Dental caries and oral health-related quality of life in Preschoolers - introducing the Swedish version of the early childhood oral health impact scale (ECOHIS).

Objective: Experience of caries has a clearly negative impact on the quality of life in preschool children. The instrument Early Childhood Oral Health Impact Scale (ECOHIS) measures the oral health-related quality of life in preschool children (Child Impact Section) and their families (Family Impact Section). The aims of the study were to develop a Swedish version of ECOHIS and to evaluate the instrument's reliability, validity, and internal consistency. Additionally, to analyse the oral health-related quality of life (OHRQoL) among preschool children who have experienced caries.Methods: The original ECOHIS questionnaire was translated into Swedish. Caregivers of preschool children aged 2-5 years were recruited at dental clinics in Sweden, to participate in the study and answer the Swedish version of the ECOHIS (S-ECOHIS). The internal consistency and reliability were assessed by using Cronbach's Alpha coefficient. In order to measure the consistency of the study, the questionnaire was re-tested two weeks later for 10 of the caregivers and assessed by using intra-class correlation coefficients (ICCs). The results from S-ECOHIS were described as descriptive data and independent t-test was performed. All data were calculated using SPSS (Statistical Package for the Social Sciences).Results: S-ECOHIS was developed by translating the original English version using a double-blinded technique. A total of 274 caregivers participated in the study and completed the questionnaire. Cronbach's Alpha was 0.84 for S-ECOHIS, 0.83 for CIS, and 0.66 for FIS. The ICC was 0.95 for the test-retest of S-ECOHIS. Among the respondents, 117 (43%) had children diagnosed with caries, while 157 (57%) had children without caries. The children with caries reported a higher total score of 5.97 (SD 6.16) of S-ECOHIS, compared to the score of the non-caries children 0.77 (SD 1.38) (p < 0.001).Conclusion: The Swedish version of ECOHIS that was developed demonstrates good validity, test-retest reliability, and internal consistency. The findings show that the oral health-related quality of life is adversely affected in preschool children with caries, with particular vulnerability observed among children with untreated caries. These results indicate that S-ECOHIS is suitable for use in future clinical and research endeavors.

Individual risk factors associated with general unintentional injuries and the relationship to traumatic dental injuries among children aged 0-15 years in the Swedish BITA study.

AIM: To investigate general unintentional injuries (GUI) and traumatic dental injuries (TDI) in relation to behavioral and psychosocial strengths and difficulties among Swedish children aged 0-17 years, and to investigate general unintentional injuries in relation to temperament and socioeconomic status among the same children. SUBJECTS AND METHODS: The study included 2363 children in four different age cohorts aged 3, 7, 11, and 15 years at the study start. Twelve Public Dental Service clinics in Sweden participated, representing different types of demographic areas, both rural and urban. Data were collected from parents and children through an interview, questionnaires, and dental records. RESULTS: Twenty-four percentage (24%) of the children had experienced a serious general unintentional injury (GUI) at some point during their lifetime up until 3 months prior to the study start. Children who were regarded by their parents as being injured more often than other children also had occasions with general unintentional injuries to a greater extent. Most general unintentional injuries occurred at home. Children with incidents of general unintentional injuries had occasions with TDI to a greater extent than children without general unintentional injury. Children, whose mothers had 11 years of school/education or less, were involved in more general unintentional injuries during the 3-month period prior to the study start, compared to children of mothers with higher education level. CONCLUSIONS: Children with general unintentional injuries had more traumatic dental injuries. Children who were assessed by their parents as being injured more often than other children also had occasions with general unintentional injuries to a greater extent. Temperament, behavioral and psychosocial strengths and difficulties had different impacts at different ages for experiencing a general unintentional injury.

Temperamental and socioeconomic factors associated with traumatic dental injuries among children aged 0-17 years in the Swedish BITA study.

