An open-label, parallel-group, randomized clinical trial of different silver diamine fluoride application intervals to arrest dental caries.

BACKGROUND: Silver diamine fluoride (SDF) is an antimicrobial agent and alternative treatment option that can be used to arrest dental decay. While there is optimism with SDF with regard to caries management, there is no true consensus on the number and frequency of applications for children. The purpose of this study was to examine the effectiveness of 38% SDF to arrest early childhood caries (ECC) at three different application regimen intervals. METHODS: Children with teeth that met International Caries Detection and Assessment System codes 5 or 6 criteria were recruited from community dental clinics into an open-label, parallel-group, randomized clinical trial from October 2019 to June 2021. Participants were randomized to one of three groups using sealed envelopes that were prepared with one of three regimens inside: visits one month, four months, or six months apart. Participants received applications of 38% SDF, along with 5% sodium fluoride varnish (NaFV), at the first two visits to treat cavitated carious lesions. Lesions were followed and arrest rates were calculated. Lesions were considered arrested if they were hard on probing and black in colour. Statistics included descriptive and bivariate analyses (Kruskal one-way analysis of variance and Pearson's Chi-squared test). A p-value of ≤ 0.05 was considered significant. RESULTS: Eighty-four children participated in the study (49 males and 35 females, mean age: 44.4 ± 14.2 months). Treatment groups were well matched with 28 participants per group. A total of 374 teeth and 505 lesions were followed. Posterior lesions represented only 40.6% of affected surfaces. Almost all SDF treated lesions were arrested for the one-month (192/196, 98%) and four-month (159/166, 95.8%) interval groups at the final visit. The six-month group experienced the lowest arrest rates; only 72% (103/143) of lesions were arrested (p < 0.001). The duration of application intervals was inversely associated with improvements in arrest rates for all lesions. CONCLUSIONS: Two applications of 38% SDF and 5% NaFV in one-month and four-month intervals were comparable and very effective in arresting ECC. Applications six months apart were less effective and could be considered inferior treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04054635 (first registered 13/08/2019).

What is Being Taught to Canadian Undergraduate Dental Students About the Oral Health of Long-Term Care Residents?

INTRODUCTION: Residents of long-term care (LTC) facilities face many oral health challenges, which are often complicated by their underlying medical conditions, use of medications and limited access to oral health care. OBJECTIVE: To determine to what extent accredited university-based dental and dental hygiene programs in Canada prepare students in the areas of geriatric oral health and oral health of LTC residents. METHODS: Accredited dental and dental hygiene programs across Canada were assessed for the degree of education and training that is presented to students on the oral health of LTC residents. A survey questionnaire, emailed to programs, was used to gather descriptive statistics (frequencies, means and standard deviations), and bivariate analysis (χ2 and t tests) was completed. A p value ≤ 0.05 was considered significant. RESULTS: Representatives of all 4 dental hygiene and 9 out of 10 dental schools responded. All four dental hygiene and seven dental programs (77.8%, 7/9) stated that geriatric oral health is an integral part of their curriculum. The majority (91.6% [11/12], 4 dental hygiene and 7 of 9 dental schools) reported that their program educates students about medically, physically and cognitively compromised geriatric patients. Eight programs (3 dental hygiene and 5 dental schools), stated that they provide clinical training opportunities with LTC residents. However, some programs reported certain barriers preventing them from providing such clinical training opportunities. CONCLUSION: Oral health educational institutions must ensure that curricula are current and evidence-based to reflect the overall oral health needs of today's aging population.

Association between early childhood oral health impact scale (ECOHIS) scores and pediatric dental surgery wait times.

