Treatment of severely decayed anterior primary teeth with short-post technique (Mushroom Restorations) under general anesthesia.

AIMS: The aim of this study was to evaluation the treatment success of the short post technique (mushroom restoration) using a composite resin in severely decayed primary anterior teeth after 6, 12, and 18 months after treatment. METHODS: Eighteen children aged 3-5 years with severely decayed primary maxillary anterior teeth (60 anterior maxillary primary teeth in total) were included. Patients were treated under general anesthesia (GA). After pulpectomy, a "mushroom shape" was formed in the root canals for the purpose of retention, and the root canals were filled with zinc oxide-eugenol (ZOE), and the teeth were restored with composite resin. The status of treatment was evaluated clinically and radiographically for periapical radiolucency, pathological root resorption, marginal fracture, and loss of restoration for each treated tooth. All findings were recorded. RESULTS: As a result of the evaluation criteria, the success rates at 6, 12 and 18 months were 86%, 80%, and 71%, respectively. None of the teeth showed apical radiolucency or pathological root resorption at the end of the 18th month period. CONCLUSION: The short-post (mushroom restorations) technique is a clinically acceptable alternative method for restoration of severely decayed primary teeth. This study supports the feasibility of treatment with this technique for pediatric patients treated under GA.

Knowledge and practice of, and attitudes toward, pulp therapy in deciduous teeth among pediatric dentists in India.

AIM: The aim of the present study was to assess the knowledge and practice of, and attitudes toward, pulp therapy in deciduous dentition among pediatric dentists. METHODS: A cross-sectional, observational survey was conducted using a closed-ended, multiple-choice questionnaire evaluating the knowledge and practice of, and attitudes toward, pulp therapy in deciduous dentition, which was formulated and sent to 360 pediatric dentists across India. Descriptive statistics were done, followed by χ2 -test to test the association between years of experience and the questionnaire items. RESULTS: A total of 3.5% of pediatric dentists performed their treatment using a rubber dam in all cases; 30% preferred to use local anesthesia prior to indirect pulp therapy (IPT). Traditional indirect pulp capping was preferred to IPT, and only 48% of them believed in not removing it completely. Pulpotomy was preferred over IPT (70%) when there was a probability of pulp exposure following complete caries excavation. Calcium hydroxide, along with iodoform, was the material of choice for the obturation of primary teeth (73.5%). A stainless steel crown was placed after pulp therapy in the primary tooth (86.3%). Most dentists believed requested immediate and 3-month follow up. CONCLUSION: The survey helps in assessing whether our views or approaches are in line with recent trends.

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.

Efficacy of Low-Level Laser Therapy in the Management of Postoperative Pain in Children After Primary Teeth Extraction: A Randomized Clinical Trial.

OBJECTIVE: This study evaluated the effect of low-level laser therapy (LLLT) on postoperative pain in children undergoing primary molar extraction. MATERIALS AND METHODS: This randomized, controlled-crossover, double-blind clinical trial was conducted with 37 children requiring bilateral extraction of primary molars. In one tooth (LLLT group), a GaAlAs diode laser (wavelength, 810 nm; continuous mode, output power 0.3 W; 180 sec, 4 J/cm(2)) was applied intraorally 1 cm from the target tissue immediately following extraction. In the contralateral tooth (control group), the hand piece was applied, but without laser activation. Children and parents rated postoperative pain on the first three evenings following extraction using, respectively, the Wong-Baker FACES(®) Pain Rating Scale (PRS) and the Visual Analogue Scale (VAS). Parents also reported if their children received analgesics. Data were analyzed using χ(2) and Mann-Whitney U tests. RESULTS: Mean VAS scores were higher for the control group than for the LLLT group on the first and second evenings, and PRS scores were higher for the control group than for the laser group on the first evening, but the differences were not statistically significant (p > 0.05). More analgesics were given to children in the control group on the first evening; however, both groups received equal amounts on the next two evenings (p > 0.05). CONCLUSIONS: Within the limitations of this study, LLLT application following primary molar extraction was not found to affect postoperative pain in children.

