Vital bleaching for children with dental anomalies: EAPD members' survey.

AIM: Understand EAPD members' practices of vital bleaching for children with dental anomalies. METHODS: An anonymous online survey sent via EAPD in January 2019, consisting of 13 questions with possible multiple answers and free text. RESULTS: 110 responses from 24 countries were obtained. The majority worked in hospitals/universities (n = 69, 63%) or private practices (n = 50, 46%) and were specialists (n = 62, 57%) or senior academics (n = 35, 32%). Most respondents (n = 74 68%) did not provide vital bleaching for children. 88 respondents (80%) belonged to EU: of these, 46 (52%) were not aware of bleaching regulations. For respondents who provided bleaching 26 (72%) undertook home bleaching, using 10% carbamide peroxide (n = 21, 58%), most commonly for 2 weeks (n = 14, 39%), following establishment of the permanent dentition (n = 21, 58%). Deciding factors included: extent (n = 27, 75%) and shade (n = 26, 72%) of discolouration and child being teased by peers (n = 23, 64%). Main reasons for not bleaching included: concerns with side effects (n = 41; 55%) and not agreeing with bleaching (n = 23, 31%). Dentists who did not bleach managed a range of conditions, most frequently molar-incisor hypomineralisation (n = 57; 77%). The majority provided composite restorations with removal of tooth structure (n = 50; 68%) with a number opting for no treatment (n = 27, 37%). CONCLUSION: This study shows wide variations in treatment of children's dental anomalies across Europe. Fears of adverse effects and personal beliefs seemed to be the main deterrents to bleaching in children. Clinicians who provided bleaching tended to opt for more conservative techniques and to take children's concerns into consideration.

Methods of space maintenance for premature loss of a primary molar: a review.

AIM: This critical appraisal attempts to answer the question: What is the best method of space maintenance (SM) following premature loss of a primary molar in children under 12 years old? METHODS: A search to identify studies relevant to the PICO was conducted. Single case reports and studies prior to 1986 were excluded. The principles of GRADE were followed to appraise the evidence. RESULTS: 20 studies were identified, which evaluated 2265 space maintainers (SMs). Two studies were graded high quality, four moderate, eight low, and six very low. All studies reported on longevity outcomes and most on adverse effects. CONCLUSIONS: There was no strong evidence favouring a particular SM, the following recommendations were made: (a) strong recommendations: In cases where rubber dam cannot be used clinicians should not use Glass Fibre Reinforced Composite Resin (GFRCR) SMs. (b) Weak recommendations: Crown and Loop SMs are recommended for loss of primary first molars; GFRCR SMs (placed under rubber dam) are recommended for loss of primary second molars. Bilateral SMs may have questionable efficacy and their use where there is loss of multiple molars in the same quadrant should be weighed against the risk of unwanted tooth movements, loss of a removable SM or no space maintenance at all.

The evaluation of spontaneous space closure after the extraction of first permanent molars.

AIM: In the UK, first permanent molars (FPMs) of poor prognosis are often planned for extraction so that second permanent molars (SPMs) erupt favourably to replace the FPMs. However, there is little published data to support this treatment strategy. The aim of this study was to assess the success of planned FPM extractions conducted 5 years ago at a dental hospital in London. METHODS: Two hundred and thirty-six SPMs from 63 patients were clinically assessed. The position of each SPM was recorded in relation to the second premolar, against patient Angle's classification and SPM radiographic development stage at the time of FPM extraction. STATISTICS: Results were analysed using ordered logistic regression. RESULTS: At the time of FPM extraction, only 54 % of SPMs were at the "ideal" stage of development (Demirjian's dental development stage E). Upper and lower arches yielded significantly different results with 92 % of all upper extractions resulting in complete space closure regardless of SPM development stage. Only 66 % of lower FPMs extracted at SPM stage E had complete space closure and no significant relationship was found between lower SPM development stage and its subsequent space closure. Space closure in both arches also appeared independent of patient Angle's classification. CONCLUSIONS: Although only over half the patients had FPMs extracted at the "ideal time", this did not appear to influence successful positioning of the upper or lower SPM. More research is required to investigate and confirm which predictive parameters have a significant effect on post-extraction orthodontic development, especially in the lower arch.