BACKGROUND: Severe Early Childhood Caries (S-ECC) is an aggressive form of tooth decay that often requires pediatric dental rehabilitative surgery. The Early Childhood Oral Health Impact Scale (ECOHIS) measures oral health-related quality of life (OHRQL). The purpose of this study was to determine whether there is an association between ECOHIS scores and surgery wait times for children undergoing dental treatment for S-ECC under general anesthesia (GA). METHODS: The hypothesis was that there is no present association between wait times and ECOHIS score. Children under 72 months of age with S-ECC were recruited on the day of their slated dental surgery under GA. Parents/caregivers completed a questionnaire that included the ECOHIS. Data were merged with other ECOHIS scores from a previous study. Wait times were acquired from the Patient Access Registry Tool (PART) database. Data analysis included descriptive statistics and bivariate analyses. A p-value of ≤0.05 was considered statistically significant; 95% confidence intervals (CIs) were reported for each correlation coefficient. This study was approved by the University of Manitoba's Health Research Ethics Board. RESULTS: Overall, 200 children participated, the majority of whom were Indigenous (63%) and resided in Winnipeg (52.5%). The mean age was 47.6 ± 13.8 months and 50.5% were female. Analyses showed ECOHIS scores were not significantly correlated with children's wait times. Observed correlations between ECOHIS and children's wait times were low and not statistically significant, ranging from ρ = 0.11 for wait times and child impact section (CIS) scores (95% CI: - 0.04, 0.26; p = 0.14), ρ = - 0.08 for family impact section (FIS) scores (95% CI: - 0.23, 0.07; p = 0.28), and ρ = 0.04 for total ECOHIS scores (95% CI: - 0.11, 0.19; p = 0.56). CONCLUSION: No significant associations were observed between ECOHIS scores and wait times. In fact, those with worse OHRQL appeared to wait longer for surgery. ECOHIS scores could, however, still be used to help prioritize children for dental surgery to ensure that they receive timely access to dental care under GA. This is essential given the challenges posed by COVID-19 on timely access to surgical care.

Improvement in Serum Vitamin D Following Dental Rehabilitation to Treat Severe Early Childhood Caries.

Purpose: The purpose of this study was to investigate changes in 25-hydroxyvitamin D (25(OH)D) levels in children with severe early childhood caries (S-ECC) following rehabilitative surgery using general anesthesia (GA). Methods: Children with S-ECC were recruited on the day of surgery for a prospective study investigating changes in nutritional status and well-being before and after surgery. Venipunctures for 25(OH)D were performed while children were in the operating room, and parents completed a questionnaire regarding nutritional intake, oral health, quality of life, and family demographics. Participants returned at a minimum of three months for a follow-up venipuncture, questionnaire, and dental examination. Analyses included descriptive, bivariate, and multivariable regression analyses. A P-value of ≤ 0.05 was significant. Results: Overall, 150 children participated, with a mean age of 47.7±14.1 months. The mean baseline 25(OH)D concentration was 49.8±16.9 nmol/L, with 17 percent having deficient levels. Overall, 106 returned for follow-up. Paired t-tests revealed significant improvements in the mean 25(OH)D levels following rehabilitation (50.1±17.1 nmol/L versus 61.2±18.7, P<0.001). The proportion with optimal and adequate 25(OH)D levels increased from 9.2 percent to 24.1 percent and from 48.3 percent to 67.8 percent, respectively, while those classified as deficient decreased from 17.2 percent to 8.1 percent from baseline to follow-up. Conclusions: Significant improvements in vitamin D concentrations were observed following dental rehabilitation. This provides additional evidence of the association between oral health and nutritional status.

Indigenous community members' views on silver diamine fluoride to manage early childhood caries.

OBJECTIVES: Early childhood caries (ECC) continues to be the leading reason for pediatric dental surgery in Canada and is particularly prevalent among Indigenous children. Silver diamine fluoride (SDF) offers an alternative method to manage non-restoratively caries. It is important to determine Indigenous communities' views on and receptivity toward SDF. AIM: To understand Indigenous community members' views on pediatric dental surgery to treat ECC under general anesthesia (GA) and receptivity to SDF as an alternative to restorative surgery. METHODS: Focus groups and sharing circles congruent with an Indigenous ways of gathering information were conducted. Three interviewers engaged eight groups of First Nation and Metis communities in three rural Indigenous communities and ne metropolitan urban setting in Manitoba, Canada. Overall, 59 individuals participated. Open coding was guided by grounded theory and further analysis using Nvivo 12 software™. RESULTS: Participants mean age was 35.6 years, 88 percent (52 individuals) had a least one child, and 32 percent (19 individuals) were employed. Eight themes emerged, including respondents' fear of dental surgery under GA, fear of pain after dental surgery, parents' need for more information before accepting SDF treatment, and concern about the black staining of treated lesions. CONCLUSIONS: Indigenous parents' acceptance of SDF as a treatment option is contingent on having more information and assurance that treatment under GA can be avoided. Understanding Indigenous parents' views may ensure better acceptance of SDF as a minimally invasive treatment option to manage ECC. A cautious and informative approach to SDF implementation in Indigenous communities is recommended.

