Retrospective Study of the Survival Rates of Indirect Pulp Therapy Versus Different Pulpotomy Medicaments.

PURPOSE: The purposes of this retrospective chart review were to determine: (1) how primary molars in need of vital pulp therapy (VPT) have been treated over a period of four years at a university-based pediatric dental practice (UBP); and which treatments-indirect pulp therapy (IPT), formocresol pulpotomy (FCP), and ferric sulfate pulpotomy (FSP)-have been successful. METHODS: Electronic patient records (axiUm) that contained the procedure codes D3120 (pulp cap-indirect) or D3220 (therapeutic pulpotomy) were totaled by year. Visit records were queried again to identify treatment failures (i.e., extractions [D7140] or pulpectomy [D3221/D3240]). A total of 2,001 primary molar teeth were included in the study. Success was compared using a Kaplan-Meier analysis. RESULTS: At the three-year follow-up, IPT had a 96.2 percent survival rate, FCP had a 65.8 percent survival rate, and FSP had a 62.9 percent survival rate (P<.0001). CONCLUSIONS: Over a four-year period of time, IPT became the more commonly used vital pulp therapy treatment at a university-based pediatric dental practice and had a significantly better survival rate than FCP or FSP.

Permanent teeth pulpotomy survival analysis: retrospective follow-up.

OBJECTIVES: The aim of the present study is to evaluate risk factors influencing the success rates of pulpotomies both in young and adult populations. METHODS: Pulpotomies (n=273) performed by a single endodontic specialist were analyzed, and data on success rates were collected. Additionally, possible explanatory variables were noted such as: age, gender, clinical findings (teeth, type of restoration after pulpotomy), radiographic findings (dentin bridge formation) and systemic conditions. The follow-up period varied from 1 to 29 years, and the results were analyzed by Kaplan-Meier survival curves and also by Cox regression. RESULTS: Age at the time of pulpotomy ranged from 8 to 79 and had not influenced the success rates (p=0.35). The formation of dentin bridge had a strong protective effect (hazard ratio-HR=0.16, p<0.001). The prosthetic crown restorations following pulpotomy had the smallest failure rate, and amalgam has not increased the risk of failure significantly in relation to prosthesis. Resin composite restorations following pulpotomy increased in 263% the risk of failure (HR=3.63, p<0.001). CONCLUSION: This study allowed inferences that pulpotomy may be a successful treatment at any age, and not only for young permanent teeth. It was also possible to conclude that the use of direct composite restorations following pulpotomies is associated with higher failure rates.

Do early dental visits reduce treatment and treatment costs for children?

PURPOSE: The purpose of this paper was to determine if number and cost of dental treatments in high caries-risk children differs in children with early dental intervention compared to children with later intervention. METHODS: Billing data from children age zero to seven years old, whose first dental visit was between January 1, 2004 and December 31, 2004, were collected from 20 corporate treatment centers serving children from lower socioeconomic status backgrounds. Data included age at first visit, dental treatment codes, and associated costs for eight years after the first dental visit. Treatment included restorations, crowns, pulpotomies, and extractions. First visit age was categorized into early starters (younger than four years old) and late starters (four years of age or older). Linear regression with cluster adjustment for clinic determined a difference in costs and dental treatments by early and late starters. RESULTS: Of 42,532 subjects, 17,040 (40 percent) were early starters and 25,492 (60 percent) were late starters. There were 3.58 more dental procedures performed on late starters, over eight years of follow-up, than on early starters (P<.001). Late starters spent $360 more over eight years of follow-up than early starters (P<.001). CONCLUSION: In this study, number of procedures performed were fewer and cost of treatment less for children seen earlier versus later.

Dental skill mix: a cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the South of England.

