The use of general anaesthesia for tooth extraction in children in London: a multi-centre study.

Following publication of the Poswillo report, the continued use of general anaesthesia in dentistry became the subject of a major debate. In particular, the provision of general anaesthetic services by general dental practitioners in order to carry out simple extractions for child patients has been called into question. Other authors have strongly supported the continued need for general anaesthesia and insist that for some patients it remains the technique of choice. There is, however, little evidence of current patterns of attendance from which argument may be advanced to support or refute the differing views. In this study data was drawn from three London dental teaching hospitals providing out-patient general anaesthesia for extractions. During the 12-month period investigated 7852 general anaesthetics had been administered for child patients. There was evidence of an increase in numbers at one centre when results were compared to those of a previous study and some evidence of a change in pattern of referral with time at the same centre, with an increase in the numbers of patients referred by general dental practitioners. Eighty-three per cent of the anaesthetics had been given for the extraction of carious primary teeth, with an average of 3.3 being extracted per child. Nearly one-third of the anaesthetics were for children under the age of 5 years.

A videofluoroscopic comparison of straw and cup drinking: the potential influence on dental erosion.

OBJECTIVE: Videofluoroscopy was used to compare drinking from a cup with drinking through straws of two varying bore diameters in different positions in the mouth. DESIGN: Clinical study at a single centre. SETTING: UK dental school. SUBJECTS AND METHODS: Twenty patients showing clinical signs of erosion which had necessitated advice and/or treatment. INTERVENTIONS: Subjects drank from a cup and through a narrow straw, which was then repositioned more posteriorly. A wide bore straw was used in two equivalent positions. Swallowing was viewed laterally and anteroposteriorly to assess involvement of incisors and molars respectively. MAIN OUTCOME MEASURES: Video recordings examined for presence or absence of fluid contact with teeth following each swallow. If contact occurred, the time was measured. RESULTS: Fourteen patients avoided fluid contact with both incisors and molars when using a straw. Compared with the cup, significant differences were found with the narrow straw (P = 0.03, 95% confidence interval of 22.6% to 31.6%), the narrow straw repositioned (P = 0.008, 95% confidence interval of 12.3% to 47.1%) and the wide straw repositioned (P = 0.03, 95% confidence interval of 3.1% to 37.5%). Contact time of fluid with anterior teeth was also significantly reduced. CONCLUSIONS: Drinking through a straw positioned toward the back of the mouth may reduce the erosive potential of soft drinks.

Factors affecting outcomes of traumatically extruded permanent teeth in children.

PURPOSE: The objectives of the present study were to determine the prevalence of residual extrusion, pulpal necrosis, and resorption for extruded permanent teeth and to establish the effect of presentation and treatment factors. METHODS: Seventy-two traumatically extruded permanent incisors were studied at the Departments of Paediatric Dentistry in Belfast, Newcastle upon Tyne, and Glasgow. The mean age of the patients was 10.1 years (range=6 to 18 years). Clinical and radiographic outcomes were analyzed and related to presenting and treatment factors. RESULTS: The initial degree of extrusion was moderate for 46 teeth (64%), and the median delay prior to repositioning was 3 hours (range=1 to 168 hours). Pulp necrosis occurred in 31 teeth (43%), residual extrusion was present in 16 teeth (23%), and inflammatory resorption occurred in 11 teeth (15%). Residual extrusion was significantly associated with a delay in repositioning the tooth, pulpal necrosis was significantly more common in teeth with closed apices and in severely extruded teeth, and inflammatory resorption was more common after pulpal necrosis. CONCLUSIONS: Residual extrusion could be minimized by earlier presentation and repositioning. The risk of pulpal necrosis is greatest for severely extruded teeth and for those with closed apices.

Case report: Denys- Drash syndrome.

BACKGROUND: Denys-Drash Syndrome (DDS) is an uncommon disorder that appears sporadically and in rare cases may be inherited as an autosomal dominant trait It manifests either at birth or within the first year of life and typically consists of the triad of congenital nephropathy, Wilms tumour and intersex disorder. CASE REPORT: A 10 year-old Caucasian girl was referred to the Dental Department, at Glasgow Royal Hospital for Sick Children by her Paediatric Nephrologist Consultant. The patient was being teased by her peers over her markedly discoloured teeth. The dental history revealed that the patient was a regular dental attendee from an early age. She was dentally anxious having only experienced dental treatment under general anaesthesia (GA) when she was 4 years old. Apparently her primary dentition also showed a generalised discolouration. TREATMENT: This consisted of multiple visits for diet analysis and tooth brushing instruction with the use of disclosing tablets. Plaque control significantly improved when using a battery operated toothbrush because of its larger handle which the patient found easier to use and a 0.05% sodium fluoride mouthwash was given for daily use. Dyract(AP) veneers directly bonded onto maxillary permanent incisors and mandibular permanent anterior teeth was carried out. This was an interim measure to improve the patient's appearance while assessing the patient co-operation. The compomer facings were replaced with BelleGlass NG veneers which were cemented onto the maxillary incisors and mandibular anterior teeth using Adhesive By Choice (ABC) system under rubber dam on two separate visits. FOLLOW-UP: At her last visit, 27 months after treatment, the patient was still satisfied with the restorative treatment. However, further teeth had erupted including all the premolars. BelleGlass NG crowns were indicated. It was also decided to replace the preformed chrome cobalt crowns with full coverage BelleGlass NG crowns.

