Knowledge, attitudes and practices of primary health care providers towards oral health of preschool children in Qatar.

OBJECTIVE: Health care providers can effectively participate in oral health promotion for children in primary care setting. Currently, there are no oral health promotion programs that involve primary health care professionals in Qatar. Hence, this study was undertaken to examine the knowledge, attitudes and practices of all health professionals who work in the Well baby Clinics in the primary health centers. METHOD: A 23-item questionnaire was distributed across 20 primary health centers. The questionnaire sought information on the demographic data of health professionals, their knowledge of oral health and their practices and attitudes towards critical oral health issues. Data were examined by Pearson Chi-squared tests or Fisher's Exact test (p = 0.05). RESULTS: The response rate of the health professionals was 67%. Only 35.7% of the 225 participants received some form of oral health training during their undergraduate programme. The participants would assess the dental problem of the child (p = 0.05) and discuss the importance of tooth brushing with the mother (p = 0.03). A significant number of respondents (p = 0.04) were unlikely to assess the children's fluoride intake. There was a significant difference in the group of participants that would examine the child's teeth (p = 0.1) and counsel the mothers on prevention of dental problems (p = 0.01). This group would also refer children to dentist at 12 months of age (p = 0.05). CONCLUSIONS: Health professionals had a positive attitude towards the anticipatory guidance elements of oral health. However, the knowledge of healthcare professionals on childhood oral health is rather limited.

Dental admissions in children under two years--a total-population investigation.

BACKGROUND: There is a lack of literature describing dental admissions in children particularly very young children. This paper describes dental and oral cavity admissions and associated factors in children under two years of age using total-population databases. METHODS: The data used for this study were extracted from population-based databases which are linkable with midwives' data collected on all births in Western Australia. Children born from 1980 to 1998 inclusive (n = 459,831) were followed until two years of age including data on deaths, hospital admissions, birth defects and intellectual disability. Dental admissions (by ICD-9 category) and associated factors were investigated. RESULTS: There were 1513 dental admissions occurring in 1459 of the children up to the age of two years. Children were most frequently admitted under ICD-9 category 521, which includes a hospital admission for dental caries (39% of all oral cavity admissions), followed by ICD-9 category 528 (29%), which includes diseases of the oral soft tissues. Univariate analysis indicated that those with intellectual disability (OR 2.10, 95%CI 1.40-3.16), birth defect (1.74, 1.45-2.09), residing in a region without fluoridated water (2.15, 1.72-2.69) being male (1.14, 1.03-1.26), those from rural areas (2.29, 2.07-2.54) and Indigenous children (4.45, 3.91-5.05) were significantly more likely to have had a dental admission. CONCLUSION: Using total-population data allowed us to describe the admissions in children under two years and associated factors while able to identify children with intellectual disability or birth defects.

Oral health attitudes and behaviours of final-year dental students.

OBJECTIVES: The objectives of this study of final-year dental students in 10 classes (1997, 2001-2009) were to examine their self-reported oral health attitudes and behaviours and describe any trends in these attributes. PARTICIPANTS AND METHODS: Students were surveyed in final semester via an anonymous questionnaire (34 behaviour questions; eight attitude statements). Distributions, trends over time and attitude-behaviour associations were examined. RESULTS: Of 583 students, 459 responded (79%). All tooth-brushed with fluoride toothpaste; 80% brushed ≥2/day. Overall, 85% flossed; over time flossing behaviour increased significantly (P < 0.05), and those flossing 1-2/day increased (P < 0.005). Over time, significant decreases occurred in those taught toothbrushing (P < 0.001) and flossing (P < 0.05), and in use of mouth rinses (P < 0.05) and tooth cleansing sticks/picks (P < 0.001). Almost all (96%) had received a dental examination; 77% attended a dentist 1-3/year. Between-meal snacking was common (84%); 71% chewed gum. Although 18% had ever smoked, 5% currently smoked. Most strongly agreed they expected to keep most of their teeth for all their life (76%); their future needs for fillings would be minimal (61%); smoking could adversely affect their teeth or gums (85%); and regular dental attendance was important for their dental health (51%). Congruent attitudes and behaviours favouring oral health were widely held concerning dental attendance, flossing and smoking. CONCLUSIONS: Final-year dental students showed well established, favourable oral hygiene attitudes and behaviours, with evidence to suggest this knowledge was developed whilst in dental school. Despite many ceasing smoking, 5% still smoked. All dental students should receive training in motivational counselling and tobacco cessation to ensure this is included in patient care.

