A questionnaire-based study of Paediatric Dentists' knowledge of teething signs, symptoms and management.

INTRODUCTION: Signs and symptoms attributed to erupting primary teeth are commonly known as "teething". Its existence is controversial with concern that overusing this term might mask other illnesses and some treatments may be unnecessary or harmful. Parents/carers can access over-the-counter remedies and may seek professional advice. This survey-based investigation explored gaps in knowledge, training, perceptions and experiences of UK Paediatric Dentists (PDs) regarding teething in young children. METHOD: Cross-sectional study with a convenience sample of PDs with different training levels, accessed through the British Society for Paediatric Dentistry membership lists. A 10-item questionnaire explored participants' knowledge of teething-related issues and management. Responses are presented using descriptive statistics. RESULTS: Of 80 responding PDs (response rate 27%), 62-74% suggested drooling, irritability, oral fixation and flushed cheeks were attributed to primary tooth eruption. Fifty-eight (72%) participants were unaware of guidelines, yet 53 (66%) felt guidance was needed. CONCLUSION: Signs and symptoms of teething might mask underlying conditions so it should be a diagnosis of exclusion. PDs attributed similar signs and symptoms to teething, as have been reported in the literature, although some commented that they did not think teething was a condition. There was a lack of awareness over guidelines.

When Less is More: Minimally Invasive, Evidence-Based Treatments for Dentine Caries in Primary Teeth - The Hall Technique and Silver Diamine Fluoride.

Evidence supports minimally invasive dentistry, and we have a better understanding of dental caries as a biofilm-mediated disease. These factors, together with the current need to reduce aerosol generation, make treatment approaches such as the Hall Technique and the use of silver diamine fluoride (SDF) more relevant than ever.Successful treatment planning depends on carious lesions being detected, their status accurately assessed, and a correct diagnosis made. Choosing the most appropriate treatment options for the tooth and child relies on marrying this with a precise history and an understanding of indications and contraindications for treatments.This article outlines the optimal use of the Hall Technique and SDF, allowing dental practitioners and therapists to use these modalities as less invasive approaches to provide the highest quality treatment for children with dental caries; less is more.

To extract or not to extract? Management of infraoccluded second primary molars without successors.

Infraocclusion is a term used to describe a tooth which has stopped its relative occlusal growth into the arch after the period of active eruption; as a result, the tooth becomes depressed below the occlusal plane. Although many aetiological mechanisms have been proposed, ankylosis is considered the primary cause of infraocclusion. Complex cases benefit from multidisciplinary management. This paper concentrates on the diagnosis and management of infraoccluded second primary molars, without permanent successors and without significant malocclusion, and provides clinicians with a treatment decision tree to aid in treatment planning.

Amelogenesis Imperfecta with Coronal Resorption: Report of Three Cases.

Intracoronal resorption of the permanent dentition in cases of amelogenesis imperfecta (AI) is a rare finding which poses an added complication to the already complex management of this condition. This paper presents three cases of AI associated with delayed eruption of permanent teeth in which asymptomatic intracoronal resorption occurred. CPD/Clinical Relevance: This paper highlights the fact that teeth affected with amelogenesis imperfecta may undergo asymptomatic intracoronal resorption which is only identifiable radiographically.

Characteristics of child dental neglect: a systematic review.

OBJECTIVE: Neglect of a child's oral health can lead to pain, poor growth and impaired quality of life. In populations where there is a high prevalence of dental caries, the determination of which children are experiencing dental neglect is challenging. This systematic review aims to identify the features of oral neglect in children. METHODS: Fifteen databases spanning 1947-2012 were searched; these were supplemented by hand searching of 4 specialist journals, 5 websites and references of full texts. Included: studies of children 0-18 years with confirmed oral neglect undergoing a standardised dental examination; excluded: physical/sexual abuse. All relevant studies underwent two independent reviews (+/- 3rd review) using standardised critical appraisal. RESULTS: Of 3863 potential studies screened, 83 studies were reviewed and 9 included (representing 1595 children). Features included: failure or delay in seeking dental treatment; failure to comply with/complete treatment; failure to provide basic oral care; co-existent adverse impact on the child e.g. pain and swelling. Two studies developed and implemented 'dental neglect' screening tools with success. The importance of Quality of Life tools to identify impact of neglected dental care are also highlighted. CONCLUSIONS: A small body of literature addresses this topic, using varying definitions of neglect, and standards of oral examination. While failure/delay in seeking care with adverse dental consequences were highlighted, differentiating dental caries from dental neglect is difficult, and there is a paucity of data on precise clinical features to aid in this distinction. CLINICAL SIGNIFICANCE: Diagnosing dental neglect can be challenging, influencing a reluctance to report cases. Published evidence does exist to support these referrals when conditions as above are described, although further quality case control studies defining distinguishing patterns of dental caries would be welcome.

Inverted impaction of a mandibular premolar associated with a dentigerous cyst: report of a case.

UNLABELLED: Inverted impaction of mandibular premolars is reported to be rare; its prevalence has not been quantified. Here we report a case in which a 12-year-old female presented with an inverted impacted manibular premolar associated with a dentigerous cyst. The likely aetiology and management of this condition is discussed. CLINICAL RELEVANCE: This case highlights the need for clinicians to be aware of the rarer causes of apparent absence of teeth from the arch and the importance of taking radiographs prior to treatment planning.