Adolescent valuation of CARIES-QC-U: a child-centred preference-based measure of dental caries.

OBJECTIVES: This study develops an adolescent value set for a child-centred dental caries-specific measure of oral health-related quality of life (OHRQoL) based upon CARIES-QC (Caries Impacts and Experiences Questionnaire for Children). This study develops a new approach to valuing child health by eliciting adolescent preferences and anchoring these onto the 1-0 full health-dead QALY (quality adjusted life year) scale using ordinal adult preferences. METHODS: Two online surveys were created to elicit preferences for the CARIES-QC classification system. The first comprised best-worst scaling (BWS) tasks for completion by adolescents aged 11-16 years. The second comprised discrete choice experiment tasks with a duration attribute (DCETTO) for completion by adults aged over 18 years. Preferences were modelled using the conditional logit model. Mapping regressions anchored the adolescent BWS data onto the QALY scale using adult DCETTO values, since the BWS survey data alone cannot generate anchored values. RESULTS: 723 adolescents completed the BWS survey and 626 adults completed the DCETTO survey. The samples were representative of UK adolescent and adult populations. Fully consistent and robust models were produced for both BWS and DCETTO data. BWS preferences were mapped onto DCETTO values, resulting utility estimates for each health state defined by the classification system. CONCLUSION: This is the first measure with predetermined scoring based on preferences to be developed specifically for use in child oral health research, and uses a novel technique to generate a value set using adolescent preferences. The estimates can be used to generate QALYs in economic evaluations of interventions to improve children's oral health.

A systematic review of the quality and scope of economic evaluations in child oral health research.

BACKGROUND: Economic evaluations provide policy makers with information to facilitate efficient resource allocation. To date, the quality and scope of economic evaluations in the field of child oral health has not been evaluated. Furthermore, whilst the involvement of children in research has been actively encouraged in recent years, the success of this movement in dental health economics has not yet been explored. This review aimed to determine the quality and scope of published economic evaluations applied to children's oral health and to consider the extent of children's involvement. METHODS: The following databases were searched: CINAHL, Cochrane Library, Econlit, EThOS, MEDLINE, NHS EED, OpenGrey, Scopus, Web of Science. Full economic evaluations, relating to any aspect of child oral health, published after 1997 were included and appraised against the Drummond checklist and the Consolidated Health Economic Evaluation Reporting Standards by a team of four calibrated reviewers. Data were also extracted regarding children's involvement and the outcome measures used. RESULTS: Two thousand seven hundred fifteen studies were identified, of which 46 met the inclusion criteria. The majority (n = 38, 82%) were cost-effectiveness studies, with most focusing on the prevention or management of dental caries (n = 42, 91%). One study quantified outcomes in Quality Adjusted Life Years (QALYs), and one study utilised a child-reported outcome measure. The mean percentage of applicable Drummond checklist criteria met by the studies in this review was 48% (median = 50%, range = 0-100%) with key methodological weaknesses noted in relation to discounting of costs and outcomes. The mean percentage of applicable CHEERS criteria met by each study was 77% (median = 83%, range = 33-100%), with limited reporting of conflicts of interest. Children's engagement was largely overlooked. CONCLUSIONS: There is a paucity of high-quality economic evaluations in the field of child oral health. This deficiency could be addressed through the endorsement of standardised economic evaluation guidelines by dental journals. The development of a child-centred utility measure for use in paediatric oral health would enable researchers to quantify outcomes in terms of quality adjusted life years (QALYs) whilst promoting child-centred research.

Novel Ameloblastin Variants, Contrasting Amelogenesis Imperfecta Phenotypes.