An in vitro comparison of detection methods for approximal carious lesions in primary molars.

BACKGROUND/AIMS: This study aimed to compare and contrast in vitro six methods to determine the most accurate method for detecting approximal carious lesions in primary molars. METHODS: Extracted primary molars (n = 140) were stored in 0.02% chlorhexidine solution and mounted in light-cured resin in pairs. The six carious lesion detection methods used by the three examiners to assess approximal carious lesions were visual inspection, digital radiography, two transillumination lights (SDI and NSK), and two laser fluorescence instruments (CDD and DDP). Five damaged teeth were discarded. The teeth (n = 135) were sectioned, serially ground, and examined under light microscopy using Downer's histological (HST) criteria as the gold standard. Intra- and inter-examiner reliability, agreement with HST, specificity, sensitivity, receiver operating characteristic (ROC) curves, and areas under the curve were calculated. RESULTS: This study found visual inspection to be the most accurate method when validated by histology. Transillumination with NSK light had the highest specificity, and digital radiography had the highest sensitivity for detecting enamel and/or dentinal carious lesions. Combining specificity and sensitivity into the area under ROC curves, enamel plus dentinal lesions were detected most accurately by visual inspection followed by digital radiography; dentinal lesions were detected most accurately by digital radiography followed by visual inspection. CONCLUSIONS: None of the four newly developed methods can be recommended as suitable replacements for visual inspection and digital radiography in detecting carious lesions on approximal surfaces of primary molars, and further developmental work is needed.

Total population investigation of dental hospitalizations in indigenous children under five years in Western Australia using linked data.

BACKGROUND: The aim of this study was to compare dental hospital admissions in a total state birth population of Indigenous and non-Indigenous children aged under five years in Western Australia. METHODS: Midwives' notification data were linked to databases of deaths, admissions, birth defects and intellectual disability. Births during 1980-1995 were followed until five years of age (n = 383,665). Dental admissions were classified by ICD-9 principal diagnosis categories. RESULTS: There were 738 dental admissions for 665 children aged up to five years of Indigenous mothers (n = 20,921). Indigenous children comprised 6.3% of all children having a dental admission in this age group; 3.2% of children with Indigenous mothers had a dental admission compared with 2.7% of non-Indigenous children. Overall, 8.7% (n = 58) of Indigenous children with a dental admission had a birth defect and 5.5% (n = 23) had an intellectual disability (compared to 8.8% and 3.2%). Indigenous children were four times more likely to be diagnosed with oral soft tissue diseases than non-Indigenous children, and less likely to be categorized as having diseases of the dental hard tissues. Indigenous children were more likely to have a longer dental admission. CONCLUSIONS: These analyses provide important findings regarding hospital admissions for Indigenous children. Admissions for disorders of the soft tissues are more common in Indigenous children.

Intake of sweet drinks and sweet treats versus reported and observed caries experience.

