Assessment of the apically extruded debris between a rotary system, a reciprocating system and hand files during the root canal instrumentation of the deciduous molars.

BACKGROUND: One of the factors that most negatively affect the endodontic instrumentation process in primary teeth is the presence of extruded debris in the periapical region. Therefore, different techniques have been evaluated to reach an answer to the question regarding which root canal preparation method produces the least amount of debris extrusion. OBJECTIVES: The main objective of this study was to assess the amount of debris extrusion as well as irrigation associated with 3 different instrumentation techniques: a rotary system (PROTAPER NEXT® - PTN), a reciprocating system (WaveOne® - WO) and hand K-files. MATERIAL AND METHODS: Forty-eight primary mandibular molars with a single distal canal were selected and randomly divided into 3 groups (n = 16). Three different techniques were used for the canal instrumentation of each group, comprising PTN, WO and hand K-files. Pre-weighed Eppendorf tubes were used for the collection of debris extrusion, then stored in an incubator at 70°C for 5 days. A one-way analysis of variance (ANOVA) test was used for data analysis, followed by Tukey's post hoc test. RESULTS: Statistically significant differences were found while comparing the PTN and WO systems with the hand files. Both PTN and WO showed less debris extrusion toward the periapical tissues than the hand files. Still, no statistically significant differences were seen between the PTN and WO groups. CONCLUSIONS: Generally, debris extrusion occurred in all of the 3 experimental groups. The PTN and WO systems showed the least debris extrusion as compared to the hand files during the root canal instrumentation of the primary teeth, and for these reasons along with the shorter operating time, it may be concluded that using rotary and reciprocating systems rather than manual files is highly advisable. However, a clinical assessment is suggested.

Comparative assessment of dentin removal following hand and rotary instrumentation in primary molars using cone-beam computed tomography.

OBJECTIVE: Pediatric endodontics has witnessed many advances in recent years, thus facilitating a faster and efficient treatment option in root canal therapy in children. This in vitro evaluation aims to determine the amount of dentin removal in primary mandibular first and second molars instrumented with hand and rotary files using cone-beam computed tomography (CBCT). MATERIALS AND METHOD: Sixty primary mandibular molars were divided into two groups: Group I was prepared by manual instrumentation using K-type files and Group II was prepared with rotary instrumentation using 0.04 Hero Shaper Classics. Both these groups were further divided into two subgroups, namely (a) primary mandibular first molar and (b) primary mandibular second molar. All the root canals were prepared up to size 30 using the stepback technique. They were mounted on silicone-based impression material and subjected to CBCT scans for the evaluation of dentin removal before and after instrumentation. Dentin removal was calculated by superimposing images using the InVivo 5.1 Anatomage software. Data were statistically analyzed using independent samples t- test. RESULTS: An average amount of dentin removed was found to be significantly higher in manual instrumentation compared to rotary instrumentation in both primary mandibular first and second molars (P < 0.001). CONCLUSIONS: Rotary technique serves as an efficient alternative to the traditional manual instrumentation by overcoming its shortcomings in terms of conservation of the remaining dentin thickness and the time required for its preparation.

Infant oral mutilation (IOM) related to traditional practices among inner city pre-school children in Sudan.

BACKGROUND: The term Infant Oral Mutilation (IOM) refers to the aggressive cultural rituals where primary canine tooth germs of infants are enucleated for therapeutic reasons. OBJECTIVES: To determine the prevalence and risk factors for IOM among inner city pre-school children in Khartoum. METHODS: In this cross-sectional study, 212 randomly selected children from twelve government pre-schools in Khartoum were examined for the presence of IOM. Socio-demographic, feeding and teething-related data were collected by self-administered questionnaires. RESULTS: The mean age of the sample was 4.7 years. The prevalence of clinical IOM was 10.8%. Multivariable regression analysis revealed that children who suffered from diarrhea during teething were 7.15 times more likely to have clinical IOM over their counterparts (p<0.0001). Mothers who were educated below elementary school level were 2.69 times more likely to have children showing clinical IOM (p= 0.0369). CONCLUSION: The present study showed that the practice of IOM is common among inner city children. Certain teething-related symptoms especially diarrhea and maternal education could be strong determinants of the malpractice of IOM.

Assessment of Er:YAG laser for cavity preparation in primary and permanent teeth: a scanning electron microscopy and thermographic study.