Sedation for dental treatment of children in the primary care sector (UK).

OBJECTIVE: To audit the clinical practice of a dental sedation service in the primary care sector and determine which services dentists use to manage unco-operative children. DESIGN: Retrospective analysis and prospective audit. SETTING: Sedation clinic in primary care, 2007, England. SUBJECTS: Children attending for dental treatment under sedation. General dental practitioners (GDPs) in the Brighton and West Sussex regions. INTERVENTIONS: Questionnaire. MAIN OUTCOME MEASURES: Clinical service audit, patient satisfaction, referrer satisfaction. RESULTS: Four hundred children (age range 5-12 years) had been referred for caries (78%), with the remainder for orthodontic extractions. The most common treatment carried out on primary and permanent teeth was extractions followed by restorations. A combination of intravenous (IV) midazolam/ketamine/fentanyl was used in 40% of cases, and IV midazolam/ketamine was used in 34% of cases. Seventy-four percent of parents responded to the satisfaction questionnaire; of these 97% rated sedation as excellent/good and 80% would choose sedation or recommend sedation for others. Only 45% of questionnaires to referrers were returned. Fifty-six percent of dentists preferred general anaesthesia (GA) and 66% preferred IV sedation. CONCLUSIONS: Dental treatment for children was provided under IV sedation with most parents satisfied with the procedure. Little difference was seen between referring dentists' perceptions of IV sedation or GA.

Perioperative local anaesthetic in young paediatric patients undergoing extractions under outpatient 'short-case' general anaesthesia. A double-blind randomised controlled trial.

OBJECTIVE: To investigate if postoperative pain/discomfort and anxiety experienced by young children who had extractions under general anaesthesia (GA) were affected by perioperative injection techniques of local anaesthetic (LA). DESIGN: A single-centre, double-blind, randomised controlled trial. SETTING: Conducted in 2002/2003 at the Unit of Paediatric Dentistry, Eastman Dental Hospital, London. METHODS: Children, aged 2-6 years scheduled for extractions under GA, were randomly assigned to receive either no LA (NLA), infiltration injection (IFL) or intraligamental injection (ITR) perioperatively. All children received analgesic suppositories after induction. OUTCOME MEASURES: Anxiety was scored using the Venham Picture Scale. Postoperative pain was scored using the Simplified Toddler-Preschooler Postoperative Pain Scale and supplemented with the Modified Pain/Discomfort Scale. RESULTS: Eighteen children received NLA, 17 received IFL and 19 received ITR. Postoperative pain/discomfort and anxiety scores were not significantly different during the period of recovery. On the first night, the intraligamental group had significantly lower pain scores (p = 0.012). CONCLUSION: Postoperative pain/discomfort and anxiety during the period of recovery experienced by young children who had extractions under GA appear not to be affected by perioperative injection techniques of LA. Upon discharge, intraligamental injection appears beneficial, as it is probably well tolerated by causing less soft tissue numbness initially and thus, reduces perceived pain/discomfort.

What is the evidence for paediatric dental sedation?

BACKGROUND AND RATIONALE: Sedation can be used to relieve anxiety and manage behaviour in children, unfortunately it is difficult to determine from published research which agents, dosages and techniques are effective. OBJECTIVE: To evaluate the relative efficacy of the various conscious sedation techniques and dosages for behaviour management in paediatric dentistry. DESIGN AND KEY METHODS: Relevant databases and reference lists from articles were searched up to December 2005. Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in anxious children up to 16 years of age. RESULTS: Sixty-five studies were included with 3372 subjects in total. Overall quality of studies was found to be disappointing with poor reporting often the main problem. CONCLUSIONS: Authors were not able to reach any definitive conclusion on which was the most effective drug or method of sedation used for anxious children due to issues with the quality and validity of published studies to date.

Sedation of anxious children undergoing dental treatment.

