Effects of restoring SDF-treated and untreated dentine caries lesions on parental satisfaction and oral health related quality of life of preschool children.

OBJECTIVES: To find out the effects of placement of atraumatic restorative treatment (ART) restorations on parental satisfaction and oral health related quality of life (OHRQoL) of preschool children with SDF-treated or untreated dentine caries lesions. METHODS: In a randomized controlled trial conducted in Hong Kong, preschool children who had cavitated dentine caries lesions were randomly assigned to receive application of silver diamine fluoride (SDF) solution or placebo (tonic water) on their caries lesions 10 weeks before receiving ART restorations. Parents were asked to rate their satisfaction with their child's teeth using a 5-point scale (5 = very satisfied, 1 = very dissatisfied) before and six months after the restorative treatment. Besides, the Chinese version of Early Childhood Oral Health Impact Scale (C-ECOHIS) was used to assess the children's OHRQoL. RESULTS: A total of 194 children participated in this study, with 101 and 93 children receiving SDF and placebo application before ART restorations, respectively. There was no significant difference in parental satisfaction and C-ECOHIS score between the SDF and placebo groups at baseline. At the 6-month follow-up, the mean parental satisfaction score regarding their child's dental health status increased significantly (p < 0.001) from 2.2 ± 0.7 to 2.8 ± 1.0 in the SDF group and from 2.3 ± 0.8 to 2.7 ± 0.9 in the placebo group. However, no significant changes (p > 0.05) in C-ECOHIS scores were found in either of the two groups after ART restoration placement. CONCLUSIONS: Placement of ART restorations can improve parental satisfaction with the health and appearance of their child's teeth but has no significant effect on the OHRQoL. CLINICAL SIGNIFICANCE: This study provides valuable information about the effects of ART restoration placement on SDF-treated or untreated dentine caries lesions regarding parental satisfaction and OHRQoL of preschool children.

Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of preschool children: A 12-months parallel randomized controlled clinical trial.

OBJECTIVES: This clinical trial investigated the efficacy of silver diamine fluoride (SDF) in arresting dentine caries in primary molars of preschoolers. Time required for treatment, adverse effects, parental aesthetic perception, anxiety and oral health related to quality of life (OHRQoL) was evaluated. MATERIALS AND METHODS: Children, 2-5 years old, with active dentine caries lesions on the occlusal surface of primary molars were randomly allocated to test group (SDF) or control group (atraumatic restorative treatment/ART). The dmf-t/DMF-T and ICDAS indexes determined the presence of caries and activity. The main outcome after 3, 6 and 12-month follow-up was assessed by a blind examiner. The time required to perform the treatments was recorded and a facial image scale was applied to assess anxiety before and after treatment. Adverse events and aesthetic perception were assessed through questions addressed to caregivers; and the OHRQoL through the B-ECOHIS questionnaire. RESULTS: In 68 patients that were randomized, the mean number of treated teeth per child was 2.42(1.04) and 2.09(1.18) in the SDF and ART groups (p = 0.074), respectively. The mean difference of arrested lesions between the groups after 12 months was -0,07(0.05; - 0.17-0.30). The time required to treat with SDF was lower than the ART (p < 0.001). There was no difference in the percentage of adverse events + aesthetic perception (p = 0.709), and the change in anxiety (p = 0.155). There was a less impact in OHRQoL after ART treatment, but only when the parents' distress subscale was considered (p = 0.012). CONCLUSION: SDF requires much less chair-time and have similar results as ART in arresting caries lesion, anxiety, adverse effects, aesthetic perception and quality of life.

Assessment of anxiety and stress markers in children submitted to educational strategies and ART-restoration: A randomized clinical trial.

OBJECTIVE: Although atraumatic restorative treatment (ART) is considered to be a good option for anxious patients, there is a lack of information whether ART associated to oral health educational strategy (OHES) would positively influence the level of anxiety and stress in children. This study aimed to evaluate the impact of OHES on anxiety and stress markers of schoolchildren submitted to ART. DESIGN: A sample of 78 six- to eight-year-old schoolchildren, with carious lesions in dentin, were randomly divided into groups: OHES + ART-group (n = 39) and ART-group (n = 39). OHES consisted of an educational interactive strategy performed once a week for four weeks. ART was performed using a standardized procedure with hand instruments and glass-ionomer cement. Anxiety and stress markers were assessed subjectively by the modified Venham Picture Test (m-VPT), modified Venham Anxiety Scale (m-VAS), while objective measures consisted of heart rate (HR) and salivary cortisol and alpha-amylase levels evaluated before, during and after treatment. RESULTS: The two groups did not differ in the perceived anxiety and in anxious behavior, and the variation along the treatment was not significant in both groups (p > 0.05). Both groups also showed higher HR "Before ART-restoration" than the other time-points as an anticipatory anxiety. ART group showed higher HR than OHES + ART group during the "Explanation of procedure" (p = 0.041) and "Deep excavation" (p = 0.018), and only ART group showed higher amylase levels "Before ART" compared to "After ART" (p = 0.004). CONCLUSIONS: It was concluded that OHES associated with ART showed a positive effect in modulating heart rate and alpha-amylase levels, that is, those markers of stress objectively measured during ART-restoration.

