High caries prevalence and risk factors among young preschool children in an urban community with water fluoridation.

BACKGROUND: Singapore is unique in that it is a 100% urban community with majority of the population living in a homogeneous physical environment. She, however, has diverse ethnicities and cultures as such; there may be caries risk factors that are unique to this population. AIM: The aims were to assess the oral health of preschool children and to identify the associated caries risk factors. DESIGN: An oral examination and a questionnaire were completed for each consenting child-parent pair. RESULTS: One hundred and ninety children (mean age: 36.3 ± 6.9 months) were recruited from six community medical clinics. Ninety-two children (48.4%) were caries active. The mean d123 t and d123 s scores were 2.2 ± 3.3 and 3.0 ± 5.6, respectively. Higher plaque scores were significantly (P < 0.0005) associated with all measures of decay (presence of decay, dt, ds). The risk factors for severity of decay (i.e., dt and ds) include child's age, breastfeeding duration, and parents' ability to withhold cariogenic snacks from their child. CONCLUSIONS: The high caries rate suggests that current preventive methods to reduce caries in Singapore may have reached their maximum effectiveness, and other risk factors such as child's race, and dietary and breastfeeding habits need to be addressed.

Occlusal fossae depth of permanent first molars assessed by visual examination: an in vitro approach.

PURPOSE: Sealant placement commonly is employed in molars with deep fissures to protect the teeth from occlusal caries. Some have advocated the some preventive approach for deep occlusal fossae in permanent molars. The decision of whether or not to place a sealant depends largely on the dentist's assessment of the depth of the occlusal fossae. The purposes of this in vitro study were to: (1) evaluate the morphology and determine the actual depth of occlusal fossae from newly erupted permanent first molars; (2) compare them with depth assessments obtained from visual examination, and (3) characterize how pediatric dentists look at the occlusal surfaces to assess fossae depth. METHODS: Fossa depth of 48 intact permanent molars was measured by a computerized micromeasurement system (Michigan Laser Digitizer) and compared with the depth assessed during a bench-top examination conducted by a panel of pediatric dentists. RESULTS: The computerized and visual measurements were positively and significantly correlated (r=0.64, P<.001). Agreement as measured by the Kappa statistic was moderate (k=0.46; 95% confidence interval=0.22-0.71; P<.001). CONCLUSION: Pediatric dentists' perception of fossa depth in permanent molars correlates moderately well with the actual fossa depth.

The virtual child: evaluation of an internet-based pediatric behavior management simulation.

This article describes an Internet-based instructional tool designed to give predoctoral dental students a virtual simulation of clinical pediatric dentistry to develop their pediatric behavior management knowledge. Effectiveness of this tool was evaluated using two consecutive classes of junior dental students. The control group was exposed to the traditional behavior management curriculum (two lectures) in a spring term course. The next class of dental students was exposed to the two lectures and, in addition, completed the behavior management simulation during the following spring term. Both groups completed a two-part examination (objective section=18 questions; open-ended section=responses to a clinical situation) designed to test their behavior management knowledge. The simulation group performed significantly better in both parts of the examination (objective section: p=.028; open-ended section: p=.012). The simulation was evaluated by students and perceived by most to be an effective addition to the curriculum. It was concluded that the experimental behavior management simulation, when added to the traditional lecture curriculum, improved pediatric behavior management knowledge in predoctoral dental students.

Predoctoral dental student evaluation of American Academy of Pediatric Dentistry's Caries-Risk Assessment Tool.

The purpose of this study was to determine predoctoral dental student evaluation of the American Academy of Pediatric Dentistry's Caries-Risk Assessment Tool (CAT) for children. Dental students were introduced to the CAT instrument as part of their didactic pediatric dentistry curriculum. These students were later encouraged to use the CAT instrument for determining caries risk in their pediatric patients. Following a two-year exposure to the CAT instrument, dental students completed an anonymous seven-item evaluation of the instrument at the end of their primary clinical experience in pediatric dentistry. The students were asked to score each item on a five-point scale ranging from strongly agree (#5) to neutral (#3) to strongly disagree (#1). Ninety-seven percent of eligible students completed the CAT evaluation questionnaire. Most students agreed that the CAT instrument was easy to understand (86 percent), simple to apply (76 percent), useful for prescribing radiographs (76 percent), and useful for determining preventive procedures (84 percent). Eighty percent of them indicated that they were likely to use the CAT instrument in their clinical practice. In conclusion, student acceptance of the CAT instrument indicates that it may educate predoctoral dental students regarding caries risk assessment in children.

