Effect of prolonged hospitalization on the maintenance of oral health: A self-report survey.

OBJECTIVES: This study aims to evaluate the effect of prolonged hospitalization on the maintenance of dental health and to assess the nursing staff's approach to addressing these concerns. METHODS: A survey questionnaire explored changes in the routine dental care of patients hospitalized for over a month. The involvement of nursing staff in addressing dental care was also evaluated. RESULTS: Fifty adult patients aged 18-89 years (mean age 62.4 ± 20.54 years), 27 (54%) males, completed the survey. During hospitalization (mean 58.59 ± 38.63 days) 26% and 18%, increased consumption of sweets and sugary beverages, between meals, respectively; 26% and 20% of the patients reduced the frequency of tooth brushing in the morning and in the evening, respectively, and 42.2% of them, reduced the quality of their toothbrushing during hospitalization. Nevertheless, 95.9% and 93.9% of them were never instructed during hospitalization to limit their consumption of sweets and sugary beverages and 83.3% and 62.5% of them had never been reminded or offered assistance during hospitalization in performing toothbrushing, respectively. The lower frequency of morning toothbrushing was significantly correlated with a lack of nurses' assistance (p = 0.004). In contrast, 62.6% reported they were reminded every day to shower. Patients in the rehabilitation and geriatrics departments reported a greater need for a brush/toothpaste (p < 0.0001) and assistance in toothbrushing (p < 0.0001). CONCLUSIONS: Prolonged hospitalization leads to significant deterioration in inpatients' dental health maintenance. Raising awareness among nurses regarding their inpatient's oral health maintenance is warranted. Providing patients with toothbrushes, toothpaste and educational materials upon hospitalization is recommended.

Overcoming local anesthesia failure during routine dental treatments in children.

BACKGROUND: Local anesthesia (LA) during routine dental treatment in children fails in 5%-35% of first attempts. No data, however, are available on the success rates of subsequent attempts. AIM: To evaluate the effectiveness of primary, secondary, and tertiary LA attempts (P-LA, S-LA, and T-LA, respectively) for anesthetizing molars during routine dental treatments in children. DESIGN: We retrospectively analyzed dental records of all children (2-18 years) who had been administered LA for the treatment of primary or permanent molars by a single paediatric dentist, between 2011 and 2022. All LAs were delivered using a computer-controlled local anesthetic delivery (CCLAD) system. RESULTS: The failure rate of P-LA in 1312 molars was 13% and correlated with age (p < .001), type of tooth (p < .001), type of treatment (p < .001), and treated arch (p < .001). The effectiveness of S-LA for buccal infiltration, intrasulcular, inferior alveolar nerve block, greater palatine nerve block (GPNB), posterior superior alveolar nerve block (PSANB), or a combination of the last two was 50%, 87.2%, 66.7%, 63.6%, 33.3%, and 100%, respectively, and was not significantly associated with age or the type of tooth, treatment, or P-LA. CONCLUSION: The optimal choice of S-LA for anesthetizing maxillary molars was a combination of PSANB and GPNB, whereas for mandibular molars, it was IS-CCLAD system.

Clinical and Radiographic Outcomes of Mineral Trioxide Aggregate Pulpotomies in Vital Permanent Teeth with Carious Pulp Exposure: A Pioneering Retrospective Study.