PURPOSE: Most studies of cavity preparation using Er:YAG lasers have employed permanent teeth. This study's purpose was to compare the cutting efficiency of an Er:YAG laser versus diamond burs in primary and permanent teeth in order to measure thermal effects on the pulp and evaluate lased surfaces using scanning electron microscopy (SEM). METHODS: A total of 80 primary and permanent teeth were used. Crater depths and mass loss were measured after delivering laser pulses at varying energies onto sound or carious enamel or dentin using the Key-3 laser. Control samples were cut using diamond burs in an air turbine handpiece. Thermal changes were measured using miniature thermocouples placed into the pulp chamber. Lased surfaces were evaluated using SEM. RESULTS: Laser ablation crater-like defects were deeper in dentin than enamel at the same pulse energy. Greater ablation rates for dentin and enamel and significantly more efficient removal of carious tooth structure by laser was present in primary teeth. Temperature rises in the pulp did not exceed the 5.5 degrees Celsius threshold in any teeth during laser ablation. CONCLUSIONS: The Er:YAG laser is an efficient device for cavity preparations in primary teeth, with no unacceptable increases in temperature detected in this model.

Pathways to emergency dental care: An exploratory study.

AIM: To describe the pathways to care associated with acute dental infections in children. METHODS: Primary carers of children presenting with facial cellulitis completed a semistructured interview that sought to establish their pathway to the emergency department and definitive treatment. Descriptive statistics were used to describe the patterns of healthcare attendances, treatment received, medications prescribed and referrals made from the time the problem was first noted. RESULTS: Interviews were completed for 12 children presenting with acute cellulitis as a result of caries in the primary dentition (mean age of 6.8 + 2.6 years). The median time lapsed since carers first became aware of the problem was 15.5 days (range 3 to 63). The mean number of health service attendances made per child was 4.5 + 1.98. A total of 17 courses of oral antibiotics were prescribed prior to definitive treatment (mean 1.4 + 1.24, range 0 to 3). Half the teeth involved had been previously 'restored'. CONCLUSION: Children presenting with acute facial cellulitis represent the last stage in a pathway of failed clinical care that is associated with significant costs to both the individual family and the community. Further work is required to understand the barriers to children accessing timely and appropriate dental treatment.

Public awareness and social acceptability of dental therapists.

OBJECTIVES: To investigate public awareness and the social acceptability of dental treatment provided by dental therapists in the UK. METHOD: A telephone survey of a representative quota sample of 1,000 UK adults. RESULTS: 10.4% of participants were aware of dental therapists as a professional group, of whom none correctly identified their permitted duties. 61.3% were willing to receive simple restorative treatment from a therapist, with acceptability predicted by being male [OR 1.44 (95% CI 1.09-1.90)], being younger [OR 1.024 (1.016-1.032)] and having a perceived need for treatment [OR 1.49 (1.09-2.5)]. Fewer were willing to allow a therapist to restore a child's tooth (54.7%, p <0.001, McNemar's test) with acceptability predicted by being younger [OR 1.026 (1.018-1.034)]. Those receiving some private treatment were less likely to report acceptability of simple restorative treatment for themselves [OR 0.61 (0.46-0.81)] or for children [OR 0.54 (0.41-0.72)]. 48.2% of participants expected to pay less for treatment provided by therapists, with acceptability of equal costs predicted by the participant being male [OR 1.81 (1.50-2.40)]. CONCLUSION: These findings identify a need for education and reassurance of the public on the training and permitted duties of dental therapists and the rationale for skill-mix in dentistry.

Extirpation of the primary canine tooth follicles: a form of infant oral mutilation.

BACKGROUND: Ebinyo is a form of infant oral mutilation (IOM), widely practiced in rural areas of eastern Africa, in which traditional healers and other village elders extirpate the primary canine tooth follicles of infants by using crude, often unsterilized, instruments or utensils. Traditional folklore suggests that the underlying tooth follicles, thought to resemble worms, are the cause of high temperature, vomiting, loss of appetite and diarrhea in infants. In addition to the serious and potentially fatal immediate postsurgical complications, many of those who undergo this practice exhibit characteristic long-term adverse dentoalveolar effects. Children in these families also may be at greater risk of undergoing other mutilation rituals because of their cultural background. CASE DESCRIPTION: We report on the clinical and radiographic findings in five siblings who apparently were subjected to IOM as infants before immigrating to the United States. CLINICAL IMPLICATIONS: Although the practice of IOM is believed to be exceedingly rare in developed countries, it is important that dentists and allied dental personnel who treat refugees from areas of the world in which IOM is endemic be aware of the social factors behind this practice as well as be able to recognize its dental and psychological sequelae.

