Stainless steel crowns as a restoration for permanent posterior teeth in people with special needs: A retrospective study.

BACKGROUND: Limited information exists regarding the use of stainless steel crowns (SSCs) in permanent teeth. The objective of this retrospective cohort study was to present the long-term clinical outcomes of the SSC compared with those of amalgam and composite resin restorations and the SSC radiographic outcomes in a special-needs population. METHODS: This study included 271 patients with at least 1 SSC restoration from the Mount Sinai Hospital Dentistry Clinic for Persons with Special Needs in Toronto, Ontario, Canada. A total of 2,621 posterior permanent tooth restorations were documented: 766 SSCs, 1,651 amalgam restorations, and 204 composite resin restorations. Clinical analysis included patient demographics, treatment parameters, and outcome assessments for each restoration recorded. Radiographic analysis of SSC restorations included 127 bite-wing radiographs and 118 periapical radiographs, measurement of interproximal bone loss, and assessment of periapical status using the Periapical Index Scale. RESULTS: The 10-year survival rates for new SSC and amalgam restorations were 79.2% and 63.5%, respectively. The 91 SSC failures included 2 recementations, 33 replacements, and 56 extractions. Primary diagnoses at the time of failure included chronic periodontal disease (25) and loose or lost SSCs (24). Of the 528 failed conventional restorations that were replaced, 60% were replaced with SSCs. The mean alveolar bone loss from mesial and distal sites was 1.36 millimeters and 1.40 mm, respectively. Therefore, 93% of the sites recorded were less than 2 mm and classified as healthy. All pre-SCC and post-SSC periapical radiographs had healthy Periapical Index Scale scores (1 or 2) recorded over an average duration of 8.4 years (1-29.1 years). CONCLUSIONS: SSCs are a durable treatment option for the restoration of the posterior permanent dentition. PRACTICAL IMPLICATIONS: Posterior permanent teeth restored with stainless steel crowns can be expected to last for 10 years and represent a viable treatment choice for severely carious or fractured posterior permanent teeth.

Ectopic Eruption of the Permanent Maxillary First Molar: Predictive Factors for Irreversible Outcome.

PURPOSE: The purpose of this study was to determine the rate of self-correction and predictive factors for irreversible outcome of mesial ectopic eruption of permanent maxillary first molars (EE), in a sample population where no interceptive treatment was initiated. METHODS: Charts of patients diagnosed with EE were reviewed, and radiographs were analyzed for predictive factors reported in the literature. RESULTS: Sixty-five EE were included in the study; 46 (71 percent) self-corrected, of which one-third occurred after age nine years. Space loss, with an average of approximately three mm, occurred in 18 EE (28 percent). Increased magnitude of impaction, degree of resorption of the primary second molar, severe lock, and bilateral occurrence were positively correlated with irreversible EE. Multiple regression analysis was positive for increased magnitude of impaction when adjusted for gender and bilateral occurrence. CONCLUSION: Spontaneous self-correction occurred in 71 percent of permanent maxillary first molars with ectopic eruption; one third of self-corrections occurred after nine years of age. Delaying treatment of ectopic eruption of permanent maxillary first molars may be a viable option when the outcome is uncertain. Increased magnitude of impaction was the most reliable predictor associated with irreversible outcome.

Validity of a simplified screening instrument for assessing overweight children in a dental setting: a cross sectional study.

BACKGROUND: Obesity, with its rising prevalence among Canadians and its estimated cost of $2 billion annually in Canada, is no longer considered a cosmetic issue, but a major health issue that imposes a great burden on the healthcare system and economy. This cross sectional study aims to evaluate the feasibility of identifying the weight status of 6 to 11 year-old children in a university dental clinic using a simplified overweight screening instrument. METHODS: One hundred sixty eight healthy children were enrolled. Weight and height were measured and overweight/obesity status was assessed using two techniques: 1) the 2007 World Health Organization Body Mass Index (BMI)-for-age reference Tables, 2) simplified overweight screening instrument without BMI calculation. Measures of overall, positive, and negative percent agreement between the two approaches were computed. RESULTS: The children's average weight, height, BMI and BMI z-score were respectively 32.6 ± 9.5 kg, 133.8 ± 10.7 cm, 17.8 ± 3.2, and 0.4 ± 1.0. The overall, positive, and negative percent agreement between the two screening approaches were respectively, 89%, 100%, and 83%. CONCLUSION: This study demonstrated the feasibility and parental acceptance of weight, height and BMI measurement in a dental setting and evidence that supports the validity of a new simplified approach to assess children's weight status without having to compute BMI. TRIAL REGISTRATION: NCT02637752 . Registered 18 December 2015.