Amelogenesis imperfecta (AI) comprises a group of rare, inherited disorders with abnormal enamel formation. Ameloblastin (AMBN), the second most abundant enamel matrix protein (EMP), plays a critical role in amelogenesis. Pathogenic biallelic loss-of-function AMBN variants are known to cause recessive hypoplastic AI. A report of a family with dominant hypoplastic AI attributed to AMBN missense change p.Pro357Ser, together with data from animal models, suggests that the consequences of AMBN variants in human AI remain incompletely characterized. Here we describe 5 new pathogenic AMBN variants in 11 individuals with AI. These fall within 3 groups by phenotype. Group 1, consisting of 6 families biallelic for combinations of 4 different variants, have yellow hypoplastic AI with poor-quality enamel, consistent with previous reports. Group 2, with 2 families, appears monoallelic for a variant shared with group 1 and has hypomaturation AI of near-normal enamel volume with pitting. Group 3 includes 3 families, all monoallelic for a fifth variant, which are affected by white hypoplastic AI with a thin intact enamel layer. Three variants, c.209C>G; p.(Ser70*) (groups 1 and 2), c.295T>C; p.(Tyr99His) (group 1), and c.76G>A; p.(Ala26Thr) (group 3) were identified in multiple families. Long-read AMBN locus sequencing revealed these variants are on the same conserved haplotype, implying they originate from a common ancestor. Data presented therefore provide further support for possible dominant as well as recessive inheritance for AMBN-related AI and for multiple contrasting phenotypes. In conclusion, our findings suggest pathogenic AMBN variants have a more complex impact on human AI than previously reported.

Impact of the Hall technique for preformed metal crown placement on undergraduate paediatric dentistry experience.

The Hall technique, a novel method of placing preformed metal crowns (PMCs) without local anaesthesia or tooth preparation, was introduced to our undergraduate dental curriculum in 2009. This study aimed to describe student experience of, and attitudes towards, PMCs before and after exposure to this new technique. Clinical data were extracted from student logbooks to determine the number of PMCs placed for cohorts graduating in 2005 (n = 55), 2009 (n = 61) and 2010 (n = 75). Five focus groups were also conducted with 29 final-year dental students. Students graduating in 2005, 2009 and 2010 had placed a mean (range) of 0.03 (0-1), 0.63 (0-5) and 1.15 (0-9) PMCs, respectively. The proportion of students who had placed a PMC increased significantly from only 1.9% in 2005 to 75% in 2010 (P < 0.05, ANOVA). Students reported some positive experiences of the Hall technique. However, concern over perceived lack of future clinical support, an anticipated increase in time and financial pressures, and the ease of use of glass-ionomer cement as an alternative were described as potential barriers to PMC use. Findings suggest that the introduction of the Hall technique has had a marked impact on the use of PMCs as a treatment modality for carious primary teeth.

Psychosocial predictors of children's oral health-related quality of life during transition to secondary school.

PURPOSE: Dental conditions have the potential to impact negatively on children's oral health-related quality of life (OHRQoL). However, little attempt has been made to investigate how psychosocial variables and significant life events affect children's OHRQoL. This research aimed to explore how children's dental status, coping, and self-esteem influenced OHRQoL during transition to secondary school. METHODS: All patients were undergoing treatment at a UK Dental Hospital. Self-report questionnaires obtained psychosocial data on self-esteem, coping styles and OHRQoL and were completed by children 3 months prior to secondary school entry and 3 months following educational transition. Data were extracted from the clinical records of the paediatric patients who agreed to participate in the research. RESULTS: A total of 92 children aged between 10 and 11 years participated at baseline (43% response rate) and 71 of these children participated in the follow-up investigation (77% response rate). Multiple lagged regression analyses revealed that clinical variables and children's self-perception of their physical appearance were significant predictors of OHRQoL following transition to secondary school. CONCLUSIONS: Children who were satisfied with their physical appearance reported fewer impacts on their OHRQoL. The mechanisms through which this domain of self-esteem impacts on OHRQoL warrants further investigation.

The success of fissure sealants placed by dentists and dental care professionals.

