RESUMO
BACKGROUND: Tooth decay (caries) is a significant health burden in young children. There is strong evidence for the benefits of establishing appropriate home-based oral health behaviours in early childhood. Dental teams are well placed to provide this information and there is clear advice on what oral health information should be given to parents. However, research has shown that there is limited guidance, training and resources on how dental teams should deliver this advice. "Strong Teeth" is a complex oral health intervention, using evidence-based resources and training underpinned by behaviour change psychology, to support behaviour change conversations in dental practice. This early phase evaluation aims to assess the feasibility of this intervention, prior to a full-scale trial. METHODS: The study recruited 15 parents of children aged 0-2-years-old and 21 parents of children aged 3-5 years old, from five NHS dental practices across West Yorkshire. Participant demographics, self-reported brushing behaviours, dietary habits, a dental examination and three objective measures of toothbrushing were collected in a home-setting at baseline, then at 2-weeks and 2-months post-intervention. Recruitment, retention and intervention delivery were analysed as key process outcomes. Brushing habits were compared to national toothbrushing guidelines - the Delivering Better Oral Health toolkit (Public Health England). RESULTS: Strong Teeth was feasible to deliver in a General Dental Practice setting in 94% of cases. Feasibility of recruitment (37%) exceeded progression criterion, however retention of participants (75%) was below the progression criterion for the 0-2 age group. More than half of children recruited aged 3-5-years had caries experience (52%). Total compliance to toothbrushing guidance at baseline was low (28%) and increased after the intervention (52%), an improvement that was statistically significant. Dietary habits remained largely unchanged. Plaque scores significantly decreased in the 3-5-year-olds and toothbrushing duration increased in all age groups. CONCLUSION: "Strong Teeth" intervention delivery and data collection in the home setting was feasible. There was a positive indication of impact on reported toothbrushing behaviours. Some amendments to study design, particularly relating to the inclusion of the 0-2-year-old group, should be considered before progression to a full trial. Trial registration ISRCTN Register: ISRCTN10709150. Registered retrospectively 24/7/2019.
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Cárie Dentária , Saúde Bucal , Criança , Pré-Escolar , Cárie Dentária/prevenção & controle , Inglaterra , Estudos de Viabilidade , Humanos , Lactente , Recém-Nascido , Pais , Estudos Retrospectivos , Escovação DentáriaRESUMO
INTRODUCTION: Dental treatment for children requires not only technical skills, but also the knowledge and confidence to provide behaviour management to support children of differing ages and stages of development. It is not surprising then that dental students find treating children especially stressful. Paediatric dentistry training is therefore a vital element of the undergraduate dental curriculum. MATERIALS AND METHODS: Eighty-six fourth-year undergraduate dental students received standard lectures and seminars about behaviour management techniques for children having local anaesthetic. The students were then randomly divided into groups using cluster randomisation. The intervention group received an intervention-based around video clips (VCs) demonstrating behaviour management techniques (BMTs) for children receiving local anaesthetic The intervention and control groups completed self-administered questionnaires to determine their level of confidence in managing local anaesthetic for children. RESULTS: There was a statistically significant difference in the level of confidence between the groups immediately after the teaching intervention (P=.003) and at 4 months (P=.001) in favour of the video group. DISCUSSION: Previous studies on the use of video as a teaching aid have reported favourable results in terms of both student attitudes and learning outcomes. The results from this study confirm the benefits of this style of teaching paediatric behaviour skills in the undergraduate dental curriculum, and the benefits were maintained at 4 months. CONCLUSION: This study has demonstrated that VCs as an additional teaching aid are an effective method in improving students' confidence for BMTs when delivering local anaesthetic.