Dental Students' Clinical Expectations and Experiences Treating Persons with Disabilities.

Persons with disabilities (PWDs) have a disproportionate level of dental disease relative to the general population. Access to care is a cause along with dentists' willingness to treat PWDs. The aim of this study was to investigate the expectations and experiences of dental students in providing treatment to these patients in a hospital-based dental clinic for PWDs. Senior dental students at the Faculty of Dentistry, University of Toronto (n=92) were surveyed prior to (Phase I) and at the end of (Phase II) mandatory clinical rotations at the Mount Sinai Hospital's Dentistry Clinic for Persons with Special Needs. Response rates were 88% for Phase I and 58% for Phase II. Before the rotations, 70% of the respondents reported little or no experience with PWDs, and 46% said they did not feel comfortable providing basic dental treatment to PWDs. However, in Phase II, significantly more students reported being comfortable than in Phase I (p=0.001). Overall, the majority of respondents (Phase I 95%; Phase II 98%) indicated they would at least attempt to provide basic dental care to PWDs after graduation. The majority also identified the opportunity to provide care and interact with PWDs as the most enjoyable aspect of their experience at the clinic. They reported that the experience helped reduce their concerns about treating PWDs including being more realistic about the time required and ideal quality of the treatment they could provide. These results suggest that their experience in the clinic significantly increased students' comfort in treating PWDs. The respondents expressed a willingness to treat PWDs once graduated and generally identified their experience as being more positive than their expectations.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: I. Material Choice.

PURPOSE: The purpose of this study was to assess the preferences of pediatric dentists in Canada and the United States about clinical decision-making related to the placement of direct restorative materials. METHODS: A cross-sectional web-based survey was used to collect the preference of all active pediatric members of the Royal College of Dentists of Canada and the American Academy of Pediatric Dentistry on the use of direct restorative materials in posterior teeth in healthy, developmentally delayed (DD), and medically compromised (MC) children. Bivariate and multivariate analyses were performed to determine the association between the predictor variables and all materials at two-tailed P<0.05. RESULTS: A response rate of 19.3 percent (n equals 762) was achieved. For DD patients, stainless steel crowns were the most preferred material for primary teeth, and a similar frequency of amalgam and composite were preferred for permanent teeth. Amalgam usage was increasingly preferred in the DD population versus healthy and MC patients. CONCLUSIONS: Composite resin was the most preferred restoration for Class I, II, and V restorations in primary and permanent teeth in healthy and medically compromised individuals. In DD individuals, stainless steel crowns and amalgam were preferred more frequently.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: II. Rubber Dam Isolation.

PURPOSE: The purpose of this study was to assess usage, indications, and contraindications for rubber dam isolation (RDI) by pediatric dentists in Canada and the United States. METHODS: A cross-sectional, web-based, self-administered survey was utilized to collect the opinions of all active pediatric dentist members of the Royal College of Dentists of Canada and the American Academy of Pediatric Dentistry on the use of direct restorative materials in posterior teeth (n equals 4,648; 19.3 percent response rate). The main survey also included a domain on the RDI utilization and its perceived indications and contraindications. Bivariate and multivariate analyses for RDI usage and its predictor were performed at two-tailed P<0.05. RESULTS: A response rate of 19.3 percent was obtained. Most participants (72.5 percent) reported using RDI "all the time." The material with the lowest usage of RDI was composite (82 percent) in the primary dentition and stainless steel crown (80.7 percent) in the permanent dentition. The three top-noted reasons for not using RDI included decreased trauma to the patient (66.2 percent), being able to prevent soft tissue from interfering without using RDI (55.9 percent), and decreased time for appointments (45.6 percent). CONCLUSION: Rubber dam isolation was valued by the majority of pediatric dentists when restoring primary and permanent dentition for all materials.

An Assessment of Direct Restorative Material Use in Posterior Teeth by American and Canadian Pediatric Dentists: III. Preferred Level of Participation in Decision-making.