OBJECTIVE: To obtain preliminary data on the effectiveness of fissure sealants placed by dentists and dental care professionals (DCPs). RESEARCH DESIGN: Case-note review of fissure sealants provided for paediatric patients within primary dental services in South Yorkshire. PARTICIPANTS: Records were retrieved for 1,100 fissure sealants, placed on first and second permanent molars of 312 children by 25 participating dentists and 25 DCPs during 2001-2003. MAIN OUTCOME MEASURES: Independent variables included operator details and patient-related factors including: caries experience at baseline, age, gender, and socio-economic status. The outcome variables were sealant retention and progression to caries at three years. Bivariate analyses were used to explore the role of potential factors associated with the success of fissure sealant survival. Kaplan-Meier survival analysis and Cox's regression models were used to estimate the probability of sealant success for both operator groups. RESULTS: Retention rates at three years for fissure sealants placed by dentists and DCPs were 62.4% (SD = 22.1) and 58.1% (SD = 21.5) respectively. After three years, 87.1% (SD = 9.8) and 84.2% (SD = 11.6) of teeth sealed by dentists and DCPs remained sound. Exploratory analysis found no significant difference in sealant retention or caries transformation rates according to operator type. CONCLUSIONS: On the basis of these preliminary findings, delegation of fissure sealants to DCPs would seem to be justified in view of the comparable sealant success rates achieved by dentists and DCPs. These data can now be used to inform future randomised controlled trials on the effectiveness of fissure sealants by different operator groups.

Seeking children's perspectives in the management of visible enamel defects.

AIM: To undertake a child-centred evaluation of treatment provision for visible enamel defects. DESIGN: Postal questionnaires, developed with children, were sent to 88 patients, aged 7-16 years, with visible enamel defects of permanent incisors and who had received microabrasion, with/without additional composite restoration at Sheffield Dental Hospital, UK. The questionnaires sought children's perceptions about their teeth before and after the intervention, as well as their evaluation of how they had been treated. Anonymised responses were graded using a 10 cm visual analogue scale (VAS) where a score of 10 indicated the most negative response, and zero the most positive response. RESULTS: Sixty three questionnaires were returned (72% response). Prior to treatment, children reported high levels of worry (VAS=6.8), embarrassment (VAS=6.9) and a perception that their teeth looked yellow and discoloured (VAS=7.3). Following treatment, children thought their teeth looked much better (VAS=1.6), felt happier (VAS=2.2) and more confident (VAS=1.6). They also felt very positive about their clinical experiences, rating the staff as extremely friendly and kind (VAS=0.4) and reporting that procedures were clearly explained (VAS=0.6). CONCLUSIONS: Simple non-invasive dental treatment can have a positive effect on appearance-related satisfaction. The use of child-centred approaches offers an invaluable insight into patient perspectives.

What children say and clinicians hear: accounts relating to incisor hypomineralisation of cosmetic concern.

AIM: To explore the range of impacts relating to incisor opacities as described by children, their general dental practitioners and paediatric dentists. METHODS: Participants included 50 children, aged 7-16 years, referred to a UK hospital paediatric dentistry service for management of incisor opacities. All children were subsequently diagnosed with molar incisor hypomineralisation. Following ethical approval, data were recorded as follows: patient demographics, distance travelled, waiting times, nature of any impacts relating to incisor opacities documented in referral letters and/or in subsequent paediatric dentistry assessment records. Additionally, children completed the short form Child Oral Health Impact Profile questionnaire (COHIP-SF19) as a self-report measure of their oral health-related quality of life (OHRQoL). RESULTS: Nearly, half (48%, n = 24) of the referral letters mentioned that the child was experiencing one or more negative social and/or functional impacts. Mean COHIP score was significantly lower (indicating poorer OHRQoL) for children whose referring dentist had identified a negative impact (COHIP = 42.9) compared to those with no documented impact (COHIP = 50.5; p = 0.018, independent t test). At the hospital consultation, negative impacts were elicited by a paediatric dentist in 86% (n = 43) of cases. Again, mean COHIP score was significantly lower for children whose assessment records noted a negative impact (COHIP = 44.5) compared to those with no recorded impact (COHIP = 60.2; p = 0.001). Families travelled a mean distance of 57 km (range 3-218 km) to the hospital service, with an average waiting time of 75 days from referral. CONCLUSION: It is encouraging that dental professionals seem to be aware of the negative psychosocial impacts experienced by some children with enamel opacities, and that children feel able to describe them.