AIM: The aim of the study was to identify individual risk factors for traumatic dental injuries (TDI) among Swedish children aged 0-17 years. The studied risk factors were temperamental reactivity of the child, family structure, parent's country of birth, and the socioeconomic status of the family represented by parental education and occupation. SUBJECTS AND METHODS: The study included 2363 children in four different age cohorts at 12 public dental service clinics in Sweden, representing different types of demographic areas, both rural and urban. Data were collected from parents and children through an interview and questionnaires. RESULTS: The more social and active children in the two older age cohorts showed less occasions of TDI. Having one parent/guardian protected the child from dental injury just as well as two parents/guardians. Parents born outside of the Nordic countries showed children with less TDI. Low parental education was related to more occasions of TDI among the children. CONCLUSIONS: This study has increased the knowledge on certain individual risk factors for TDI. To prevent dental injuries, information could be given to families and children at risk.

Traumatic dental injuries among children aged 0-17 years in the BITA study - a longitudinal Swedish multicenter study.

BACKGROUND/AIM: To prevent traumatic dental injuries (TDI), there is a need for vital information. This information could be reached using certain specific variables. The aim of this study, therefore, was to investigate TDI in different age groups, their etiology, and differences by gender, in Swedish children aged 0-17 years. SUBJECTS AND METHODS: The study included 2363 children in four different age cohorts from 12 Public Dental Service clinics in Sweden. The design was a 5-year longitudinal study including yearly clinical examinations, retrospective and prospective data compiled from dental records and interviews regarding TDI. RESULTS: The prevalence for TDI was 37.6% (889) with no gender differences. Boys suffered more injuries during the spring and fall compared to girls. The incidence of 2.8% varied between the age groups where preschool children presented the highest incidence. No changes in prevalence for TDI were found for the years included in the study. The most common reason for TDI was Falling (42.1%). The frequencies for the etiological factors varied between the ages. CONCLUSIONS: The TDI prevalence showed to be stable at a high level in spite of great efforts in Sweden and worldwide to reduce it. Knowledge in why, where, and when TDI appears is therefore essential for dental personnel who will work to reduce TDI.

Parental attitudes and experiences of dental care in children and adolescents with ADHD--a questionnaire study.

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition characterized by age-inappropriate levels of inattention, hyperactivity-impulsiveness or a combination of these. The aim of this study was to analyze parental attitudes to and experience of dental care, oral hygiene and dietary habits in children/adolescents with ADHD. Twenty- six parents of 31 subjects, 20 boys and 11 girls, aged 5-19 years with ADHD registered at the Gothenburg Child Neuropsychiatric Clinic, were invited. The parents answered a questionnaire regarding different oral problems when visiting the Clinic of Pediatric Dentistry, Gothenburg, for an oral examination of their child. The parents felt the dental care at the Public Dental Service was good, but noted a lack of knowledge regarding child neuropsychiatry among the dental staff which may influence the dental treatment. Fifteen parents reported their children had experienced mouth pain and 15 reported their child had suffered from both discomfort and pain from local anesthesia. Thirteen of the children had a dental trauma and 12 parents reported pain in connection to the dental treatment. Pain related to filling therapy was stated by 11 parents. According to the parents, five children suffered from dental fear but 15 reported the child had a general fear. Pursuant to the parents, the beverage for dinner was mainly milk or water, while sweet drinks were more frequent when thirsty. Seventeen parents reported their children had poor oral hygiene or could not manage to brush their teeth and 14 of the 31 children only brushed once a day or less. The results show that the parents experience a lack of child neuropsychiatric knowledge, care and patience from the dental staff, which may influence the treatment. Oral hygiene/tooth brushing is neglected and the frequent consumption of sugar is difficult for the parents to handle.

An explorative analysis of the recruitment of patients to a randomised controlled trial in adolescents with dental anxiety.

Randomised controlled trials (RCTs) are considered to provide the most reliable evidence on the efficacy of interventions. The aim of this study was to describe the recruitment process of an RCT study set up to evaluate a Cognitive Behavioural Therapy (CBT) intervention programme for adolescent patients with dental anxiety (DA). The participants were recruited from a consecutive sample of adolescent patients (12-19 yrs old) referred for DA to a specialised pediatric dentistry clinic. Age, gender, and reason for referral were recorded for the possible eligible patients as part of the drop-out analysis of the recruitment process. Participants were then randomized to the intervention (CBT integrated with dental treatment) or control (adapted dental treatment) condition. In the recruitment process, 138 possible eligible patients met inclusion criteria, of these 55 were enrolled, 44 declined participation and 39 patients were excluded.The patients enrolled in the RCT did not differ from the non-participants with regard to age, gender or cause of referral. As a result of difficulties in the recruitment process, the study period was extended. The considerable proportion of non-participants as evident from the recruitment process may pose a threat to the external validity of the clinical trial. From a clinical perspective, the reasons for the lack of motivation to participate in behavioural interventions and the failure to appear warrant further investigation.