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Anestesia Dentária , Anestesia Local , Recursos Audiovisuais , Competência Clínica , Educação em Odontologia/métodos , Odontopediatria/educação , Gravação em Vídeo , Criança , HumanosRESUMO
The aim of designing and fabricating the surgical templates was to assist the surgical component of premolar transplantation, by establishing and replicating the root dimensions of the donor premolar tooth. The correct template could be used to assess the socket preparation (width and depth) prior to placement of the transplant in the recipient site, obviating the need to repeatedly try the donor tooth for fit at the recipient site, thereby minimising trauma to the periodontal ligament of the donor tooth. Seventy-five mandibular premolars and 50 maxillary second premolars were selected with varying stages of root development. All teeth had been extracted for orthodontic reasons. The root was measured for its length (maxL) and maximum (maxW) and minimum width (minW) with digital callipers from standardised reference points. These measurements were then used in the design of premolar transplant templates. The mean measurements for second maxillary premolars were maxL 14.6 mm (± 1.7), maxW 8.3 mm (± 0.5) and minW 4.9 (± 0.3). The mean measurements for mandibular premolars were maxL 14.8 (± 1.6), maxW 7.4 (± 0.6) and minW 5.3 (± 0.5). From these measurements, a range of maxillary second premolar and mandibular premolar templates have been fabricated. These figures also inform the multidisciplinary planning process for the space requirements at the donor site prior to transplantation.
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Anatomia Transversal , Dente Pré-Molar/transplante , Modelos Anatômicos , Alvéolo Dental/anatomia & histologia , Adolescente , Dente Pré-Molar/anatomia & histologia , Precisão da Medição Dimensional , Humanos , Planejamento de Assistência ao Paciente , Estudos Prospectivos , Raiz Dentária/anatomia & histologia , Transplante AutólogoRESUMO
Objectives To examine the quality of UK-based oral health promotion materials (OHPM) for parents of young children aged 0-5 years old.Data sources OHPM were obtained via email request to dental public health consultants and oral health promotion teams in the UK, structured web-based searches or collected from oral health events.Data selection Materials were included if: they were freely available; they were in English; they were parent facing and included oral health advice aimed at children aged 0-5-years-old.Data extraction Quality assessment was based on: whether the oral health messages were consistent with Public Health England's Delivering better oral health guidance, and what barriers to good oral health were addressed by the OHPM using the Theoretical Domains Framework (TDF).Data synthesis A wide range of printed and digital OHPM were identified (n = 111). However, only one piece of material covered all 16 guidance points identified in Public Health England's Delivering better oral health (mean 6, SD 4), and one other material addressed all 12 domains of the TDF (mean 6, SD 2).Conclusions Although there were examples of high quality, further development is required to ensure OHPM are clear, consistent and address a wider range of barriers to good oral health behaviours.
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Promoção da Saúde , Saúde Bucal , Educação de Pacientes como Assunto , Pré-Escolar , Cárie Dentária/prevenção & controle , Humanos , Lactente , Recém-Nascido , Pais , Educação de Pacientes como Assunto/métodosRESUMO
AIM: This systematic review was undertaken in order to develop guidelines for the European Academy of Paediatric Dentistry for the management of non-vital permanent anterior teeth with incomplete root development. METHODS: Three techniques were considered; apexification by single or multiple applications of calcium hydroxide, use of Mineral Trioxide Aggregate (MTA) for the creation of an apical plug followed by obturation of the root canal, and finally a Regenerative Endodontic Technique (RET). Scottish Intercollegiate Guideline Network (SIGN) Guidelines (2008) were used for the synthesis of evidence and grade of recommendation. RESULTS: Variable levels of evidence were found and generally evidence related to these areas was found to be weak and of low quality. It was not possible to produce evidence-based guidelines based on the strength of evidence that is currently available for the management of non-vital immature permanent incisors. CONCLUSIONS: Based on the available evidence the European Academy of Paediatric Dentistry proposes Good Clinical Practice Points as a guideline for the management of such teeth. It is proposed that the long term use of calcium hydroxide in the root canals of immature teeth should be avoided and apexification with calcium hydroxide is no longer advocated. The evidence related to the use of a Regenerative Endodontic Technique is currently extremely weak and therefore this technique should only be used in very limited situations where the prognosis with other techniques is deemed to be extremely poor. The current review supports the use of MTA followed by root canal obturation as the treatment of choice.
