Indirect pulp capping versus pulpotomy for treating deep carious lesions approaching the pulp in primary teeth: a systematic review.

AIM: To assess dental practice regarding the use of indirect pulp capping or pulpotomy in children with deep carious lesions approaching the pulp in primary teeth and to compare the efficacy of the two pulp treatments. STUDY DESIGN: Systematic review. We searched the Cochrane Library, PubMed via MEDLINE, and EMBASE as well as the reference lists of included reports and ClinicalTrials.gov (for ongoing trials). Eligible studies were surveys of dental practice sent to dentists regarding the use of indirect pulp capping and pulpotomy in children with deep carious lesions approaching the pulp in primary teeth and any type of clinical study. Two review authors independently extracted data and assessed risk of bias in duplicate. RESULTS: Of the 481 potentially eligible articles, 11 were included in the review: 8 described surveys of dental practice, 1 a non-randomised study, and 2 ongoing randomised trials. The surveys of dental practice showed an overall increase in the teaching and practice of indirect pulp capping in primary teeth. The non- randomised study found a statistically significant difference in favour of indirect pulp capping for clinical and radiological success at 3 years but with high overall risk of bias. CONCLUSIONS: Despite the success rate of indirect pulp capping for treating deep carious lesions approaching the pulp in primary teeth, practitioners still hesitate to practice this technique because of lack of evidence and studies on this topic. Thus, for strong evidence, investigators are encouraged to conduct randomised trials comparing the efficacy of indirect pulp capping and pulpotomy for treating deep carious lesions approaching the pulp in primary teeth.

DMF from WHO basic methods to ICDAS II advanced methods: a systematic review of literature.

BACKGROUND: Evaluation of caries status has changed with emergence of modified ways of managing the condition. There is a need to assess the relationship between the old and new methods of registering caries. OBJECTIVE: To identify the ICDAS II codes to be used to record the D-component of the DMF index as defined in the WHO Basic Methods, 1997 publication. METHOD: A review of literature published between January 2002 and January 2012 was undertaken using "ICDAS" as keyword in an electronic search. Only epidemiological studies that used ICDAS II as an evaluation criterion calculated the DMF indices and gave the ICDAS II codes for the diagnosis of caries lesions, were included. RESULTS: Fourteen studies met the inclusion criteria. The DMF designations that corresponded with the WHO definition were D(3-6)MF (10 studies), D(4-6)MF (4 studies) or D(5-6)MF (3 studies). The D-component referred to cavitated carious lesions (7 studies) or dentine caries (7 studies), but there was no consensus on the ICDAS II codes that are used to define them. Only the ICDAS II codes 5 and 6 had unanimous support; they were always counted as "Caries", but there was less certainty for codes 3 and 4. The only study on fields that compared both methods showed D(3-6) to be the always associated with the D-component of the DMF index as defined in the WHO Basic Methods. CONCLUSION: There was disagreement of the ICDAS II codes to be used for the DMF calculation; and when there was a need to compare DMF values between studies, the diagnosis threshold should be verified to be the same.

Clinical decision on pit and fissure sealing according to the occlusal morphology. A descriptive study.

BACKGROUND: The objective of this descriptive study was to evaluate the clinical decision on sealing pits and fissures according to the occlusal morphology in patients with low individual caries risk (ICR). MATERIALS AND METHODS: A total of 222 dentists, 86 affiliated to the French Society of Paediatric Odontology (SFOP) and 136 general practice dentists (GPs), answered the same questionnaire with illustrations of 4 occlusal surfaces of permanent molars: they indicated firstly if these were at risk and secondly the corresponding decision regarding sealing. This questionnaire assessed the decision on widening pits and fissures before sealing and the type of sealant material used. Multivariate logistic regression analyses were performed to identify the factors associated with the clinical decision to widen pits and fissures. RESULTS: Sealing of at-risk teeth was indicated by 89% of dentists, whereas sealing of not at-risk occlusal surfaces was recommended by 46%. SFOP dentists were more prone to recommend pit and fissures sealants. The multivariate analyses demonstrated that only the type of material was associated with the clinical decision to widen pits and fissures. Forty eight percent of dentists choose the same material in all clinical situations. CONCLUSION: The wide variations in sealant use and placement technique implies there is no apparent consensus among GP and SFOP dentists. Although the criteria are similar in numerous scientific societies, not all dentists are acting upon these recommendations.

