Child dental anxiety, parental rearing style and referral status of children.

OBJECTIVE: Treating children can be difficult for both dentist and child. In some cases treatment fails and those children are referred to a specialist paediatric dentist. Different factors can be put forward for referral of children, such as factors relating to the child, dentist and parent. Possible child-related factors can be dental anxiety and the child's temperament. A possible parental factor is the parental rearing style. The objective of this study was to assess the possible associations between dental anxiety, parental rearing style and referral status of children. METHODS: Parents of 120 non-referred and 335 referred paediatric dental patients were asked to fill out the Child Rearing Practices Report (CRPR) and the Child Fear Survey Schedule Dental Subscale (CFSS-DS) on behalf of their children. RESULTS: The questionnaires were filled out by 115 (96%) parents of primary schoolchildren and by 331 (99%) parents of referred children. Referred children were younger than non-referred children, t(442) = 6.9, p < 0.01, and had significantly more dental anxiety, t(430) = -8.7, p < 0.01. No differences existed between parents of referred children and parents of non-referred children on parental rearing-style. No differences existed between fearful and non-fearful children on parental rearing-style and also no correlation existed between children's dental anxiety and their parent's rearing style. However, non-referred children with parents using an authoritarian parenting style were more anxious than the other non-referred children. CONCLUSIONS: In the present study, referral status and dental anxiety of 4-12 year old children were not associated with parental rearing style.

Dental fear in children with a cleft lip and/or cleft palate.

OBJECTIVE: To assess the level of dental fear in children with a cleft lip and/or palate, to compare this level with that of a normative group testing the hypothesis that children with a cleft lip and/or palate have a higher level of dental anxiety than children from the general population, and to assess the relation between dental fear and coping. DESIGN: Cross-sectional study. SETTING: VU Medical Centre University Amsterdam. PATIENTS: A total of 110 children (4 to 12 years old, 50 girls) with a cleft lip and/or palate. INTERVENTIONS: Dental fear in the study group was compared with a normative group of Dutch children. MAIN OUTCOME MEASURES: Dental fear was investigated using the parental version of the dental subscale of the Children's Fear Survey Schedule for children aged 4 and 5 years old (n = 36). Also the Inventory of Stressful Situations was completed. Children aged 6 to 12 years old also completed the Dental Cope Questionnaire. RESULTS: Young children with a cleft lip and/or palate experience more dental fear compared with children in a normative control group (Children's Fear Survey Schedule dental subscale scores: 30.3 ± 14.6 compared with 24.6 ± 8.6, p < .01). A weak correlation was found between the child's dental anxiety (Children's Fear Survey Schedule dental subscale) and his or her coping behavior (Dental Coping Questionnaire) (r = .196 p < .05). A clear correlation exists between the total Inventory of Stressful Situations and total Children's Fear Survey Schedule scores of the youngest age group (r = .507 p < .01). CONCLUSIONS: Findings support the hypothesis that dental anxiety is related to a higher level of exposure to medical interventions at a young age.

Regenerative endodontic therapy: a follow-up of 47 anterior traumatised teeth.

PURPOSE: To collect long-term survival data in anterior traumatised teeth on the outcome of Regenerative Endodontic Treatments (RET) with a network of dentists working in different clinics to overcome the problem of anecdotical evidence. METHODS: The seven dentists from Paediatric REsearch Project (PREP) performed RET treatments following the same protocol in five different secondary dental care clinics in the Netherlands. Treatment resulting in pain, apical problems, sinus tracts, resorption or fracture were considered as failure of treatment. RESULTS: 47 teeth in 38 children were treated between January 2009 and September 2017 and had at least 6 month follow-up (mean 35 months). Apical closure was seen in 27 teeth (25 cases) and root length growth in 6 teeth (6 cases). Thickening of the root walls was seen in 20 teeth (20 cases) and obliteration of the root canal in 30 teeth (25 cases). Of 38 teeth with apical inflammation at the start of treatment, no radiographic sign of apical inflammation was visible at 3 months in 13 of 28 teeth; taking up to 42 months for radiographic signs of apical inflammation to be not visible. Nineteen of 35 teeth showed discoloration at the beginning of treatment. After 18 months two teeth showed signs of ankylosis, but were still functional. After 36 months one more tooth showed signs of new apical inflammation and 2 months later it was extracted. CONCLUSIONS: With three failures in 47 treated teeth, RET seems to be a promising treatment for difficult to treat anterior traumatised teeth with an open apex.