Previous radiographic experience of children referred for dental extractions under general anaesthesia in the U.K.

OBJECTIVE: To determine what proportion of children undergo radiographic assessment prior to referral to a dental hospital for extractions under general anaesthesia. BASIC RESEARCH DESIGN: This prospective survey was conducted over a 6-month period. A data sheet was used to record the following information: patient's age; referrer's name and place of work (general dental practice or community dental service); teeth to be extracted (primary dentition and/or permanent dentition) and reported previous radiographic examination. Patients were excluded from the study if, following a clinical examination, radiographs were not actually deemed necessary for diagnosis and treatment planning purposes. Clinical setting A paediatric dentistry clinic within a dental hospital in the North of England. Participants 161 patients with a mean age of six years (SD = 2.2, range = 3-14 years) who were referred to the dental hospital for extractions under general anaesthesia. RESULTS: Overall, 12.4% of children had reportedly undergone a previous radiographic assessment prior to hospital referral. A significantly greater proportion of children referred for permanent tooth extractions had been subject to radiographic examination compared to children referred for primary tooth extractions (46.2% as compared to 6.3%; P = 0.001 chi-squared test). Furthermore, patients referred from the community dental service were significantly more likely to have had previous dental radiographs than children referred from general dental practice (36.9% compared to 9.3%; P = 0.003 chi-squared test). CONCLUSIONS: Radiographs do not appear to be routinely employed for caries diagnosis and treatment planning in young children within general dental practice in the U.K.

The psychosocial impact of oral conditions during transition to secondary education.

AIM: Transition to secondary education is a significant life event. Little is known about the impact of oro-facial conditions during this time and how concerns may contribute as a risk factor to negative adaptation. The aim of the study was to explore experiences of young people with oro-facial conditions as they undergo the transition to secondary education. STUDY DESIGN: Qualitative interview and diary study. METHODS: Participants were children aged 11-12 years with a range of clinical conditions who attended a dental hospital. Participants completed a two-week diary during the transition and were interviewed about the diary and their experiences. The interviews were audio-taped and transcribed verbatim. RESULTS: Seventeen participants returned the diary and were interviewed; they described both changes in school environment and social interactions. A key finding was the concerns about aspects of themselves that children developed during this time. For some young people these concerns were about their oro-facial condition. No links between gender, severity of condition and experiences of school were apparent. CONCLUSION: Transition to secondary education affected young people to varying degrees. Timely treatment for those concerned about the condition of their teeth may improve the likelihood of positive adaptation.

The case report in 21st century child dental literature.

AIM: To review recent dental child case reports to determine: 1 the main focus of the paper; 2 perceived contribution to the dental literature and, 3 involvement of the child. STUDY DESIGN: Systematic review. METHODS: Case reports published between 2000 and 2005 were identified using Medline via Ovid and Embase databases. Papers were reviewed to determine: their perceived value; whether they related to a single case or case series; the main dental condition; how the child was referred to, and inclusion of any child-centred input within the report. RESULTS AND STATISTICS: 663 case reports, from 82 journal titles, were subject to review. The majority presented a single patient (82%) and discussed a type of intervention or treatment (58%). The most common themes related to oral pathology/medicine (28%), and orthodontics (26%). Most children were referred to as 'patients' (74%) with little use of personalised terms (4%). Few reports included any child-centred input or contribution from a proxy (10% and 2% respectively). Inter- and intra-examiner repeatability for categorisation was excellent. CONCLUSIONS: The majority of child-related reports described a treatment or intervention which is surprising given the low level of case reports in the hierarchy of evidence. The child's perspective in the presenting complaint or outcome needs greater consideration.

Who attends a Children's Hospital Emergency Department for dental reasons? A two-step cluster analysis approach.