BACKGROUND: Research suggests that health professionals who have trained together have a better understanding of one another's scope of practice and are thus equipped for teamwork during their professional careers. Dental hygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. This study examines patterns of delegation (selected tasks and patients) by dental students to DHT students training together in an integrated team. METHODS: A retrospective sample of patient data (n = 2,063) was extracted from a patient management system showing the treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in the South of England over two academic years. The data extracted included key procedures delegated by dental students to DHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patient demography. χ2 tests were conducted to investigate the relationship between delegation and patient age group, gender, smoking status, payment-exemption status, and social deprivation. RESULTS: A total of 2,063 patients managed during this period received treatments that could be undertaken by either student type; in total, they received 14,996 treatment procedures. The treatments most commonly delegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatric extractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to a DHT student. Associations were found between delegation and patient age group and smoking status (P <0.001). Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) and patients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared with non-smokers (45% cf. 26%; P <0.001). CONCLUSIONS: The findings suggest that delegation of care to DHT students training as a team with dental students, involved significantly greater experience in treating children and adult smokers, and providing preventive rather than invasive care in this integrated educational and primary care setting. The implications for their contribution to dentistry and the dental team are discussed, along with recommendations for primary care data recording.

Preventive Services by Medical and Dental Providers and Treatment Outcomes.

OBJECTIVE: Nearly all state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children; yet, little is known about how treatment outcomes compare with children visiting dentists. This study compared the association between the provider of preventive services (PCP, dentist, or both) with Medicaid-enrolled children before their third birthday and subsequent dental caries-related treatment (CRT) and CRT payment. METHODS: We conducted a retrospective study of young children enrolled in North Carolina Medicaid during 2000 to 2006. The annual number of CRT and CRT payments per child between the ages of 3 and 5 yr were estimated with a zero-inflated negative binomial regression and a hurdle model, respectively. Models were adjusted for relevant child- and county-level characteristics and used propensity score weighting to address observed confounding. RESULTS: We examined 41,453 children with > 1 preventive oral health visit from a PCP, dentist, or both before their third birthday. Unadjusted annual mean CRT and payments were lowest among children who had only PCP visits (CRT = 0.87, payment = $172) and higher among children with only dentist visits (CRT = 1.48, payment = $234) and both PCP and dentist visits (CRT = 1.52, payment = $273). Adjusted results indicated that children who had dentist visits (with or without PCP visits) had significantly more CRT and higher CRT payments per year during the ages of 3 and 4 yr than children who had only PCP visits. However, these differences attenuated each year after age 3 yr. CONCLUSIONS: Because of children's increased opportunity to receive multiple visits in medical offices during well-child visits, preventive oral health services provided by PCPs may lead to a greater reduction in CRT than dentist visits alone. This study supports guidelines and reimbursement policies that allow preventive dental visits based on individual needs.

Minimal intervention dentistry procedures: a ten year retrospective study.

UNLABELLED: Minimal Intervention Dentistry (MID) is an effective treatment approach with increasing acceptance among dental professionals. OBJECTIVE: This study aimed to evaluate the MID impact on Dentistry by analyzing procedures performed on patients treated at a Pediatric Dentistry Graduate Program clinic which implemented MID. STUDY DESIGN: The number of procedures including sealants, modified atraumatic restorative treatment (mART), resin crowns, direct pulp capping, pulpotomy, pulpectomy, and deciduous/ permanent extractions from 333 pediatric patients treated between the years 2001 to 2003 and 2008 to 2010 in Distrito Federal, Brazil were analyzed. Statistical analysis involved chi-square and G Williams tests. RESULTS: 783 procedures were analyzed and demonstrated that there was a significant reduction of sealant placement in the last triennium when compared to the first one (p<0.0001). Moreover, there was a significant increase in the amount of mART (p<0.0001). This increase in mART procedures resulted in a significant reduction in procedures with pulp involvement: direct pulp capping (p=0.0014), pulpotomy (p=0.0014) and pulpectomy (p=0.0002). CONCLUSIONS: Based on the results, MID represented a positive impact on the intervention on caries lesions in patients, mainly reflected by the significant reduction in the number of direct pulp capping, pulpotomy and pulpectomy.