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Tratamento do Canal Radicular , Dente não Vital/terapia , Adolescente , Criança , Dentição Permanente , Odontologia Baseada em Evidências , Humanos , Guias de Prática Clínica como Assunto , Medicina Regenerativa/métodos , Medicina Regenerativa/normas , Obturação do Canal Radicular/métodos , Obturação do Canal Radicular/normas , Tratamento do Canal Radicular/métodos , Tratamento do Canal Radicular/normasRESUMO
AIM: This was primarily to examine the effect of premature extraction of primary teeth (PEPT) on subsequent malocclusion and need for orthodontic treatment in the permanent dentition. The secondary aim was to correlate the effect of PEPT with loss of space in the primary and mixed dentitions. METHODS: A predefined protocol was developed and registered prospectively with PROSPERO database. The electronic databases, searched, were MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials. The study designs considered for inclusion were controlled trials, cohort, and case-control studies. Risk of bias was assessed using a validated quality assessment tool. RESULTS: 513 studies were identified. Sixteen studies were included in the systematic review, one study reported on malocclusion, and 15 studies reported on space changes. Narrative synthesis was undertaken owing to the heterogeneity of the included studies. No study examined the effect of PEPT on orthodontic need. Most studies reported on space dimensions used a split-mouth design and were at a high risk of bias. CONCLUSIONS: The included literature identified that PEPT led to various features of malocclusion and space loss in the mixed and permanent dentitions. No studies, that met the inclusion criteria, described the effect of PEPT on the subsequent need for orthodontic treatment.
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Ortodontia Corretiva/métodos , Extração Dentária/efeitos adversos , Dente Decíduo , Humanos , Má Oclusão/terapiaRESUMO
AIM: To assess the views and experience of the UK dentists specialising in paediatric dentistry (trainees) about molar incisor hypomineralisation (MIH) and compare the findings with the responses from a group of UK general dental practitioners. METHOD: A web-based questionnaire was sent to dentists undergoing specialist training in paediatric dentistry. The same questionnaire was completed by a group of general dentists who stated an interest in treating children, with various levels of experience. The questionnaire sought information on clinical experience and the views of the dentists on the impact of MIH on children and families. RESULTS: Specialty trainees (37) from different paediatric dental departments in the UK completed the online survey, giving a total response rate of 71%. The questionnaire was also completed by 31 general dental practitioners. There was difficulty in distinguishing MIH from other conditions for both groups. Increased sensitivity of affected teeth was the most frequently encountered problem with 51% of the trainees and 76% of the dentists saying this was often or always a challenge. The trainees were particularly concerned about the pain children experienced and about the appearance of the condition. Both groups felt that parental anxiety occurred in almost all cases. CONCLUSIONS: Both groups felt that MIH presents several clinical challenges and has a negative effect on the quality of life of the affected children and their families. There were significant differences in the views and perceptions between the two groups.
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Hipoplasia do Esmalte Dentário/terapia , Odontopediatria , Criança , Competência Clínica , Restauração Dentária Permanente , Odontólogos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incisivo , Dente Molar , Qualidade de Vida , Reino UnidoRESUMO
Globally, dental caries is one of the most prevalent diseases and is more common in children living in deprived areas. Dental caries is preventable, and guidance in the United Kingdom recommends parental supervised brushing (PSB): a collection of behaviors-including twice-daily toothbrushing with fluoridated toothpaste-that should begin upon eruption of the first tooth (approximately 6 to 12 mo of age) and for which children need to be helped or supervised by an adult until at least 7 y of age. The aim of this study was to explore parents' experiences of toothbrushing with their young children and to establish barriers and facilitators to PSB at individual, interpersonal, and environmental levels according to the theoretical domains framework. Qualitative semistructured interviews guided by the framework were conducted with 27 parents of young children (<7 y) in 2 deprived areas of the United Kingdom. Framework analysis was used. Parents were not aware of national guidance concerning their active involvement in toothbrushing; however, they did have detailed knowledge of toothbrushing practices for children, and their intentions were to brush their children's teeth themselves twice every day as part of a family routine. Nonetheless, parents' difficulties experienced in managing their children's challenging behavior and the environmental context of their stressful lives meant that many parents adopted a role of simply reminding their children to brush or watching them brush. As such, the main barriers to PSB among parents living in deprived areas were skills in managing their children's behavior and environmental influences on family life. The results of our study have clear implications for the development of appropriate interventions to address the modifiable barriers to improve parental adoption of PSB. Knowledge Transfer Statement: The results of this study will be used to develop a behavior change intervention to encourage parental supervised brushing. The intervention-which is likely to be delivered through health practitioners rather than dental teams-will be developed to reduce dental caries among young children and will require evaluation in terms of its clinical and cost effectiveness.
