Sealant versus Fluoride in Primary Molars of Kindergarten Children Regularly Receiving Fluoride Varnish: One-Year Randomized Clinical Trial Follow-Up.

OBJECTIVES: The objectives of this study were to measure the caries preventive effect of sealants applied to occlusal surfaces of primary molars compared to fluoride varnish applications, and to assess the retention rate of sealants after 1 year. METHODS: 147 first-grade pupils from two kindergarten schools in Kuwait, whose parents gave their written consent, were included. The children were examined by one dentist using the International Caries Detection and Assessment System. After the examination, sealants and fluoride varnish were applied on the selected occlusal surfaces of primary molars by another dentist. The jaw quadrant for intervention was selected randomly; molars on the contralateral side of the mouth received the contralateral intervention. Examinations and intervention were provided on the school premises in the mobile dental unit with a portable spotlight. Moisture was controlled by cotton rolls, suction and air drying. The follow-up examinations were conducted after 1 year. All children received fluoride varnish before and 6 months after the intervention. RESULTS: From 267 matched pairs of occlusal surfaces of primary molars, varnished surfaces were significantly more likely to develop new caries lesions than the sealed ones (odds ratio = 2.92; 95% confidence interval = 1.82-4.71) during the 1-year follow-up. The majority (73.0%) of the sealants were completely retained and 15.1% partially. CONCLUSIONS: Sealing fissures seems to be better in preventing occlusal caries lesions in primary molars than applying only fluoride varnish. After 1 year, the majority of sealants were retained sound.

Oral health-related quality of life among parents and teachers of disabled schoolchildren in Kuwait.

OBJECTIVE: The objective of this study was to assess the oral health-related quality of life between the parents and the teachers of disabled schoolchildren in Kuwait. SUBJECTS AND METHODS: The three category response version of the General Oral Health Assessment Index (GOHAI) (12 questions, always, sometimes, never) was used in the questionnaires in Kuwait. Three hundred and eight (308) parents and 112 teachers were enrolled in this study. RESULTS: The mean age of the parents was 45 ± 9.9 years and of the teachers 38 ± 8.4 years. The mean GOHAI was 27.2 ± 3.5 among the parents and 27.8 ± 3.3 among the teachers (p = 0.091). GOHAI was higher in the older age groups (p = 0.002) and among the parents with a university education (p < 0.001). GOHAI was also higher with increasing toothbrushing frequency among the parents (p = 0.047) and the teachers (p = 0.003). Altogether, 203 (66%) of the parents and 85 (76%) of the teachers were always able to swallow comfortably; 123 (40%) of the parents and 41 (37%) of the teachers were able to eat without discomfort. Overall, 132 (43%) of the parents and 41 (37%) of the teachers were always pleased and happy with the looks of their teeth and gums, or dentures. The Cronbach's alpha (0.83) indicated a high degree of internal consistency between different GOHAI items. CONCLUSION: There seemed to be no difference in the impact of oral health on the quality of life between the parents and the teachers of disabled schoolchildren. Oral health had a relatively weak impact on the quality of life of these adults.

Parental attitude toward behavioral management techniques in dental practice with schoolchildren in Kuwait.

OBJECTIVE: The objective of this study was to evaluate the parental attitude toward different management techniques used during dental treatment of schoolchildren in Kuwait. SUBJECTS AND METHODS: One hundred and eighteen parents who accompanied their children to the clinics of Hawally School Oral Health Program in Kuwait participated in this study. The parents viewed a videotape which showed scenes of different behavioral management techniques (BMTs) and then completed a questionnaire. RESULTS: Positive reinforcement, effective communication, tell-show-do, distraction, modeling and nonverbal communication were considered as the most approved techniques. Hypnosis and parental separation were moderately approved techniques. Voice control, nitrous oxide sedation, protective stabilization (physical restraint), general anesthesia, hand-over-mouth technique and conscious sedation were the least approved techniques. A majority (99%) of parents regarded the use of various BMTs as a key factor for successful dental care for their children. Acceptance of each BMT was not related to parental age, gender, nationality, educational level or occupation. CONCLUSION: Most parents preferred the nonpharmacological techniques to pharmacological techniques. Techniques employing drugs and restraint were considered as least acceptable. Further studies comparing the effectiveness of various BMTs are required.

Dental caries experience of Kuwaiti schoolchildren.

OBJECTIVE: This study was designed to measure the dental caries experience of Kuwaiti schoolchildren. METHODS: A national epidemiologic survey of the 5-14 year old children (n = 4,588) was conducted in the 5 governorates of Kuwait in 2001. Eight trained and calibrated dentists examined the children. Dental caries was scored using WHO criteria. RESULTS: In the primary dentition, the percentage of 5- and 6-year-old children with dft = 0 was 12.6% and 14.4% respectively. The corresponding mean dft/dfs for 5- and 6-year-olds were 4.6/9.7 and 4.6/9.9. For the permanent dentition, the percentage of 12- and 14-year-old children with DMFT = 0 was 26.4% and 21.7% respectively. The corresponding mean DMFT/DFS figures for 12- and 14-year-olds were 2.6/3.4 and 3.9/4.2. The d/D component was the major contributor to these mean scores. Poor oral hygiene (OR = 2.0; 95% CI = 1.7 - 2.4) and increasing age (OR = 1.4; 95% CI = 1.3 - 1.5) were significantly associated with caries risk in the permanent dentition. CONCLUSIONS: Caries levels are similar to those in neighbouring and other Middle East countries. There is a clear need for expanding the national school oral health programme to reach those children who are not yet receiving systematic preventive and curative services. Further studies are required to monitor the effect of the extensive caries preventive programme now in place in Kuwait.

