Effectiveness of the "pain-free dental injection" (PaFein) teaching model in reducing children's pain: A randomized, controlled study.

PURPOSE: This study explores the effectiveness of a comprehensive structured teaching model - the "PaFein" - for instructing postgraduate pediatric dental residents in the provision of pain-free local anesthesia to children. METHODS: Ten postgraduate pediatric dental residents and 172 children between the ages 5 and 13 participated in the study following ethical approval. The previously measured baselines guided the randomization of study and control groups. The study group (five residents) attended the PaFein course (9 hours). Based on power calculations, residents performed dental injections (8 mandibular block, 8 palatal/lingual and 14 buccal infiltrations) in randomly assigned child patients. Demographic data of residents/children, parental and self-report anxiety scores and Visual Analogue Scale (VAS) pain scores were noted to examine children's anxiety and pain during dental injections. RESULTS: Children's mean anxiety score did not differ significantly between groups; however, VAS pain reports during dental injections (a, b, c, d) were found lower in the PaFein study group than the control group (p < 0.05). VAS pain reports for (a) buccal injections were 1.08 and 1.9 (p = 0.02); (b) inferior alveolar nerve blocks were 1.58 and 3.37 (p = 0.0002); (c) palatal/lingual injections were 1.34 and 3.02 (p < 0.0001); (d) total means were 1.28 and 2.59, respectively (p = 0.0001). VAS pain reports of anxious and non-anxious children in the PaFein study group (1.63 and 1.17) were also lower than the control group (3.33 and 2.39) (p < 0.0001 and p = 0.005). CONCLUSION: The "PaFein" teaching model was found to be effective in training dental residents to reduce dental injection pain in children, including the anxious ones.

Effect of self-efficacy and empathy characteristics of post-graduate residents on local anesthesia administration performances: Pilot study.

PURPOSE: The "Profile and Competences for the European Dentist" document addresses some competencies as a must for graduating dentists, some of which are stated as providing humane and compassionate care to all patients and administering local anesthesia for pain management. Within this perspective, this study aims to investigate the effect of self-efficacy and empathy characteristics of post-graduate residents (post-grads) on the perceived pain and anxiety scores of children during local anesthesia administrations. MATERIALS AND METHODS: Ten pediatric dentistry post-grads and 91 children aged between 5 and13 years participated in the study. Post-grads performed 120 injections as part of their routine dental treatment in children. Demographic data, self-efficacy, and empathy scale scores of post-grads, anxiety, and pain scores of children were recorded during injections. RESULTS: Self-efficacy scale scores of residents ranged between 66 and 74 with a mean score of 69.80 ± 2.69. Empathy scale scores were between 77 and 97 and the mean was 89.20 ± 6.24. Significant and negative correlations were observed between self-efficacy scores of post-grads and pain scores of children (r = -0.205 and p = 0.025). Empathy scores of post-grads established a significant and positive correlation with children's anxiety scores (r = 0.244 and p < 0.007). CONCLUSIONS: Self-efficacy and empathy characteristics of post-grads were found to have an impact on the perceived pain and anxiety scores of children during local anesthesia administrations. Empathetic post-grads with higher self-efficacy provided an enhanced local anesthesia experience for child patients. Therefore, educational programs should also be organized aiming to develop self-efficacy and empathy characteristics of post-grads for a more humane and compassionate dental experience in child patients.

Antibacterial and photodynamic effects of some plant extracts for cavity disinfection.

BACKGROUND: In current dental treatments, with the aim of a preventive approach,it is argued that removing only the infected layer of dentin is sufficient for cavity preparation. However it is impossible to be sure that the infected layer was completely removed. In addition, the cause of secondary caries and post operative sensitivities has been reported as residual bacteria in some studies. The aim of this study is to investigate the antibacterial and photo-active properties of Cotinus coggygria Scop., Rumex cristatus DC., Beta vulgaris L.var.cicla and Eruca sativa aqueous extracts, and to investigate their usefulness for cavity disinfection in dentistry. METHOD: The aqueous solutions of plant extracts were prepared to be at a maximum concentration and the Streptococcus mutans solutions mixed with phosphate buffered saline to give 108 cfu/mL. A 430-480 nm wavelength light source was used for the irradiation. Three different applications were made: extract + Streptococcus mutans mixture exposed to ligh; extract + Streptococcus mutans mixture that was not exposed to light and S. mutans exposed to light. RESULTS: No antibacterial effect was found for the second and third applications. In the first application, however, irradiation with extract + Streptococcus mutans mixture reduced the number of microorganisms in the beginning by 99% for only Rumex cristatus DC. extract (log 2). CONCLUSION: Rumex cristatus DC. extract can be used as an alternative in photo-active disinfection of cavities in dentistry.