PURPOSE: The purpose of this study was to assess Canadian and American pediatric dentists' preferred level of participation in clinical decision-making. METHODS: A web-based survey was used to collect the opinions of all active Royal College of Dentists of Canada members and American Academy of Pediatric Dentistry members on the use of direct restorative materials in posterior teeth (n equals 4,648; 19.3 percent response rate). The main survey also included a domain to elicit participants' preferred role in clinical decision-making, ranging from an active role (the dentist takes the primary role in decision-making while considering patients/caregivers opinions) to a passive role (the dentist prefers to have the patient guide the decision-making). Bivariate and multivariate analyses for the preferred role and its predictor were performed (two-tailed P<0.05). RESULTS: Fifty-eight percent of participants preferred an active role. The passive role was chosen three times more by those who worked in a hospital-based setting (odds ratio [OR] equals 3.15, 95 percent confidence interval [CI] equals 1.13 to 8.79) or a university-based setting versus a combined setting (OR equals 3.61, 95 percent CI equals 1.11 to 11.77). CONCLUSION: The majority of participants preferred an active role in decision-making, a role that may not be consistent with a patient-centered practice that emphasizes patient autonomy in decision-making.

Oral neutrophil levels: a screening test for oral inflammatory load in pregnancy in a medical setting.

BACKGROUND: A multitude of studies suggest an association between periodontal disease and adverse birth outcomes, but the findings have been equivocal. Although the evidence is controversial, it is biologically plausible, and the key link may be inflammation. Because periodontitis is at times either active or inactive, trying to correlate the presence of pockets, for example, to adverse outcome of pregnancy might be preordained to failure or at least confusion. Alternatively, if inflammatory activity associated with periodontitis could be measured, it might be possible to correlate oral inflammatory load (OIL) to adverse pregnancy outcomes more precisely, but given the low incidence of adverse pregnancy outcomes, large populations must be studied. This underscores the need to use a means for assessment of OIL that is reliable, reproducible, and so simple to perform that it does not require dental expertise and can be used for large numbers of patients attending obstetrics units. The objective of this study was to demonstrate that OIL can be measured in a cohort of pregnant females presenting for obstetric care and secondarily to ensure that there was a realistic correlation to the presence of periodontitis. METHODS: Sixty-three pregnant females were recruited, and 15-second saline rinses were collected to measure OIL as represented by counts of oral neutrophil levels. Periodontal examinations were performed to determine the extent of the correlation between the presence of clinical markers of periodontitis, such as pockets and clinical attachment loss to the OIL. RESULTS: Using this small cohort of patients, a test for oral inflammatory disease could be administered successfully in a non-dental setting. In addition, there was a statistically significant increase (two-fold, P < 0.05) in oral neutrophil counts found in patients with periodontitis compared with those without periodontitis. CONCLUSION: The rinse assay can be used as a screening tool for oral inflammation, which was also related to the presence of periodontitis, in pregnant females attending a medical clinic.

The importance of the initial comprehensive dental examination.

New diagnostic technology that improves patient care is becoming more common in dental practices at both the generalist and specialist levels. However, new diagnostic tests may be ordered prematurely or given more importance than warranted, resulting in misdiagnoses or delay of appropriate treatment. In this report, we describe a case in which several oral health care professionals failed to diagnose persistent facial pain correctly, in part because of failure to conduct a comprehensive dental examination and over-reliance on new technology. During 13 months of persistent mandibular pain, various diagnoses and treatments, the patient did not have a comprehensive dental examination-an examination that would have revealed periradicular periodontitis in tooth 25 causing the referred mandibular pain. This case demonstrates the importance and value of the initial comprehensive history and clinical examination, followed by conventional imaging to arrive at an accurate diagnosis and treatment plan.

Evaluation of periodontal disease and oral inflammatory load in adults with special needs using oral neutrophil quantification.

The purpose of this study was to validate and assess the feasibility of using an assay of oral neutrophils to measure periodontal inflammation in uncooperative adults with special needs. Conventional periodontal measurements and neutrophil counts obtained from oral swabs were performed on patients having dental care under general anesthesia (GA) and at subsequent recall. Forty-nine patients were assessed under GA and 30 (61%) returned for follow-up. A high prevalence of gingival inflammation was found at baseline and oral neutrophil levels positively correlated with traditional periodontal parameters (p < 0.05). Neutrophils were acquired using swabs for 100% of patients examined at recall and a significant reduction in oral inflammatory load was noted after a single treatment session (p < 0.05), despite the persistence of poor oral hygiene and prolonged recall intervals. This study demonstrates that oral neutrophil quantification may serve as a novel and standardized method for clinical assessment of periodontal diseases in people with special needs.

A retrospective study of a modified 1-minute formocresol pulpotomy technique part 1: clinical and radiographic findings.