Indirect pulp capping in the primary dentition: a 4 year follow-up study.

PURPOSE: Evaluate clinical and radiographic changes in primary teeth submitted to indirect pulp capping (IPC) over a 48-month-period. METHODS: Twenty seven primary molars with deep caries, but without preoperative signs of irreversible pulpits, were treated with IPC. The teeth were randomly divided into two groups, according to the material used for protection of the dentin-pulp complex. (1) a calcium hydroxide liner (Dycal) and (2) glass ionomer cement (Vitremer). RESULTS: After 48 months, Group-1 showed a success rate of 88.8% and Group-2 of 93%. No statistical significant difference between the groups was observed (P = 0.62). CLINICAL SIGNIFICANCE: The results of this study suggested that indirect pulp capping in primary teeth arrests the progression of the underlying caries, regardless of the material used as a liner.

Indirect pulp treatment of primary posterior teeth: a retrospective study.

PURPOSE: This study was performed to assess retrospectively the clinical and radiographic success of indirect pulp treatment (IPT) on primary posterior teeth, and to compare the influence of caries risk, skills of the operator, and restorative material on the success of IPT. METHODS: A retrospective review of records of patients treated with IPT in the pediatric dental clinic at The University of Michigan, School of Dentistry from July 1993 through July 1999 was completed in January 2000. Two hundred fifty-five records with IPT were reviewed, from which 132 patients met the inclusion criteria, with 187 primary posterior teeth treated with an IPT. The patients were followed clinically and radiographically for a time ranging between 2 weeks to 73 months. Data were analyzed using survival analysis methods. RESULTS: The success of IPT was 95% (178/187 teeth), with only 9 failures. The 1-year probability of survival of each tooth was estimated to be 96% using an exponential survival model. The use of a base over a calcium hydroxide liner significantly increased the success rate of IPT (P = .0095). The use of a stainless steel crown (SSC) after an IPT was significantly more successful than the use of an amalgam (P=.026). IPT performed on primary first molars failed more frequently than on second primary molars (P = .045). There was no significant difference between maxillary and mandibular primary molars. CONCLUSIONS: Indirect pulp treatment is a successful technique and should be considered as an alternative pulp therapy procedure in deeply carious primary posterior teeth. The use of a base over the liner in addition to a SSC dramatically increases the success of an IPT.

Indirect pulp treatment: in vivo outcomes of an adhesive resin system vs calcium hydroxide for protection of the dentin-pulp complex.

PURPOSE: The purpose of this prospective and randomized in vivo study was to compare the clinical and radiographic outcomes of an adhesive resin system vs a calcium hydroxide liner for protection of the dentin-pulp complex of primary molars treated with indirect pulp treatment. METHODS: Forty-eight primary molars with deep occlusal caries, but without preoperative signs and symptoms of irreversible pulpitis, received indirect pulp treatment and were restored with a composite resin (Z100). The teeth were randomly divided into 2 groups according to the material used for protection of the dentin-pulp complex: (1) adhesive resin system (Scotchbond MultiPurpose); and (2) calcium hydroxide liner (Dycal). These teeth were evaluated clinically and radiographicaly for 2 years. RESULTS: After 2 years, 83% (19/23) of the teeth treated with calcium hydroxide and 96% (24/25) of teeth treated with only the adhesive resin system presented a successful outcome, as determined by clinical and radiographic examination. Interradicular and/or periapical lesions were the most predominant signs of treatment failure, since 3 out of 23 teeth treated with calcium hydroxide and 1 out of 25 teeth treated with only adhesive resin presented this outcome. One tooth treated with the calcium hydroxide liner was diagnosed with internal root resorption at the 18-month examination. Of the 5 teeth diagnosed from radiographs as a failure of the indirect pulp treatment, none presented clinical signs/symptoms of pulpitis or necrosis such as the presence of fistula, enhanced tooth mobility, or pain. CONCLUSIONS: This study demonstrates that protection of the dentin-pulp complex of primary molars with an adhesive resin system results in similar clinical and radiographic 2-year outcomes as compared to calcium hydroxide when indirect pulp treatment is performed in Class I composite restorations.