RESUMO
BACKGROUND: Dental caries in young children is a major public health problem impacting on the child and their family in terms of pain, infection and substantial financial burden on healthcare funders. In the UK, national guidance on the prevention of dental caries advises parents to supervise their child's brushing with fluoride toothpaste until age 7. However, there is a dearth of evidence-based interventions to encourage this practice in parents. The current study used intervention mapping (IM) to develop a home-based parental-supervised toothbrushing intervention to reduce dental caries in young children. METHODS: The intervention was developed using the six key stages of the IM protocol: (1) needs assessment, including a systematic review, qualitative interviews, and meetings with a multi-disciplinary intervention development group; (2) identification of outcomes and change objectives following identification of the barriers to parental-supervised toothbrushing (PSB), mapped alongside psychological determinants outlined in the Theoretical Domains Framework (TDF); (3) selection of methods and practical strategies; (4) production of a programme plan; (5) adoption and implementation and (6) Evaluation. RESULTS: The comprehensive needs assessment highlighted key barriers to PSB, such as knowledge, skills, self-efficacy, routine setting and behaviour regulation and underlined the importance of individual, social and structural influences. Parenting skills (routine setting and the ability to manage the behaviour of a reluctant child) were emphasised as critical to the success of PSB. The multi-disciplinary intervention development group highlighted the need for both universal and targeted programmes, which could be implemented within current provision. Two intervention pathways were developed: a lower cost universal pathway utilising an existing national programme and an intensive targeted programme delivered via existing parenting programmes. A training manual was created to accompany each intervention to ensure knowledge and standardise implementation procedures. CONCLUSIONS: PSB is a complex behaviour and requires intervention across individual, social and structural levels. IM, although a time-consuming process, allowed us to capture this complexity and allowed us to develop two community-based intervention pathways covering both universal and targeted approaches, which can be integrated into current provision. Further research is needed to evaluate the acceptability and sustainability of these interventions.
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Cárie Dentária/prevenção & controle , Pais , Escovação Dentária/métodos , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Escovação Dentária/estatística & dados numéricosRESUMO
BACKGROUND: This study investigated the frequency, patterns and causes of dental trauma in patients seeking emergency treatment at a dental hospital, and evaluated the impact of an electronic structured injury history form to collect key information. METHODS: A retrospective audit was undertaken of all emergency presentations at the Royal Dental Hospital of Melbourne from 2009 to 2012. Dental trauma and injury surveillance data were collected and evaluated with reference to the criteria of the Victorian Emergency Minimum Dataset. Statistical analysis included chi-squared and Fisher's exact tests. RESULTS: A total of 88,610 new emergency courses of care were created, with 3642 (4.1%) identified as new dental trauma cases in 3574 patients. A total of 6001 teeth were injured with a mean of 1.7 teeth per patient (range: 1-8 teeth). The improvement of injury surveillance information collected using the electronic form compared with the paper form was statistically significant (p<0.001). CONCLUSIONS: The dental trauma findings of this study are consistent with other studies regarding age, gender, location, cause and injury type. This study also confirmed the benefits of electronic collection of dental injury surveillance data that can assist policy planners and health service providers in designing and delivering effective dental injury prevention and management services.
Assuntos
Traumatismos Dentários/epidemiologia , Acidentes Domésticos/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos em Atletas/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Auditoria Odontológica , Registros Odontológicos/estatística & dados numéricos , Unidade Hospitalar de Odontologia/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estudos Retrospectivos , Avulsão Dentária/epidemiologia , Fraturas dos Dentes/epidemiologia , Dente Decíduo/lesões , Vitória/epidemiologia , Adulto JovemRESUMO
INTRODUCTION: An avulsed permanent tooth is one of the few true emergencies in dentistry. Children who suffer this injury require urgent dental care and prompt follow-up care. There is very limited evidence available regarding the provision of treatment for avulsion injuries in primary dental care. OBJECTIVES: To explore the experience of UK dentists in relation to the management of avulsed permanent teeth. METHOD: A self-completion questionnaire was designed and piloted. Questionnaires were sent to a random selection of one thousand GDPs with a stamped addressed return envelope. A second mailshot was sent to non-responders after eight weeks. Simple descriptive analysis was undertaken using Microsoft Excel. The results were compared with those from an earlier, similar study in Wales. RESULTS: A total response rate of 61% was achieved. Just over 40% of responding dentists recalled replanting an avulsed permanent tooth in a child. CONCLUSIONS: Many dentists have limited or no experience of treating children with avulsed permanent teeth. Thirty-four percent of dentists have children with avulsion injuries under their care. Children with these traumatic injuries may benefit from shared care involving an interdisciplinary specialist team, in line with recommendations from the British Society of Paediatric Dentistry National Clinical Guidelines for Management of Avulsed Permanent Teeth in Children.