PURPOSE: The purpose of this study was to assess the clinical and radiographic outcomes of a 1-minute application of full-strength Buckley's formocresol with concurrent hemostasis using the medicated cotton pledget in human primary teeth. METHODS: Using a retrospective chart review, clinical and radiographic data were available for 557 primary molars in 320 patients. Descriptive statistics and survival analysis were used to assess outcomes. RESULTS: Overall clinical success, radiographic success, and cumulative 5-year survival rates were approximately 99%, 90%, and 87%, respectively. Internal root resorption (∼5%) and pulp canal obliteration (∼2%) were the most frequently observed radiographic failures. Thirty-nine teeth were extracted due to clinical and or radiographic failure. Mandibular molars were 6 times more prone to radiographic failure than maxillary molars. CONCLUSIONS: Success rates for the modified technique are comparable to techniques that use the 5-minute diluted or full-strength solutions reported in the literature. This 1-minute full-strength formocresol technique is an acceptable alternative to published traditional techniques.

A retrospective study of a modified 1-minute formocresol pulpotomy technique part 2: effect on exfoliation times and successors.

PURPOSE: The purposes of this study were to evaluate the: effect of a 1-minute application of full-strength Buckley's formocresol with concur- rent hemostasis using the medicated cotton pledget in human primary teeth on their successors; and exfoliation times compared to the contralateral nonpulpotomized tooth. METHODS: Using a retrospective chart review, clinical and radiographic data were available for 557 primary molars in 320 patients. RESULTS: There was no difference between treated and control teeth in the number of enamel defects of succedaneous teeth (P<.45). Approximately 66% exfoliated at the same time as their contralateral counterpart and approximately 29% exfoliated earlier (P<.001). CONCLUSIONS: This 1-minute technique showed a tendency toward early exfoliation, but no effect on clinical management, and no increase in incidence of defects on succedaneous teeth was observed. The 1-minute full-strength formocresol technique may be considered an acceptable alternative to the 5-minute formocresol pulpotomy.

Mount Sinai Hospital dental program for persons with disabilities: role in undergraduate dental education.

Access to dental care for persons with special needs or disabilities continues to be a problem. This population is known to have a high incidence of dental disease, but unfortunately oral health is a significant unmet health need in many cases. To address this need, the Mount Sinai Hospital Dental Program for Persons with Disabilities was developed over 30 years ago by staff within the discipline of pediatric dentistry at the faculty of dentistry of the University of Toronto. Undergraduate students receive hands-on clinical training in dental management of persons with disabilities, the majority of whom have a developmental disability and could receive care in a community-based dental practice. This program has been successful, but access to community care is still an issue for the population served. Two new initiatives have been introduced in an attempt to develop personal links between persons with disabilities and future dentists, the first a series of lectures given by persons with disabilities and the second a nonprofit organization dedicated to raising awareness of the need for dental care for persons with disabilities. Among other activities, the organization sponsors a community-based event called Sharing Smiles Day, which brings together dental students and persons with disabilities in a carnival-like setting where the emphasis is on personal interactions. Dental preventive education is also provided but is of secondary importance. These initiatives and the program as a whole represent recognition of the responsibility of educators to ensure that new graduates have both the education and the desire to provide needed dental care to persons with disabilities.

Access to dental care for persons with developmental disabilities in Ontario.

OBJECTIVES: This study was undertaken to determine the proportion of persons primarily with developmental disabilities who encounter difficulties accessing dental care in Ontario, to identify perceived barriers to accessing dental care and to determine if persons with disabilities and their caregivers believe that oral health is important. METHODS: Community organizations providing services mainly to persons with developmental disabilities in Ontario were recruited to circulate a questionnaire to their members by mail or the Internet. Fourteen organizations mailed out a total of 1,755 paper questionnaires in autumn 2006, of which 420 (23.9%) were returned; in addition, 236 Internet questionnaires were returned. RESULTS: Of the 656 paper and Internet responses, 634 were deemed valid. Most of the respondents had developmental disabilities. Almost three-quarters of respondents (464 [73.2%] ) reported being able to access dental services in Ontario. Personal (internal) factors were more likely to represent barriers to dental care than external factors. CONCLUSIONS: The majority of persons with disabilities and most caregivers believed that oral health is important for overall health.

The role of hospital-based dentistry in providing treatment for persons with developmental delay.

