Prevalence of early childhood caries and enamel defects in four and five-year old Qatari preschool children.

BACKGROUND: Dental caries is the most prevalent chronic disease in early childhood in most communities worldwide. Several studies conducted in the Gulf Cooperation Council countries have documented a high prevalence of early childhood caries (ECC). To date, no studies have been conducted in Qatar to examine the prevalence of ECC and enamel developmental defects in preschool children. The present study aimed to determine the prevalence of ECC and enamel defects in preschool children aged four and five years attending kindergartens in Qatar. METHODS: A descriptive cross-sectional study was performed among 250 children randomly selected from 16 public kindergartens. Caries experience was measured using the World Health Organization caries criteria (dmft) for tooth rather than surface; enamel defects were scored by the modified developmental defects of enamel index. Descriptive statistics and Chi-Square test of relatedness were used. RESULTS: A response rate of 63 % was reported. The overall caries prevalence of the study sample was 89.2 %; 15.6 % of the examined children had ECC and 73.6 % had severe ECC. Developmental enamel defects were present in 39 % of children and 27 % had demarcated enamel opacities. CONCLUSION: The high rate of dental caries and enamel defects recorded in this study for this young age group has strongly emphasized the necessity of community-based preventive programs and professional care that should begin during pregnancy and in early childhood.

An evidence-based assessment of the clinical guidelines for replanted avulsed teeth. Part I: Timing of pulp extirpation.

BACKGROUND: Clinical guidelines for the management of avulsed teeth recommend pulp extirpation (PE) within 10 to 14 days of replantation. The principles of evidence-based dentistry can be used to assess whether this is the best approach based on currently-available evidence. The objective of this study was to use the principles of evidence-based dentistry to answer the PICO Question: (P) For a replanted avulsed permanent tooth, (I) is early PE within 10 to 14 days of replantation, (C) compared with delayed pulp extirpation, (O) associated with an increased likelihood of successful periodontal healing after tooth replantation? MATERIALS AND METHODS: A literature search was performed across four internet databases for relevant citations (n = 38,400). Limiting citations to those in English and removing duplicates produced a set of titles (n = 14,729) which were sieved. Relevant titles were selected for abstract assessment (n = 628), and then papers were selected for examination (n = 84). Inclusion criteria were applied and six papers (total 236 teeth) met the final criteria for meta-analysis. RESULTS: Meta-analyses found a statistically significant association between PE performed after 14 days and the development of inflammatory resorption [common odds ratio (COR) = 0.37, standard error (se) = 0.50, 95% confidence interval (CI): 0.14-0.98]. Pulp extirpation within 10 days of replantation was not significantly associated with a decreased likelihood of developing inflammatory resorption. There were no statistically significant differences in PE times for functional healing, acceptable healing without progressive resorption, or the development of replacement resorption. CONCLUSION: There is clinical evidence for an association between PE performed after 14 days following replantation and the development of inflammatory resorption. This investigation supports the current clinical guidelines for PE within 10 to 14 days of replantation.

Splinting duration and periodontal outcomes for replanted avulsed teeth: a systematic review.

Clinical guidelines are now available for the management of avulsed teeth. The principles of evidence-based dentistry can be used to assess whether these guidelines are based on currently-available evidence. A qualitative systematic review was conducted of relevant clinical literature to examine the evidence on splinting duration and periodontal healing outcomes. The review was constrained markedly by small sample sizes, retrospective nature of clinical audits, dissimilarities of selected studies in their design, methodology and observation periods, and lack of uniformity in terminology for outcomes. A total of 138 replanted avulsed permanent teeth pooled from four papers each reporting both short-term splinting (14 days or less) and long-term splinting (over 14 days) in accord with current clinical guidelines, were studied. The evidence for an association between short-term splinting and an increased likelihood of functional periodontal healing, acceptable healing, or decreased development of replacement resorption, appears inconclusive. The study found no evidence to contraindicate the current guidelines and suggests that the likelihood of successful periodontal healing after replantation is unaffected by splinting duration. Pending future research to the contrary, it is recommended that dentists continue to use the currently-recommended splinting periods when replanting avulsed permanent teeth.

An evidence-based assessment of the clinical guidelines for replanted avulsed teeth. Part II: prescription of systemic antibiotics.