AIM: This was to study the intakes of sweet drinks and sweet treats of children and their caries risk using the Paediatric Risk Assessment Tool (PRAT, 2003) and Caries-risk Assessment Tool (CAT, 2007-8). STUDY DESIGN: Parents of 266 healthy primary school children completed the PRAT questionnaire during their child's dental appointment at the Royal Dental Hospital of Melbourne, Australia, describing their fluid and sweet treat intakes in the past 24 hours, oral hygiene practices and past caries. A subgroup (n=100) was examined clinically (CAT) for caries requiring restoration, visible plaque, gingivitis, orthodontic appliances, enamel defects, and use of dental care. RESULTS: The estimated mean daily fluid intake was 1.5+/-0.5L; fluids were consumed 3-5/ day by 57% of children and 78% usually had evening/night drinks. Fluids consumed were: tap water by 90%, milk by 74%, juice by 50%, regular soft drink by 30%; sweet treats were consumed by 62% and confectionery by 25%. Most children (69%) brushed their teeth > or =2/day; 5% flossed daily. Parentally-reported caries was associated significantly with increasing treats frequency (p=0.006). In the subgroup, 81% were at high caries risk; 47% had irregular dental care; 21% had sweet drinks/foods frequently between meals; 49% had visible plaque/gingivitis, and 34% had enamel demineralisation. Caries observed in the past 12 months was associated significantly with evening sweet drinks (p=0.004), and suboptimal fluoride exposure (p=0.009). Caries observed in the past 24 months was associated significantly with treats frequency (p=0.006), intake of sweet drinks plus treats (p=0.000), enamel demineralisation (p=0.000) and irregular dental care (p=0.000). CONCLUSIONS: The PRAT and CAT are valuable tools in assessing children's caries risk. The risk of caries from frequent intake of sweet drinks, either alone or in addition to sweet treats, must be emphasised to parents. All parents, and particularly those of children assessed at high risk from intakes of sweet drinks and sweet treats, suboptimal fluoride exposure, or enamel demineralisation, must be encouraged to obtain regular dental care for their children.

Dental management of amelogenesis imperfecta patients: a primer on genotype-phenotype correlations.

Amelogenesis imperfecta (AI) represents a group of hereditary conditions which affects enamel formation in the primary and permanent dentitions. Mutations in genes critical for amelogenesis result in diverse phenotypes characterized by variably thin and/or defective enamel. To date, mutations in 5 genes are known to cause AI in humans. Understanding the molecular etiologies and associated inheritance patterns can assist in the early diagnosis of this condition. Recognition of genotype-phenotype correlations will allow clinicians to guide genetic testing and select appropriate management strategies for patients who express different phenotypes. The purpose of this paper was to provide a narrative review of the current literature on amelogenesis imperfecta, particularly regarding recent advances in the identification of candidate genes and the patterns of inheritance.

Clinical studies on molar-incisor-hypomineralisation part 1: distribution and putative associations.

AIM: This was to describe the distributions of affected first permanent molars (FPMs) in a sample of children with molarincisor- hypomineralisation (MIH) and molar hypomineralisation (MH), and to examine their perinatal and medical histories for putative associations with molar hypomineralisation. STUDY DESIGN: A sample of 416 children aged 6-14 years with MIH or MH was identified from a specialist paediatric dental practice in Melbourne, Australia. METHODS: A questionnaire regarding perinatal and medical histories was sent to their parents/guardians; 182 (44%) useable questionnaires were returned and the dental records of these children were reviewed. RESULTS: The 182 dentitions were distributed as: MIH: 104; MH: 65; MIH* (permanent incisors unerupted): 13. These dentitions contained 720 FPMs; 429 FPMs were hypomineralised, distributed as: MIH: 282 FPMs; MH: 124 FPMs; MIH*: 23 FPMs. The 282 affected FPMs occurred in dentitions with MIH as: 1 FPM: 27%; 2 FPMs: 15%; 3 FPMs: 17%; 4 FPMs: 40% (mean 2.7 +/- 1.3 FPMs/dentition). The 124 affected FPMs occurred in dentitions with MH as: 1 FPM: 49%; 2 FPMs: 28%; 3 FPMs: 6%; 4 FPMs: 17% (mean 1.9 +/- 1.1 FPMs/dentition). The distribution of moderate to severe hypomineralisation in FPMs was: MIH: 89%; MH: 73%. Affected FPMs were similarly distributed between gender, quadrants and arches. At least one condition putatively associated with MIH/MH was seen in histories of 166 children (91%); ear infections, fevers, and perinatal conditions occurred in 53-66% of children. Frequent condition combinations were: ear infections + fevers (40% of children); antibiotics + ear infections (54%); antibiotics + other illnesses (56%). CONCLUSIONS: All four FPMs in a given dentition were more likely to be affected and to differing extents in MIH than in MH. Putative associations appear to exist between MIH/MH and combinations of antibiotic use, ear infections, fevers, perinatal conditions, and other illnesses in the child's first 3 years. It is proposed that MIH is a more severe form of the hypomineralisation condition than MH, forming an MIH spectrum.