Validating the dental subscale of the children's fear survey schedule using Rasch analysis.

Rasch analysis was used to examine the validity of the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS). Data were collected from parents of children in regular dental care (n = 240) and from parents of children referred to a specialized pediatric dental clinic (n = 200). The Rasch model is a probabilistic model in which estimations are based on the relationship between person ability and item difficulty, and the present study investigated the validity of the CFSS-DS through analysis of person and item fit, dimensionality, ordering of thresholds, local dependency, and differential item functioning. The results show multidimensionality of the original scale, and an adjusted version consisting of six items with good fit to the model is suggested. The adjusted scale makes interval-level analysis possible, and time efficiency and elimination of previously criticized items argue in favor of the adjusted scale.

Dento-alveolar characteristics in adolescents born extremely preterm.

It has been shown that children born extremely preterm (EPT) often suffer from medical complications and growth restrictions in early childhood. Catchup growth diminishes these effects but the children are known to have lower weight, height, and head circumference as school children. Effects on enamel development have been shown. How this affects the dento-alveolar outcome during adolescence is not known. Forty EPT children with a gestational age (GA) of less than 29 weeks, at 12-16 years of age, and matched healthy controls born at term, with a GA of 37-43 weeks, were examined. Data from the clinical examination, dental casts, and bitewing radiographs were collected and compared. Malocclusion was noted, and dento-alveolar length, width, palatal height, and mesio-distal tooth width were measured. Medical diagnoses, neurological, and neuropsychiatric disturbances were noted at the time of the survey. The two groups were compared with an epidemiological normal reference material. The results showed no differences between the controls and reference material. Angle Class II was the most frequent malocclusion associated with morbidity, neurological, and neuropsychiatric disturbances, followed by deep bite and overjet. Three or more malocclusions were almost twice as common among the EPT children compared with the controls. Significantly smaller incisors, canines, and first molars were found. In summary, the EPT children, during adolescence, had medical aberrations as well as dento-alveolar effects opposed to the healthy children born at term. Dentists should be aware of this and treatment plans should be made in due time.

Common experiences of pain in children and adolescents--an exploratory factor analysis of a questionnaire.

The aim of the study was to reduce everyday and dental treatment pain items included in the extended Children's Pain Inventory (CPI), used in a prior study on Swedish children and adolescents. Another aim was to, by means of exploratory factor analysis (EFA), expose hitherto undiscovered dimensions of the CPI pain variables and thus to improve the psychometric properties of CPI. As some pain items are relevant merely to some individuals, a new and more useful questionnaire construction would enhance the internal validity of the instrument in observational surveys. EFA was applied on the extended CPI instrument. 368 children, 8-19 years old, had answered a questionnaire comprising 10 dental and 28 everyday pain variables. These pain items were analysed using a series of sequentially implemented EFA. Interpretations and decisions on the final number of the extracted factors was based on accepted principles; Kaiser's Eigenvalue >1 criterion, inspection of the scree plot and the interpretability of the items loading. The factors were orthogonally rotated using the Varimax method to maximize the amount of variance. Of all tested EFA models in the analysis, a two, three, four, and five factor model surfaced. The interpretability of the factors and their items loading were stepwise examined; the items were modulated and the factors re-evaluated. A four factor pain model emerged as the most interpretable, explaining 79% of the total variance depicting Eigenvalues > 1.014. The factors were named indicating the profile of the content: Factor I cutting trauma to skin/mucosal pain, Factor II head/neck pain, Factor III tenderness/blunt trauma pain, Factor IV oral/dental treatment pain.

Evaluation of method parameters for sound undecalcified dental enamel proteomics using liquid chromatography-mass spectrometry.