[Principles of oral health care for children]. / Uitgangspunten van mondzorg voor kinderen.

In this article the principles of child oral health care in the Netherlands and the consequences of cariological principals of oral health care delivery to children are described. First of all the age of the child plays a very significant role in decisions concerning prevention and restoration. In addition, the combination of a positive attitude on the part of the dentist and a pain-free treatment can prevent fear of treatment and avoidance behaviour of the children. In the treatment of carious lesions, moreover, the oral health care provider should consider to what extent the problem is related to behaviour and fits in the multi-factorial caries model. Restorative treatments should be considered as supporting prevention, reducing caries activity and eliminating the effects of neglected oral health care. Prevention has to be seen as an essential element of the treatment model and it should start early from the standpoint of habit formation and the rapid demineralization process in the deciduous dentition which results from failed preventive care.

[Tooth development disturbances following haematopoietic stem cell transplantation]. / Langetermijneffecten op de gebitsontwikkeling na stamceltransplantatie.

Forty children treated with allogenic haematopoietic stem cell transplantation for haematological malignancies, were examined at least 2 years after transplantation. The researchers collected information concerning subjective oral symptoms, the results of a panoramic radiograph and the findings of an oral examination. Nearly all children had tooth development disturbances, including missing teeth, shortened roots, and arrested root development. The study group showed a significantly higher prevalence of missing teeth than the standard values for first and second premolars in both maxilla and mandible, as well as for second molars in the mandible. Children younger than 3 years of age at the start of the treatment missed significantly more teeth than older children. The mean root-crown length ratios of several tooth types were lower when compared with a control group of healthy Finnish children. The mean dental age was higher than the mean chronological age due to early final apical root formation.

Long-term adverse effects of hematopoietic stem cell transplantation on dental development in children.

PURPOSE: The purpose of this study was to assess late effects of cytotoxic therapy with hematopoietic stem cell transplantation (HCT) on dental development in survivors of childhood cancer. MATERIALS AND METHODS: Forty children who underwent allogeneic HCT for a variety of hematological malignancies were evaluated at a minimum of 2 years after transplantation. We obtained information on oral symptoms, exposed panoramic radiographs (PRG), and performed an oral examination. PRGs were scored for agenesis and root and/or crown abnormalities. The root-crown ratio was calculated, and dental age was assessed using Demirjian' s method. MAIN RESULTS: The studied group showed a significantly higher prevalence of tooth agenesis compared to normative data for first and second premolars in both the maxilla and mandible, as well as the second molars in the mandible (all p values <0.001). Children who were <3 years old at the time of cancer treatment had significantly more missing teeth than older children, F(2,37) = 7.58, p < 0.002. Root-crown ratios were lower in the study sample than those from normative data. In addition, the mean dental age was higher (as a result of earlier apical root closure) than the mean chronological age, t(28) = 2.47, p < 0.020. CONCLUSIONS: Nearly all children examined had dental development disturbances, including agenesis, short roots, and arrested root development. An oral/dental evaluation and preventative oral supportive care regimens should be part of programs monitoring late effects in long-term survivors of childhood cancer.

[Diagnostic and restorative behaviour in Dutch dentists' paediatric dental care]. / Diagnostisch en restauratief gedrag van Nederlandse tandartsen in de kindertandheelkunde.