Purpose: Vital partial pulpotomy (PP) or cervical pulpotomy (CP) in carious pulp-exposed permanent teeth preserves tooth vitality, promotes pulp healing, decreases treatment costs, and shortens treatment duration, which is a significant factor in treating noncooperative children. The aim of this retrospective study was to compare clinical and radiographic outcomes of partial and CP in vital carious-exposed permanent teeth. Materials and methods: All vital permanent teeth with carious pulp exposure, treated by pulpotomy using mineral trioxide aggregate (MTA) during 2017-2019, by two operators in one dental center, were included in the study. Around 118 permanent teeth in 97 children and adolescents (mean age 10.9 years) were evaluated 6-57 months postoperatively. Results: The total success rates of CP and PP were 82.5 and 80.8%, respectively (p = nonsignificant). The only factor that significantly affected the success rate was the presence of preoperative periapical pathology. Teeth without such pathology showed an 87.3% success rate compared to 74.1 and 58.3% in teeth with preoperative enlarged periodontal ligament (PDL) or with periapical radiolucency, respectively (p = 0.0301). Demographic variables, maturation state of the tooth, type of tooth (incisor, premolar, molar), postoperative variables, such as the presence of radiographic dentinal bridge, partial or full obliteration of the pulp during the follow-up period, and the integrity of the final restoration during the recall examinations did not affect the success rate of the treatment. Conclusion: Partial and CP in vital permanent teeth with carious pulp exposure in children and adolescents might be a reliable alternative to full root canal treatment (RCT). How to cite this article: Yoshpe M, Kaufman AY, Lin S, et al. Clinical and Radiographic Outcomes of Mineral Trioxide Aggregate Pulpotomies in Vital Permanent Teeth with Carious Pulp Exposure: A Pioneering Retrospective Study. Int J Clin Pediatr Dent 2023;16(4):555-559.

The impact of COVID-19 lockdown on maintenance of children's dental health: A questionnaire-based survey.

BACKGROUND: The COVID-19 pandemic has been associated with several changes in maintenance of children's dental health. The aim of this study was to evaluate the extent of these changes. METHODS: Parents were asked to respond anonymously to a questionnaire regarding alterations in their children's oral habits, such as frequency of eating and drinking, toothbrushing, signs of stress, and receiving oral health care during the lockdown period. The participants were reached either during their visit to the clinics or via the social media groups of the authors. RESULTS: There were 308 parents of children aged 1 through 18 years who responded to the questionnaires. The authors found associations between increased frequency of eating and drinking, decreased frequency of toothbrushing, and postponing oral health care. Among the children, 11% experienced more frequent oral signs of stress, such as temporomandibular disorder and aphthous stomatitis, during the lockdown. Although children from all age groups ate and drank more frequently between meals, younger children received a diagnosis of carious lesions more often during the lockdown (P = .015). CONCLUSIONS: During the lockdown, many children changed their eating, drinking, and toothbrushing habits and, thus, increased their risk of developing caries. PRACTICAL IMPLICATIONS: During pandemic-associated re-care visits or recall visits, it is imperative to conduct a detailed interview regarding changes in oral health habits. In children at high risk, dentists recommended more diagnostic and preventive measures to prevent deterioration of their oral health. Moreover, dentists should put more emphasis on motivational interviewing to help children resume healthier routines after the lockdown.

Computerized three-dimensional design for accurate orienting and dimensioning artificial dental socket for tooth autotransplantation.

OBJECTIVE: To present an improved, accurate, and efficient method for planning and preparing an artificial socket for autotransplantation, by using a three-dimensional (3D) surgical guide and a replica of the transplanted donor tooth. The guide and the tooth replica were fabricated using a computerized 3D simulation. A case treated with this approach is presented. METHOD AND MATERIALS: Cone beam computed tomography (CBCT) and computerized 3D simulations (Simplant plus registration as stereolithography) were used for planning the optimal artificial socket position and dimensions, within the limitations of the alveolar bone borders and the adjacent teeth roots, and for producing a metal replica of the transplanted tooth. The replica was used to assure the correct socket preparation and orientation before extraction and replantation of the donor premolar. RESULTS: The entire procedure time for autotransplantation of a permanent second premolar to the incisor site without the buccal plate was about 45 minutes. At 15 months' follow up, clinical examination of the transplanted tooth demonstrated both normal mobility and no sensitivity to cold stimulation. A radiographic examination revealed continuous root development and pulp obliteration. The adjacent teeth maintained their vitality with no pathologic signs. CONCLUSION: We present an improved technique for autotransplantation based on computerized 3D simulations and guidance for accurate dimensioning and optimal locating of the artificial socket relative to the alveolar bone borders and the adjacent teeth roots. This technique may significantly simplify the autotransplantation procedure and will probably also increase its success rate and use in young patients, even in cases with absence of a buccal plate.