Effect of xylitol candies on plaque and gingival indices in physically disabled school pupils.

OBJECTIVE: To evaluate the effectiveness of xylitol candies on plaque and gingival index scores on physically disabled school pupils in Kuwait. METHODOLOGY: Altogether 145 school pupils (105 in the xylitol group and 40 in the control group), with ages ranging from 10 to 27 years (mean age = 14.7 +/- 3.1 years), participated in this 18-month intervention program. The school health nurses distributed xylitol candies to the pupils three times during the school day. Plaque was scored according to the Silness and Löe Plaque Index, and gingivitis according to the Löe and Silness Gingival Index. RESULTS: The mean Plaque Index score decreased from 1.73 to 1.14 (p < 0.001), and the mean Gingival Index score from 1.74 to 1.16 (p < 0.001) in the study group. Significant differences were found between the xylitol and the control groups in the reduction of Plaque (p = 0.037) and Gingival Index scores (p = 0.008). There was high correlation between the individual Plaque and Gingival Index scores at baseline (r = 0.93) and at the final examinations (r = 0.95). CONCLUSION: Consuming xylitol candies three times during school days seemed to reduce both the Plaque and Gingival Index scores. This school-based delivery system offered a practical way to distribute and use xylitol candies among these disabled pupils. The regular use of xylitol candies may, therefore, support oral hygiene routines in disabled pupils.

Supervised toothbrushing and oral health education program in Kuwait for children and young adults with Down syndrome.

The authors report on the effectiveness of a school-based, supervised toothbrushing program among a group of 112 children with Down syndrome in Kuwait. The study involved 45 boys and 67 girls, who ranged in age from 11-22 years (mean, 14.8 years). The participants had moderate mental retardation and attended one of two special needs schools. Plaque was scored according to the Silness and Löe plaque index and gingivitis according to the Löe and Silness gingival index. Supervised toothbrushing and dental health education sessions were conducted twice a week. The program was evaluated at the end of three months. The mean plaque score decreased from 1.93 to 0.95 (p < 0.001), and the mean gingival score from 2.00 to 0.83 (p < 0.001). This three-month supervised toothbrushing program was effective in reducing plaque and gingivitis scores, but the key to long-term success of the program is sustaining the children's motivation to make oral hygiene a part of their daily life.

MTA pulpotomy as an alternative to root canal treatment in children's permanent teeth in a dental public health setting.

OBJECTIVE: This prospective clinical study evaluated the success of vital pulpotomy treatment for permanent teeth with closed apices using mineral trioxide aggregates (MTA) in a dental public health setting. METHODS: Twenty-seven mature permanent first molars and 2 premolars (in 25 patients) with carious exposure were treated using MTA pulpotomy. Age of patients ranged from 10- to 15-years (mean=13.2±1.74-years). Four trained and calibrated practitioners performed the same clinical procedure for all patients. Following isolation and caries removal, the inflamed pulp tissue was completely removed from the pulp chamber. This was followed by irrigation with 2% sodium hypochlorite. Haemostasis was achieved using a cotton pellet damped in normal saline. A white MTA paste was placed against the pulp orifices. MTA was covered with a damped cotton pellet and a base of IRM. Patients were recalled after 1 day where a glass ionomer liner and a final restoration were placed. Teeth were evaluated clinically and radiographically for up to 47 months. RESULTS: Mean follow-up period for all teeth was 25±14 months. Twenty-six of the 29 teeth were clinically asymptomatic with no evidence of periradicular or root pathology during the follow-up period. The estimated success rate was 90%. Three teeth presented with clinical symptoms of pain and radiographic evidence of periradicular pathology that indicated root canal treatment (RCT) or extraction. CONCLUSION: When managing carious pulp exposures of permanent teeth with closed root apices in children, MTA pulpotomy showed a high success rate. CLINICAL SIGNIFICANCE: MTA pulpotomy for permanent molars in children is a viable alternative to RCT.

Maxillary canine-to-first premolar bilateral transposition in a female with Down syndrome. A case report.

OBJECTIVE AND IMPORTANCE: To report a case of the bilateral transposition of the maxillary canines with the premolars in a 17-year-old female with Down syndrome. CLINICAL PRESENTATION AND INTERVENTION: A 17-year-old female presented with moderate mental retardation; she was short and of small stature, and she had a round cherubic face and a broad forehead. Clinical intraoral examination revealed bilateral malpositions of the maxillary canines and premolars as transposition. She had an open mouth, macroglossia and a protruding tongue. The case required the combined orthodontic and prosthetic treatment to achieve an acceptable morphologic and esthetic occlusion. However, the parents refused to accept the proposed treatment. Extractions of the roots and caries treatment were done as these were considered priority for the patient. CONCLUSION: This rare and severe positional anomaly represents an orthodontic challenge and its correction involves treatment risk and requires a great deal of control and carefully applied mechanics.