Case report: A medieval case of molar-incisor-hypomineralisation.

INTRODUCTION: Molar-incisor-hypomineralisation (MIH) has been identified in recent years as a condition affecting the first permanent molars and, in some cases, the permanent incisors. Many factors have been suggested as to its aetiology. Examples of MIH have also been reported in skeletal remains in the past. These historical examples have, however, been for unknown individuals. CASE REPORT: A skull that has become available for dental examination that is uncertainly attributed to be that of Lady Eleanor Talbot (c.1436-1468) who ended her life as a Carmelite nun in Norwich (England). The dental findings of the examination showed enamel defects of molar teeth 36 and 46, as well as small areas on other molars, and striations of the enamel of permanent anterior teeth consistent with MIH. There is exposure of the roots of some maxillary teeth with resultant root caries. The presence of areas of enamel decalcification commensurate with 'Turner teeth' on 43 and 44 indicates that there were likely to have been periapical abscesses secondary to dental caries of the primary teeth. In addition, there is occlusal wear of all of teeth with extensive calculus and periodontal exposure of the roots of the mandibular incisors. Failed development or very early ante-mortem loss of premolars 15 and 25 is evident, as well as evidence in the same region of a large abscess cavity with extensive maxillary bone destruction. Healing cribra orbitalia, porosity, which is considered to be an indicator of nutritional stress, is visible on the superior aspect of the left orbit. CONCLUSION: A case of MIH is reported in a skull dating from the mid-15th century.

The conduct of dental research: the protocol, a guide.

BACKGROUND: Research today requires detailed planning to ensure efficient work, to raise funding and to fit into time constraints. AIM: The aim of this article is to provide a broad guidance on the layout and content of a research protocol. METHOD: Years of experience in writing research protocols were used to give guidance on writing, timings, content, layout and successful completion.

Submitting an application for research ethics clearance.

BACKGROUND: Research involving human subjects requires approval by a research ethics committee before commencement. What appears to many researchers to be a daunting task can be relatively easy if approached sensibly. AIM: The aim of this paper is to offer advice to potential applicants for ethics approval of their research. METHOD: The paper provides practical information, based on years of experience, for novice and experienced applicants to a research ethics committee.

Writing scientific papers for publication: "Without publication research is sterile".

BACKGROUND: The publication of basic science and clinical research findings, as well as new clinical diagnosis and treatment techniques, is widely disseminated. These days there is considerable competition to publish so the selection process is even more competitive. AIM: To present advice as to how to enhance the chances of being published and more importantly how to prepare a paper for submission. METHOD: Instructions are presented as to the steps to be taken in writing a scientific manuscript. This covers Introduction, Materials and Methods, Results and Discussion. Guidance is given as to what should be included and also what should be left out. The precision of writing is paramount and scientific text needs to be simple, easily read and translated by those whose day-to-day language is not English. Advice is given on journal selection and how to ensure the best chance of manuscript acceptance.

Congress abstracts: preparing abstracts for submission and successful acceptance.

AIM: To provide guidance on writing congress abstracts for submission and how to increase the chance of acceptance. REVIEW: There is increasing competition for submitted abstracts to be accepted by scientific congresses. Because the facilities or size of a congress may be limited a selection process is often used based upon the quality of abstracts submitted. Accordingly, it is crucial for a researcher to prepare an abstract very carefully to ensure the best chance of acceptance. The approaches to preparing an abstract and the techniques for enhancing quality are reviewed. Suggestions and guidance are given to ensure the production of a well structured, informative and scientifically sound abstract.

Reviewing scientific manuscripts.

AIM: To provide guidance on reviewing scientific manuscripts for publication. REVIEW: Scientific peer review is possibly one of the most important tasks a scientist is asked to do. It carries a great responsibility and needs to be conscientiously and thoroughly carried out. It is most important that a reviewer decides very quickly whether to undertake a review and if so to complete the task. It must at all times be objective, as positive as possible and seen as contributing to the advancement of our knowledge. This review provides suggestions as to best practice in reviewing a scientific manuscript in dentistry. The various aspects of importance: accepting or declining a review, objectivity, approaches to reading and taking notes, assessment of methods, validity and reproducibility of results and evaluating a discussion, are covered in detail and the standards that are required considered. Suggestions are made as to how a review should be reported.

Review: behaviour management techniques in paediatric dentistry.

BACKGROUND: Behaviour management is widely agreed to be a key factor in providing dental care for children. Indeed, if a child's behaviour in the dental surgery/office cannot be managed then it is difficult if not impossible to carry out any dental care that is needed. It is imperative that any approach to behavioural management for the dental child patient must be rooted in empathy and a concern for the well being of each child. REVIEW: Based on various presentations given at Congresses of the European Academy of Paediatric Dentistry (EAPD), documents reviewing behaviour management prepared by the Clinical Affairs Committee of the EAPD, and written submissions to the Executive Board of the EAPD, a review of the various approaches to the behaviour management of the child dental patient was completed. All aspects of non-pharmacological behavioural management techniques described in the literature over the past 80 years were reviewed. FINDINGS: There is a very wide diversity of techniques used but not all are universally accepted by specialist paediatric and general dentists. Wide cultural and philosophical differences are apparent among European paediatric dentists that seem difficult to bridge when forming agreed guidelines. Accordingly, this review highlights those behaviour techniques that are universally accepted such as tell, show, do (TSD) or positive reinforcement, but nevertheless describes the most commonly mentioned techniques for which there are descriptions in the literature. CONCLUSION: A wide variety of behavioural management techniques are available to paediatric dentists which must be used as appropriate for the benefit of each child patient, and which, importantly, must take into account all cultural, philosophical and legal requirements in the country of dental practice of every dentist concerned with dental care of children.