The Burden of Early Childhood Caries in Canadian Children and Associated Risk Factors.

Introduction: Early childhood caries (ECC) is any caries in the primary dentition occurring in children under the age of six. ECC is common in many population groups in Canada. Objective: The purpose of this review was to describe the burden of ECC in Canada, the prevalence and associated risk factors for ECC, and its impact on childhood health based on the existing published literature. Methods: A review was conducted to assess published Canadian studies on ECC identified through searches of electronic databases. Databased searched included PubMed, Medline, Cinahl, and the library catalog of the University of Manitoba. Known publications on ECC that were not identified by the electronic search were also considered. Only the studies that reported the prevalence of ECC or caries in preschool aged children were considered. In-depth assessments were restricted to those studies that employed logistic regression analysis to investigate relationship between ECC and risk factors or nutritional status and quality of life. Results: A total of 36 studies were identified that related to ECC in Canadian children. Overall, 27 related to prevalence and 12 reported on risk factors, four related to the association between severe ECC and nutritional health and well-being, while only one related to the oral microbiome composition. Published studies reveal that the prevalence of ECC can be as high as 98% in some parts of Canada. Commonly identified risk factors include age, sex, socio-economic status, parental beliefs, family characteristics, debris/plaque, enamel hypoplasia, and behavioral (oral health or feeding behaviors) tendencies. Conclusions: Current literature reveals that many Canadian children are affected by ECC. The development of ECC appears to be strongly associated with social determinants of health including low household income and the level of parental education or employment status. Associations were also observed between ECC and the child's age at first dental visit and parental beliefs about child's oral health. Children with enamel hypoplasia are also at significantly greater odds for experiencing caries. Future research should include assessments of developmental defects of enamel to better understand the association between enamel hypoplasia and ECC.

Oral Health-Related Quality of Life of Canadian Preschoolers with Severe Caries After Dental Rehabilitation Under General Anesthesia.

Purpose: The purpose was to determine changes in the oral health-related quality-of-life (OHRQoL) of children with severe early childhood caries (S-ECC) following dental rehabilitation under general anesthesia (DRGA). Methods: This prospective cohort study involved caregivers completing questionnaires, including the Early Childhood Oral Health Impact Scale (ECOHIS). Data analysis included descriptive statistics, bivariate analyses, effect size, and multiple linear regression. Results: Initially, 150 children were enrolled, mean age of 47.7±14.2 (SD) months. The baseline mean total ECOHIS score was 6.3±5.3. Higher baseline ECOHIS scores were associated with single-parent families, low-income house-holds, higher decayed, missing, and filled primary teeth (dmft) scores, and having extractions (P ≤ 0.05). Multiple linear regression results showed low household income (P=0.01) and the child not having Registered First Nation status (a specific population of Indigenous Canadians; P=0.03) were significantly and independently associated with higher total baseline ECOHIS scores. At follow-up, 103 children had a mean total ECOHIS score of 3.5±2.9 versus a baseline score of 6.3±5.4. Change in total ECOHIS and three of four Child Impact Section domains showed significant improvement (P<0.001) post-DRGA. Worse follow-up ECOHIS scores were only associated with the child being male (P=0.02). Conclusions: Improvements in oral health-related quality of life were observed following DRGA. Consideration should be given for using the Early Childhood Oral Health Impact Scale to help prioritize children waiting for DRGA. (Pediatr Dent 2019;41(3):221-8) Received November 22, 2018 | Last Revision February 28, 2019 | Accepted April 1, 2019.

Problems faced by complete denture-wearing elderly people living in jammu district.