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Dentição Permanente , Odontologia Geral , Odontopediatria/métodos , Avulsão Dentária/terapia , Criança , Humanos , Inquéritos e QuestionáriosRESUMO
Various environmental factors have been associated with the timing of eruption of primary dentition, but the evidence to date comes from small studies with limited information on potential risk factors. We aimed to investigate associations between tooth emergence patterns and pre-conception, pregnancy and postnatal influences. Dentition patterns were recorded at ages 1 and 2 years in 2915 children born to women in the Southampton Women's Survey from whom information had been collected on maternal factors before conception and during pregnancy. In mutually adjusted regression models we found that: children were more dentally advanced at ages 1 and 2 years if their mothers had smoked during pregnancy or they were longer at birth; mothers of children whose dental development was advanced at age 2 years tended to have poorer socioeconomic circumstances, and to have reported a slower walking speed pre-pregnancy; and children of mothers of Asian ethnicity had later tooth development than those of white mothers. The findings add to the evidence of environmental impacts on the timing of the eruption of primary dentition in indicating that maternal smoking during pregnancy, socio-economic status and physical activity (assessed by reported walking speed) may influence the child's primary dentition. Early life factors, including size at birth are also associated with dentition patterns, as is maternal ethnicity.
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Efeitos Tardios da Exposição Pré-Natal , Dente Decíduo , Adulto , Desenvolvimento Infantil , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Gravidez , Fumar , Fatores Socioeconômicos , CaminhadaRESUMO
The single intravenous injection to rats of 1 ml of serum from an insulin resistant patient without an excessive titre of insulin antibodies (total extractable insulin levels: 0.8 U/l, serum insulin binding capacity: 1.58 U/l) and no demonstrable insulin receptor antibodies, produced fasting hyperglycemia in the animals on the fourth day following the injection (FPG: 212 +/- 35 mg %). On the 7th day the FPG returned to normal but the IVGTT was still pathological. After 14 days there was complete normalisation of the IVGTT. Glucose intolerance did not occur when rats were injected with 1 ml of the following control sera: the patient's serum following 6 months of treatment with cyclophosphamide when her insulin resistance was in remission, pooled sera from IDD's without insulin resistance, serum from an insulin resistant IDD with a high titre of insulin binding capacity (greater than 40 U/l) or with serum from a normal human subject. There were no alterations on light microscopy of the pancreatic islets of rats sacrificed on the 4th or 21st days. The above data suggest that our patient carried an uncharacterised substance which was capable of inducing glucose intolerance in rats. Hypothetically, it may be postulated that it was an immunoglobulin or some other protein acting via downregulation of insulin receptors or interfering with a post-receptor event mediating insulin action.
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Diabetes Mellitus/fisiopatologia , Resistência à Insulina , Animais , Diabetes Mellitus/sangue , Feminino , Teste de Tolerância a Glucose , Humanos , Pessoa de Meia-Idade , Ratos , Ratos Endogâmicos , Fatores de TempoRESUMO
The authors report a clinical trial designed to compare the discomfort produced by plain and epinephrine-containing lidocaine solutions during local anesthesia in the maxilla. Twenty-four healthy volunteers were recruited; each received buccal and palatal infiltrations on each side of the maxilla in the premolar region. The solutions were 2% lidocaine and 2% lidocaine with 1:80,000 epinephrine. Allocation to side was randomized and operator and volunteer were blinded to the identity of the solutions. Volunteers recorded injection discomfort on a 100-mm visual analogue scale (VAS). Volunteers were included in the trial if a score of at least 30 mm was recorded for at least 1 of the matched pair of injections. Differences between treatments were measured using Student's paired t test. Twelve volunteers recorded a VAS score of at least 30 mm for 1 or both buccal injections, and 17 volunteers reached this score for palatal injections. Buccal injection pain was less when the plain solution was used (P = .04) and was not influenced by the order of the injection. Palatal injection discomfort did not differ between the solutions; however, the second palatal injection was more uncomfortable than the first palatal injection (P = .046). These results suggest that plain lidocaine produces less discomfort than lidocaine with epinephrine when administered into the maxillary premolar buccal sulcus in individuals who report moderate pain during this injection. Palatal injection discomfort does not differ between these solutions.
