Effectiveness, Costs and Patient Acceptance of a Conventional and a Biological Treatment Approach for Carious Primary Teeth in Children.

BACKGROUND: Over the last years, conventional restorations for the treatment of active carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves less invasive techniques that alter the environment of the CL isolating it from the cariogenic biofilm and substrate. AIM: To investigate the cost-effectiveness and patient acceptance of 2 treatment approaches for the treatment of deep CLs in primary teeth in children. METHODS: This was a retrospective/prospective cohort study carried out in 2 UK specialist hospital settings. Data on cost-effectiveness was extracted retrospectively from clinical dental records of 246 patients aged 4-9 years. A prospective study design was used to explore patient acceptance of the 2 treatment approaches. One hundred and ten patients aged 4-9 years and their carers completed 2 questionnaires on treatment acceptance. RESULTS: In total, 836 primary teeth that had received treatment with either approach were included. More than 2 thirds (75.7%) of the restorations in the conventional approach were of non-selective removal to hard dentine followed by pulpotomy (24.3%). In the biological approach, most of the restorations were stainless steel crowns placed with the Hall Technique (95%) followed by selective removal to firm dentine (5%). The majority of the primary teeth remained asymptomatic after a follow-up period of up to 77 months; 95.3% in the conventional and 95.8% in the biological arm. When the treatment costs were analysed, a statistically significant difference was found between the mean costs of the 2 approaches with a mean difference of GBP 45.20 (Pound Sterling; p < 0.001), in favour of the biological approach. The majority of the children and carers were happy with the conventional or biological restorations. CONCLUSION: Although both approaches had similar successful outcomes, the biological approach consisting mainly of Hall Technique was associated with reduced treatment costs. Both approaches were accepted favourably by the children and carers.

Mandibular block or maxillary infiltration: does it influence children's opposition to a subsequent dental visit?

PURPOSE: Local anesthesia by mandibular block or maxillary infiltration is commonly administered to children receiving dental treatment of primary molars. Discomfort, when presenting, most often involves the lower lip. The purpose of this study was to investigate whether children would be more opposed to attending a dental treatment following anesthesia by mandibular block than by maxillary infiltration. METHODS: Each of 102 children in two age groups: 3 to 5 years, and 6 to 9 years, received the two types of local anesthesia at dental appointments one week apart. Their opposition to attending a subsequent appointment was assessed by parent report. RESULTS: More adverse reactions were observed during and following anesthesia with mandibular block than with maxillary infiltration. Few of the children in either age group expressed opposition to attend a dental visit after receiving mandibular block or maxillary infiltration in the previous visit. CONCLUSIONS: Though more adverse reactions were observed in children following mandibular block than maxillary infiltration, this did not result in increased opposition to attend a subsequent dental appointment.

Premedication intake behavior--does it predict behavior during dental treatment?

OBJECTIVES: To investigate whether behavior during hydroxyzine administration predicts children's behavior during dental treatment and whether behavior during treatment is affected by the complexity of treatment. MATERIALS AND METHOD: 118 children aged 2 to 6.5 years old were treated under conscious sedation with oral premedication (3.7 mg/kg of hydroxyzine in a concentration of 50 mg/5 cc. hydroxyzine) and 50% nitrous oxide/oxygen sedation. Children were divided in two age groups: aged 2 to < or = 4 years old, and aged 4 > to 6 years old. Behavior during first examination; cooperation during premedication administration, cooperation during nitrous oxide nose-mask placement, behavior during dental treatment, treatment duration and complexity of treatment were recorded. RESULTS: More children in the older group took the premedication willingly (p = 0.026). Significant correlation (p = 0.002) between behavior during examination and nitrous oxide mask acceptance was found in the older age group. No correlation was found regarding the cooperation during premedication intake and behavior during treatment within and between age groups. No statistical differences within the groups and between the groups were found between complexity of treatment and behavior during treatment. CONCLUSIONS: Premedication intake is not a reliable predictive tool for behavior during treatment in children aged 2-6.5 years. Complexity of treatment does not influence behavior during treatment in children aged 2-6.5 years.

Comparison of the effects of cognitive behavioural therapy and inhalation sedation on child dental anxiety.

AIM: To compare the effectiveness of inhalation sedation with nitrous oxide/oxygen (N2O/O2) and cognitive behavioural therapy (CBT) in reducing dental anxiety in preschool children. STUDY DESIGN: Randomised controlled clinical trial. METHODS: This study was conducted on 45 preschoolers with moderate to severe dental anxiety (determined by the Children's Fear Survey Schedule Dental Subscale), who required pulp treatment of at least one primary mandibular molar. Baseline anxiety and cooperation levels were determined using Venham Clinical Anxiety and Cooperation Scales (VCAS and VCCS) and Venham Picture Test (VPT) at the first dental visit (dental prophylaxis and fluoride treatment). Before the second dental visit (pulp treatment), the children were randomly assigned to one of three groups--1: control, 2: N(2)O/O(2) and 3: CBT. In group 1, the usual behaviour management techniques were used, in group 2, nitrous oxide/oxygen gas was used and in group 3, unrelated play, Benson's breathing and positive self-talk and modelling were used. Anxiety and cooperation levels were determined at three periods: injection, rubber dam placement and the application of a high-speed handpiece with VCAS and VCCS and VPT. Finally, anxiety and cooperation differences between the two dental visits were compared within the three groups. STATISTICS: Chi square, ANOVA and Kruskal-Wallis and Mann-Whitney U tests were used. RESULTS: N(2)O/O(2) and CBT significantly resulted in lower anxiety and higher cooperation in the second visit (at all three periods) compared to the control, although there was no significant difference between these two treatment methods. CONCLUSION: Both test methods were effective in reducing dental anxiety in preschoolers. Considering the adverse effects and necessity of equipment and trained personnel when using nitrous oxide and oxygen inhalation sedation, cognitive behavioural therapy is preferable because of its better applicability.

Assessing change in quality of life and dental anxiety in young children following dental rehabilitation under general anesthesia.

PURPOSE: This study's purpose was to investigate how young children's and parent/caregivers' oral health-related quality of life and children's dental fears were affected by dental rehabilitation under general anesthesia (DRGA). METHODS: A consecutive clinical sample of dyads of parents/caregivers and their four- to six-year-old children who received DRGA were surveyed before and after DRGA. Parents/caregivers responded through a self-administered questionnaire [Early Childhood Oral Health Impact Scale (ECOHIS)], and children received a dentist-administered questionnaire [children's fear survey schedule-dental subscale (CFSS-DS)]. RESULTS: The final sample consisted of 311 children/caregiver dyads. One to six teeth were extracted in 91 percent of children. There was a 44 percent decrease in total ECOHIS scores following treatment (P<.001). Overall child impact section scores decreased 34 percent following treatment (P<.001), and family impact section scores decreased 65 percent (P<.001). CFSS-DS anxiety scores after dental treatment were significantly higher for 14 of 15 situations/conditions assessed (P<.001). There was a trend of higher CFSS-DS scores in children who received increasing numbers of extractions. CONCLUSION: Children's and parent/caregivers' quality of life improved after the children received dental rehabilitation under general anesthesia, and children's fears increased for all situations tested. The number of extractions the children received was associated with increased levels of fear.