Parental views on delivering preventive advice to children referred for treatment of dental caries under general anaesthesia: a qualitative investigation.

OBJECTIVES: To: 1, Explore opinions of parents of children undergoing caries treatment under general anaesthesia (GA) regarding delivery of oral health advice; 2, Discover current oral health practices and beliefs; 3, Inform further research and action. METHODS: Qualitative study using semi-structured interviews and thematic data analysis, sampling parents of children aged 3-10 years undergoing GA tooth extraction due to dental caries. RESULTS: Twenty nine parents were interviewed (mean age 38.9 years, range 28-50, sd 6.4). The mean age of their children was seven years (range 3-10, sd 2.1). All children required deciduous tooth extractions (5.1 teeth on average). Those that also required permanent tooth extractions had on average 2.1 permanent teeth extracted. Many parents knew the importance of oral hygiene and sugar limitation, describing it as 'general knowledge' and 'common sense'. However, few understood that fruit juice is potentially cariogenic. Parenting challenges seemed to restrict their ability to control the child's diet and establish oral hygiene. Many reported not previously receiving oral health advice and reported never having fluoride varnish applied. There were requests for more caries prevention information and advice via the internet, schools or video games. CONCLUSION: Parental oral health knowledge, parenting skills, and previous advice received seem to all be issues related to the oral health of those children. Providing advice, especially in respect to fruit juice cariogenicity and the benefits of fluoride application through a child-friendly website, including a video game, as well as the use of school programmes might be an acceptable approach.

The influence of smear layer removal on primary tooth pulpectomy outcome: a 24-month, double-blind, randomized, and controlled clinical trial evaluation.

BACKGROUND: The effect of smear layer (SL) removal on primary tooth pulpectomy outcome has not been well elucidated. AIM: To determine the effect of SL removal on primary tooth pulpectomy outcome. METHODS: This is a double-blind, randomized, and controlled clinical trial. Forty-eight patients were randomly divided into SL removal (G1 = 40 teeth) or smear layer nonremoval (G2 = 42 teeth) groups. Following the chemomechanical preparation with K-files and 2.5% sodium hypochlorite (NaOCl), teeth were irrigated with either 6% citric acid and 0.9% physiologic solution (G1) or only 0.9% physiologic solution (G2). Camphorated paramonochlorophenol was used as intracanal medication. At the second appointment, 1 week after, root canals were filled with zinc oxide-eugenol paste. Clinical and radiographical baseline criteria were stipulated equally for both groups. RESULTS: The success rate (G1 = 91.2%; G2 = 70.0%) was statistically different (P = 0.04) between the groups. In G2, the outcome was affected significantly by pulpal necrosis (P = 0.02), pre-operatory symptoms (P = 0.02), and periapical/inter-radicular radiolucency (P = 0.04). CONCLUSION: The pulpectomy outcome was improved by smear layer removal. The outcome for teeth with pulpal necrosis, pre-operatory symptoms, or periapical/inter-radicular radiolucency was significantly improved by removal of the smear layer.

Effectiveness of two flavored topical anesthetic agents in reducing injection pain in children: a comparative study.

UNLABELLED: Topical anesthesia is widely advocated in pediatric dentistry practice to reduce pain and anxiety produced by administration of local anesthesia. There are different combinations of topical anesthetic agents that are marketed worldwide. However, sparse literature reports exist regarding clinical efficacy of these agents. AIM: To compare the clinical effectiveness of two strawberry flavored topical anesthetics viz. Precaine (8% Lidocaine + 0.8% Dibucaine) and Precaine B (20% Benzocaine) in children before intra oral local anesthetic injections and for extraction of mobile primary teeth. STUDY DESIGN: This triple blind clinical study included sixty children divided equally under three techniques--palatal injections, inferior alveolar nerve block and extraction of mobile primary teeth. Both the products were used alternately using split mouth design in two visits and the child's pain response was assessed using VAS and SEM pain scale. The scores obtained were subjected to statistical analysis. RESULTS: Precaine has shown lower mean scores in all the techniques under both the pain scales, but were statistically insignificant. Gender wise comparison has also shown lower mean scores for Precaine for both males and females, however these were statistically insignificant. On visit wise comparison, Precaine B reported significant lower scores (p < 0.05) in visit 2 compared to visit 1 for inferior alveolar nerve block and extraction of mobile primary teeth under SEM pain scale. CONCLUSION: Precaine (8% Lidocaine + 0.8% Dibucaine) can be used as effectively as Precaine B (20% Benzocaine).