Management of Ankylotic Root Resorption Following Dental Trauma: A Short Review and Proposal of a Treatment Protocol.

Ankylotic root resorption is a serious complication following traumatic dental injuries. The aetiology of root resorption includes acute injury to the cementum and periodontal ligament, and subsequent biological processes that propagate the harm. The aim of the present paper is to present a structured treatment protocol for teeth that have experienced trauma and are at risk of developing ankylotic root resorption, followed by a decoronation protocol for situations in which ankylotic root resorption developed. This protocol provides a structured road map from the primary dental trauma, through the initial development of ankylosis detected radiographically, to the clinical manifestation that results in significant infra-occlusion. The current protocol integrates the best available evidence from the literature and from published guidelines. Ample contradictory data, which mainly consists of case reports related to the treatment of ankylotic root resorption, is available in the current literature. No accepted protocol or uniform guidelines for treatment in these cases exist, and many clinicians prefer avoiding replantation of an avulsed tooth that seems to have an uncertain longterm prognosis, or performing decoronation when infra-occlusion developed. As a result, young patients lose the benefits associated with replantation and decoronation procedures. The option of re-implantation of the avulsed teeth should be considered irrespective of the negative long-term prognosis. Following ankylosis development, the goal of submerging the tooth root (decoronation) is to maintain the horizontal dimension of the alveolar ridge and also to gain vertical dimension, allowing implant placement in the future.

Evaluation of Orthodontic and Triple-headed Toothbrushes When Used Alone or in Conjunction with Single-tufted Toothbrush in Patients with Fixed Lingual Orthodontic Appliances. A Randomized Clinical Trial.

UNLABELLED: Brushing with a single-tufted toothbrush in conjunction with a manual toothbrush has been widely recommended, although its effectiveness has not been proven. This study investigated the effectiveness of orthodontic and triple-headed toothbrushes when used alone or in conjunction with the single-tufted toothbrush in patients with fixed lingual orthodontic appliances. METHODS: In this randomized, single-blinded, controlled clinical trial, orthodontic patients (N = 26, mean age 27.3 years) with lingual fixed appliances were asked to brush with a triple-headed or an orthodontic toothbrush alone for one month, followed by brushing in conjunction with the single-tufted toothbrush for an additional month. Teeth were professionally cleaned at baseline and one month later. A clinician blinded to group assignments examined the patients and evaluated tooth plaque index, bracket plaque index, modified gingival index and bleeding on probing at baseline at one month and two months. RESULTS: After one month of brushing with the orthodontic toothbrush, the mean plaque index for tooth and bracket, bleeding index and gingival index were higher by 74.4% (0.68 vs. 0.39, p = 0.026), 54.2% (0.37 vs. 0.24), 15.4% (0.15 vs. 0.13) and 30% (0.26 vs. 0.20), respectively, than after brushing with the triple-headed toothbrush. After combined brushing with the single-tufted toothbrush, no additional statistical differences were found between groups. CONCLUSION: When used alone, the triple-headed toothbrush seems to remove plaque more effectively than the orthodontic toothbrush. The addition of the single-tufted toothbrush eliminates differences between groups.

The diagnostic and treatment challenges associated with traumatized intruded permanent incisors: a case report.