[The atraumatic restorative treatment approach in pediatric dental care: a comparative clinical study].

The aim of this study was to assess and compare the discomfort levels during Atraumatic Restorative Treatment and Minimal Cavity Preparation using rotary instruments and Air abrasion method. The results of the study suggest that ART induces less discomfort, therefore this method can be recommended for children who have a fear of dental procedures as well as for children with intellectual disabilities.

Salivary Cortisol Levels and its Implication on Behavior In Children with Autism during Dental Treatment.

UNLABELLED: The aim of the study was to estimate the diurnal variations of salivary cortisol in children with autism and healthy children and it's implication on behavior during non-invasive dental procedures. STUDY DESIGN: 50 children with autism and 50 healthy children in the age group between 6 to 12 years of both genders with the need for dental treatment were included in the study. Whole unstimulated saliva was collected from them during early hours of the day and during evenings for 2 consecutive days . The collected saliva was then subjected to electrochemiluminescence assay . Minimum invasive dental procedures like hand scaling, pit and fissure sealants and glass ionomer cement restorations were performed for the participants each time after the saliva sample collection and their behavior during the procedures was rated using Frankl's Behavior Rating Scale. RESULTS: Significant correlation was seen between cortisol levels and behavior in children with autism. As cortisol levels increased in children with autism, behavior worsened and as the cortisol levels decreased they showed positive behaviour. CONCLUSION: Cortisol acts as a stress marker and studying the diurnal variations of salivary cortisol can help us in attaining better knowledge about the behavior pattern and thereby assist us in modifying the behavior modification procedures and treatment planning in this group of special children.

[Atraumatic restorative treatment in relation to pain, discomfort and dental treatment anxiety]. / Atraumatic restorative treatment in relatie tot pijn, ongemak en angst voor tandheelkundige behandelingen.

Dental treatment anxiety usually develops during childhood due to a bad experience and the dental drill as well as the injection needle are the most common causes. The Atraumatic Restorative Treatment provides the opportunity to provoke little or no dental treatment anxiety because only hand instruments are used and local anaesthesia is seldom required. Several scientific studies have indicated that the Atraumatic Restorative Treatment causes less pain, discomfort and anxiety by comparison with conventional treatments. Therefore, the Atraumatic Restorative Treatment is considered to be promising for the treatment of carious lesions in anxious children and adults, and potentially also for patients suffering from dental treatment phobia. Furthermore, the Atraumatic Restorative Treatment may be indicated as the primary treatment method in children to prevent dental treatment anxiety and treatment under general anaesthesia. These conclusions must still be confirmed with responsible scientific research.

Effect of different protocols for treating cavities in primary molars on the quality of life of children in Brazil--1 year follow-up.

The aim of this study was to test the hypothesis that the conventional restorative treatment (CRT) and the atraumatic restorative treatment (ART) protocols, in comparison with the ultra-conservative treatment (UCT) protocol, would increase the quality of life of children over a period of 1 year. Cavitated primary molars of 302 children 6-7 years of age were treated according to the CRT, ART and UCT protocols at the school compound. Children's parents completed the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) at baseline and one year later. Paired t-test, Chi-square test and ANOVA were applied in analysing the data. Questionnaires from 277 and 160 children were collected at baseline and after 1 year, respectively. A statistically significant difference in B-ECOHIS scores over the 1-year period was found for domains 'child symptoms' (P = 0.03) and 'child psychology' (P = 0.02). Treatment protocols did not statistically significantly influence the changes in B-ECOHIS scores over the 1-year period (P = 0.78). It can be concluded that the UCT protocol was as good as the two restorative protocols. All treatment protocols were effective in reducing children's experience of pain, their sleeping problems and their irritability and/or frustration levels over the 1-year period.

Anxiety in children during occlusal ART restorations in primary molars placed in school environment and hospital dental setup.