Deep carious lesions management in children and adolescents: a questionnaire survey among dentists practicing paediatric dentistry in France.

INTRODUCTION: While many questionnaire surveys have been undertaken worldwide to investigate practices toward deep carious lesion (DCL) management in adults, very few are related to children and adolescents. The present cross-sectional study aimed to assess DCL management in children and adolescents among dentists practicing paediatric dentistry in France (Fr-DPPDs). The secondary objective was to compare practices between Fr-DPPDs and dentists registered in the European Academy of Paediatric Dentistry (EAPD). METHODS: A questionnaire was electronically administrated to members of the CEOP (Collège des Enseignants en Odontologie Pédiatrique), the SFOP (Société Française d'Odontologie Pédiatrique), and the EAPD. Descriptive analyses, Chi-square and McNemar tests, ANOVA, crude and adjusted binary logistic regression analyses were performed. RESULTS: A total of 99 Fr-DPPDs and 146 EAPD members answered the questionnaire. Among the Fr-DPPDs, the preferred caries removal (CR) methods were the complete CR in one step for primary teeth and mature permanent teeth (respectively, 70% and 48%) and in two steps for immature permanent teeth (39%). EAPD members were more likely, than Fr-DPPDs, to choose selective CR versus complete CR in primary teeth (odds ratio = 2.60; 95% CI 1.39-4.85). Moreover, for primary or immature permanent teeth, general practitioners were less likely to choose selective CR than specialists and exclusive practitioners in paediatric dentistry, (p < 0.001). CONCLUSION: Tooth type [primary, permanent (immature or mature)] seemed to influence DCL management. Fr-DPPS should prioritise pulpal vitality when managing DCL.

Restorative thresholds for carious lesions in primary molars: French dentist's decisions.

PURPOSE: Questionnaire surveys have been undertaken worldwide to investigate practices and knowledge related to carious lesion management, particularly in adults. The primary objective of this cross-sectional survey was to investigate restorative thresholds (RTs) used for carious lesions in primary molars by dentists practising paediatric dentistry in France. Dentists were surveyed by a specifically developed questionnaire based on clinical and radiographic caries classifications. The secondary objective was to explore restorative management strategies in primary molars. METHODS: A structured questionnaire assessing RTs and management strategies for occlusal and approximal carious lesions of primary molars was anonymously and electronically administered via SurveyMonkey® to dentists who were members of the Société Française d'Odontologie Pédiatrique. Descriptive analyses, Chi-square test, McNemar test, and logistic regression analyses considering dependent RT variables for occlusal and approximal carious lesions were performed. RESULTS: Among 250 dentists surveyed, 201 responded (response rate 80.4%). Overall, 43% (n = 87) and 75% (n = 151) of respondents would place their RTs in enamel for occlusal and approximal lesions, respectively. Dentists with an exclusive practice of paediatric dentistry more frequently would choose a RT in dentine for approximal lesions than did other dentists (p = 0.010). A preparation technique including sound dental tissues was less frequent for occlusal than approximal lesions (n = 31; 15% vs n = 60; 30%). Overall, 75% (n = 151) of respondents used the same restorative material for occlusal and approximal lesions. CONCLUSION: In general, dentists practising paediatric dentistry in France overtreated lesions on primary molars, which contradicts minimal intervention recommendations. RTs are too often indicated for enamel-confined carious lesions.

Carious lesion management in children and adolescents by Australian dentists.