Clinical studies on molar-incisor-hypomineralisation part 2: development of a severity index.

AIM: This was to examine the records of 182 children (aged 6-14 years) with molar-incisor-hypomineralisation (MIH) or molar hypomineralisation (MH) in order to develop and examine a Hypomineralisation Severity Index for first permanent molars (FPMs). STUDY DESIGN: Records of 429 FPMs in these children were examined and scored for eruption status, extent of hypomineralisation, sensitivity, number of restorative treatments; summed scores were converted to an index for each dentition (possible range: 1.25-7.00). Indices were examined regarding medical conditions occurring singly or in combinations in parentally-recalled children's histories to age 3 years; mean indices were compared for dentitions with these conditions/combinations. RESULTS: The proportion of FPMs receiving no/preventive treatment was higher in dentitions with MH than with MIH (56% vs. 41%); restorative treatment for FPMs was more frequent in dentitions with MIH than with MH (45% vs. 29%). Dentitions with MIH had higher severity indices than those with MH (MIH: index range: 3.25-5.25: 43%; MIH: index range: 1.25-2.00: 61%). Mean severity indices clearly had a higher trend in dentitions of children with certain condition combinations than for those without. Ten condition combinations each contained 3 to 5 medical conditions; 11/12 condition combinations included fevers; 9/12 included chicken pox; 9/12 included perinatal conditions, 6/12 included antibiotic use. CONCLUSIONS: A preliminary Hypomineralisation Severity Index developed for dentitions with hypomineralised first permanent molars in children has shown that MIH and MH form part of an MIH spectrum, where MIH is a more severe form of the condition than MH. The index has indicated associations between hypomineralisation of these molars and combinations of medical conditions, particularly implicating fevers, chicken pox, perinatal conditions and antibiotic use. Further clinical studies are indicated to validate the proposed index and confirm its prognostic value in treatment planning.

Mineral trioxide aggregate as a pulpotomy medicament: an evidence-based assessment.

AIM: The principles of evidence-based dentistry were used to compare mineral trioxide aggregate (MTA), formocresol (FC), ferric sulphate (FS) and calcium hydroxide (CH) as primary molar pulpotomy medicaments. METHODS: Electronic databases were searched and sieved for relevant papers by examining titles, abstracts and finally full texts. Included were randomized clinical trials (RCTs) and clinical trials (CTs) comparing the clinical and radiographic successes of MTA, FC, FS and CH pulpotomies. Data were extracted and common odds ratios (CORs) were derived by fixed effects meta-analysis (direct or indirect MA). Mean clinical and radiographic success rates from relevant study arms were examined. RESULTS: Eighteen RCTs and 10 CTs (total 1,260 molars) were identified to compare MTA and FC. Direct MAs found MTA was significantly more successful clinically (COR=3.11; 95%CI=1.09-8.85) and radiographically (COR=4.50; CI=1.78-11.42) than FC, and clinical and radiographic data confirmed this. Fourteen RCTs and 4 CTs (total 959 molars) were identified to compare MTA and FS. Indirect MAs found no statistically significant difference in clinical successes, but a statistically significant difference in the radiographic successes of MTA and FS (COR=4.69; CI=1.70-12.95). Clinical and radiographic data showed MTA was significantly more successful than FS. Nine RCTs and 7 CTs (total 531 molars) were identified to compare MTA and CH. Indirect MAs found statistically significant differences in the clinical (COR=6.48; CI=1.75-24.0) and radiographic (COR=10.47; CI=3.35-32.76) successes of MTA and CH. Clinical and radiographic data confirmed MTA was significantly more successful than CH. CONCLUSION: Currently available evidence suggests MTA compared with FC, FS and CH as a pulpotomy medicament resulted in significantly higher clinical and radiographic successes in all time periods up to exfoliation.