The aim of this study was to determine what the approach of Dutch dentists is in the treatment of children. Prevention, X-ray diagnostics and restorative care were compared in four consecutive age groups (< 6 years old, 6-8, 9-11, 12-17 years). The insurance claims of 4550 dentists over a period of 3 consecutive years were studied. The findings showed that dentists who made use of X-rays and provided restorative care for children younger than 6 also provided restorative care for subsequent age groups on average 1.4-2.9, 1.3-2.5 and 1.2-1.8 times more than, respectively, dentists who did not make use of X-rays but did provide restorative care for children under 6 and dentists who neither made use of X-rays nor provided restorative care for children under 6. The first group of dentists also made more use of X-rays in the subsequent age groups: 3.7, 3.4 and 1.9 times respectively. On the basis of these results it can be concluded that starting restorative treatment and the use of X-rays for children younger than 6 is predictive for the quantity of care provided by dentists for the older groups of children.

[Fear of dental treatment among children. Influence of experience and psychological functioning]. / Angst voor een tandheelkundige behandeling bij kinderen. Invloed van ervaring en psychisch functioneren.

This research considers whether fear of dental treatment among children is linked with a prior (negative) experience with local anaesthesia or with psychological functioning. Furthermore, the study investigated whether these factors play a role in anxious behaviour before and during a local anaesthetic injection. In this study 128 children between the ages of 4 and 11 took part. With the help of video recordings, the anxious behaviour before and during the local anaesthetic injection was scored using the Venham-scale. During the treatment one of the child's parents or guardians was asked if the child had previously been given a local anaesthetic injection (experience). The fear of dental treatment and the child's psychological functioning were measured using the parents' version of the 'Dental Subscale' of the 'Children's Fear Survey Schedule' and the 'Strengths and Difficulties Questionnaire' respectively. Results showed a correlation between on one hand fear of dental treatment and on the other hand anxious behaviour before and during a local anaesthetic injection and psychological functioning. Furthermore, results indicated that children with fear of dental treatment exhibited more fearful behaviour before and during an injection with local anaesthetic. Only in the case of children whose psychological functioning was reduced there was a significant relationship between experience with local anaesthesia and fearful behaviour prior to the injection of a local anaesthetic.

Hypomineralized second primary molars: prevalence data in Dutch 5-year-olds.

The aim of this cross-sectional observational study was to report on the prevalence of hypomineralizations in second primary molars in 5-year-old Dutch children. In the study 386 (45% girls) 5-year-old Dutch children, all insured by a Health Insurance Fund, participated. Scoring criteria for molar incisor hypomineralization molars were adapted to score second primary molars. The prevalence of hypomineralized second primary molars (HSPM) was 4.9% at child level and 3.6% at tooth level. Most HSPMs (87%) showed demarcated opacities, followed by posteruptive enamel loss (40%).

[Treatability of children according to Dutch dentists]. / Behandelbaarheid van kinderen gezien door de ogen van de tandarts.

Most dentists find it important to treat the dentition of children; nevertheless cavities often remain untreated. In order to gain insight into the treatability of children, a survey was carried out involving 4,500 dentists of a health insurance company. A representative group answered questions about the necessity of treatment, and treatability of children and about the possibility of referring children to a colleague or a paediatric dentist. According to the questionnaire dentists find it important to treat the dentition of children. Most problems during dental treatment occur in the 0-6 years age group. Dentists are more likely to refer children in this age group to a colleague or pediatric dentist for treatment.

Barriers and opportunities to oral health in Dutch-Moroccan children in the Netherlands: a narrative report.

INTRODUCTION: Previous studies showed that 5-year-old Dutch-Moroccan children had significantly higher dmft scores compared to Dutch children of the same age, even after correction for socio-economic status. The mechanisms underlying this difference are little understood. AIM: To explore cultural factors involved in poorer oral health of Dutch-Moroccan children by identifying knowledge, attitudes and behaviour of their mothers concerning their children's oral health. METHODS: In 2012 mothers of Dutch-Moroccan preschool children in two cities in the Netherlands were interviewed in two focus groups (n = 16) or individual semi-structured interviews (n = 13). Semi structured interviews were also c onducted with three oral health professionals, working with Dutch-Moroccan children, and one physician from an under-five-clinic. All interviews were voice recorded, transcribed and inductively coded. MAXQDA software was used for data analysis. RESULTS: All mothers mentioned pain complaints, swelling and black front teeth as oral health problems in their children. Although mothers were aware that brushing teeth and reducing sugary snacks are effective preventative strategies, they did not sufficiently implement these measures. This was due to lack of brushing skills, insufficient awareness of the daily sugar intake of their children and their childrearing concerning these measures. Most mothers indicated they felt empowered in making dental care decisions. CONCLUSIONS: This research revealed the presence of knowledge on preventive strategies regarding their children's oral health in Dutch-Moroccan mothers, but an inadequate implementation of these measures in their daily lives. Additional qualitative research is needed to gain deeper insight for broader exposure of values, knowledge and culture.