Intrusions are considered among the most severe forms of dental trauma and are associated with severe late complications. Usually general dental practitioners are the first to see and treat these children. The present case describes the challenges associated with the diagnosis and treatment of late complications of complete intruded maxillary incisors accompanied by profound buccal displacement in an 8-year-old patient. The treatments performed included root-canal treatment of right central incisor using mineral trioxide aggregate (MTA) and a combination of surgical and orthodontic repositioning of the intruded left incisor. Clinical and radiographic examinations at 2 years' follow-up revealed intact lamina dura and no sign of ankylosis in both incisors, apexogenesis of the right central incisor, and positive response to pulp testing of the left central incisor. The present report emphasizes the need to follow a child with severe dental injury and to consult with trained specialists when needed.

Pediatric intraoral high-flow arteriovenous malformation: a diagnostic challenge.

Arteriovenous malformations (AVMs) are rarely reported in the dental pediatric literature. They may develop adjacent to primary molars and can be life-threatening due to their potential for massive bleeding. The most common symptom associated with documented cases of AVMs is spontaneous gingival bleeding. Other clinical signs include pain, erythematous gingiva, resorption and mobility of teeth, soft tissue discoloration, facial swelling, and asymmetry. Radiographically, AVMs are osteolytic lesions. The purpose of this report was to describe the challenge of diagnosis of a high-flow arteriovenous malformation located in the primary maxillary molar region, which was misdiagnosed as a dentoalveolar abscess adjacent to previously treated primary molars. A decision to extract a tooth with gingival swelling and associated spontaneous bleeding should be made after the differential diagnosis of a vascular malformation has been ruled out.

Nephrocalcinosis associated with continuous enamel hypoplasia and severe alveolar bone loss: a case report and literature review.

Enamel-renal syndrome (ERS) is a rare manifestation of nephrocalcinosis that has been associated with generalized enamel hypoplasia. The purpose of this paper was to describe, for the first time, the association of enamel-renal syndrome with severe localized periodontal bone loss. A 13-year-old boy presented with: generalized hypoplastic enamel; intrapulpal calcifications; retention of primary teeth; delayed eruption of permanent teeth; enlarged dental-follicles; misshaped roots of permanent teeth; gingival overgrowth; severe localized alveolar bone loss; and severe malocclusion. His parents were first cousins, suggesting autosomal recessive inheritance. Further studies are necessary to clarify whether the etiology of the oral disturbances relates to the genetic defect in the dental tissue or to the continuous metabolic distress associated with renal dysfunction. Nevertheless, since nephrocalcinosis is often asymptomatic, dentists should refer children with generalized enamel hypoplasia or/and multiple intrapulpal calcifications to nephrologists.

Success rate of IR midazolam sedation in combination with C-CLAD in pediatric dental patients-a prospective observational study.

Objective. To evaluate the success rate of intra-rectal (IR) midazolam in combination with nitrous oxide/oxygen (N2O) sedation in young uncooperative dental patients when the local anesthesia is delivered by a computerized controlled local anesthetic delivery (C-CLAD). Study Design. This observational study consisted of 219 uncooperative children (age: 4.3 ± 1.69 y) who received IR midazolam (0.4 mg/kg) and N2O to complete their dental treatment. Measured variables included: child's pain disruptive behavior during delivery of anesthesia by C-CLAD (CHEOP Scale), child behavior during treatment (Houpt scale), dental procedure performed, and side effects that appeared during treatment. Results. There was a high level of cooperation (mean score: 6.69 ± 2.1) during administration of local anesthesia. Good-to-excellent behavior was shown by 87% of the children during treatment. Planned treatment was completed by 184 (92%) patients. No statistically significant changes were noticed in the oxygen saturation levels before and after treatment. Children with side effects included 3 (1.3%) with nistagmus, 5 (2.3%) with diplopia, and 18 (8.2%) with hiccups. Three consecutive sedations decreased the overall behavior score by 5.7% compared to the first appointment (p < .05). Conclusions. IR midazolam-N2O sedation in combination with C-CLAD is very effective for delivery of dental treatment to young uncooperative children.

Effect of Preventive Oral Hygiene Measures on the Development of New Carious lesions.