BACKGROUND: Current clinical guidelines recommend prescribing systemic antibiotic therapy (SAT) for patients having an avulsed permanent tooth replanted. The principles of evidence-based dentistry can be used to assess whether this is the best approach based on currently-available evidence. The objective of this study was to use the principles of evidence-based dentistry to answer the PICO question: (P) for a replanted avulsed permanent tooth, (I) is prescribing SAT, (C) compared with not prescribing SAT, (O) associated with an increased likelihood of successful periodontal healing after tooth replantation? MATERIALS AND METHODS: A literature search was performed across four internet databases (Ovid Medline, Cochrane Library, PubMed, ISI Web of Science), for relevant citations (n = 35 702). Limiting citations to those in English and removing duplicates produced a set of titles (n = 14 742) that were sieved according to evidence-based dentistry principles. Relevant titles were selected for abstract assessment (n = 782), identifying papers for examination (n = 74). Inclusion criteria were applied and three papers (326 total teeth) met the final criteria for meta-analysis. RESULTS: Meta-analyses found no statistically significant difference between prescribing or not prescribing antibiotics for acceptable periodontal healing without progressive root resorption (common odds ratio = 0.90, SE = 0.29, 95% confidence intervals = 0.51-1.58). CONCLUSION: The evidence for an association between prescribing SAT and an increased likelihood of acceptable periodontal healing outcome is inconclusive. This investigation of antibiotic use as defined in the clinical guidelines indicates there is inconclusive clinical evidence from studies of replanted avulsed human teeth to either contradict or support the guideline. Pending future research to the contrary, dentists are recommended to follow current guidelines in prescribing SAT when replanting avulsed teeth.

Evidence-based assessment of tooth-colored restorations in proximal lesions of primary molars.

UNLABELLED: The purpose of this study was, using evidence-based dentistry, to compare the successes of glass ionomer cement (GIC), resin-modified GIC (RmGIC), composite resin (CR), and polyacid-modified composite resin (PAMCR) in primary molar proximal lesions. METHODS: The PICOT question was: P: in primary molar proximal lesions; I: does the use of 1 material (GIC, RmGIC, CR, or PAMCR); C: compared with the remaining materials; O (Outcome): result in higher success rates; T: when followed for at least 1 year? Relevant articles (256) were identified from databases then sieved by titles, abstracts, and full texts. Following exclusions, 36 dinical trials-including 25 randomized clinical trials (RCTs)-remained. Extracted data were meta-analyzed. RESULTS: GIC restorations had a significantly (P<.05) lower likelihood of success than RmGIC and CR restorations. Overall success rates were: (1) GIC (691 restorations)=75%; (2) RmGIC (276)=89%; (3) CR (620)=83%; (4) PAMCR (596)=87%. Mean success rates did not differ significantly (P>.05): (1) GIC (6 studies)=65+/-34%; (2) RmGIC (3 studies)=93+/-7%; (3) CR (7 studies)=85+/-12%; and (4) PAMCR (8 studies)=90+/-10%. CONCLUSIONS: Few articles were available to determine the best material. Recognizing material improvements since 1990, earlier data may be noncomparable. RmGIC had the highest success rates, but fewest studies and fewest restorations; only one product was assessable. Prospective RCTs should be of at least 5 years' duration to determine correctly the success rate of Class II restorations in primary molars.

Genetic and environmental influences on dentofacial structures and oral health: studies of Australian twins and their families.

Our studies of the teeth and faces of Australian twins commenced at the School of Dentistry, The University of Adelaide in the early 1980s. There are now over 900 pairs of twins enrolled in our continuing investigations, together with 1200 relatives. There are 3 main cohorts of participants. The first cohort comprises around 300 pairs of teenage twins for whom various records have been collected, including dental casts, facial photographs, finger and palm prints and information on laterality, including handedness. The second cohort comprises around 300 pairs of twins who have been examined at 3 stages of dental development from approximately 4 years of age to about 14 years: at primary, mixed, and permanent dentition (excluding 3rd molars) stages. The most recent study of tooth emergence and oral health, for which we are currently recruiting twins, will provide a third cohort of around 500 twin pairs aged from around birth to 3 to 4 years of age. Our broad aim in these studies has been to improve our understanding of how genetic and environmental factors contribute to variation in dental and facial features, and to oral health. We have also used our data to investigate aspects of the determination of laterality, particularly the fascinating phenomenon of mirror imaging. We plan to maximize the use of the longitudinal data and DNA we have collected, and continue to collect, by performing genome-wide scans for putative genetic linkage peaks for a range of dental features, and then to test for association between a series of likely candidate genes and our phenotypes.

Early childhood caries: an update.

Early childhood caries is the currently accepted term used to describe dental caries occurring in infants and toddlers. It is a multifactorial, transmissible and infectious disease that has recently been under scrutiny in the literature. The microflora, substrate, saliva and host are key factors involved in the pathogenesis, together with the immature host defence system and developing bacterial flora. Immature enamel surfaces and developmental defects of enamel should also be considered in the aetiology. This paper addresses the controversies of the cariogenicity of bovine milk, human breast milk and infant formulas. Clinical management should be planned according to age, extent of lesions, compliance of primary caregivers and where treatment is rendered (private or public sector). Cases of early childhood caries need comprehensive restorative management and preventive treatment together with the help of other health care professionals.