Infant oral mutilation: a New Zealand case series.

Infant oral mutilation is a practice performed by traditional healers in many Eastern African countries. The sequelae of this practice have been recognised and reported on in many developed countries due to the migration of populations, customs and beliefs. This article describes three cases of infant oral mutilation that have been diagnosed in the Dental Department at Hutt Hospital, Lower Hutt.

Comparison of pre-emptive ibuprofen, paracetamol, and placebo administration in reducing post-operative pain in primary tooth extraction.

BACKGROUND: This study investigates preliminary investigations that a pre-emptive analgesia administration may reduce post-extraction pain. AIM: This prospective, placebo-controlled, randomized, double-blind trial was planned to compare the efficacy of the pre-emptive administration of ibuprofen, paracetamol, and placebo in reducing post-extraction pain in children. DESIGN: Forty-five children, ages 6-12, who needed primary mandibular molar tooth extraction were treated in paediatric dental clinics, with treatment preceded by local anaesthesia and analgesic drugs during the preoperative period. A five-face scale was used to evaluate pain reaction during the injection, extraction, and post-operative period. Self-report scores were recorded when the local anaesthesia had been administered in soft tissues and both before and after the extraction was completed. The Kruskal-Wallis and Mann-Whitney U tests (with Bonferroni correction paired t-test as the post hoc test) were used at a confidence level of 95%. RESULTS: The use of pre-emptive analgesics showed lower scores compared to the placebo, irrespective of the age, weight, gender of the child, and the number of teeth extracted during the study period. Additionally, ibuprofen exhibited lower pain scores (P < 0.05) compared to paracetamol at the 15-min (P < 0.001) and 4-h (P < 0.009) periods. CONCLUSIONS: Preoperative use of ibuprofen and paracetamol may provide a pre-emptive analgesic effect in paediatric patients who receive adequate analgesia during mandibular primary tooth extraction.

Clinical evaluation of 3Mix and Vitapex as treatment options for pulpally involved primary molars.

OBJECTIVE: The aim of this study was to compare the clinical and radiographic success of 3Mix and Vitapex((R)) for root canal treatment of pulpally involved primary molars. METHODS: Fifty teeth from 37 healthy children aged 3-8 years with pulpally involved primary molars needing root canal procedures were treated with 3Mix or Vitapex((R)) before restoration with stainless steel crowns. The research employed a prospective single-blinded randomized design. The subjects were followed up clinically and radiographically at 6 and 12 months, respectively. The outcome was compared using a Z-test with a significance level of 0.05. RESULTS: Both groups showed 100% and 96% clinical success at 6 and 12 months, respectively. At 6 months, radiographic success of 3Mix and Vitapex((R)) was 84% and 80%, respectively, and at 12 months, radiographic success of 3Mix and Vitapex((R)) was 76% and 56%, respectively. Considering the radiographic findings at the end of 6 and 12 months, no statistically significant differences were found between the two groups (P = 0.356 and 0.068, respectively). CONCLUSION: 3Mix and Vitapex((R)) can be used as a root canal treatment agent in pulpally involved primary teeth.

Microleakage of glass ionomer restoration in cavities prepared by Er,Cr:YSGG laser irradiation in primary teeth.