PURPOSE: To evaluate the effect of preventive oral hygiene measures on the development of new carious lesions. MATERIALS AND METHODS: Children regularly and irregularly attending recall appointments in a paediatric dental clinic were interviewed regarding their preventive measures performance. Newly developed carious lesions were also recorded. The files of 651 children were analysed. RESULTS: A significant negative correlation was found between newly developed carious lesions and total number (P < 0.001) and frequency (interval in months to the next dental examination) of recall appointments (P = 0.021), regular toothbrushing twice a day (P < 0.0001), regular brushing in the evening (P < 0.001), high fluoride concentration in toothpaste (P < 0.0001) and drinking water between meals (P = 0.015), but not with regular brushing in the morning or eating more than 6 times a day. Multivariate analysis revealed three of the variables independently correlated with the development of new carious lesions: brushing regularly twice a day, concentration of fluoride in the toothpaste greater than 1100 ppm and frequency of follow-ups. CONCLUSIONS: Regular toothbrushing twice a day is of high importance for caries prevention. Fluoride concentration of > 1100 ppm in toothpaste should be recommended for children (considering the child's age) in order to maximise the fluoride protective effect. The importance of attending periodic recall appointments in order to maintain long term oral health should be emphasised.

Oral hygiene instructions provided by dental hygienists: results from a self-report cohort study and a suggested protocol for oral hygiene education.

OBJECTIVE: To investigate the extent to which dental hygienists target their efforts toward patients' oral hygiene instruction. METHOD AND MATERIALS: A population of 179 dental hygienists who attended an annual meeting were given a structured anonymous questionnaire to assess information regarding their habits of instructing patients about oral hygiene measures. RESULTS: The dental hygienists were females aged 21 to 68 years (mean age 39.05 ± 18.18); 49.7% worked in private practice, 21.7% in public practice, and 28.57% in both. Overall, 70.9% reported that they provided oral hygiene instruction to all their patients; 28.5% to most of their patients; and 0.6% reported that they never provided oral hygiene instruction. Among the participants, 54.5% reported giving instruction at every treatment, 41% at every periodic treatment, and 4.5% only on first meeting. The reasons for not instructing their patients included: lack of time (21.7%), the patients know how to brush (61.5%), and the patient appears uninterested (23.6%). Most of the participants (77.7%) reported giving the same hygiene instructions for patients at high and low risk for caries and/or periodontal disease. CONCLUSION: Participants did not use enough demonstration methods in order to improve their patients' performance. Dental hygienists should pay more attention to instruction and education regarding oral hygiene preventive measures. Dental practitioners employing hygienists should encourage oral hygiene instruction programs in their clinics. Those programs should include repetitious demonstrations and reinforcement in order to improve overall outcome and prevention of future disease.

Metal tooth-like surgical templates for tooth autotransplantation in adolescents.

OBJECTIVES: The aim of this study was to suggest a way to fabricate surgical templates to assist the surgeon in preparing the recipient socket when performing premolar autotransplantation. METHODS: Premolars used previously for extractions of periodontal ligament (PDL) fibroblasts were used in this study as archetype of models for tooth transplantation. Eighty-four mandibular and maxillary first and second extracted premolars were reviewed. All teeth were extracted for orthodontic reasons. From these teeth, eight teeth were selected to serve as archetype of models in which all the other teeth were at equal size or smaller in maximum 2 mm in M-D or B-L dimension. These teeth were sent to dental technician to perform identical archetype stainless steel templates. During autotransplantation immediately following donor tooth extraction, the appropriate template is chosen out of the toothlike stainless steel surgical templates and the donor tooth is then immediately replaced in its socket. This enables the surgeon to prepare the recipient site without manipulating the donor tooth and thus preventing damage to the PDL cells of the donor tooth. Only after the recipient site had been prepared to the appropriate size and shape according to the template, the donor tooth is removed from its socket, immediately placed at the recipient site and splinted as recommended. CONCLUSIONS: The advantage of the presented metal tooth-like surgical templates described in this study is that a set of stents has been produced by replicating different common shape adolescent premolars that reflect the biological variation in size and shape of these teeth.