OBJECTIVE: To evaluate the anxiety in children during occlusal atraumatic restorative treatment (ART) in the primary molars of children; and compare the anxiety for ART procedure performed in school environment and in hospital dental setup. STUDY DESIGN: A randomized controlled trial where one dentist placed 120 ART restorations in 60 five- to seven year-olds who had bilateral matched pairs of occlusal carious primary molars. A split-mouth design was used to place restorations in school and in hospital dental setup, which were assigned randomly to contralateral sides. Anxiety was evaluated by Modified Venhem score and the heart rate of the children at five fixed moments during dental treatment. RESULTS: At the entrance of the children into the treatment room, statistically significant difference between treatment in school environment and treatment in hospital dental setup for venham score and heart rate could be found (P = 0.023 and P = 0.037 respectively). At the start of the treatment procedure higher venham score and heart rate was observed in children treated in hospital dental setup in comparison with the children treated in school environment, finding was statistically significant (P = 0.011 and P = 0.029 respectively). During all other three points of treatment, the Venham scores of the children treated in school were lower than those of the children treated in hospital dental setup but statistically not significant (P > 0.05). Positive co-relation between Venham scores and Heart rate was established. No statistically significant relation could be established between boys and girls. CONCLUSIONS: Overall anxiety in children for ART treatment was found to be less and the procedure was well accepted irrespective of environment where treatment was performed Hospital dental setup by itself made children anxious during entrance and starting of the treatment when compared to children treated in school environment.

Association between oral health-related quality of life and atraumatic restorative treatment in school children: an exploratory study.

BACKGROUND: The present study's objectives were to compare the perceptions of oral health-related quality of life (OHRQoL) among school children presents dental caries with that of caries-free school children, and to evaluate the subjective impact of atraumatic restorative treatment (ART) on the OHRQoL of school children. DESIGN: Exploratory study. SETTING: Public school in Piracicaba, Brazil. MATERIALS AND METHODS: The sample was composed of 30 children in the age-group of 8-10 years. The children were divided into two groups: one with caries and other without caries. The information related to OHRQoL was obtained through the administration of the Child Perceptions Questionnaires (CPQ 8-10 ). To evaluate the impact of ART on the school children's OHRQoL, the CPQ 8-10 was re-administered 4 weeks after the initial treatment. For statistical analysis we used the nonparametric Wilcoxon test for two dependent variables (test and re-test groups) and the nonparametric Mann-Whitney test for independent variables (test and control groups). RESULTS: It was observed that children with dental caries reported larger impact of oral health conditions on the quality of life when compared with the caries-free group, especially in the emotional and social well-being domains ( P ≤.05). After the school children who presented with dental caries received ART, there was improvement in the median scores of CPQ 8-10 in all of the domains, but particularly in the functional limitation domain ( P ≤.05). CONCLUSION: Dental caries exerts a strong influence on the OHRQoL of children. ART was shown to be a simple and painless caries management approach that could improve the OHRQoL of school children.

Patterns of dental anxiety in children after sequential dental visits.

AIM: To determine whether gradually exposing Brazilian children to the dental environment would decrease their levels of dental anxiety over a 14.5-month period. STUDY DESIGN AND METHODS: The study was carried out on 302 children of both genders, aged 6-7 years old. Dental anxiety was assessed using the Facial Image Scale (FIS) at five time points: 1) before an epidemiological examination; 2) before the first treatment session; 3) before the second treatment session; 4) before the first evaluation session 5) before the second evaluation session. STATISTICS: ANOVA, Student-t tests and ANCOVA were used to analyse the data. RESULTS: There was a statistically significant decrease in levels of dental anxiety between time points 1 and 5. Eighty-nine percent of the children with FIS score 1 or 2 at baseline had the same scores at the last time point, whereas 82% of children with FIS score 4 or 5 at baseline had a FIS score of 1 or 2 at the last time point. CONCLUSION: A gradual exposure of children to the dental environment in sequential dental visits of different natures in a school premise decreased their levels of dental anxiety over a 14.5-month period.

Dental anxiety in 6-7-year-old children treated in accordance with conventional restorative treatment, ART and ultra-conservative treatment protocols.