BACKGROUND: Anxiety about dental treatment or behaviour management problems can be a barrier to its uptake in children. Sedation can be used to relieve anxiety and manage behaviour, unfortunately it is difficult to determine from published research which agents, dosages and techniques are effective. OBJECTIVES: To evaluate the relative efficacy of the various conscious sedation techniques and dosages for behaviour management in paediatric dentistry. SEARCH STRATEGY: Computerised: MEDLINE, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Dissertation Abstracts, SIGLE, the World Wide Web (Google) and the Community of Science Database were searched for relevant trials and references up to December 2004. Reference lists from relevant articles were scanned and the authors contacted to identify trials and obtain additional information. There were no language restrictions. Trials pre-1966 were not searched. SELECTION CRITERIA: Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in anxious children up to 16 years of age. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions and outcome measures and results were independently extracted, in duplicate, by two authors. Authors of trials were contacted for details of randomisation and withdrawals and a quality assessment was carried out not using any formal scoring system. The Cochrane Oral Health Group statistical guidelines were followed. MAIN RESULTS: Sixty-one studies were included with 3246 subjects in total. Overall quality of studies was found to be disappointing with poor reporting often the main problem. Data reported could not be easily aggregated into groups to facilitate description of results. Meta-analysis of the available data was also not possible for the same reason. The variety of differing drug regimens compared made it difficult to isolate groups of studies that were sufficiently similar in design to allow sensible comparison. Where groups of studies could be isolated, then the differing outcome measures used made their meta-analysis impossible. AUTHORS' CONCLUSIONS: Review authors were not able to reach any definitive conclusion on which was the most effective drug or method of sedation used for anxious children. A list of proposed areas of study was described.

Sedation of anxious children undergoing dental treatment.

BACKGROUND: Anxiety about dental treatment maybe a barrier to its uptake in children. Sedation can be used to relieve anxiety and manage behaviour, unfortunately it is difficult to determine from published research which agents, dosages and techniques are effective. OBJECTIVES: To evaluate the relative efficacy of the various conscious sedation techniques and dosages for behaviour management in paediatric dentistry. SEARCH STRATEGY: Computerised: MEDLINE, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Dissertation Abstracts, SIGLE, the World Wide Web (Google) and the Community of Science Database were searched for relevant trials and references. Searches were carried out for MEDLINE and EMBASE up to June 2003 and for the remaining databases December 2002. Reference lists from relevant articles were scanned and the authors contacted to identify trials and obtain additional information. There were no language restrictions. Trials pre-1966 were not searched. SELECTION CRITERIA: Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in anxious children up to 16 years of age. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions and outcome measures and results were independently extracted, in duplicate, by two authors. Specialist advice was asked to categorise interventions. Authors of trials were contacted for details of randomisation and withdrawals and a quality assessment was carried out not using any formal scoring system. The Cochrane Oral Health Group statistical guidelines were followed. MAIN RESULTS: Fifty-three studies were included with 2345 subjects in total. Overall quality of studies was found to be disappointing with poor reporting often the main problem. Data reported could not be easily aggregated into groups to facilitate description of results. Meta-analysis of the available data was also not possible for the same reason. The variety of differing drug regimens compared made it difficult to isolate groups of studies that were sufficiently similar in design to allow sensible comparison. Where groups of studies could be isolated, then the differing outcome measures used made their meta-analysis impossible. AUTHORS' CONCLUSIONS: Authors were not able to reach any definitive conclusion on which was the most effective drug or method of sedation used for anxious children. A list of proposed areas of study was described.

Systematic review of studies comparing the anti-caries efficacy of children's toothpaste containing 600 ppm of fluoride or less with high fluoride toothpastes of 1,000 ppm or above.

