of conscious sedation vs. general anesthesia for the dental treatment of their young child.

AIM: To investigate the impact of video information on parental preoperative anxiety and perception and their preference of conscious sedation versus general anesthesia for the dental treatment of young patients. METHOD/MATERIALS: Parents were given a verbal explanation regarding the two treatment options and were then asked to fill out a prescreening questionnaire. Their preference for mode of treatment was obtained and their preoperative anxiety level was measured on a visual analog scale (VAS). A video film depicting two children under going dental treatment with conscious sedation (CS) and a third child undergoing general anesthesia (GA) for dental treatment was shown to the parent. Following the viewing of the video film a post-screening questionnaire was given. Parents' post screening anxiety was measured and they were asked if their perception and preference of the two modes of treatment remained the same or changed. RESULTS: 40 parents were included and completed the trial. The prescreening anxiety level of parents was 2.79 (+/-1.05, SD) and was not significantly different than the post screening anxiety level of 2.91 (+/- .99 SD, paired t- test p=0.432). The majority of parents preferred CS to GA for the treatment of their child prior to screening of the video. Among the few who chose GA (n=5) all but one changed their choice after viewing the video to CS. However, this difference was not found to be statistically significant due to the small number of subjects in this group (McNemar test, p = 0.125). Most parents voiced the opinion that the video film contributed to their knowledge and also considered GA as having more risks than CS. An interesting finding was that a statistically significant difference was found regarding parent's perception of the two procedures and what they actually saw in the video. The majority of parents stated that their initial perception of GA was not similar to their viewing experience, conversely, CS matched their expectations. CONCLUSION: Parents' anxiety regarding their child's dental treatment under GA or CS is not affected by the viewing of a video film depicting either method. Parent's perception of GA is different than the actual procedure and may affect their choice of treatment.