OBJECTIVE: To test the hypothesis that dental anxiety levels of children treated in accordance with the conventional restorative treatment (CRT) are higher than in children treated with the atraumatic restorative treatment (ART) or ultra-conservative treatment (UCT) protocols. MATERIALS AND METHODS: In total, 302 children aged 6-7-years old, with at least two dentine carious lesions, constituted the sample. A parallel group study design was used with ART and UCT as test groups and CRT as the control. The treatment was divided into two sessions. In the first session, one carious tooth (class II in a primary molar) was randomly selected and treated according to one of the treatments. All other treatments were performed in the second session. Before the first (FIS Tx-1) and before the second session (FIS Tx-2) the level of dental anxiety was assessed using the Facial Image Scale (FIS). The GLM test and Spearman's Rank Correlation Coefficient were used to analyse the data. RESULTS: No treatment group effect was observed on the FIS Tx-2 score (p = 0.64). A FIS Tx-1 score (p < 0.0001) effect on the FIS Tx-2 score was observed. The correlation coefficient between FIS Tx-1 and FIS Tx-2 scores was r = 0.30 (p < 0.0001). CONCLUSION: At the beginning of the second session there was no difference in dental anxiety levels of the children treated in the first session according to the three treatment protocols. A high dental anxiety score before the first session was a predictor of a high dental anxiety score at the second treatment session.

Changes in the quality of life of Tanzanian school children after treatment interventions using the Child-OIDP.

This study aimed to examine the evaluative properties of the Child Oral Impacts on Daily Performances (Child-OIDP) inventory and to estimate treatment-associated changes in the OIDP and self-reported oral health following atraumatic restorative treatment (ART) and oral health education (OHE). A total of 1,306 school attendees in Kilwa, Tanzania, completed the Child-OIDP inventory before, and 6 months after, treatment. The post-treatment questionnaire assessed change in perceived oral health. Complete baseline and follow-up data were obtained for 104, 117, and 1,085 participants who received, respectively, ART fillings (Group A), ART fillings and tooth extraction (Group B), and OHE only (Group C). The longitudinal validity, responsiveness, and treatment-associated changes were calculated using anova, effect sizes, and repeated general linear models (GLM). The follow-up prevalence was 73.8%. The mean changes in the OIDP total- and subscale scores were negative within those who reported 'worsened' oral health, and positive in subjects reporting 'improved' oral health. Effect sizes for the total OIDP score ranged from -0.2 within the category 'worsened' to 0.4 within the category 'improved'. Changes following treatment were more extensive in Group B compared with Groups A and C, and in Group C compared with Group A. The Child-OIDP showed promising evaluative properties and responsiveness to change following ART fillings, ART fillings and tooth extraction, and OHE.

A group of general dental practitioners' views of preformed metal crowns after participation in the Hall technique clinical trial: a mixed-method evaluation.

AIMS: The aims of this study were to investigate and describe the views of a group of general dental practitioners (GDPs) on their use of preformed metal crowns (PMCs) with the conventional method and the Hall Technique. The practitioners involved had previously taken part in a clinical trial of the Hall Technique. METHODS: The dentists' views were explored using a semi-structured interview (transcribed and analysed using a framework approach) and their use of crowns investigated (for conventional and Hall Technique) using a short questionnaire. RESULTS: Fourteen out of 17 dentists who participated in the trial were interviewed and completed the questionnaire. Prior to the trial, only three of the GDPs had been using conventional PMCs at all and this was 'infrequently'. None had been using them routinely. The semi-structured questionnaires revealed three main themes reflecting positively on the GDPs' experiences with the Hall Technique: its ease of use, its high patient acceptability, and the dentists' perceived clinical effectiveness of the technique. Thirteen of the 14 GDPs stated that they would continue to use the Hall Technique routinely and only one thought that he would not use it. CONCLUSION: Among a small group of GDPs with little experience or training in the use of the Hall Technique, it was perceived to be easy to use routinely, acceptable to patients and effective.

Dental anxiety and pain related to ART.

UNLABELLED: Atraumatic Restorative Treatment (ART) is considered to be well accepted, both by children and by adult patients. The objective of this review is to present and discuss the evidence regarding the acceptability of ART, from the patient's perspective. Aspects related to dental anxiety/fear and pain/discomfort have been highlighted, to facilitate better understanding and use of the information available in the literature. CONCLUSIONS: The ART approach has been shown to cause less discomfort than other conventional approaches and is, therefore, considered a very promising "atraumatic" management approach for cavitated carious lesions in children, anxious adults and possibly, for dental-phobic patients.

Dental anxiety and pain related to ART

Atraumatic Restorative Treatment (ART) is considered to be well accepted, both by children and by adult patients. The objective of this review is to present and discuss the evidence regarding the acceptability of ART, from the patient's perspective. Aspects related to dental anxiety/fear and pain/discomfort have been highlighted, to facilitate better understanding and use of the information available in the literature. CONCLUSIONS: The ART approach has been shown to cause less discomfort than other conventional approaches and is, therefore, considered a very promising "atraumatic" management approach for cavitated carious lesions in children, anxious adults and possibly, for dental-phobic patients.