OBJECTIVE: This study aims to validate a methodology for analyzing undecalcified, sound dental enamel proteomics using Liquid Chromatography-Mass Spectrometry (LC-MS). The study evaluates various parameters, including the impact of dental root coverage on protein contamination, the efficacy of protease inhibitors during enamel sample preparation, repeatability of LC-MS measurements on dental enamel, and statistical analysis. The study also assesses the effectiveness of combined trypsin and semi-trypsin searches in Mascot for obtaining additional protein identification data. DESIGN: Sound dental enamel was removed using a wet grinding technique, then digested with trypsin and labeled with TMT prior to LC-MS analysis. The resulting proteomes were matched against the Homo sapiens Swissprot Database, with searches in Mascot performed using both trypsin and semitrypsin. Statistical methods were employed to analyze the data. RESULTS: The study found that covering dental roots with composite during dental enamel microdissection is advisable, while using protease inhibition during microdissection may not be fully supported. The proteomic analyses demonstrated statistical repeatability and reliability, with consistent and reproducible proteomic data obtained from healthy dental enamel. Furthermore, employing both trypsin and semitrypsin searches in Mascot provided additional proteomic information. CONCLUSIONS: Overall, this study validates a methodology for analyzing undecalcified, sound dental enamel proteomics using LC-MS, and provides insights into various factors that can affect the quality and reliability of proteomic data. These findings have implications for future studies pursuant to understanding the proteomic mechanisms underlying dental enamel formation and other associated processes.

A pilot study comparing optical coherence tomography, radiography, clinical photography, and polarisation microscopy for studies of hypomineralisation disturbances in enamel.

Aim: To investigate the use of optical coherence tomography (OCT) as a tool to assess general and localised hypomineralisation defects in the enamel. Design and Materials: Ten extracted permanent teeth (four teeth with localised hypomineralisation, four teeth with general hypomineralisation, and two healthy controls) were used in this study. In addition, four participants who underwent OCT served as living controls for the extracted teeth. Methods: The OCT results were compared with clinical photographs, digital radiographs, and polarising microscopy images of tooth sections (considered the gold standard) to determine the method with the most accurate information regarding the extent of enamel disturbances: 1) visibility of enamel disturbance (visible yes/no); if yes, 2) extent of the disturbance in the enamel; and 3) determination of the plausible involvement of the underlying dentin. Results: OCT was more accurate than digital radiography and visual assessment. OCT could provide information about the extent of localised hypomineralised disturbances in the enamel that was comparable to that with polarisation microscopy of the tooth sections. Conclusion: Within the limitations of this pilot study, it can be concluded that OCT is suitable for investigating and evaluating localised hypomineralisation disturbances; however, it is less useful in cases with generalised hypomineralisation of the enamel. In addition, OCT complements radiographic examination of enamel; however, more studies are necessary to elucidate the full extent of the use of OCT in case of hypomineralisation.

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 3. Injuries in the primary dentition.

Traumatic injuries to the primary dentition present special problems and the management is often different as compared with the permanent dentition. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialities were included in the task group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion or majority decision of the task group. Finally, the IADT board members were giving their opinion and approval. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care for management of primary teeth injuries. The IADT cannot and does not guarantee favorable outcomes from strict adherence to the guidelines, but believe that their application can maximize the chances of a positive outcome.

Risk indicators for poor oral health in adolescents born extremely preterm.

Children born extremely preterm often suffer from medical complications that have been shown to affect their oral health as toddlers and school children.The aim of this study was to investigate oral health and possible risk indicators for poor oral health in adolescents born extremely preterm compared with a control group and relate the findings to medical diagnoses at the clinical examination. Also in the same groups, compare the frequency of mineralization disturbances and its relation to postnatal morbidity and treatments. The medical records postnatally,was noted in 45 extremely preterm infants with a gestational age (GA) of <29 weeks, at 12 - 16 years of age and in age and gender matched fullterm controls with 37-43 weeks GA. A dental clinical examination was performed including a salivary examination. Medical diagnoses were noted at the time of the survey. Data from the patient dental records at 3, 6, and 9 years of age was compiled. The findings were related to gestational age, birth weight, neonatal and postnatal medical diagnoses treatments and medical diagnoses at the clinical examination. The result showed that the prevalence of plaque, gingivitis and the occurrence of Streptococcus mutans were higher among adolescents born extremely preterm compared to matched controls, and the saliva secretion was lower in the extremely preterm infants. The frequency of caries did not differ between the groups. Mineralization disturbances were more frequent in the primary dentition and more severe in the permanent dentition among the children born extremely preterm. No association between dental pathology, neonatal and postnatal morbidity and treatments was found. In conclusion, adolescents born extremely preterm have an increased number of risk indicators for a poorer oral outcome compared with the controls and more severe mineralization disturbances. These findings may imply an increased vulnerability for poorer oral health later in life.