Periapical status and quality of root fillings in a selected adult Riga population.

AIM: The aim of the study was to assess the prevalence of apical periodontitis and quality of root canal fillings in an adult Riga subpopulation. MATERIALS AND METHODS: Panoramic radiographs of Latvian adults 35-44 year old attending a private dental clinic for the first time during the period of 2004-2008 were included in the study. Totally, 312 out of 1248 panoramic radiographs were randomly selected and examined for periapical conditions and endodontic treatment quality. The technical quality of root fillings was evaluated in terms of length in relation to the root apex and lateral adaptation to the canal wall. The periapical status was assessed using the PAI index. The data were analyzed using SPSS 14 computer software program. Statistical significance was assessed by the chi-squared (Pearson's) test. RESULTS: Out of the 312 individuals examined 224 (72%) had one or more teeth with apical periodontitis (PAI 3-5) and 272 individuals (87%) had one or more endodontically treated teeth. Amongst 7065 teeth evaluated 1255 (18%) were endodontically treated. Only 285 teeth (23%) of the root canal treated teeth were with complete root canal fillings. There was a statistically significant relationship between quality of root canal fillings and apical periodontitis (p<0.0001). In teeth with complete fillings only 15% were with apical periodontitis, but apical periodontitis were detected in 342 teeth (35%) with incomplete root fillings. CONCLUSION: The results from this study indicates a high prevalence of apical periodontitis and low quality of root fillings in a selected adult Riga population.

Pulp exposures in adults--choice of treatment among Swedish dentists.

This study comprises a survey of Swedish dentists'treatment preferences in cases of carious exposure of the dental pulp in adults.The survey was conducted as part of a comprehensive report on methods of diagnosis and treatment in endodontics, published in 2010 by the Swedish Council on Health Technology Assessment. A questionnaire was mailed to a random subsample of 2012 dental offices where one dentist at each office was requested to answer all questions. Each questionnaire contained one of three sets of questions about endodontic practice routines.Thus around one-third of the subsample received case-specific questions about treating carious exposure. Only general practitioners aged below 70 years were included.The final study sample comprised 412 participants.The dentists were presented with two case scenarios. In Case 1 a 22-year old patient had a deep carious lesion in tooth 36 and in Case 2 a 50-year old patient had a deep carious lesion in tooth 14.The participants were asked to nominate their treatment of choice: pulp capping, partial pulpotomy or pulpectomy. For Case 1, 17 per cent of the respondents selected pulpectomy; the corresponding rate for Case 2 was 47 per cent. Female gender and age group 25-49 years were predictive of selection of less invasive treatment options. However, according to recent guidelines (2011) from the National Board of Health and Wellfare, Swedish dentists are recommended to elect pulpectomy prior to pulp capping/partial pulpotomy when confronted with a tooth having a cariously exposed pulp in adults.

Utilization of emergency services for non-traumatic dental disease.

PURPOSE: To identify and characterize children who utilize emergency dental services for non-traumatic dental disease. STUDY DESIGN: Caregivers of children under 12 years old who seek out emergency services for the treatment of non-traumatic dental disease will be surveyed regarding their child's current oral health status. Patient's clinical data will be obtained and they will be further followed for a period of 2 months to determine if they follow-up with recommendations for comprehensive dental care. RESULTS: One hundred and ninety-eight people participated in the study (97% response rate). Eighty-three percent of the children were diagnosed with dental caries. Seventy-four percent of patients of record presented with an emergency at least once before and 73% had a history of one or more broken appointments. Patients with a history of previous emergency visits (OR = 3.45, CI = 2.05, 5.81) or a history of missed appointments (OR = 2.21, CI = 1.42, 3.58) were significantly more likely to fail to return for comprehensive care (P < .01). CONCLUSION: This study shows that those who utilize emergency services more than once, or have a history of missed appointments are more likely to continue to utilize emergency dental services as their primary means for dental care.