Assessment of early postoperative pain and haemorrhage in young children undergoing dental extractions under general anaesthesia.

BACKGROUND: There have been a lot of guidelines issued about dental extractions under general anaesthesia. There is a considerable body of research about the use of local anaesthetic as an adjunct. Some of this research appears to be contradictory about the use of local anaesthetic in addition to general anaesthesia in very young children. This study attempts to clarify the issue. AIM: To determine whether postoperative pain/distress in the early recovery period was different for those children who did or did not have local infiltration anaesthesia for extractions under general anaesthetic, and whether the incidence of clinically significant postoperative bleeding was different for the two groups. DESIGN: Children aged 2-6 years, admitted for extraction of deciduous posterior teeth under general anaesthetic, were randomized to groups that were or were not given local infiltration anaesthesia during the procedure. The children were premedicated with paracetamol and ibuprofen, and had absorbable haemostatic packs inserted during the operation. Staff blinded to treatment allocation made observations in the recovery period of pain and any interventions for bleeding. RESULTS: There was no difference in postoperative pain, as measured using CHEOPS scale between the two groups, but an increase in post operative bleeding in the group who did not have local anaesthetic administered 5/38 compared to 0/38, P = 0.02. CONCLUSIONS: As use of local anaesthetic reduces bleeding without altering pain or distress in young children undergoing posterior deciduous tooth extraction, we should consider using as an adjunct to general anaesthesia.

Further dental treatment needs of children receiving exodontia under general anaesthesia at a teaching hospital in the UK.

OBJECTIVES: The aim of this study was to investigate the subsequent dental treatment needs of children who had dental extractions under general anaesthesia (GA) in 1997 in the Day Case Unit at Leeds Dental Institute (LDI), Leeds, UK, and the reasons for repeat dental GAs (DGAs). STUDY DESIGN: The authors conducted a retrospective longitudinal analysis. SUBJECTS AND METHODS: Information collected from hospital records for the 6-year period following the first DGA included: reasons for the DGA in 1997 and teeth extracted; the number of subsequent DGAs, reasons and treatment; incidents of and reasons for toothache or swelling after 1997; treatment under local anaesthesia (LA) or inhalation sedation (IS) at LDI during the 6 years following the DGA in 1997. RESULTS: The study population consisted of 484 children, who received GA exodontia at LDI with a mean age of 6.35 years [95% confidence interval (CI) = 6.1, 6.6] and age range of 1-16 years. The most common reason for extractions at the original DGA in 1997 was dental caries, and the mean number of extractions was 4.24 (95% CI = 4.05, 4.43). Primary teeth extractions accounted for 82% of the cases. In total, 143 children (27.5%) had a record of follow-up treatment at LDI. Of these children, 32% had treatment under LA, 7% under LA and IS, and 15% received preventive care only. The overall repeat rate for DGA was 10.7%, with caries (84%) being the main reason for this. Of the teeth subsequently extracted, 72% were recorded as caries-free or unerupted at the time of the DGA in 1997. CONCLUSIONS: A large proportion of the follow-up visits were to treat newly developed dental disease during the 6 years following the DGA in 1997. A more proactive approach towards preventive care may have resulted in the reduction of the development of new dental disease.

Pattern of dental extraction in children in a Nigerian tertiary hospital.

Changes that occurred in the pattern of tooth extraction in the last 13 years among a population of children in Nigerian were studied. The result of this study was then compared to that of a past study done in the same institution 13 years earlier. Information on age, gender, and indication of tooth extraction was collected prospectively from 379 consecutive patients who visited the outpatient Pediatric Dental Clinic for the first time during the year 2002. Results showed tooth extraction due to caries decreased, while there was an increase in tooth extraction from an apparent increase in orthodontic treatment needs. Acute necrotizing ulcerative gingivitis (ANUG), a significant cause of tooth loss in the last decade, decreased significantly. The pattern of deciduous tooth loss also changed as more anterior teeth were lost for orthodontic reasons in this present study. The pattern of tooth loss in the permanent dentition remains very similar to that of the past study, though more premolars were lost in the present study. There appears to be an increasing need for tooth extractions in orthodontic treatment for this population of children. The focus of planned dental health care provisions, treatment policies, and training emphasis in child dental care may need to shift to addressing orthodontic needs.