Mineral trioxide aggregate as a pulpotomy medicament: a narrative review.

BACKGROUND: Several medicaments have been used to devitalize remaining pulp or maintain pulp vitality and promote healing. Based on pulpal biocompatibility and good sealing ability, a growing interest in more biocompatible materials promotes mineral trioxide aggregate (MTA) as an alternative to traditional medicaments. Uniquely, MTA can preserve pulpal health predictably and promote healing with pulp regeneration. METHODS: Using electronic search all papers published since 1993 on the use of MTA in paediatric dentistry were identified. This paper provides a narrative review of the current literature on MTA, formocresol, ferric sulphate and calcium hydroxide with particular reference to primary teeth pulpotomy medication. CONCLUSION: The use of formocresol or formaldehyde-based medicaments should be replaced with more biocompatible medicaments possessing antimicrobial and pulpal regenerative properties. Of the four pulpotomy medicaments discussed, mineral trioxide aggregate is recommended as the medicament of choice.

The effect of pit and fissure sealants on the detection of occlusal caries in vitro.

AIMS: To compare, in vitro, the effect of placing opaque (OPS) and clear fluorescing (CFS) pit and fissure sealants (PFS) on the detection of occlusal caries (OCD). STUDY DESIGN: Occlusal surfaces of 67 extracted molars were examined under standardised conditions by 6 final year undergraduate dental students, using visual, bitewing radiography, transillumination (FOTI), laser fluorescence (LF) and tactile methods of caries detection. The teeth were then assigned randomly to two groups for PFS placement: OPS and CFS; then the OCD methods were repeated. Caries presence/absence was determined histologically on serial sections examined under stereo-microscopy (10x). RESULTS: Before PFS placement the sensitivity and specificity for the OCD methods were: visual: 68%, 71%; radiographic: 15%, 95%; FOTI: 36%, 93%; LF: 49%, 83% and tactile: 39%, 67%, respectively. After placement of OPS, the sensitivity of LF (20%) and visual (13%) methods decreased and specificity increased (93%, 98% respectively). Placement of CFS resulted in minor changes in sensitivity and specificity. Correlation (Spearman's Rho coefficients) between OCD methods and histological intra-dentinal caries for pre- PFS, OPS, and CFS were: visual: 0.38, 0.34, 0.33; FOTI: 0.42, 0.35, 0.43; and LF: 0.41, 0.30, and 0.45 respectively. CONCLUSIONS: The sensitivity of all OCD methods was low, as well as their correlation to the histological gold standard. Placing OPS further decreased the sensitivity of LF and visual methods, whereas placing CFS had little effect on all OCD methods. It is recommended that tactile detection of occlusal caries should be discontinued, and the probe used only to clean the pits and fissures gently for more accurate visual detection, or prior to pit and fissure sealant placement. Further research into the development of an affordable, robust, accurate and easy to use method for OCD is required.

Adding casein phosphopeptide-amorphous calcium phosphate to sports drinks to eliminate in vitro erosion.

PURPOSE: Enamel erosion can occur with frequent consumption of sports drinks. The purpose of this study was to determine a minimal concentration of casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) which when added to a sports drink would eliminate such erosion in vitro. METHODS: Human enamel specimens were immersed in: (1) the sports drink Powerade; (2) Poweradeplus 4 concentrations of CPP-ACP (0.063%, 0.09%, 0.125%, 0.25%); or (3) double deionized water. Windows of test and control enamel were profiled, and the enamel surface characteristics were examined under scanning electron microscopy (SEM). RESULTS: The pH of test solutions increased and the titratable acidity decreased with increasing CPP-ACP concentrations. Erosive step lesions occurred in specimens immersed in Powerade (mean depth=38.70kA +/- 5.60), which were eliminated by the addition of CPP-ACP to Powerade at all test concentrations except 0.063% CPP-ACP. Microscopic surface irregularities on test enamel were observed, apparent as adherent granules or globules. These may represent redeposited mineral phases following mobilization of calcium and phosphate from CPP-ACP. Tasters in a taste panel could not distinguish Powerade from Powerade plus 0.125% CPP-ACP. CONCLUSIONS: Adding casein phosphopeptide-stabilized amorphous calcium phosphate to the sports drink Powerade significantly reduced the beverage's erosivity without affecting the product's taste.