Dental treatment of patients with systemic diseases compared to patients with developmental disabilities under general anesthesia.

The medical and dental records were examined for 46 patients with systemic diseases (SD) and 75 patients with developmental disabilities (DD) aged 2-20 years, who had received dental treatment under general anesthesia (GA). Age, gender, decayed missing and filled teeth (dmft/DMFT), dental procedures, duration of GA, and posttreatment hospitalization were recorded. Before treatment, dental disease in the primary teeth was significantly higher among the group with SD (p= 0.04). In the permanent teeth, dental disease was higher among the group with DD, though not significantly. More teeth were restored, (p= 0.015) and total dmft (p= 0.043) was significantly higher among subjects with SD. In the permanent teeth, more extracted and more restored teeth and higher DMFT were noted among subjects with DD, though not significantly. Only pulpectomies were significantly more prevalent among those with DD (p= 0.038). Six subjects needed hospitalization due to their diseases after GA.

Awareness and attitude of patients' parents toward pulp therapy of the primary teeth: a clinical survey.

AIMS AND OBJECTIVE: The present study was carried out to find out the awareness and attitude of parents of patients, toward the pulpal treatment of primary teeth, visiting a dental hospital in a Bangalore suburban area. MATERIALS AND METHODS: A total of 685 parents of the child patients requiring pulp treatment procedures visiting the dental OPD over a period of 18 months were personally interviewed with a questionnaire and their responses were immediately computed. RESULTS: Urban populations seeking dental treatment are more in number as compared to the rural population. Pain and associated feature was the most common reason among both urban (71.92%) and rural (93.3%) patients visiting a dental office. CONCLUSIONS: It is important to create more awareness among the populace of our country about the significance of maintaining a healthy primary dentition and attendant sequalae if not done so.

Pulpotomy to stainless steel crown ratio in children with early childhood caries: a cross-sectional analysis.

PURPOSE: This study's purpose was to determine the pulpotomy-to-crown ratio (PCR) in a high-early childhood caries patient population and factors associated with choice of pulpotomy and crown treatments. METHODS: This was a retrospective quality assurance chart review. Five calibrated examiners (kappa=0.86) rated radiographic caries from available films. Demographic data, including age, health status, medications, and pain score, were collected along with pulpotomy- and crown-related treatment characteristics of location of tooth, treatment site, and level of operator skill. RESULTS: The record review of 521 patients (mean age=5.1 ± 1.9 years old) revealed 1,365 stainless steel crowns (SSCs) performed with 461 pulpotomies in a 6-month period, in both operating rooms (1,043 SSCs) and ambulatory settings (322 SSCs). The mean PCR was 0.34, with PCR decreasing with increasing patient age. Pulpotomy and crown treatments increased with radiographic caries severity with a significant association between pulpotomy and radiographic severity (P<.001). More severe pain was associated with greater likelihood of pulpotomy (P<.001). Age, operator type, and site of treatment did not affect choice of pulpotomy. CONCLUSIONS: The mean pulpotomy-to-crown ratio in this high-early childhood caries pediatric population was 0.34. Pain, the American Society of Anesthesiologists classification system, and radiographic caries severity were predictors of pulpotomy, but operator type and location of treatment were not.

Prevalence of apical periodontitis of root canal-treated teeth and retrospective evaluation of symptom-related prognostic factors in an urban South Korean population.

OBJECTIVES: This study aimed to investigate the prevalence of apical periodontitis among root canal-treated teeth in an urban South Korean population and evaluate prognostic factors for periapical radiolucency and its symptoms. STUDY DESIGN: The periapical status of 896 root canal-treated teeth was evaluated by using digital panoramic radiography. Five prognostic factors were analyzed: length and density of the root filling, presence of crown restoration, probability of unilateral bite, and presence of missing canals. RESULTS: The prevalence of apical periodontitis among root canal-treated teeth in the study population was 22.8%, and 29.3% of these teeth had received dental treatment for pain relief. Evaluation of the prognostic factors indicated that inadequacy of endodontic treatment was more predictive of apical periodontitis than the absence of a crown restoration. CONCLUSION: Inadequate root filling length appeared to be the most important prognostic factor related to apical periodontitis and its acute symptoms among root canal-treated teeth.