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Anestesia Dentária , Anestésicos Locais/administração & dosagem , Dor Facial/etiologia , Administração Bucal , Adulto , Método Duplo-Cego , Combinação de Medicamentos , Epinefrina/administração & dosagem , Feminino , Humanos , Injeções/efeitos adversos , Lidocaína/administração & dosagem , Masculino , Medição da Dor , Palato Duro , Vasoconstritores/administração & dosagemRESUMO
It was the purpose of the present investigation to determine if there were differences in soft-tissue anesthesia in the palate following infiltration and greater palatine nerve block anesthesia and to compare lidocaine with lidocaine plus epinephrine as palatal soft tissue anesthetics. Two studies using 10 volunteers were performed. In one trial, volunteers received a palatal infiltration opposite the second maxillary bicuspid on one side and a greater palatine nerve block on the other. Response to sharp probing and pain-pressure thresholds were measured on each side over a 1-hour census period. In the second trial, volunteers received 2% plain lidocaine as a palatal infiltration on one side and a similar infiltration of 2% lidocaine with 1:80,000 epinephrine on the other in a double-blind randomized fashion. Response to sharp probing was assessed over a 55-minute period. Data were analyzed using Student's paired t tests. The response to sharp probing and pressure-pain thresholds did not differ between palatal infiltration and greater palatine nerve block over the 1-hour period. Lidocaine with epinephrine provided longer lasting anesthesia than plain lidocaine following palatal infiltration (P < .001). Greater palatine nerve block and palatal infiltration provide similar soft-tissue anesthesia. Lidocaine with epinephrine produces longer-lasting soft-tissue anesthesia than plain lidocaine following palatal infiltration.
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Anestesia Dentária/métodos , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Palato Mole , Adulto , Dente Pré-Molar , Método Duplo-Cego , Epinefrina/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Nervo Maxilar , Bloqueio Nervoso/métodos , Dor/fisiopatologia , Limiar da Dor/fisiologia , Palato Mole/inervação , Placebos , Pressão , Estatística como Assunto , Fatores de Tempo , Vasoconstritores/administração & dosagemRESUMO
Intrusion injuries to the permanent dentition are amoung the most severe types of dental injuries, occurring in 0.3-1.9% of all dental trauma cases. The current clinical guidelines in the management of intrusion injuries are based on level B evidence due to the infrequent nature of this type of injury, coupled with a lack of high quality evidence-based studies. This paper presents four cases of severe intrusion injuries that were successfully managed using an interdisciplinary approach. The cases described here highlight the benefits of orthodontic repositioning of severely intruded teeth in the short and medium terms. Although orthodontic repositioning was unsuccessful in the final case, this did not preclude subsequent surgical repositioning. Interdisciplinary collaboration allowed two of the cases described to be effectively managed with premolar autotransplantation alongside orthodontic treatment. The cases demonstrated here indicate the difficulties in providing the current recommended treatment modalities at non-specialist clinics. They accentuate the importance of an immediate referral of such complex cases to a specialist centre where interdisciplinary management is readily available.