OBJECTIVES: Emergency departments (EDs) have been identified as key providers of dental care although few studies have examined patterns of attendance or clusters of characteristics. The aim was to identify the reasons for visits to an ED, whether these remained stable over time, and characterize clusters of patients by socio-demographic and attendance variables. METHODS: Pseudonymized data were obtained for children who attended the ED in 2003-2004, 2004-2005 and 2012-2013. Presenting complaint was categorized as attending for dental or nondental reasons. Other variables analysed included patient (age, sex, ethnicity and deprivation) and attendance characteristics (distance travelled, season, nature of complaint, time elapsed since onset of symptoms, day of week and hours of attendance), together with treatment outcome (advice, antibiotics and referral). To assess trends over time, analyses were conducted on patient, attendance and treatment outcome variables. To examine whether patients could be characterized by socio-demographic and attendance variables, a two-step cluster analysis was undertaken on 2003-2004 data set and validated on 2004-2005 and 2012-2013 data sets. RESULTS: In 2003-2004, 550 children attended the ED for dental reasons rising to 687 in 2012-2013. The most important predictors of dental attendance were as follows: nature of complaint, ethnicity, time elapsed, sex and deprivation of the area in which children lived. The analysis showed two clusters: cluster 1 was comprised of children who attended the ED for dental injury, were of White ethnicity and attended within 24 h of onset of symptoms. Children in this cluster were likely to be from the least or less deprived areas (compared to Cluster 2) and were more likely to be males. Cluster 2 comprised of children attending the ED for caries, oral mucosal lesions or other complaints, were likely to be of other (non-White) ethnicities and were likely to attend more than 24 h after symptoms began. Children in this cluster were more likely to come from the most deprived areas and were both males and females. The clusters varied according to treatment outcome; those patients in Cluster 2 were more likely to be prescribed medication, whilst those children in Cluster 1 were more likely to be referred to another specialty. CONCLUSIONS: A significant number of visits to the ED were for dental reasons with two clusters of children. The results have identified groups of patients for whom appropriate dental provision is lacking and where targeted services are needed to improve outcomes for children and reduce the burden on EDs.

Unusual extrinsic staining following microabrasion in a girl with amelogenesis imperfecta.

BACKGROUND: Developmental defects of enamel (DDE), such as amelogenesis imperfecta (AI), may present with tooth discolouration that is of aesthetic concern to the affected individual. Children and young people with DDE may therefore seek dental interventions to improve their dental appearance. The most commonly employed approaches include microabrasion, bleaching and/or placement of composite resin veneers. CASE REPORT: A 13-year-old girl with hypomature AI requested treatment for the 'marks' on her teeth which were having a negative impact on her social interactions. Clinical examination revealed generalised dense white opacities, and a microabrasion approach was performed on 11, 12 and 13 using a commercial preparation of 6.6 % hydrochloric acid. Concerningly, the girl's father phoned the next day reporting that his daughter's teeth had turned 'orange'. An urgent review revealed that the treated teeth had indeed become an orange colour. Further enquiry found that the patient had eaten a tomato pizza immediately after her dental treatment and this was believed to have caused the severe extrinsic staining. The patient was provided with a 16 % carbamide peroxide preparation for night-time use in a laboratory-made tray. A 2-week review revealed complete resolution of the staining. FOLLOW-UP: Direct composite resin restorations were subsequently provided for the girl's maxillary anterior teeth to achieve an optimal cosmetic result and she has remained pleased with her dental appearance. CONCLUSION: Clinicians should be aware of the potential for extrinsic staining following microabrasion or tooth bleaching. Patients should be advised against consuming coloured food and drink for at least 48 h after their treatment.

Content analysis of children's television advertising in relation to dental health.

This paper provides some disturbing facts and figures about the amount of television being watched by children. In addition, it reports on the volume and type of television advertising aimed at young people, both in the United Kingdom and other developed countries. In view of recent public and professional concern as to the possible adverse effects of food advertising on children's health, this study set out to examine what proportion of television advertisements, directed at children, promoted products potentially harmful to dental health. Forty-one hours of children's television programming broadcast on ITV1, the main UK commercial channel, were recorded on to videotape for subsequent analysis. Almost 1,000 adverts were analysed; each was timed and broadly categorised as relating to a food/drink product or non food/drink product. Advertisements for food and drink were further subdivided according to their sugar and/or acid content. We found that, on average, 24 adverts were shown per broadcast hour, which accounted for 15.8% of the total schedule time. 34.8% of adverts related to food/drink products, and 95.3% of these promoted products that were deemed potentially cariogenic or erosive. The most frequently promoted food/drink products included breakfast cereals with added sugar (26.3%), confectionery (23.7%) and non-carbonated soft drinks (18.1%). It is very concerning that, despite recent specific codes of practice outlined by the Independent Television Commission for Children's Advertising, many food and drink products promoted during children's programming are potentially damaging to dental health.