BACKGROUND: The management of carious lesions in children and adolescents can have lifelong implications for the patient. The aim of this study was to assess the decision-making process of dentists when managing carious lesions in children and adolescents. METHODS: Approximately, 11 000 dentists listed as members of the Australian Dental Association Inc. (ADA) and Australian and New Zealand Society of Paediatric Dentistry (ANZSPD) were emailed a link in April 2017 to a 19-question survey delivered by SurveyMonkey™. RESULTS: In this study, 887 responses were received. In 'enamel-limited' carious lesions, dentists intervened most frequently in primary tooth approximal (365, 41.1%), followed by permanent tooth occlusal (295, 33.3%) and approximal (244, 27.5%), and primary tooth occlusal (203, 22.9%) surface carious lesions. Age, university of graduation, practicing state, decade of graduation and frequency of treatment of children between 6 and 15 years were significant demographic factors influencing the restorative threshold. CONCLUSIONS: Australian dentists reported significant variation in their management of approximal and occlusal carious lesions in both primary and permanent teeth. A substantial proportion of respondents would intervene surgically on non-cavitated enamel-limited lesions.

The use of Erbium:YAG laser for caries removal in paediatric patients following Minimally Invasive Dentistry concepts.

AIM: The Er:YAG laser has proven to be effective and efficient in dental hard tissue ablation. The Minimally Invasive Dentistry (MID) approach in caries removal is to stop the disease process and to restore lost tooth structure and function, maximizing the health potential of the tooth. One of the most important concepts of the MID is to preserve as much as possible the dental tissue and this approach is even more important in primary dentition where the dimensions of the crown are smaller and the dimension of the pulp chamber is bigger in relationship to the crown. After treating 30 children's teeth (primary molars and first permanent molars) with the Er:YAG laser, we come to conclusion that laser treatment possesses the requirements of Minimal Invasive Dentistry: the possibility to ablate small area of infected layer guarantees maximum conservation of the tooth structure; using the antibacterial property of the Er:YAG laser we can decontaminate the affected layer that retains its remineralising potential; the lack of smear layer after vaporization with laser assures a better retention of the composite resin to the dentine; preparing the enamel surface with laser before etching gives a better marginal seal of the composite restoration.

Root canal posts for the restoration of root filled teeth.

BACKGROUND: The foundation for the reconstruction of endodontically-treated teeth can be provided by a metal or a non-metal post and core system but no guidelines exist for choosing one or the other in particular clinical cases. OBJECTIVES: To assess the effectiveness of different post and core systems for the restoration of endodontically-treated teeth. The primary objective of this review was to compare the clinical failure rates of the different types of posts. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3), MEDLINE (from 1966 to September 2005), Scopus (from January 1985 to December 2004) and EMBASE (until December 2004). We looked through reference lists of articles and dental conference proceedings. We contacted researchers in the field and manufacturers. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials (RCTs) comparing failures on endodontically-treated permanent teeth with different types of post. The outcomes were loss of retention, post fracture and root fracture. DATA COLLECTION AND ANALYSIS: Two review authors (Michele Muller-Bolla (MMB) and Cybele Borg (CB)) independently assessed the quality of trials and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Two trials involving 317 participants were included but only one of them, involving 200 participants, compared metal to non-metal posts. The other answered to the secondary objective. The risk of failure was greater with metal-cast posts (9/98) compared to carbon fibre posts (0/97) (risk ratio (RR) = 0.05 (95% confidence interval (CI) 0.00 to 0.90)) but the study was at high risk of bias. Thus fewer failures occurred when using non-metal posts but the evidence is unreliable. AUTHORS' CONCLUSIONS: Our systematic review could not specify which type of post and core system should be used when two or three dentine walls remain. More RCTs are needed to confirm whether fibre-reinforced post and core systems are superior and to clarify the influence of the remaining tooth structure on the treatment outcome of the different post and core systems available. Well-defined inclusion criteria focusing on the number of dentine walls (two or three) should be used.