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Dentição Permanente , Incisivo/lesões , Traumatismos Dentários/terapia , Criança , Feminino , Humanos , Masculino , Radiografia , Traumatismos Dentários/diagnóstico por imagemRESUMO
OBJECTIVE: To investigate in children the factors that influence the number of visits per tooth following traumatic dental injuries (TDI) to the permanent dentition. METHOD: A retrospective convenient sample of 100 children who had been treated for TDI at Leeds Dental Institute was identified. A multilevel negative binomial regression model was developed to identify factors influencing the number of visits per tooth. Data including age, gender, postcode, number of visits, treatment provided, number of teeth injured, type of periodontal and hard tissue diagnoses, healing modality, root maturity, pulp and tooth survival, and any history of previous or subsequent trauma to same tooth were analysed using SPSS 18.0 and MLWIN. RESULTS: 186 teeth were affected by trauma in 100 patients. Median total number of visits per tooth was six visits with a range of 1-22 visits. The factors that were found to influence number of visits included: distance travelled, hard tissue diagnosis, periodontal injury diagnosis and pulp survival (P < 0.05). A mile increase in distance travelled from home to clinic led to a 1.2% reduction in the number of visits per month (-0.012; SE 0.005), a diagnosis of a severe hard tissue injury was associated with 44% increase (0.362; SE 0.105) compared to no hard tissue injury, a diagnosis of a complicated periodontal injury compared to no periodontal injury was associated with a 30% increase (0.260; SE 0.124), a diagnosis of a uncomplicated periodontal injury compared to no periodontal injury was associated with a 31% increase (0.271; SE 0.124) and a diagnosis and treatment for a non-vital tooth in comparison to a vital tooth led to a 26% increase (0.230; SE 0.080) in the number of visits. There was a significant variation in the number of treatment visits at patient level (0.260; SE 0.048). CONCLUSION: Complicated hard tissue injuries, complicated and uncomplicated periodontal injuries, diagnosis and treatment for pulp necrosis and the distance between clinic and patient's home all significantly influenced the number of visits needed to treat TDI.
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Odontologia Geral/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Incisivo/lesões , Visita a Consultório Médico/estatística & dados numéricos , Traumatismos Dentários/economia , Traumatismos Dentários/terapia , Adolescente , Fatores Etários , Criança , Polpa Dentária/lesões , Necrose da Polpa Dentária/etiologia , Necrose da Polpa Dentária/terapia , Dentição Permanente , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Análise Multinível , Periodonto/lesões , Características de Residência , Estudos Retrospectivos , Tratamento do Canal Radicular/estatística & dados numéricos , Fatores Sexuais , Coroa do Dente/lesões , Traumatismos Dentários/complicações , Dente não Vital/complicações , Reino UnidoRESUMO
BACKGROUND: Fraser syndrome is a rare autosomal recessive disorder of which there has only previously been one case reported in the dental literature. The main characteristics are cryptophthalmos, syndactyly and genital abnormalities. Orofacial findings reported are: facial asymmetry, cleft lip and palate, high arched palate, dental crowding, fusion of primary teeth, dental hypoplasia, malocclusion, and supragingival calculus. CASE REPORT: A 15 year old girl with Fraser syndrome attended Bradford and Airedale salaried dental services complaining of painful mandibular anterior teeth. On examination she presented with hypodontia, shortened roots, and the mandibular anteriors had a titanium trauma splint fixed to reduce the mobility. This had been placed 4 years previously by a paediatric specialist. However oral hygiene was poor around it and therefore the patient had calculus and gingivitis. TREATMENT: The splint was removed followed by subgingival scaling under local analgesia, fissure sealants of all posterior teeth, regular oral hygiene instruction and scaling, and occasional use of chlorhexidine gel. FOLLOW-UP: She has been reviewed regularly with frequent scalings over two years. CONCLUSION: This case reports the possibility of hypodontia and short roots being associated with Fraser syndrome.
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Anodontia/etiologia , Síndrome de Fraser/complicações , Raiz Dentária/anormalidades , Adolescente , Consanguinidade , Cálculos Dentários/etiologia , Cálculos Dentários/terapia , Raspagem Dentária , Assimetria Facial/etiologia , Feminino , Humanos , Má Oclusão Classe II de Angle/etiologia , Higiene Bucal/educação , Contenções Periodontais/efeitos adversos , Mobilidade Dentária/etiologiaRESUMO
A 16-year-old female who was diagnosed with palmar-plantar keratosis and Papillon-Lefevre syndrome in life died following a period of stress/affray. Autopsy examination revealed evidence of minor trauma and a grossly abnormal heart. The heart was sent fresh and intact to a cardiac pathologist for examination. This revealed a dilated cardiomyopathy with left ventricular fibrosis, without fatty infiltration of the right ventricle. The features were in keeping with Carvajal syndrome, a variant of Naxos disease. This rare cardiac pathology and the interaction between stress (physiological, psychological and traumatic) and natural disease are discussed. The role of prompt referral for cardiac pathology assessment and association with the genodermatoses is also considered.