Replantation of avulsed primary incisors: a risk benefit assessment.

Parents of preschool children with avulsed primary incisors may request replantation. Although dental textbooks uniformly recommend that primary teeth not be replanted, some case reports advocate the procedure. This review of case reports identifies a number of pathological outcomes of replantation and provides information for clinicians and parents on the risks that may accompany replantation.

Interceptive orthodontics in the real world of community dentistry.

OBJECTIVE: To test the applicability and effectiveness of interceptive orthodontics in a community field trial. DESIGN: Prospective screening for suitable malocclusions, implementation of treatment and analysis of outcomes 12 months later. SETTING: Community dentistry in urban and rural areas of Northern Ireland, 1996-98. SUBJECTS AND METHODS: The initial sample consisted of 2002 children (1014 boys, 988 girls) who were screened in routine community dental inspections. One thousand and sixty (523 aged 9 years, 537 aged 11 years) were domiciled in the urban area of greater Belfast and 942 (479 aged 9 years, 463 aged 11 years) in the rural area of Enniskillen and Omagh, Co. Tyrone. INTERVENTIONS: Interceptive orthodontic treatment. OUTCOME MEASURES: Dental health component of the Index of Orthodontic Treatment Need (IOTN) and specially devised local indices of treatment outcomes. RESULTS: With the use of an interception gauge, orthodontic screening was included in the community dental inspections without difficulty. Thirty-three per cent of children were in need of interceptive treatment. Only 20% of those in need both attended for recall and underwent treatment. Compliance was better in the rural area but the need, with particular reference to extraction of carious first molars, was greater in the urban area. The numbers of children in IOTN grades 4 and 5 fell from 69% at the beginning of the study to 42% at the end. The outcome judged by local indices was 94% in the range of complete success to minimal improvement with only 2% showing deterioration. CONCLUSIONS: One in three children screened in community dental inspections at age 9 and 11 years would benefit from interceptive orthodontics. Parents and children seem reluctant to accept offers of interceptive orthodontics and to having the treatment carried out. Among those complying fully, the interceptive measures are very successful. Not only does community interceptive orthodontics improve the condition being treated but also reduces the need for further treatment.

An investigation into the response of palatally displaced canines to the removal of deciduous canines and an assessment of factors contributing to favourable eruption.

The effect of the removal of deciduous canines on palatally displaced maxillary canines was assessed and factors contributing to a successful outcome were analysed. Thirty-nine consecutive patients of mean age 11.2 years (standard deviation 1.43), with 47 palatally displaced canines were included in the study. The cases were examined clinically and radiographically for a maximum period of 2 years following deciduous canine removal. Twenty-nine (62 per cent) of the 47 ectopic canines achieved a normal eruptive position and nine (19 per cent) showed some improvement in eruptive position. The outcome of the removal of the deciduous canine depended on the position of the permanent canine. Horizontal overlap of the nearest incisor was found to be the most significant factor. If this exceeded half the tooth width, success was unlikely. The presence of crowding was found to affect adversely the favourable eruption of the canine. Discriminant analysis was carried out to try to identify clinical features which could act as prognostic indicators for the outcome of deciduous canine removal.

The influence of extractions caries cause on the development of malocclusion and need for orthodontic treatment.

The influence of premature extraction of deciduous teeth, and extraction of permanent teeth due to caries on the frequency of malocclusions was analysed. The patient group comprised 915 children aged 8-16 from a province of Northern Italy. 204 children had experienced premature loss of deciduous teeth and 442 had had permanent teeth extracted, due to caries. The permanent teeth most frequently extracted were the first molars. It was obvious that extraction caries cause had detrimental effect on the development of occlusion resulting in an increased frequency of malocclusions. The frequency of single malocclusion traits was compared between the groups of children with and without loss of teeth. The malocclusion traits most frequently observed in children who had experienced extraction, were dentitional anomalies due to malaligned teeth. Only minor changes in the occlusal anomalies could be observed. There was, however, a pronounced increase in the need for minor as well as major orthodontic treatment. On the basis of these findings it could be concluded that extraction of teeth due to caries should be avoided if the aim of dental service on a population basis is to ensure a well functioning dentition for the maximum number of people.