[Neglect of oral care in children: a matter of integral approach]. / Verwaarlozing van de mondverzorging bij kinderen: een kwestie van integrale aanpak.

Inadequate oral care will eventually result in pain and inflammation. Inadequate oral care in children may be the result of ignorance, inability to deal with an uncooperative child or parental neglect. Poorly cared-for dentition in a child may be a sign of child neglect as defined by the Royal Dutch Medical Association's (KNMG) Reporting Code "Child Abuse and Domestic Violence". Restorative treatment of caries lesions ("filling holes") in a child with neglected teeth masks the lack of oral health care. Non-restorative treatment methods focus on stopping caries activity. These methods require adequate guidance of oral health care. This means motivating parents to re-brush the child's teeth every day. Medical care-providers, including GPs, paediatricians and public health nurses are necessary to provide alerts regarding neglect of dental care. They can investigate whether the oral problems indicate wider problems of neglect in the child. It is recommended that medical care-providers and dental care-providers work together and make use of their respective expertise.

Fracture strength of cusp replacing resin composite restorations.

PURPOSE: To assess the influence of an additional shoulder preparation on the fracture strength of a cusp-replacing direct resin composite restoration in a premolar that previously had an amalgam MOD restoration followed by fracture of a cusp. MATERIALS AND METHODS: Two preparation designs were tested. In extracted sound premolars an MOD amalgam cavity was simulated followed by fracture of a cusp (Group A). Group B was the same as Group A but a shoulder was added along the cervical outline of the preparation. As a control group, cusp fracture was simulated but no MOD amalgam cavities were prepared. For each group, 14 preparations were made using a copy milling technique. All 42 preparations were restored using a direct resin composite restoration technique. Restorations were loaded until fracture. RESULTS: The fracture strength of the preparation with shoulder was not significantly different from the preparation without the shoulder. The fracture strength of the preparations in the reference group, which had no resistance form, was significantly less than in Groups A and B (ANOVA, P<0.05).

A randomized clinical trial of cusp-replacing resin composite restorations: efficiency and short-term effectiveness.

PURPOSE: This study aimed to assess the efficacy and short-term effectiveness of the morphology and function of direct and indirect cusp-replacing resin composite restorations. MATERIALS AND METHODS: In 94 patients, 106 cusp-replacing restorations for maxillary premolars were fabricated to restore Class II caries lesions with 1 cusp missing. Fifty-four direct (Clearfil AP-X) and 52 indirect (Estenia) resin composite restorations were placed following a strict protocol. The treatment technique and operator were assigned randomly. Treatment time was recorded for all restorations. One-month postoperative evaluation included assessment of postoperative sensitivity and presence of occlusal and proximal contacts. RESULTS: Treatment time for the indirect technique (68 +/- 17 min) was longer than for the direct technique (45 +/- 13 min). Regression analysis revealed that the restorative method, operator, and location of the preparation outline had a statistically significant effect on the total treatment time. Occlusal contacts were observed in 94% of the direct restorations and in 98% of the indirect restorations (chi-square, P>.05). Mesial proximal contacts were present in 98% of the direct and in 97% of the indirect restorations (chi-square, P > .05). Distal contacts were present in 100% of the restorations for both techniques. Postoperative sensitivity within 1 week posttreatment was reported for 11% of the direct restorations and for 13% of the indirect restorations, but decreased to 4% and 6%, respectively, after 1 month (chi-square, P > .05). CONCLUSION: The results of this study suggest that in the short term, both direct and indirect adhesive techniques are adequate to restore the morphology and function of premolars presenting with Class II caries lesions and a missing cusp.

A survey of cusp fractures in a population of general dental practices.

PURPOSE: This study was conducted to expand the knowledge on the incidence of complete cusp fractures of posterior teeth in Dutch general practices. MATERIALS AND METHODS: During a 3-month period, data were obtained from 28 general practitioners, representing 46,394 patients. For each new case of complete cusp fracture, clinicians recorded information using a standard form with questions relating to location of the fracture, cause of fracture, and restorative status of the tooth prior to the cusp fracture. RESULTS: There were 238 cases of complete cusp fracture recorded. The results of this study indicate an incidence rate of cusp fractures of 20.5 per 1,000 person-years at risk. Molars were more frequently registered with cusp fractures than premolars (79% vs 21%). Maxillary molars presented more fractures of buccal cusps (66% vs 34%), while mandibular molars presented more fractures of lingual cusps (75% vs 25%). Almost 77% of the cases had been restored on three or more surfaces. Statistical analysis revealed a positive correlation between history of endodontic treatment and subgingival fracture location. Mastication was most frequently reported as the cause for fracture (54%), although one can argue whether the occlusal force was the cause or the immediate reason. CONCLUSION: This study revealed that complete cusp fracture is a common phenomenon in dental practice and has shown differences in cusp fracture with respect to tooth type and restorative status of the tooth. Teeth with a history of endodontic treatment are susceptible to unfavorable subgingival fracture locations.