Successful conservative treatment of dentigerous cyst following intrusion of lower primary incisors.

This paper reports on the development of a dentigerous cyst associated with a lower permanent incisor following intrusion of two lower primary incisors. The small root remnant of one of the traumatized primary incisors was associated with granulation tissue, while the second incisor was discolored and suspected of being non-vital. The associated permanent incisor and other adjacent incisors were apically and laterally dislocated from their natural site of eruption. The conservative treatment included extraction of the involved primary discolored incisor, as well as the root remnant, followed by removal of the granulation tissue. After 18 months of follow-up, the permanent incisors were erupting in normal position, without pathological signs of the dentigerous cyst. Following severe traumatic injury to a primary tooth, periodic radiographic follow-up, until eruption of the correspondent permanent tooth, is recommended.

Alveolar bone width preservation after decoronation of ankylosed anterior incisors.

INTRODUCTION: The aim of the study was to assess the alteration of alveolar ridge dimensions after decoronation procedures in children and adolescents at least 1 year after surgery. METHODS: Twelve children who underwent decoronation of ankylosed maxillary anterior incisors with at least 1 year after surgery follow-up were recalled for reevaluation. All decoronations were performed when the ankylosed teeth were submerged 1-1.5 mm. During the recall appointment, impressions of the upper arch were obtained. The bucco-palatal alveolar dimensions of the decoronated teeth were measured on the cast at the mid-mesiodistal distance from the missing tooth and were compared with the distance from the contralateral healthy incisor. RESULTS: Overall, 12 children (9 male and 3 female) were reevaluated up to 82 months after decoronation (mean, 49.58 ± 24 months). The mean age of the patients at the time of trauma was 9.83 ± 2.8 years. The average bucco-palatal dimension of the alveolar ridge at the mid-decoronation area was 9 ± 1 mm compared with 10.17 ± 0.9 mm at the contralateral homologous tooth (difference of 1.67 ± 1.12, P = .004). The findings show a positive statistical correlation between the duration of the follow-up period and the bucco-palatal dimension of the alveolar ridge (P = .027). CONCLUSIONS: Although decoronation of ankylosed young permanent incisors resulted in a decrease in the bucco-palatal dimension with time, it did not prevent additional alveolar growth that occurs with age in a developing child and thus may help maintain the alveolar bone ridge width, height, and continuity and assist in future rehabilitation with less invasive ridge augmentation procedures required for implant placement.

The relationship between nurses' oral hygiene and the mouth care of their patients.

To investigate the extent to which a relationship may exist between nurses' own oral hygiene and their commitment and capability of following instructions for tooth brushing with conventional and triple-headed toothbrushes, to cerebral palsy (CP) children. The study included 43 individuals with CP and their 44 nurses. A structured questionnaire was designed to assess I. Demographic characteristics of the nurses II. Nurses' knowledge and maintenance of their own oral-hygiene and that of their CP patients. Nurses' ability to follow instruction for tooth-brushing was evaluated and scored using the TB-PS-I/Ashkenazi index following the first brushing, as well as on a recall visit one month later. More nurses (72.7%) reported routine tooth-brushing in the morning than in the evening (40.9%). Most nurses (73%) reported not flossing their teeth at all, and more than half reported visiting their dentist only when they suffer pain. A positive correlation was found between the nurses' knowledge of preventive oral measures and their compliance with their own oral hygiene and with that of their CP patients. Similarly, a positive correlation was found between nurses' receiving previous instruction for correct oral hygiene and their maintenance of their patients' oral hygiene. Institutions for CP patients should disseminate information on oral hygiene to staff, as a means of increasing their maintenance of their patients' oral health.