Oral hygiene measures and promotion: review and considerations.

Current mechanical and chemotherapeutic approaches to oral hygiene aim to modify the oral microflora to promote healthy periodontal and dental tissues. Current oral hygiene measures, appropriately used and in conjunction with regular professional care, are capable of virtually preventing caries and most periodontal disease and maintaining oral health. Toothbrushing and flossing are most commonly used, although interdental brushes and wooden sticks can offer advantages in periodontally involved dentitions. Chewing sugar-free gums as a salivary stimulant is a promising caries-preventive measure. Despite new products and design modifications, mechanical measures require manual dexterity and cognitive ability. Chemotherapeutic supplementation of mechanical measures using dentifrices, mouthrinses, gels and chewing gums as delivery vehicles can improve oral hygiene. The list includes anticalculus, antibacterial and cariostatic agents. For the population at large to make effective use of these oral hygiene measures, oral hygiene promotion needs to be implemented. Considerations include the role of parents, school and the media for children and the workplace, social environments. nursing homes and trained carers for adults and the elderly. Community oral hygiene promotion must attempt to maximise opportunities for oral health for all and reduce inequalities by removing financial and other barriers. Oral health approaches should be tailored to lifestyles and abilities of children, adults and the elderly in order to enable them to make decisions to improve personal oral hygiene and oral health.

Aided augmentative communication in managing children with cerebral palsy.

The use of an aided augmentative communication system to achieve effective communication between the pediatric dentist and the child with cerebral palsy is described. This type of communication involves symbols placed on a communication board and may be used together with conventional behavior management techniques for successful delivery of dental treatment. A multidisciplinary team caring for the child is necessary to achieve successful outcomes. Aided augmentative communication is a promising adjunct for the care of the child with communication impairment, and may be of particular value in pediatric dental practices where the staff are able to practice and master its use for selected child patients.

A study of the dental treatment needs of children with disabilities in Melbourne, Australia.

A selected population of children with disabilities in Melbourne, Australia, was studied with reference to their oral disease and treatment needs. A total of 300 children (aged 9-13 years), 150 attending special developmental schools (SDS) and 150 attending special schools (SS), received an oral examination and the parent/guardian completed a questionnaire. Six levels of function were defined, based on the child's independence for five self-care activities (brushing teeth, feeding self, dressing self, walking and performing toilet). The caries experience of children in the SS was lower than in SDS (d + D: 1.3 +/- 1.6 versus 1.5 +/- 2.4; dmft + DMFT: 2.0 +/- 2.3 versus 2.5 +/- 3.1); those attending SDS had higher unmet preventive and restorative needs. Significant associations were seen between the number of decayed teeth, the dmft + DMFT index, and the level of function (p < 0.005). Periodontal disease was prevalent; significant associations were seen between periodontal status, the need for periodontal therapy, and the level of function (p < 0.005). Assessment of the level of function by staff could assist in triaging individuals for urgent dental examination. Despite 41 per cent of children requiring simple treatment, the preventive and treatment needs of many remained unmet. Following examination, diagnosis and treatment planning by a dentist, much of the preventive, simple treatment and oral health promotion could be performed by trained dental auxiliaries. An epidemiological survey followed by the implementation and evaluation of a long-range public dental health care plan for children and adolescents with disabilities is needed urgently.

Professional development for dentists: patterns and their implications.