The dental health and preventative habits of cardiac patients attending the Royal Hospital for Sick Children Glasgow.

AIM: To assess the dental health and preventive practices of child patients with congenital heart disease treated at the Royal Hospital for Sick Children, Glasgow. STUDY DESIGN: A retrospective study using an audit data collection sheet. METHODS: Data collected for 370 paediatric cardiac patients between January 2002 and December 2003 was analysed to obtain an insight into these patients' tooth brushing methods, use of fluoride (F), dental attendance and past dental treatment. An oral examination assessed the patient's caries experience. RESULTS: There were 195 subjects aged between 1 and 5 years, 105 were 6 - 11 years and 70 were 12 -16 years of whom 291 (78%) children were registered for dental care. Of these children 331 (90%) maintained that they brushed their teeth regularly with F- toothpaste. Experience of dental treatment revealed that 132 (36%) children had undergone previous dental treatment. Oral examination showed that out of 370 patients, 236 (64%) had no active caries. The dental health of the cardiac subjects was poor compared with that of Scottish primary school children (5 year-olds) and the 12 year-olds but compared favourably with the 14-year old group. STATISTICS: The relationship between caries activity and frequency of toothbrushing was significant (p<0.01). The relationship between caries activity and attendance for dental care was not significant. CONCLUSION: Children with cardiac problems should be identified in early infancy through liaison with medical colleagues and the family offered all the preventive advice and regular dental care necessary to prevent dental disease.

Missing C, supplemental D and supplemental premolar all in one quadrant: a case report.

This case report describes a non-syndromic Caucasian patient who presented with a missing upper right primary canine and a supplemental upper right primary first molar. Later, a supplemental premolar developed in the upper right quadrant. The report highlights the importance of early diagnosis of dental anomalies and a multidisciplinary approach to treatment planning. A regular review and radiographic examination are essential.

Chemomechanical caries removal in primary teeth in a group of anxious children.

Chemomechanical removal of dental caries has considerable potential in the treatment of patients with management problems, especially in paediatric dentistry. The aim of this study was to assess the acceptance and success of the technique in young nervous patients. A group of 20 patients, aged between 4 and 10 years with a high level of dental anxiety was selected. The study achieved a success rate of over 90% in acceptance of cavity preparation by this procedure followed by placement of a restoration. The length of time required for cavity preparation was comparable with conventional methods. The need for local anaesthesia was reduced or eliminated and the children did not complain of any pain during the procedure. It is concluded that chemomechanical caries removal in vivo in primary teeth is an effective alternative to conventional mechanical caries removal and is advantageous in patients who have a phobia to the dental handpiece and/or injections.

Pain reported by children after dental extractions under general anaesthesia: a pilot study.

A prospective study has been performed of factors influencing postoperative pain in a cohort of children undergoing dental extractions under general anaesthesia. Postoperative pain was assessed immediately after recovery from anaesthesia and also by using a visual linear analogue scale which was completed by the parent hourly for the first 10 hours and then at 24 hours. Analgesic use was also recorded. The most significant factor influencing postoperative pain was the relationship of the accompanying adult to the child; children attending with their mothers were more likely to complain of postoperative pain (P < 0.05). The results also suggested that the age of the patient and the extraction of primary rather than permanent teeth were influencing factors, although they did not reach statistical significance. Pain was reported by 57.5% of the children immediately after treatment. It would seem that the greatest need for postoperative analgesia is immediately after the dental procedure, especially in young children undergoing multiple extractions.

Dentigerous cysts involving permanent incisors: four case reports.

Four cases of dentigerous cysts involving permanent incisors are reported. In each case the primary predecessor had been traumatized, was discoloured and suspected of being non-vital. Epithelial proliferation of the follicular tissues induced by chronic periapical inflammation of the predecessors is suggested as the most likely pathogenesis of cystic transformation in these cases. Regular radiographic review of discoloured primary incisors is recommended.

Regional odontodysplasia: report of four cases.

Four cases of regional odontodysplasia are described. Clinically erupted teeth appear hypoplastic and are often mobile. The radiographic appearance has given rise to the term 'ghost teeth' and the cases presented demonstrate this with short roots which are less well calcified than normal teeth. Clinical and radiographic findings showed that this condition affects only one side of the jaw, but can be seen in any part of the upper or lower jaws. This article represents cases in different parts of the mouth with varying degrees of involvement.