The effect of toothbrush design on the ability of nurses to brush the teeth of institutionalized cerebral palsy patients.

AIM: To compare the effectiveness of two toothbrush designs in tooth brushing by nurses of individuals with cerebral palsy. METHODS: Following instruction, nurses brushed the teeth of 21 individuals with a single-headed-toothbrush, and 22 with a triple-headed-toothbrush. After one month, the nurses brushed their patients with the other toothbrush, following instruction. Tooth brushing performance skill was evaluated and scored using the TB-PS-I/Ashkenazi index following the first brushing as well as on a recall visit one month later. RESULTS: After 1 month, 7.6% of the nurses required further instruction following brushing with the triple-headed toothbrush compared to 15% after brushing with the single-headed. Reductions in plaque and gingival indices were greater after using the triple- headed than single-headed toothbrush. More nurses preferred the triple-headed toothbrush (75.5% compared to 22.6%). CONCLUSION: Brushing by nurses of cerebral palsy patients was more effective and instruction better retained with a triple-headed compared to single-headed toothbrush.

Radiographic changes associated with pulp infection in primary incisor roots and in their developing permanent dental follicles.

PURPOSE: Early diagnosis and treatment of pulp infection in primary incisors are important for preventing systemic infection and damage to the permanent tooth bud. The purpose of this retrospective case-control study was to identify radiographic changes associated with pulp infection in primary incisor roots and their developing permanent dental follicles. METHODS: Oblique occlusal radiographs of 102 primary maxillary incisors with sinus tracts were compared to 390 radiographs of incisors from healthy same-age children. RESULTS: Compared with controls, teeth with sinus tracts had more inflammatory root resorption (odds ratio [OR]=50.7, P<.001), pulp pathosis (OR=13.0, P<.001), deep caries (OR=3.9, P<.001), past traumatic injury (OR=3.4, P<.001), enlarged dental sac (OR=10.8, P<.001), loss of lamina dura of the dental sac (OR=27.5, P<.001), and increased radiolucency of the dental sac of the corresponding permanent tooth bud (OR=19.5, P<.001). In multivariate logistic regression, 2 variables were associated with radiographic changes in the primary root (inflammatory resorption, P<.001; and pulp pathosis, P=.004). Two variables associated with changes in the permanent tooth bud (loss of lamina-dura and increased radiolucency) were independently associated with the presence of a sinus tract, P<.001. CONCLUSION: Deep caries, inflammatory resorption, pulp pathosis, loss of lamina-dura, and increased radiolucency of the dental sac were statistically associated with presence of a sinus tract.

Assessment of parental tooth-brushing following instruction with single-headed and triple-headed toothbrushes.

PURPOSE: The purpose of this study was to evaluate the effect of toothbrush design on the ability of parents to effectively brush their children's teeth. METHODS: Parents of children (mean age=5.1±0.75 years old) from 4 kindergarten schools were randomly assigned to receive instruction in brushing their children's teeth using a manual single-headed toothbrush (2 schools) or a triple-headed toothbrush (2 schools). The parents' ability to brush their children's teeth was evaluated according to a novel toothbrush performing skill index (Ashkenazi Index), based on 2 criteria: (1) placement of the toothbrush on each tooth segment to be brushed ("reach"); and (2) completion of enough strokes on each segment ("stay"). One month after instruction, tooth-brushing ability was re-evaluated and plaque index of the children's teeth was assessed. RESULTS: One month after instruction, parents using the triple-headed toothbrush received significantly higher scores on the tooth-brushing performance index (~86%), than did those in the single-headed group (~61%; P=.001). The plaque index was significantly higher in the single-headed group (0.97±0.38) vs the triple-headed group (0.72±0.29; P<.01). The tooth-brushing performance index correlated negatively with the plaque index (P<.01). CONCLUSIONS: A triple-headed toothbrush promotes more consistent tooth-brushing by parents than does a single-headed toothbrush.