The effect of prolonged and exclusive breast-feeding on dental caries in early school-age children. New evidence from a large randomized trial.

To study the effects of prolonged and exclusive breast-feeding on dental caries, we followed up children participating in the Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial of a breast-feeding promotion intervention based on the WHO/UNICEF Baby-Friendly Hospital Initiative. A total of 17,046 healthy, mother-infant breast-feeding pairs were enrolled from 31 Belarussian maternity hospitals and affiliated polyclinics, of whom 13,889 (81.5%) were followed up at 6.5 years. At follow-up, polyclinic pediatricians transcribed the reports of a standard dental examination performed by public health dentists at age 6 years and recorded in the children's polyclinic charts. Analysis was based on intention to treat, with a statistical model that accounts for clustering within hospitals/clinics to permit inferences at the individual level. The experimental intervention led to a large increase in exclusive breast-feeding at 3 months (43.3 vs. 6.4%, p < 0.001) and a significantly higher prevalence of any breast-feeding at all ages up to and including 12 months. No significant intervention effects were observed on dental caries. Our results, based on the largest randomized trial ever conducted in the area of human lactation, provide no evidence of beneficial or harmful effects of prolonged and exclusive breast-feeding on dental caries at early school age.

Oral health indicators for children and adolescents: European perspectives.

AIM: The purpose of the European Global Oral Health Indicators Development Project (EGOHIDP) was to support the exchange of expectations and experiences among experts in the field of oral health statistics and their audience, in particular policy makers, resulting in recommendations for a list of essential oral health indicators. EGOHIDP was supported by the Health and Consumer Protection Directorate-General of the European Commission to point out a short list of essential indicators for Oral Health. METHODS: Systematic review of the existing indicators and consensus process between a group of experts in oral health related areas. RESULTS: The short list of 40 oral health indicators was determined (rate of agreement >70%) among the European experts members of the project. Twelve items focus on Oral Health of children and adolescents: they are described in the present paper. CONCLUSION: Further developing phases aimed to establish standardised methodological criteria for the collection of oral health data are also described.

Manual toothbrush wear and consequences on plaque removal.

OBJECTIVE: The aim of this study was to determine the mean time interval before needing to discard different types of manual toothbrushes based on wear, and on the impact of progressive wear on plaque removal efficacy. METHODOLOGY: Two cross-over randomized clinical trials involving the same 12 volunteers tested four toothbrushes of different designs. In Study 1, the brushes were the Butler 211 (BTB) and Fluocaril Sensia (FSTB). In Study 2, the brushes were Elmex InterX (ETB) and Elgydium Interactive (ELTB). In both trials, the volunteers randomly used one of the two toothbrushes for two minutes twice a day during the first week, and the other brush during the following week, and continued this alternating routine for two months. An image acquisition system and the Visilog 5.2 image analysis program were used to calculate the wear index (WI) after one and two months of use for each toothbrush. The OHI-S plaque index (PI) was recorded after one and three minutes of tooth brushing at one and two months. The Friedman or Kruskal-Wallis test was used to compare data. RESULTS: Except for the ELTB, the wear of the toothbrushes was greater during the first month of brushing than during the second. The total WI was FSTB 35.46 (range = 62.11), ELTB 30.14 (range = 67.92), ETB 48.77 (range = 123.87), and BTB 98.20 (range = 134.75). The differences were significant at p = 0.008. The post one-minute PI scores significantly increased with wear, except in the case of ELTB (p = 0.244). When comparing all toothbrushes' PI at the one and three-minute tooth brushing times, there were significant differences at one month among them at p < 0.0001. CONCLUSION: The amount of wear depended on the toothbrush design. It was greater for rectangular tooth brushing areas or when bristles had smaller diameters and different heights. With two-month-old toothbrushes, plaque removal was better when there was less measurable wear.

Performance of a recent light fluorescence device for detection of occlusal carious lesions in children and adolescents.