Evidence-based assessment: evaluation of the formocresol versus ferric sulfate primary molar pulpotomy.

PURPOSE: Formocresol and ferric sulfate were evaluated as pulpotomy medicaments using evidence-based dentistry principles. Formocresol has been challenged as a potential carcinogen and mutagen, leading to consideration of ferric sulfate. METHODS: The PICOT statement was: (P) In human carious primary molars with reversible coronal pulpitis, (I) does a pulpotomy performed with ferric sulfate, (C) compared with formocresol, (O) result in dinical/radiographic success, (T) in time periods up to exfoliation? Relevant papers (N=894) were identified from databases and inclusion criteria were applied; 94 papers remained (randomized clinical trials [RCTs]=7; clinical trials [CTs]=28; case-control studies=14; opinions, cohort, and cross-sectional studies=4; reviews=22; irretrievable papers=19). Three RCTs and 10 CTs (total teeth: formocresol=753; ferric sulfate=90) were meta-analyzed; 1 RCT and 1 CT were tested for homogeneity (odds ratios; 95% confidence intervals); 3 RCTs and 10 CTs were examined by student's t test. RESULTS: Clinical data indicated ferric sulfate was significantly more successful than formocresol (OR=1.95; CI=1.01-3.80). Radiographic data indicated no difference between medicaments (OR=0.90; CI=0.58-1.39). Medicaments did not differ with t-tests of clinical (P>.10) and radiographic (P>.50) data. CONCLUSIONS: This evidence-based assessment concluded that, in human carious primary molars with reversible coronal pulpitis, pulpotomies performed with either formocresol or ferric sulfate are likely to have similar clinical/radiographic success.

Effectiveness of interventions to promote continuing professional development for dentists.

BACKGROUND: Continuing education is incumbent upon dentists as health professionals, but its promotion may be required, particularly in order to ensure regular professional updating. Continuing professional development may be delivered in a variety of ways, and new strategies and techniques must be evaluated for effectiveness. AIM: To evaluate the effectiveness of two interventions utilizing the philosophies and techniques of the discipline of Quality Improvement. METHOD: A self-assessment instrument (a manual) for quality dental practice was developed using the Delphi technique. A randomized, controlled trial of the interventions was conducted under field conditions for dental practice in Victoria, Australia. Dentists in Test Groups 1 and 2 completed the self-assessment manual, and received relevant references and their own scores for the manual in comparison with empirical standards. Dentists in Test Group 1 also attended a continuing education course on Quality Improvement. Dentists in Control Group 1 completed the manual only and received feedback of their scores. Dentists in Test Groups 1 and 2, and in Control Group 1 completed the manual again after 1 year as a post-intervention follow-up. Dentists in Control Group 2 completed the manual only at 1 year. RESULTS: The intervention involving self-assessment, receipt of scores and references for the manual resulted in modest improvements in total scores for dentists after 1 year, although a response bias was apparent. CONCLUSION: An effective method of facilitating change in quality dental practice was identified. Assessment of strategies and techniques for professional development of dentists should include observation of patterns of participation.

Use of mouthguards by basketball players in Victoria, Australia.

Basketball is a popular sport in Australia. Although orofacial injuries are common, mouthguard (MG) wear in basketball appears to be low. The purposes of this study were: to measure mouthguard wear by basketball players before and after a promotional intervention; to assess players' knowledge of the value of mouthguards for prevention of injury; and to describe their experience of orofacial injury. Two questionnaires (baseline and follow-up) were administered to a convenience sample of 496 basketball players in Victoria, Australia. Players recruited were youths (12-15-year olds, n = 208) and adults (18 years and over, n = 288), from all basketball levels (social to elite). Completion of the baseline questionnaire was followed immediately by an intervention comprising written and verbal information, a mouthguard blank and instructions on mouthguard construction. The follow-up questionnaire was mailed to all respondents 10-12 weeks later; 135 youths (65%) and 157 adults (54%) completed this. Mouthguard wear at baseline was low but was more frequent at games (62%) than at training (25%). Despite 90% of players acknowledging the protective value of a mouthguard, wear by youths did not increase following the intervention, and wear by adults increased by only 14% for training and 10% at games. Previous orofacial injury was recorded at baseline by 23% of players, but few had requested compensation from Basketball Australia (youths, 17%; adults, 30%). Two predictor variables were statistically identified as related to mouthguard wear: previous orofacial injury and age group. Mouthguard wear was significantly more frequent amongst players with previous injury; such players were 2.76 times more likely to be wearers than those without previous injury. Youths were 2.31 times more likely to wear mouthguards than adults. Only 34 players (12% of respondents at follow-up) had a mouthguard constructed from the blank provided. Although youth and adult groups differed, the overall extent of mouthguard use was disappointingly low. Despite wide recognition of mouthguard value, the intervention had little effect on promoting their use.