Innervation of human tooth pulp in relation to caries and dentition type.

The neural status of carious teeth, particularly those associated with a painful pulpitis, is largely unknown. This study sought to determine differences in the innervation density of human primary and permanent teeth and whether caries or painful pulpitis was associated with anatomical changes in pulpal innervation. Coronal pulps were removed from 120 primary and permanent molars with a known pain history. Teeth were categorized as intact, moderately carious, or grossly carious. Using indirect immunofluorescence, we labeled sections for the general neuronal marker, protein gene product 9.5. Using image analysis, we found permanent teeth to be significantly more densely innervated than primary teeth. While there was no significant correlation with reported pain experience, neural density in both dentitions increased significantly with caries. Analysis of these data suggests that caries-induced changes in neural density may be functionally more important in the regulation of pulpal inflammation and healing than in the processing and perception of dental pain.

Immunocytochemical and electron-microscopic features of tooth pulp innervation in hereditary sensory and autonomic neuropathy.

Characteristics of the pulpal innervation in teeth obtained from a 4-year-old Asian boy with hereditary sensory and autonomic neuropathy, type II (HSAN) were investigated. Four minimally carious primary teeth were split longitudinally and prepared for either fluorescent immunocytochemistry or electron microscopy. The occurrence and distribution of specific neuropeptides were determined by the use of antisera to calcitonin gene-related peptide (CGRP), substance P (SP), neuropeptide Y (NPY), and vasoactive intestinal polypeptide (VIP). The overall innervation of the pulps was visualized using antiserum to protein gene product 9.5; an antiserum to dopamine beta-hydroxylase was used to identify postganglionic sympathetic fibres. Pulpal innervation in HSAN was notably different from that of normal teeth: in comparison with the controls, HSAN teeth had an overall marked reduction in pulpal innervation with an absence of large nerve bundles and the subodontoblastic plexus. CGRP- and SP-immunoreactivity was absent in HSAN specimens and VIP-immunoreactivity was reduced. However, NPY-immunoreactivity appeared to be increased within certain regions of the pulp/dentine complex. In addition, there was evidence of NPY-immunoreactive fibres extending into dentine, a feature not seen in the controls. Electron microscopy revealed an absence of myelinated nerve fibres and a paucity of unmyelinated fibres. CGRP and SP have a well-established role in nociceptive processing and their absence in the HSAN teeth would seem to correspond with the clinical presentation of marked peripheral sensory deficit, characteristic of this condition. An up-regulation of NPY-immunoreactivity has previously been reported in animal teeth following nerve injury and a similar mechanism may have stimulated increased NPY expression in HSAN teeth, but the functional significance of its presence within dentinal nerves is not known.

Sports-related oral injury and mouthguard use among Sheffield school children.