[Post-academic dental specialties. 10. Post-academic specialization in pediatric dentistry]. / Beroepsdifferentiatie in de tandheelkunde 10. De differentiatieopleiding tot tandarts-pedodontoloog.

As is the case with other dental disciplines, pediatric dentistry has moved in the direction of a specialized educational programme. After a cautious start at the end of the last century, the European Academy of Paediatric Dentistry (EAPD) and the Dutch Association of Pediatric Dentistry have now recognized the previously existing programme at the Academic Center for Dentistry Amsterdam (ACTA) and a register for dentists-pedodontologists has been established. Recently, about 30 dentist-pedodontologists have received their certification. They work in private practice, pedodontic secondary dental practice and centers for special dental care as well as in university (hospital) clinics. They willingly assist the general dental practitioner with advice and active treatments.

[Dental anxiety and needle phobia in children. A relationship?]. / Angst voor tandheelkundige behandeling en naaldangst bij kinderen. Een verband?

This cross-sectional study aimed at explaining the nature of needle phobia and its relationship in dental phobic children with evidence on age-related differences. The patient sample included randomly selected patients and an group of referred anxious children. The children were divided into three age groups and arranged into three anxiety groups. Needle phobia was demonstrated to be age-related, but should be considered as a separate phenomenon, being not specific for dental anxiety.

[Children's distress during application of local anaesthesia. Computerized tool versus traditional syringe]. / Ongemak van kinderen tijdens het geven van lokale anesthesie. Vergelijking van een geautomatiseerd systeem en de traditionele methode.

This study compared the level of distress in children during the application of local anaesthesia by a computerized tool (Wand) and by a traditional syringe. The influence of children's mild or extreme anxiety regarding the dental procedure was also determined. 125 children between the ages of 4 and 11 years old participated in this study. Their discomfort was recorded on videotape and marked on the Venham scale and the Observational Scale of Behavioral Distress at 15 second intervals. Parents rated their child's level of anxiety on the Dental Subscale of the Children's Fear Survey Schedule. The results indicate that mildly anxious children suffered less distress and showed less muscle tension, verbal protest and body movement during the first 2 intervals when the computerized tool was used. However, the maximum distress score at the moment of injection was similar in both methods. There was no difference found in the level of distress in the highly anxious children.

Association between Bone Mass and Dental Hypomineralization.

The aim of this study was to examine the association between the bone mass (bone mineral content [BMC]) and hypomineralized second primary molars (HSPMs)/molar incisor hypomineralization (MIH) in 6-y-old children. This cross-sectional study was embedded in the Generation R Study, a population-based prospective cohort study, starting from fetal life until adulthood in Rotterdam, Netherlands. The European Academy of Pediatric Dentistry criteria were used to score the intraoral photographs on the presence or absence of HSPMs and MIH. Bone mass was measured with a dual-energy x-ray absorptiometry (DXA) scan. Intraoral photographs and DXA scans were available in 6,510 6-y-old children. Binary logistic regression models were used to study the association between the bone mass and HSPMs/MIH. In total, 5,586 children had their second primary molars assessed and a DXA scan made; 507 children were diagnosed with HSPM. Of 2,370 children with data on their permanent first molars, 203 were diagnosed with MIH. In the fully adjusted model, children with lower BMC (corrected for bone area) were more likely to have HSPMs (odds ratio, 1.13; 95% confidence interval, 1.02 to 1.26 per 1-standard deviation decrease). A lower BMC (corrected for bone area) was not associated with MIH (odds ratio, 1.02; 95% confidence interval, 0.87 to 1.20 per 1-standard deviation decrease). We observed a negative association between BMC (corrected for bone area) and HSPMs. No association was found between BMC (corrected for bone area) and MIH. Future research should focus on investigating the mechanism underlying the negative association between the bone mass and HSPMs. Our study, in a large population of 6-y-old children, adds the finding that BMC (corrected for bone size) is associated with HSPMs but not with MIH in childhood.