AIM: To assess the validity and reliability of a recent light fluorescence device, Soprolife® (Sopro-Acteon group) in detecting occlusal caries in children and adolescents and to compare its diagnostic performance with DIAGNOPen® (Kavo). METHODS: A multi-centre study was carried out to validate Soprolife® in 103 children, aged from 5-15 years, on 310 primary and 433 permanent posterior teeth. The sensitivity (SE), specificity (SP) and the area under the Receiver Operating Characteristic (ROC) curve (AUC) were evaluated using visual International Caries Detection and Assessment System (ICDAS) and radiographic examinations as the gold standards. The performance of the Soprolife® was compared with that of the DIAGNOPen® on the same teeth. The reproducibility was assessed using weighted Kappa coefficient. RESULTS: When all carious lesions using ICDAS 1-6 were considered, SE, SP and AUC for the Soprolife® were 88.50, 70.73 and 0.84 respectively. The validity was significantly higher for primary teeth (AUC = 0.90) than for permanent teeth (0.80); the validity of the Soprolife® (0.84) was significantly higher than that of DIAGNOPen® (0.80). The inter- and intra-examiner kappa coefficients were 0.87 and 0.85 respectively. CONCLUSION: The Soprolife® was a valid instrument providing reproducible results, particularly for primary teeth.

Side effects of hyperbaric oxygen therapy in children with cerebral palsy.

BACKGROUND: This article reports the side effects observed in a double-blind placebo-controlled multi-center randomized clinical trial carried out to assess the efficacy and safety of hyperbaric oxygen (HBO2) therapy in children with cerebral palsy. Intention-to-treat analysis did not prove to have a beneficial effect. MATERIAL AND METHODS: 111 children aged 3 to 12 years were included and followed for 8 weeks. They all received 40 compressions of 1 hour (5 days per week). In the treated group (n=57), HBO2 sessions consisted of an exposure to 100% oxygen at 1.75 atmosphere absolute (atm abs) while children in the control group (n=54) received air at 1.3 atm abs. A physician carried out a general health surveillance including an ear examination prior to and immediately following each session. All clinical events occurring during the course of the study were recorded. FINDINGS: Events were classified in 3 categories: Events related to pressure/volume changes, events related to oxygen toxicity, and other events. No events due to oxygen toxicity were noted. Only middle ear barotrauma significantly differed according to the groups (50% in HBO2 session group versus 27.8% in control group). Other events were rare and equivalent in both groups. CONCLUSION: Short-term exposure to HBO2 at medium level pressure (1.75 atm abs) was responsible for a significant increase of middle ear barotrauma compared to children that received very low external pressure (1.3 atm abs).

Effect of sono-abrasion in the microleakage of a pit and fissure sealant.

PURPOSE: To assess the microleakage of a pit and fissure sealant after preparing enamel with sono-abrasion, used alone or associated with acid etching. This technique was compared with classical enamel preparations i.e. acid etching and diamond bur associated with etching. MATERIALS AND METHODS: Ninety 3rd molars were used. In the mesial halves, the fissures were prepared with sono-abrasion and acid etching for 15 seconds. Then, the samples were randomly assigned to three groups of 30. They were either treated with acid etching alone (group 1), widened mechanically with a bur and etched for 15 seconds (group 2) or prepared with sono-abrasion alone (group 3). Then, the resin-based sealant was applied according to the manufacturer's recommendations. The teeth were thermocycled and placed in a 1% solution of methylene blue. The teeth showing microleakage and the means of infiltration were assessed with an image analysis system. RESULTS: The poorest results were obtained with sono-abrasion alone which showed a greater number of specimens with microleakage (73.3%) (p < 0.001). They also showed the highest mean of microleakage (0.85+/-0.79 mm vs 0.1+/-0.26 for acid; 0.35+/-0.85 for bur associated with etching p < 0.0001); and 0.19+/-0.45 for sono-abrasion associated with etching. CONCLUSION: No significant difference was noted between the three types of enamel preparation using etching. Sono-abrasion can be used for preparing dental enamel prior to sealing the tooth but it does not eliminate the need for etching.