CONTEXT: Poor oral health is increasing dramatically among old people especially those living in rural and remote areas. Various factors such as low education background, low income, poor living conditions, unhealthy lifestyle, inadequate oral hygiene and tobacco use lead to poor oral health among older people which in turn lead to risks to their general health. The older people especially from rural areas are apprehensive about seeing a dentist and do not visit them regularly. This may lead to various problems which may have a detrimental influence on their quality of life. AIM: To know the problems faced by complete denture wearers in rural areas in Jammu district. MATERIALS AND METHODS: Fifty patients from rural area Bishna, initially treated with a complete denture in the maxilla or mandibles were examined. The data were collected with the help of a questionnaire. RESULTS: The results revealed that majority of respondents were in the age - group of 65-70 y. Majority of respondents complained of "difficulty chewing", "sore spots", "painful and swollen gums". Majority of respondents had difficulty in speech, it was difficult for them to interact and communicate with their dentures on. Most of the respondents had lost confidence and had low self esteem. Clinical observations revealed that the commonest condition associated with denture wearing was Oral Stomatitis/ Burning mouth Syndrome, Superimposed infection and Angular cheilitis. CONCLUSION: Older people should Communicate and visit dentists, regularly, so that the dentists can adjust the treatment and pace according to their needs. Behavioural therapy techniques can make dental visits relatively anxiety and pain-free.

Cleidocranial dysplasia: a case report illustrating diagnostic clinical and radiological findings.

Cleidocranial dysplasia (CCD) is a rare congenital defect, primarily affecting bones, undergoing intramembranous ossification. CCD presents with skeletal defects of several bones, the most striking feature of which are partial or complete absence of clavicles, late fontanels closure, and presence of open skull sutures and multiple wormian bones. These patients may be first noticed by the dentist because of the aesthetic problems or delayed eruption of teeth experienced by the patient. Here, we report a typical case of CCD in a 15-year-old female who had classical diagnostic feature of this syndrome.

A Comparative Evaluation of the Effect of Resin based Sealers on Retention of Crown Cemented with Three Types of Cement - An In Vitro Study.

AIM: In an effort to control postoperative sensitivity, dentin sealers are being applied following crown preparations, with little knowledge of how crown retention might be affected. A previous study demonstrated no adverse effect when using a gluteraldehyde-based sealer, and existing studies have shown conflicting results for resin-based products. This study determined the retention of the casting cemented with three types of cement, with and without use of resin sealers and it determined the mode of failure. MATERIALS AND METHODS: Extracted human molars (n=60) were prepared with a flat occlusal, 20-degree taper, and 4-mm axial length. The axial surface area of each preparation was determined and specimens were distributed equally among groups (n=10). A single-bottle adhesive system (one step single bottle adhesive system) was used to seal dentin, following tooth preparation. Sealers were not used on the control specimens. The test castings were prepared by using Ni-Cr alloy for each specimen and they were cemented with a seating force of 20 Kg by using either Zinc Phosphate (Harvard Cement), Glass Ionomer (GC luting and lining cement,GC America Inc.) and modified-resin cement (RelyXTMLuting2). Specimens were thermocycled for one month and were then removed along the path of insertion by using a Universal Testing Machine at 0.5 mm/min. A single-factor ANOVA was used with a p value of .05. The nature of failure was recorded and the data was analyzed by using Chi-square test. RESULTS: Mean dislodgement stress for Zinc phosphate (Group A) was 24.55±1.0 KgF and that for zinc phosphate with sealer (Group D) was 14.65±0.8 KgF. For glass ionomer (Group B) without sealer, the mean value was 32.0±1.0 KgF and mean value for glass ionomer with sealer (Group E) was 37.90±1.0 KgF. The mean value for modified resin cement (Group C) was 44.3±1.0KgF and that for modified resins with sealer (Group F) was 57.2±1.2 KgF. The tooth failed before casting dislodgement in 8 to 10 specimens cemented with modified-resin cement. CONCLUSION: Resin sealer decreased casting retentive stress by 46% when it was used with Zinc phosphate. However, sealer use resulted in 60% increased retention when it was used with Glass ionomer cement. The modified-resin cement produced the highest mean dislodgement stress, which nearly always exceeded the strength of the tooth.