OBJECTIVE: To determine the clinical effectiveness of low fluoride (F) toothpastes, containing 600 ppm or less, with toothpaste containing 1,000 ppm or more fluoride in preventing dental caries. DESIGN: Systematic review of randomised controlled trials comparing low fluoride toothpastes containing 600 ppm F or less with toothpastes containing 1,000 ppm or more in children or adults. RESULTS: Seven randomised controlled trials were included. These were categorised into two groups depending on the fluoride concentration in the low fluoride group (250 and 500 ppm) and analysed separately. 250 PPM: Results of the meta-analysis were statistically significant (p = 0.002 and 0.0005) and in favour of the control group (1,000 ppm). DFS increments in the 250-ppm group were 0.6-0.7 greater than the 1,000-ppm group. 500 PPM: Only two studies were in this category, and one of them failed to present the baseline caries levels, so a meta-analysis was not carried out. CONCLUSION: 250 ppm fluoride dentifrice was not as effective in caries prevention in permanent dentition as dentifrice containing 1,000 ppm F or more. More studies have to be carried out to test the anticaries efficacy of 500 against 1,000 ppm and above.

Occlusal caries detection in primary teeth: a comparison of DIAGNOdent with conventional methods.

OBJECTIVE: To compare the accuracy and repeatability of three diagnostic systems (DIAGNOdent, visual and radiographic) for occlusal caries diagnosis in primary molars. DESIGN: Two examiner, in vitro, blinded study. Histological gold standard. MATERIALS AND METHODS: 58 occlusal surfaces of primary molars examined in turn by two examiners using each of three diagnostic systems (DIAGNOdent, visual and radiographic). These results were compared with a histological gold standard. Sensitivity and specificity were calculated for each diagnostic system at a range of thresholds. Inter- and intra- examiner repeatability were calculated for each diagnostic system using the kappa statistic. MAIN OUTCOME MEASURES: Sensitivity, specificity, inter and intra examiner repeatability for each diagnostic system. RESULTS: The highest sensitivity values were provided by DIAGNOdent (0.77 and 0.80, examiners 1 and 2 respectively) however this was offset by a lower specificity (0.82 and 0.85) than all other systems with the exception of examiner 1 at V1 visual threshold. The DIAGNOdent gave the highest values of kappa for intra- and inter-examiner repeatability with the exception of intra-examiner repeatability for examiner 2 where visual diagnosis had the highest value of kappa. CONCLUSION: The DIAGNOdent was the most accurate system tested for the detection of occlusal dentine caries in primary molars. The performance of the DIAGNOdent systems was not statistically significantly better than that achieved using visual examination for non-cavitated teeth (V1 and V2 threshold). DIAGNOdent may prove useful as a predictive clinical tool, however with appropriate training visual examination may offer similar results without the need for additional equipment.

An investigation of the oral status and reported oral care of children with heart and heart-lung transplants.

AIM: To investigate the oral health status and oral microflora of children who have received heart and heart-lung transplants. Parental knowledge and current practice of oral health procedures by the child were also investigated. SAMPLE AND METHOD: Thirty-five children attending the Cardio-Thoracic Transplant Unit, Great Ormond Street Hospital for Children were included. Measurements were compared with children matched by age and gender attending the trauma clinic at the Department of Paediatric Dentistry, Eastman Dental Hospital. Teeth were examined for the presence or absence of caries or enamel defects. Plaque deposition, gingivitis, gingival bleeding and gingival enlargement were measured and a swab was taken to look at the oral microbial flora. A questionnaire was used to assess parental knowledge of dental health procedures and the current practice of these. RESULTS: There were no significant differences between transplant and control children in caries experience, plaque or gingivitis. Children with heart or heart-lung transplants had significantly greater numbers of enamel defects and more gingival enlargement than control children, children in the heart transplant group had significantly more gingival bleeding. There was little difference in the dental knowledge and reported behaviour of the transplant group compared to the control group. CONCLUSION: The dental needs of heart and heart-lung transplant patients treated at the Great Ormond Street Hospital for Children were similar to those of the control group in this study, however further improvement could be made in educating parents and children on the importance of caries prevention and good oral hygiene.

Effect of oral melatonin administration on sex hormone, prolactin, and thyroid hormone concentrations in adult dogs.