BACKGROUND: Approaches to models of professional development for dentists continue to evolve. This study examined the participation and attitudes of dentists in non-formal and informal professional development and continuing dental education. METHODS: Two methodologies were utilised: a self-administered cross-sectional survey of dentists in Victoria, Australia (conducted October to December, 1994), and a review of the records of the Continuing Education Unit of the School of Dental Science at The University of Melbourne for 1995 to 1999. For the cross-sectional survey, the sampling frame was the register of dentists of the Dental Board of Victoria in 1994. RESULTS: From a sample of 616 dentists invited to participate, 396 usable questionnaires were returned (response rate, 66.8 per cent). The valid data indicated that 52.5 per cent of dentists belonged to a study group, 66.5 per cent subscribed to at least one dental journal (other than the Australian Dental Journal), 88.9 per cent discussed dental matters with colleagues regularly, 98.6 per cent personally assessed their own work, 13.3 per cent did not attend continuing education courses and 18.1 per cent did not complete any courses in the year preceding the survey. Participation patterns in continuing education courses were related to socio-demographic characteristics of dentists. Some support was apparent for flexible delivery options for professional development. CONCLUSIONS: Involvement of dentists in Victoria, Australia in professional development activities is high, with complex participation patterns. Whether these patterns adequately address their own and the community's needs for such activities is debatable. Such issues should impact on any regulatory models for professional development for dentists and the development and use of alternative continuing education modalities.

Fourier analysis of facial profiles of young twins.

Twins studies provide a powerful approach to determining the relative contribution of genetics and environment to observed variation. Such studies assume trait differences in monozygous (MZ) twins are due to environmental factors and those in dizygous (DZ) twins are due to both genetic and environmental factors. This study quantitated facial profiles of twins using Fourier equations, determining their value in profile analysis and the assessment of the genetic contribution to facial shape. Standardized profile slide photographs of 79 pairs of 4-6 year-old twins (37 MZ pairs, 42 DZ pairs) were scanned and x and y coordinates were extracted from each profile using sellion and Camper's plane as references. The coordinates were subjected to Fourier analysis and the normalised vertex projection coefficients were studied. The means of the differences between coefficients for MZ co-twins did not differ significantly from that of DZ co-twins, although the DZ group showed higher mean differences in the higher harmonics. Subjective examination of superimposed reconstructions showed wider variation between DZ co-twins than MZ co-twins. Correct classification of twins by discriminant function analysis using Fourier coefficients was similar for both groups (MZ: 70.3%; DZ: 73.8%). Fourier analysis could quantitate facial profiles of young children and differentiate some details, but was unable to discriminate between genetic and environmental influences, and any possible interactions between these influences, on their overall facial profiles at this developmental stage.

Assessing caries risk in children.

With the dramatic improvements in the oral health of children in Australia that have occurred over the past two decades, the option of, and the need for, targeted prevention of dental caries for those at high risk has become apparent. Since caries is of multifactorial aetiology, the clinical outcome varies depending on which factor, or combination of factors, is prominent in a particular individual; this may be related to both age and stage of life. Tests for caries risk can assist in prediction, but clinical signs and history are as important in assessing the main cause(s) of caries in an individual. In studies involving several factors, past caries experience (especially of the first permanent molar) continues to be the best predictor of future caries in children. Despite their ready availability, tests in the form of commercial kits are still expensive; no one test is an adequate predictor of caries risk, and the specificity and sensitivity of the tests are not reliably diagnostic for an individual. There is a need for regional longitudinal risk assessment studies in which potential risk factors are identified before the onset of caries in order to maximize predictive power and then validated against subsequent caries. Caries activity may not be able to be predicted in a population with low disease prevalence. Any risk assessment strategy must be followed by appropriate preventive interventions.

Child abuse and dentistry: a study of knowledge and attitudes among dentists in Victoria, Australia.

Child abuse is a disturbingly common finding in society today. In view of the high proportion of orofacial injuries seen in victims of child abuse, dentists are in a strategic position to recognize and report suspected cases. The present study of 347 dentists in Victoria, Australia, assessed the level of knowledge and attitudes among dental professionals on the important issue of child abuse. While a high level of interest was shown by the participants towards this issue, a need for further information and training in the recognition and reporting of child abuse was seen in the survey findings. While dentists at present are not legally mandated in all states of Australia to report suspected cases of child abuse, the dental profession is in a key position to play an active role in the identification and reporting of this substantial community problem.