An investigation into dentists' management methods of dental trauma to maxillary permanent incisors in Victoria, Australia.

Trauma to anterior teeth in children could become a long-term problem to dental health. To a large extent, the management actions of the dentists involved will determine the clinical outcome and, in turn, these actions will be related to their levels of knowledge. The aim of this study was to investigate dentists' knowledge of managing traumatic injuries to maxillary permanent incisors in children. A self-completion questionnaire containing 19 questions on management methods of treating dental trauma was mailed to 693 dentists in Victoria, Australia. The response rate achieved was 61%. This survey found that some of the respondents had adequate management knowledge for the different types of traumatic injuries, while others did not have the correct information. Approximately half the dentists considered milk as the preferred extraoral storage medium of choice for avulsed teeth and a period of 7-10 days splinting after replantation. A large proportion of dentists showed inadequate knowledge with regard to understanding the biological mechanisms causing replacement root resorption (61%) and external inflammatory root resorption (74%). Overall, the respondents to this survey demonstrated only a moderate level of knowledge in management of traumatic injuries to maxillary permanent incisors in children. Continuing professional development programmes may be a means of improving this deficient knowledge base.

Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date?

Formocresol pulpotomy (FP) in the United States is most frequently used to treat asymptomatic caries near the pulp in primary teeth. Indirect pulp therapy (IPT) is also indicated and has a significantly higher long-term success. Pulpotomy is thought to be indicated for primary teeth with carious pulp exposures, but research shows the majority of such teeth are nonvital or questionable for treatment with vital pulp therapy. IPT has a significantly higher success in treating all primary first molars, but especially those with reversible pulpitis compared with FP. The purpose of this article was to review the dental literature and new research in vital pulp therapy to determine the following: (1) Is a pulpotomy indicated for a true carious pulp exposure? (2) Is there a diagnostic method to reliably identify teeth that are candidates for vital pulp therapy? (3) Is primary tooth pulpotomy out of date, and should indirect pulp therapy replace pulpotomy?

Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date?

Formocresol pulpotomy (FP) in the United States is most frequently used to treat asymptomatic caries near the pulp in primary teeth. Indirect pulp therapy (IPT) is also indicated and has a significantly higher long-term success. Pulpotomy is thought to be indicated for primary teeth with carious pulp exposures, but research shows the majority of such teeth are nonvital or questionable for treatment with vital pulp therapy. IPT has a significantly higher success in treating all primary first molars, but especially those with reversible pulpitis compared with FP. The purpose of this article was to review the dental literature and new research in vital pulp therapy to determine the following: (1) Is a pulpotomy indicated for a true carious pulp exposure? (2) Is there a diagnostic method to reliably identify teeth that are candidates for vital pulp therapy? (3) Is primary tooth pulpotomy out of date, and should indirect pulp therapy replace pulpotomy? )

Periapical status and quality of root canal fillings and coronal restorations in a Greek population.

OBJECTIVE: To investigate the quality of root canal fillings and coronal restorations in relation to periapical status in a Greek population. METHOD AND MATERIALS: A total of 320 patients who required full-mouth radiographic examination were included. The quality of root canal fillings and the periapical status, as well as the quality of coronal restorations, were assessed by radiographic criteria. Results were analyzed using random effects logistic regression models. RESULTS: Root canals with adequate filling length had a lower incidence of apical periodontitis than root canals with inadequate filling length (51.7% versus 63.4%, P ;= .002). Root-filled canals with adequate coronal restorations showed a lower incidence of apical periodontitis than those with inadequate restorations (47.3% versus 67.4%, P; < .001). When both root filling and coronal restoration were assessed, the incidence of apical periodontitis ranged from 39.2% to 67.6%. CONCLUSION: Quality of root canal treatment, as well as quality of coronal restoration, are strongly associated with the incidence of apical periodontitis.