General dental practitioners' knowledge and attitudes on children's pain and pain management-A questionnaire survey.

The aim was to study general dental practitioners' knowledge and attitudes on pain and pain management in children and adolescents, using a multidimensional questionnaire. There is little information on dentists' views on pain in children. The research question was how attitudes and knowledge may correlate to the dentists' age, sex, years of professional experience, the proportion of working time devoted to treating children and adolescents, as well as being a parent. At the time of the study, 387 general dentists working for the Public Dental Service participated in a web-based, multidimensional validated questionnaire holding the categories (A) views on the care of children in pain, (B) physiology, (C) pain alleviation, (D) medication, (E) sociology/psychology, (F) Pain assessment instruments and methods, (G) non-medication methods of pain alleviation, and (H) documentation of pain management. The age categories were given as; below 25, 25-35, 36-45, 46-55 years, and older than 55 years of age. 71% of the responders were female. The dentists' age cohort, as well as the years of professional experience, tended to make a difference as to the pain interventions in children and adolescents (P < 0.03). The female dentists, in comparison to the male dentists, conveyed different pain treatment strategies (P < 0.03). The proportion of working time devoted to treating children and adolescents, as well as being a parent, did not show significant differences regarding pain strategies. Associations were observed between the age of the dentists studied, the number of years as professionals and the knowledge and attitudes that benefit children's pain treatment. Being a parent was not significant. In this studied group, female dentists displayed significantly more care regarding pain management, than did their male colleagues. Furthermore, the study highlighted the need for a short questionnaire, user-friendly yet with retained multidimensionality.

Chemical aspects on dental hard tissues in primary teeth from preterm infants.

Preterm children with very low birth weight suffer from several neonatal and postnatal complications that may affect the mineralization of teeth. Clinical and morphological studies have shown enamel aberrations in teeth from preterm children. In this study, the chemical composition in enamel and dentin was compared in primary teeth from preterm children and full-term children, and the relationship between the chemical composition and the morphological appearance was investigated. Enamel and dentin in 17 exfoliated primary teeth, from 14 children with a gestational age below 29 wk, were investigated and compared with 36 exfoliated primary teeth from full-term children, using X-ray microanalyses (XRMA). In comparison with the teeth from the controls, the teeth from preterm children had a higher relative value of carbon (C), a lower relative value of calcium (Ca), a lower ratio of calcium/phosphorus (Ca/P) and a lower ratio of Ca/C throughout the outer part of the enamel. In dentin, the relative values for P were higher, and Ca/P ratio was lower, at the dentin-pulp junction. The Ca/P ratio indicated normal hydroxyapatite in the crystals in enamel and dentin. The lower ratio of Ca/C in the bulk and outer part of the enamel indicated more porous enamel.

Everyday- and dental-pain experiences in healthy Swedish 8-19 year olds: an epidemiological study.

BACKGROUND: Very little is known about children's everyday pains and dental treatment pains. A child's gender, age, and level of dental anxiety are factors that could interplay with the perception of pain and are thus worth studying. AIM: The objectives of this study were to investigate the frequency and reported intensity levels of children's everyday- and dental-pain experiences, and to study the reported pains in relation to gender, age, and dental anxiety. DESIGN: Three hundred and sixty-eight consecutive patients (8-19 years, mean age 13.5 years) from three different Public Dental Service were recruited. Pain ratings were obtained using McGrath's Children's Pain Inventory list and some additional items. Dental anxiety was estimated by the Dental Anxiety Scale. RESULTS: Most frequently experienced everyday pains were headache and tummy/stomach ache. Among dental treatment events, dental injection was reported to be most often ranked as painful, and more frequently by girls. Both dental and everyday pains were rated higher grouping children with high dental anxiety. CONCLUSIONS: The frequency of pain experiences are the same in Swedish children as in other populations. There is a relation between dental anxiety and the perception of pain.