Dental health of 6-year-old children in Alpes Maritimes, France.

AIM: To describe the dental health status of 6-year-old children using the ICDAS-II advanced method and to evaluate the association between the known caries risk factors with the cavitated caries lesion (WHO basic method) or with both non-cavitated and cavitated caries lesion caries (ICDAS II). METHODS: In this cross-sectional study, a questionnaire was used to evaluate oral health and dietary habits of children. A clinical examination and a Cario analysis test (Pierre Fabre Oral care) were performed. STATISTICS: Logistic regression analyses were used to assess the association between caries and daily tooth-brushing, dietary habits, visible plaque and salivary factors. RESULTS: There were 341 children (52% female and 6.25+/-0.46 years of age) in this study. Using the ICDAS-II advanced method, 39% of the children were caries-free. This proportion was larger (67.2%) using the WHO method. In multivariate models, visible dental plaque and Streptococcus mutans count were associated with caries experience registered as ICDAS-II codes 1-6 or codes 3-6. The absence of daily tooth-brushing with fluoridated toothpaste was associated only with caries experience ICDAS-II codes 3-6. CONCLUSION: The use of WHO or ICDAS-II method changed the proportion of caries-free children but not the clinical caries risk factors associated with caries experience.

Reduced salivary flow induced by systemic isotretinoin may lead to dental decay. A prospective clinical study.

BACKGROUND: The adverse effects of isotretinoin have been well documented, but dental side effects over the course of treatment have never been studied. OBJECTIVES: To prospectively document the oral side effects experienced by a group of patients taking isotretinoin and to compare the changes in oral health and salivary parameters with a control group. METHODS: A cohort study was conducted within the dermatology department at the University Hospital in collaboration with two private dermatology practices in Nice, France. Patients were treated at a dose of 0.5 mg/kg/day. The control group was made up of students from the University of Nice-Sophia-Antipolis. The salivary flow, the buffer capacity of saliva, the number of pathogen bacteria and the DMFT index (number of decayed, missing and filled teeth) were assessed at each visit. RESULTS: Eighteen patients and 99 controls were available for evaluation. None of the oral parameters varied with time in the control group, whereas the DMFT significantly increased in the treated group (3.07 +/- 3.85 vs. 3.41 +/- 4.36; p<0.036). The salivary flow gradually decreased with time (p<0.004), but the patients recovered their baseline salivary flow 2 months after the end of the treatment. CONCLUSIONS: This study clearly showed that patients treated with isotretinoin experienced oral side effects.

Periapical status, prevalence and quality of endodontic treatment in an adult French population.

AIM: The aim of this study was to determine the periapical status and the quality of root-canal treatment amongst an adult population attending the dental school in Nice, France during 1998. METHODOLOGY: Patients who attended the dental school for the first time during 1998 were included. Panoramic radiographs, taken by a trained radiology assistant, were used in this study. The periapical areas of all teeth with the exception of third molars, were examined and the technical quality of root fillings were evaluated for both apical extension and density. Statistical analyses were conducted using anova, Chi-square, Fisher's PLSD and Cohen's Kappa tests. RESULTS: The survey involved 344 patients: 180 females and 164 males. Males had significantly fewer natural remaining teeth than females (P<0.03). Similarly, the average number of root-filled teeth was lower for males (P<0.01). Nonroot-filled teeth (n=6126) had significantly fewer signs of periapical pathology than root-filled teeth (n=1429) (1.7% vs. 31.5%, P<0.0001). The majority of root fillings were poorly executed. There was a significant correlation between the presence of periapical pathology and inadequate root-canal fillings (P<0.001). CONCLUSIONS: The results of the present study indicate that many root-canal treatments were technically unsatisfactory in terms of quality and treatment outcome. There is a need for endodontic retreatment in the population examined.