OBJECTIVE: To determine the effect of oral melatonin (MT) administration on serum concentrations of sex hormones, prolactin, and thyroxine in dogs. DESIGN: Prospective study. ANIMALS: 8 male and 8 female adult sexually intact dogs. PROCEDURE: 5 male and 5 female dogs were treated with MT (1.0 to 1.3 mg/kg [0.45 to 0.59 mg/lb] of body weight), PO, every 12 hours for 28 days; the other 6 dogs were used as controls. Blood samples were collected on days 0, 14, and 28, and serum concentrations of estradiol-17 beta, progesterone, testosterone, androstenedione, 17-hydroxyprogesterone (17-HP), dihydroepiandrostenedione sulfate (DHEAS), prolactin, and thyroxine were determined. On day 5, serum MT concentrations were measured before and periodically for up to 8 hours after MT administration in 4 treated dogs. RESULTS: Female dogs treated with MT had significant decreases in serum estradiol, testosterone, and DHEAS concentrations between days 0 and 28. Male dogs treated with MT had significant decreases in serum estradiol and 17-HP concentrations between days 0 and 28. Serum MT concentrations increased significantly after MT administration and remained high for at least 8 hours. Prolactin and thyroxine concentrations were unaffected by treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Melatonin is well absorbed following oral administration and may alter serum sex hormone concentrations.

Symmetric cutaneous necrosis of the hind feet and multicentric follicular lymphoma in a cat.

A 7-year-old castrated male domestic shorthair cat was admitted to the veterinary teaching hospital for evaluation of symmetric necrosis of the skin of its hind feet and high liver enzyme activities. Lymphoma was diagnosed on cytologic examination of a fine needle aspirate of the liver. The owner declined treatment for the lymphoma. On postmortem histologic examination, lymphoma was found in the liver, stomach, and multiple lymph nodes. Immunohistochemical staining revealed the neoplasm to have a mixed B- and T-cell follicular arrangement, and a diagnosis of multicentric follicular lymphoma was made. The distal portion of the feet were necrotic, but a neoplastic infiltrate was not seen on histologic examination. After thrombosis and vasculitis were excluded as causes, the ischemic necrosis of the feet of the cat in this report was considered a paraneoplastic syndrome, as can be seen in people with lymphoma or other internal malignancies.

Occlusal caries diagnosis: an in vitro histological validation of the Electronic Caries Monitor (ECM) and other methods.

OBJECTIVES: The aim of this in vitro study was to validate the use of the Electronic Caries Monitor (ECM) for the detection of enamel and dentinal caries on the occlusal surfaces of posterior teeth, and to compare it with visual examination, fibre-optic transillumination, conventional and digital bitewing radiography. METHODS: One-hundred and three extracted posterior permanent teeth with no apparent occlusal cavitation were selected and examined using each system. Thirty teeth were re-examined with each system to assess repeatability. Each tooth was then serially sectioned and examined histologically for occlusal caries. RESULTS: The occlusal surfaces of 25 teeth had caries in enamel and 37 had dentinal carious lesions. The sensitivity and specificity of the ECM were 0.78 and 0.80 for the diagnosis of occlusal dentinal lesions (cut-off = 0.391) and 0.65 and 0.73 for enamel lesions (cut-off = 0.501). The weighted kappa value for repeatability of the ECM was 0.68. Of the other diagnostic systems, visual examination provided the best combination of sensitivity and specificity, 0.24 and 0.97 for dentinal caries and 0.60 and 0.73 for enamel caries, respectively. CONCLUSION: The ECM was the most accurate diagnostic tool for the in vitro diagnosis of early, non-cavitated occlusal lesions on posterior teeth.

Malignant pheochromocytoma (paraganglioma) of the organ of Zuckerkandl: a study of two cases.

Ten percent of pheochromocytomas are found in extra-adrenal locations and are called paragangliomas. In recent years we have had the opportunity to study two patients with malignant paragangliomas of the organ of Zuckerlandl. Only 13 cases of such neoplasms have been reported previously. Our cases are of interest because of their features of recurrence, distant metastases, response to adjuvant therapy, and long survival.

Renal papillary adenocarcinoma.

Papillary adenocarcinoma of the kidney is an uncommon variant of renal tubular carcinoma, which on radiographic and ultrasonographic evaluation presents characteristically as a predominantly solid hypovascular or avascular mass. Surgery is required to distinguish this lesion from other solid renal lesions, which differs from the more common form of renal tubular carcinoma in several important respects.