Oral health status in a group of children and adolescents with myotonic dystrophy type 1 over a 4-year period.

AIM: The aim of this longitudinal study was to evaluate changes in oral health, orofacial function, and dental care in children with myotonic dystrophy type 1 (DM1) in comparison with a control group. METHODS: Thirty-six DM1 patients and 33 control patients out of originally 37 in each group were examined on two occasions about 4 years apart. Caries, plaque, and gingivitis were registered, mouth opening capacity assessed and the ability to cooperate in dental treatment estimated. Questionnaires concerning different aspects of oral health and care, symptoms of temporomandibular dysfunction (TMD), and dental trauma were also used. RESULTS: The DM1-patients, in particular the boys, had significantly more caries, plaque, and gingivitis than the control patients on both occasions and the increase in decayed missing or filled permanent teeth (DMFT) and surfaces (DMFS) was significantly larger. They received more dental care and had lower cooperation ability. Mouth opening capacity and increase of it was significantly lower and symptoms of TMD were significantly more frequent. CONCLUSIONS: DM1 patients, as they grow older, have increasing amounts of plaque and risk of caries and gingivitis. They have more TMD problems. Behaviour management problems do not seem to decrease with age. Increased prophylactic care is essential for DM1 patients.

Analysis of some elements in primary enamel during postnatal mineralization.

The primary teeth start to mineralize in utero and continue development and maturation during the first year of life.The aim of this study was to investigate the concentrations of some elements, C, F, Na, Mg, Cl, K and Sr, by secondary ion mass spectrometry (SIMS) in human primary incisors at different stages of mineralization.The teeth derived from an autopsy material from children who had died in sudden infant death.The buccal enamel of specimens from the ages 1, 2, 3, 4, 6 and 19 months, respectively, was analyzed. It was evident that posteruptive effects play an important role in composition of the outermost parts of the enamel. Before the tooth erupts, the concentrations of the elements vary with the maturation grade of the mineralization in the enamel. Sodium was the element with the highest concentration of the measured elements and chlorine was the element of lowest concentration.The 19 month old specimen, considered as the only mature and erupted tooth, showed to differ from the other specimens.The concentration of fluorine, in the 19 month old specimen's outermost surface, is readily seen higher compared with the other specimens at this depth zone. In the 19 month old specimen the concentration of carbon is lower. Potassium, sodium and chlorine have higher concentrations, in general, in the 19 month old specimen compared with the immature specimens. The thickness of the enamel during mineralization was calculated from data from SIMS.The thickness of the buccal enamel of primary incisors seemed to be fully developed between 3-4 months after birth, reaching a thickness of 350-400 microm.

Elemental composition of normal primary tooth enamel analyzed with XRMA and SIMS.

There is an interest to analyze the chemical composition of enamel in teeth from patients with different developmental disorders or syndromes and evaluate possible differences compared to normal composition. For this purpose, it is essential to have reference material. The aim of this study was to, by means of X-ray micro analyses (XRMA) and secondary ion mass spectrometry (SIMS), present concentration gradients for C, O, P and Ca and F, Na, Mg, Cl, K and Sr in normal enamel of primary teeth from healthy individuals. 36 exfoliated primary teeth from 36 healthy children were collected, sectioned, and analyzed in the enamel and dentin with X-ray micro analyses for the content of C, O, P and Ca and F, Na MgCl, K and Sr. This study has supplied reference data for C, O, P and Ca in enamel in primary teeth from healthy subjects. No statistically significant differences in the elemental composition were found between incisors and molars.The ratio Ca/P is in concordance with other studies. Some elements have shown statistically significant differences between different levels of measurement. These results may be used as reference values for research on the chemical composition of enamel and dentin in primary teeth from patients with different conditions and/or syndromes.