Hospital dentistry is important to the delivery of oral health care to persons with disabilities. Recent cuts in funding for hospital dentistry in Ontario have placed a great strain on the health care system"s ability to meet the demand for such care. General anesthesia is an accepted treatment option for patients who are uncooperative, but involves inherent risks. In this paper, we present the case of a person with developmental delay who received dental treatment under general anesthesia and subsequently developed complications to support the position that a dental program for persons with special needs should be provided in a hospital setting to minimize their risk of suffering serious complications and to ensure their safety.

Patients with special health care needs in general and pediatric dental practices in Ontario.

The objective of this study was to determine the involvement of Ontario's general and pediatric dentists in providing care to patients with special health care needs (PSHCNs). A questionnaire was developed and sent to a randomly selected sample of general dentists and to all pediatric dentists in Ontario; response rates were 52% and 90%, respectively. Most general dentists and all pediatric dentists reported that they provided a full range of dental services to PSHCNs. Most (80%) general dentists treat PSHCNs of all ages, whereas 60% of pediatric dentists report only treating PSHCNs up to the age of 18 years. A majority of both groups report treating PSHCNs whose dental care is paid through various government-funded programs. Most general dentists received training in the treatment of PSHCNs in undergraduate dental school, and 40% reported taking continuing education courses in this area. Most pediatric dentists received this training during their advanced dental specialty training, and 29% reported taking continuing education courses in this area. The results of this survey appear to demonstrate that general and pediatric dentists in Ontario provide a full range of dental services to PSHCNs, treat patients with a variety of disabilities and of all ages and are interested in pursuing continuing education that focuses on the delivery of dental care to PSHCNs. However, the results may be inaccurate because of question design flaws and responder bias among the 52% of surveyed general dentists who returned their questionnaires.

Replantation of permanent incisors in children using Emdogain.

The aim of this study was to determine whether application of an enamel matrix protein derivative, Emdogain (Biora AB Malmo, Sweden) to the root surface of avulsed permanent incisors would improve postreplantation outcomes in a pediatric population. Between June 1999 and May 2002, 25 avulsed permanent maxillary incisors (22 centrals and three laterals) were treated with Emdogain and followed for up to 32 months, mean duration 20.6 months (range: 6.9-32.5 months). Mean patient age at the time of treatment was 12.0 years (range: 7.7-17.6 years) and mean extra-alveolar duration was 185 min (range: 100-300 min). At the end of their follow-up each of the replanted incisors demonstrated radiographic evidence of replacement root resorption and clinical evidence of ankylosis. None of the replanted teeth were affected by inflammatory root resorption and there was no evidence of infection. When compared with the control samples from Barrett and Kenny (Endod Dent Traumatol 1997;15:269-72.) and Andersson et al. (Endod Dent Traumatol 1989;5:38-47.) this sample treated with the Emdogain protocol demonstrated significantly less root resorption than either of the control samples (anova, P < 0.0001). Although the Emdogain protocol did not produce periodontal regeneration, it did eliminate inflammatory resorption and infection and led to significantly less root resorption compared with the two historical controls.

Development and testing of an audio-visual aid for improving infant oral health through primary caregiver education.

PURPOSE: To create and test an audio-visual (AV) aid for providing anticipatory guidance on infant oral health to caregivers. METHODS: A DVD-video containing evidence-based information about infant oral health care and prevention in accordance with the American Academy of Pediatric Dentistry guidelines has been developed (www.utoronto.ca/dentistry/newsresources/kids/). It contains comprehensive anticipatory guidance in the areas of pregnancy, oral development, teething, diet and nutrition, oral hygiene, fluoride use, acquisition of oral bacteria, feeding and oral habits, causes and sequelae of early childhood caries, trauma prevention, early dental visits and regular dental visits. A questionnaire was developed to test the knowledge of expectant and young mothers (n = 11) and early childhood educators (n = 16) before and after viewing the video. RESULTS: A significant lack of knowledge about infant oral health was indicated by the proportion of "I don"t know" (22%) and incorrect (19%) responses to the questionnaire before the viewing. Significant improvement in knowledge (32%; range -3% to 57%; p < 0.001) was indicated by the proportion of correct responses (91%) following a single viewing of the AV aid. CONCLUSION: This AV aid promises to be an effective tool in providing anticipatory guidance regarding infant oral health in high-risk populations. Unlike existing educational materials, this aid provides a comprehensive, self-directed, evidence-based approach to the promotion of infant oral health. Widespread application of this prevention protocol has the potential to result in greater awareness, increased use of dental services and reduced incidence of preventable oral disease in the target populations.