PURPOSE: The purpose of this study was to evaluate microleakage of cavity preparation in primary teeth made with an Er, Cr:YSGG laser (L) or high-speed drill (HD) and conventional (CGIC) and resin-modified glass ionomer cement (RMGIC). METHODS: One hundred primary teeth were divided into 10 groups (N=10): (a) groups 1 and 2 represented cavities prepared by a no. 1012 diamond bur with HD; (b) groups 3 through 10 represented cavities prepared with an Er, Cr:YSGG laser (with a repetition rate of 20 Hz power settings varying for enamel=2.5 W and 3 W and dentine=1.0 W and 1.5 W). After cavity preparation, samples were restored with CGIC (Ketac Molar Easy Mix) and RMGIC (Vitremer), impermeabilized, thermal cycled, stained, washed, and sectioned. The degree of dye penetration was scored by 3 standardized examiners using a light stereoscope at X30 magnification. RESULTS: The Kruskal-Wallis test detected no statistical differences between the cavity preparation methods (P<.049). Neither of the GICs tested were able to avoid microleakage, and the RMGIC showed the lowest statistical degree of microleakage compared with CGIC for both types of cavity preparation. CONCLUSIONS: The Er,Cr:YSGG laser provided an equivalent method of cavity preparation compared to the high-speed drill. The resin-modified glass ionomer cement showed the lowest degree of microleakage. This restorative material should be considered when choosing the cavity preparation method.

Deciduous tooth extraction & folkloric beliefs in the Samsun region.

This study was designed to investigate the methods of deciduous tooth extraction applied to children, and the effects of parents' educational status and place of residence on the way deciduous teeth are regarded in folklore in Samsun city and neighboring villages. Using questionnaires, this study tried to determine the type of superstitions held by parents living in the city and neighboring village. The questionnaire inquired about methods used to extract their deciduous teeth, what parents had done with them, and their preferred extraction methods. A significant relationship was established between the age at which the parent first visited the dentist and the method used to extract their child's deciduous teeth. Folk beliefs are not related to place, namely urban or rural living, but are concepts handed down through tradition; the educational status of parent is likewise irrelevant to the holding of folk beliefs among parents in this sample.

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.

Efficacy of intraosseous injections of anesthetic in children and adolescents.

OBJECTIVE: The goal of this study was to determine the efficacy of the intraosseous (IO) injections of anesthetic as a primary technique in children and adolescents. STUDY DESIGN: A cohort of 181 children and adolescents underwent a total of 225 sessions of IO injections of 4% articaine with 1:200,000 epinephrine using the Quick Sleeper 2 system. RESULTS: Evaluations could be performed in 215 sessions (171 patients, 247 teeth), yielding success rates of 91.2% (sessions) and 91.9% (teeth). The success rate was 95% (133 of 140) for temporary teeth (endodontics 96.6%, restorations 100%, extractions 88%) and 87.9% (94 of 107) for permanent teeth (endodontics 92.3%, restorations 89.9%, extractions 75%). No difference was noted in terms of age (P > .05). No cases of biting of mucosa or postinjection pain were noted. CONCLUSIONS: The IO injection of anesthetic using a computer-controlled osseous perforation and delivery system can be considered as a good alternative or supplement to classic infiltration techniques in children and adolescents.

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.

A comparison of oral midazolam and nitrous oxide sedation for dental extractions in children.

The aim of the study was to compare oral midazolam and inhaled nitrous oxide as sedative agents during the management of children aged 5-10 years presenting for extraction of primary teeth under local anaesthetic. Subjects required two visits for the extraction of four primary teeth, one in each quadrant of the mouth, and were randomly allocated to be given nitrous oxide 30% in oxygen or oral midazolam 0.3 mg.kg(-1) at the first visit, the other technique being used at the second visit. Vital signs, sedation levels and behavioural scores were recorded, and postoperative recall and satisfaction were reported by the patients. Thirty-five children, with a mean [range] age of 7.4 [5-10] years, completed the treatment. The mean dose of oral midazolam given was 8.6 [3.3-16.5] mg. The mean times taken to achieve the maximum level of sedation for midazolam and nitrous oxide sedation were 15.9 [2-30] min and 6.8 [2-10] min, respectively. Physiological parameters remained within acceptable clinical limits for both types of sedation. Oral midazolam was considered acceptable by 59% and was preferred by 36%. Oral midazolam sedation in 5 to 10-year-old children was shown to be as safe and effective as nitrous oxide in oxygen sedation for extraction of primary teeth but would not be the method of choice for all patients.