OBJECTIVE: The study was undertaken primarily to determine the frequency of use of mouthguards for sports among secondary school children. Information was also sought regarding the prevalence and aetiology of oral trauma; sports most frequently played; source of mouthguard; reported problems with use; and attitudes towards mouthguard. DESIGN: A total of 557 questionnaires was completed (an average response rate of 72.3 per cent). SETTING: Sheffield secondary schools (15). PARTICIPANTS: Seven hundred and seventy 14-15-year-old children. RESULTS: A tooth or lip/mouth injury was reported by 44.2 per cent and 54.4 per cent of the group respectively, and was significantly more prevalent among males. Just over 26 per cent of all reported oral trauma was attributed to sports-related accidents, but the aetiology varied significantly according to gender and social class. The subjects participated in a wide range of sporting activities with 57.4 per cent of boys frequently playing rugby and soccer. Girls most often engaged in netball (15.9 per cent) and hockey (10.3 per cent). Statistical analysis revealed only a significant effect of social class (as measured by school type and location) on the sport most frequently played by girls. Approximately 14 per cent of pupils professed to have worn a mouthguard for sports at some stage, although less than 6 per cent were currently wearing one. Gender and social group had a significant effect on the reported use of mouthguards with use significantly less among girls and those from lower socio-economic groups. Overall, nearly 70 per cent of pupils thought that mouthguards were helpful in preventing oral trauma and the majority of respondents would consider wearing one. However, girls were significantly less certain than boys about their willingness to use a mouthguard. CONCLUSIONS: In view of the evidence for the protective attributes of mouthguards there is considerable scope for promoting their wider use, especially among girls and children from a lower socio-economic background.

Interrelationship between dental age and chronological age in Somali children.

OBJECTIVE: To compare dental age (DA) with chronological age (CA) in Somali and white Caucasian children, resident in Sheffield. DESIGN: Cross-sectional study. SETTING: Paediatric dentistry clinic, Charles Clifford Dental Hospital, Sheffield. SUBJECTS: Somali children under 16 years of age and age- and gender-matched white Caucasian subjects. OUTCOME MEASURES: Dental age was determined for each subject, using their existing panoramic radiographs. Comparisons of the difference between dental age and chronological age (DA-CA) were made for gender and ethnic group, using independent sample t tests at the 0.05 level of significance. RESULTS: The sample group comprised 162 subjects: 84 Somali and Caucasian boys (mean age 10.55 years) and 78 Somali and Caucasian girls (mean age 11.24 years). The mean difference between DA and CA was found to be 1.01 years for Somali boys, 0.19 years for Caucasian boys, 1.22 years for Somali girls, and 0.52 years for Caucasian girls. The difference between DA and CA was significantly greater in Somali subjects than in Caucasian children. A few Somali subjects showed a marked discrepancy between chronological age and dental age (range -1.75 to 5.42 years), which was most evident in 8- to 12-year-old children. CONCLUSION: Somali children are significantly more dentally advanced than their Caucasian peers. This finding highlights the need for population-specific dental development standards for accurate dental age assessment.

Self-inflicted gingival injury in a young girl.

A case of self-inflicted gingival trauma in a 7-year-old girl is presented. The progression of the injurious behaviour over a 4-year period is described. Dental measures proved to be ineffective in resolving the habit.

Caries experience and dental attendance of Somali children living in a British city.

AIM: To facilitate the planning of future dental services, this study sought baseline data, relating to caries experience and dental attendance, for Somali children resident in Sheffield, UK. METHODS: A convenience sample of 4 to 14 year old Somali children was drawn from pupils attending Somali religious education classes, youth groups and selected schools in Sheffield. During 1998 and 1999, 238 Somali children were subjected to a dental examination and a structured interview. RESULTS: The mean age of the study population was 9.4 years with equal male and female distribution. The majority of children (58%) had been born in Somalia compared with 29% in the UK or 13% in another country. Just over half of the sample had English-speaking mothers. The mean dmft for 4 to 6 year olds was 2.12 and 50% demonstrated a past caries experience. In the 7 to 10 year old group, mean dmft was 2.05 and caries had again affected 50% of subjects. Mean DMFT for 11 to 14 year olds was 1.37 and 58% showed evidence of previous caries experience. The mother's reported ability to speak English was a strong predictor of caries experience in the group as a whole. Interestingly, an English-speaking mother was associated with low caries prevalence in young children, but with high caries prevalence in children over the age of 7 years. Finally, only 57% of subjects had seen a dentist within the previous 12 months, and almost half of these visits had been prompted because of a specific problem. CONCLUSION: It is evident that some Somali children have a high caries experience, with mother's ability to speak English being the greatest predictor of dental disease. Preventive strategies need to be developed for this population and regular dental attendance should be encouraged.