Child coping strategies, dental anxiety and dental treatment: the influence of age, gender and childhood caries prevalence.

AIM: This was to investigate what coping strategies are used by children, the efficacy of these strategies and the influences of age, gender, dental anxiety, pain experience and childhood caries prevalence (place of residence) upon the efficacy of the coping strategies used by Dutch (NL) children in The Netherlands and Northern Ireland (NI). METHODS: Convenience samples of Dutch and NI children were taken and asked to fill out a coping questionnaire (Dental Cope Questionnaire) and an anxiety schedule (CFSS-DS). Data were entered onto a SPSS database and subjected to frequency distributions, Chi-square analysis, t-tests and analysis of variance. RESULTS: The children used a wide variety of coping strategies in dealing with pain in dentistry. The most frequently used and those reported to have the greatest efficacy by the children in this investigation were cognitively based strategies. Different strategies were used in relation to place of residence, age and level of dental anxiety. The variance in the number of strategies used was significantly explained by the experienced pain during dental treatment. The efficacy of the coping strategies used was significantly explained by level of dental anxiety. CONCLUSIONS: Dental coping strategies used by children seem to vary with age, dental anxiety and pain experience. This information can help dental practitioners to adjust his or her treatment to the child's emotional needs.

[Behavioral strategies in pediatric dental treatment. A necessity?]. / Omgangsstrategieen bij de behandling van kinderen. Een noodzaak?

The American Academy of Pediatric DEntistry is regularly publishing updates of protocols and guidelines. The article Dutch summary of and comment on a special issue of the journal Pediatric Dentistry with evaluated protocols and articles on guidelines for dentists. The protocols have been adapted to modern insights, but not very practical described. To use these protocols and guideliness in Dutch pediatric dentistry, it is advocated to take into consideration the individual child's age and behaviour and to base one's strategies on data of randomized clinical trials.

The etiology of childhood dental fear: the role of dental and conditioning experiences.

This study was aimed to examine the relative importance of invasive treatment experiences in the acquisition of dental fear in children. For this purpose, the complete dental history of 401 children (5-10 years) was studied. The level of dental fear in these children was assessed using the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Differences in treatment variables between fearful and low fearful children were analyzed, and regression analysis was performed to determine significant predictors of dental fear. A significant but weak relation with the number of extractions was found, while no relation with the number of fillings was found. The results have indicated that within the (direct) conditioning pathway, objective dental experiences seem to play a minor role in children's fear acquisition, and it was suggested that subjective dental experiences may play a more decisive role. In addition, clinical support for the latent inhibition theory was provided.

Dental Discomfort Questionnaire: predicting toothache in preverbal children.

AIM: In the present study the value of the Dental Discomfort Questionnaire in predicting toothache in young children is analysed. METHODS: The Dental Discomfort Questionnaire (DDQ-8; Cronbach's alpha 0.75) was completed by parents on behalf of their children (N=99; mean age 47 months). Half of the children were referred to a special dental care centre and the other half were controls from a day care centre. RESULTS: The behaviours from the DDQ-8 appeared to be more often present in those children with decayed teeth and toothache than in those without decayed teeth or toothache. A score of 3 or higher on the DDQ-8 seemed the best cut-off point to predict toothache in children. The receiver operating characteristic curve (ROC) showed that the DDQ-8 has predictive value for toothache. STATISTICS: The validity of the DDQ-8 was expressed as sensitivity, specificity and positive predictive value and negative predictive value. The DDQ's ability to discriminate between patients with and without toothache was estimated by the area under the ROC area of the questionnaire. CONCLUSIONS: The DDQ-8 could be helpful for parents, non-dental healthcare workers and researchers in predicting the existence of toothache in preverbal children.