Restorative treatment decisions for deep proximal carious lesions in primary molars.

AIM: To assess clinicians' individual variables that might influence decision-making for the restoration of deep proximal carious lesions in primary molars. METHODS: A pre-coded questionnaire that sought participants' treatment choices for a deeply carious second mandibular primary molar, as depicted in a simulated periapical radiograph, along with a specific clinical scenario, was distributed among a random sample of 157 dentists and 15 paediatric dentists. Participants were asked to answer questions. After combining the pulpotomy and pulpectomy treatment choices under a 'pulp therapy' category, a binary dependent variable was constructed. Logistic regression of the ratio of the participants who would restore the questioned tooth by a method in question, was run. RESULTS: A total of 155 dentists (116 males and 39 females) completed the survey, giving a response rate of 90%. Of these 53% of dentists recommended pulpotomy followed by definitive restoration and 39% recommended removal of caries and restoration without pulp therapy. In the logistic regression model, males and graduates of English language undergraduate dental programs had higher probabilities of restoring without prior pulp therapy (p<0.03 and p<0.02, respectively). Compared with graduates of Asian programs, dentists who graduated from Eastern Europe and the Middle East, showed lower likelihoods of restoring the tooth without prior pulp therapy (p<0.01 and p<0.004, respectively). Dentists who treated an average of 6-16 child patients during a week had a lower probability of restoring the tooth without prior pulp therapy than those who were not currently involved in treating children (p<0.01). No other measured variables were associated with participant's treatment choices. CONCLUSIONS: The lack of agreement among dentists regarding their optimal treatment recommendations for deep proximal carious lesions appears to be due mainly to inter-individual, educational, training and practice characteristic factors.

Factors affecting treatment outcomes following complicated crown fractures managed in primary and secondary care.

The aims of this retrospective observational study were to determine the factors which affect treatment provision and the Median Survival Time (MST) for maintenance of tooth vitality following complicated crown fracture. The survey was carried out for patients treated at Newcastle Dental Hospital (NDH) according to departmental guidelines over a 2-year period following the introduction of a new protocol for management of these types of injuries. Seventy-three cases of complicated crown fracture were identified in 69 children with a mean age of 10.3 years (SD = 2.5 years). Seventy-one percent of the fractures occurred in males (M:F ratio was 2.5:1). Fifty-one percent of the complicated crown fractures were in immature teeth. Of the 73 traumatised teeth, 45% presented initially in general dental practice (GDP), 37% at the dental hospital and 8% at local accident and emergency departments with the remaining 10% seen at other or unrecorded locations. Of the 41 fractures, which presented initially at a location other than the dental hospital, 38% were referred to the dental hospital without the provision of an emergency pulp bandage. The overall definitive treatments provided for the 37 open apex teeth included pulp cap (19%), partial pulpotomy (32%), cervical pulpotomy (8%) and pulpectomy (35%), while for the 36 closed apex teeth it was pulp cap (28%), pulpotomy (11%), and pulpectomy (61%). Of the 30 teeth, which underwent vital pulp therapy (18 open and 12 closed apex), the MST for the 15 teeth treated with pulp caps was 1460 days (95% CI: 1067, 1853) while for the 15 teeth treated with pulpotomies it was 1375 days (95% CI: 964, 1786). There was no statistically significant difference in the MST between teeth treated with pulp caps and pulpotomies. In conclusion, the proportion of patients referred to secondary care with complicated crown fractures without provision of a pulp bandage is of some concern. More conservative treatment of closed apex teeth sustaining complicated crown fractures, utilizing vital pulp therapy techniques would appear to be appropriate.