Salivary parameters and caries indices in children with black tooth stains.

OBJECTIVE: Black tooth stain in children has been associated commonly with a low caries experience. The present study aimed to to compare salivary factors and caries indices in children with and without black tooth stain and to investigate the relationship between caries and caries associated salivary factors in these children. STUDY DESIGN: Salivary flow rate, pH, buffering capacity, total calcium and phosphorus were determined. Calcium and phosphorus levels were assayed by Inductive Coupled Plasma with Atomic Emission Spectrometry. DMFT and dft indices were evaluated according to WHO criteria. RESULTS: Significantly higher levels of salivary buffering capacity and calcium, and lower flow rate were found in children with black tooth stain compared with those of without black tooth stain (p < 0.01, p = 0.044 and p = 0.037, respectively). The differences in phosphorus and pH were not significant between the groups. The dft index was found to be significantly lower in children with black tooth stain than children without black tooth stain (p = 0.030). However, DMFT did not change between the groups. There is no relationship between salivary parameters and caries indices in children with black tooth stain. CONCLUSION: It is suggested that low caries tendency seen in children with black tooth stain may be associated with high salivary calcium and buffering capacity.

Fluoride levels in various black tea, herbal and fruit infusions consumed in Turkey.

The fluoride contents were determined by ion-selective electrode in 26 black tea samples originally produced in Turkey, Sri Lanka, India and Kenya, and in 14 herbal and seven fruit infusions originated from Turkey. Fluoride content in black tea infusions ranged from 0.57 to 3.72 mg/L after 5 min of brewing. Higher fluoride levels were found in black teas originated from Turkey when compared with teas originated from Sri Lanka. Moreover higher fluoride levels were determined in black tea bags compared with granular and stick-shaped black teas. However, herbal and fruit infusions were characterized by low values of fluoride (0.02-0.04 mg/L) after 5 min of brewing and increasing brewing time to 10 min caused only slight increases in some infusions. As a result, consuming tea infusions prepared from some black tea available in Turkish market, especially black tea bags, in large quantities may lead to exposion to a high amount of fluoride which may cause dental fluorosis. Although fruit and herbal infusions are safer to consume their fluoride contents are too low for caries prevention. In countries such as Turkey where tea is traditionally consumed, the fluoride concentration and daily safety precautions should be indicated on tea products.

Is it the injection device or the anxiety experienced that causes pain during dental local anaesthesia?

AIM: The aim of this study was to investigate the influence of anxiety and type of dental injection, a plastic syringe or an electronic computerized device, on the pain perceived by children. DESIGN: Two dental injectors, a computerized device (Wand, Milestone Scientific, Livingston, NJ, USA) and a traditional plastic syringe, were compared. Forty-one children, aged 9-13 years, who had registered for treatment in Marmara University, Istanbul, Turkey, were included in the study. Both anxious and non-anxious children were included in the study group. The Children's Fear Survey Schedule-Dental Subscale, Facial Image Scale, Spielberger's State Anxiety Index for Children, and heart rates were used to determine the anxiety levels. Participants were assigned to interventions by using random allocation. The first appointment was designed as an introductive familiarization session and injections were administered in the second and third sessions, with one or the other injector. The visual analogue scale was used for pain measurement after injections. RESULTS: No significant differences in injection pain scores were observed between the Wand and traditional plastic injector. Higher levels of pre-injection anxiety were found to be related to more severe pain reports by the children. CONCLUSIONS: Anxiety plays an important role in the pain reaction of children, and was found to be more determinative in pain perception than the injection devices preferred.

Children's preferences concerning the physical appearance of dental injectors.

PURPOSE: This pilot study was carried out to assess how the physical appearance of dental injectors influenced children's choice. METHODS: The study group consisted of 34 randomly selected children (17 boys, 17 girls) between the ages of 7 and 11 (mean age=8.6 +/- 1.4), who had been registered for treatment at the School of Dentistry, Marmara University. A combination of tests-the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), Venham Picture Test (VPT), and facial image scale (FIS)-were used to assess the multi-dimensional character of children's dental anxiety. Dental injectors (Wand, Citoject, traditional metal injector [MI], and plastic injector [PI]) were displayed on a tray and introduced to the children. The children were asked to consider which injectors they would choose "if their tooth had to be put to sleep," and their preferences were noted starting with their first choice. RESULTS: The children's first choice was: (1) the Wand (56%); (2) PI (29%); (3) Citoject (12%); and (4) MI (3%). The anxious children (n= 13) preferred the Wand with significantly higher ratings (Wand=84%; Citoject=8%; MI=8%; PI=0%). CONCLUSION: The physical appearance of dental injectors is important to children and even more important for children who are anxious.