A review of slow-release fluoride devices.

BACKGROUND: Fluoride has been used to combat dental caries using a number of different clinical approaches. An exciting relatively new development is fluoride slow-releasing devices that consistently elevate intra-oral fluoride levels of plaque and saliva for prolonged periods of up to two years. METHODS: The literature on the use of slow-releasing fluoride devices in dentistry were reviewed. A Medline search on key words was carried out. All papers in English were individually reviewed. RESULTS: Slow-releasing fluoride devices have been shown to be effective in elevating salivary fluoride levels in both animals and human studies and to enhance the remineralisation of dental enamel. They have been demonstrated to be safe to use and without the risk of fluoride toxicity. A double blind randomised clinical trial demonstrated 76% fewer new carious surface increment in high caries-risk children after two years. CONCLUSIONS: These devices have a number of potential uses in dentistry and in particular have great potential for caries prevention of non-compliant high caries-risk groups.

Sucrose and dental caries: a review of the evidence.

The aim of this study was to conduct a review of the literature to assess the relationship between quantity and pattern of sucrose use and dental caries. Using hand and electronic methods (MEDLINE, EMBASE) the literature was searched for epidemiological papers concerning any relationship of sugars and dental caries published since 1856. Superficial hand searching was carried out between 1856 and 1940, detailed hand searching 1940-1966 and electronic 1966-2007. Selection criteria were set based on, but not confined to, Cochran style standards. Investigations were categorized as A, fulfilling all criteria; B1, relevant fulfilling 19 of 23 criteria; B2, relevant but fulfilling only between 12 and 18 of the selection criteria; and C, all other papers. There were 95 papers meeting most (more than 12) or all of the selected criteria. Only 1 paper was graded A; 31 as B1. There were in addition some 65 as B2 and all the rest as C, which were discarded. There were a wide variety of study designs and those graded A or B1 comprised 23 ecological cross-sectional, 7 cohort and 2 case control studies. Summary results showed that 6 papers found a positive, significant relationship of sugar quantity to dental caries, 19 of 31 studies reported a significant relationship of sugar frequency of use to dental caries. The balance of studies does not demonstrate a relationship between sugar quantity, but a moderately significant relationship of sugar frequency to dental caries.

Restoration of primary teeth: clinical criteria for assessment of the literature.

AIM: This is was to establish a system of clinically based criteria for the assessment of papers published in peer reviewed journals concerning the use of restorative techniques in primary teeth. BACKGROUND: Various publications that consider the approaches to be taken to setting up assessment criteria with the dental/medical literature were reviewed. These included the so called 'Cochrane criteria'. On the basis of this review a set of clinically based criteria were drawn up that were then used to produce a list of criteria to be used in a series of systematic reviews of the literature concerning the various restorative techniques, materials and medicaments for pulp therapy and the restoration of primary teeth. RESULTS: There were 23 criteria that were felt to be appropriate. The list of 23 criteria were deemed to be appropriate for pulp therapy and 21 for restorative techniques and materials. Conclusion.A set of clinically based criteria is suggested for the systematic review of publications on restorative techniques for primary teeth.

Cost-effectiveness of a long-term dental health education program for the prevention of early childhood caries.

AIM: To evaluate the benefit-cost (B/C) and cost-effectiveness (C/E) of a long-term dental health education program to prevention early childhood caries (ECC) through home visits. METHODS: The data collected over a three year period in a dental health education programme (DHE), previously reported [Kowash et al., 2000] for infants aged 8 months at start were analysed for B/C and C/E. Dental caries indices (BASCD) for dmft and dmfs were used. Costs were based on British National Health Service (UK) fees for treating children by general dental practitioners and salaries for community dental officers in the Community Dental Services in the UK. Comparisons were made for B/C and C/E with results from a clinical trial of a slow releasing fluoride device (SRFD), community water fluoridation (CMF) and a school based fissure sealant program (FSP) using the hypothetical community of Niessen and Douglass, [1984]. RESULTS: The cavities, as ECC, saved over the three year period indicated a B/C ratio for the DHE of 5.21 compared with SRFD of 4.17; CWF of 1.15 and FSP of 0.42. The C/E results were 1.92, 2.40, 8.66 and 23.74 respectively. CONCLUSION: A dental health education program of home visits with mothers of young infants to prevent early childhood caries and starting at 8 months of age, gave better benefit-costs and costs effectiveness ratios than other preventive programs.

Slow-release fluoride glass devices: in vivo fluoride release and retention of the devices in children.

AIMS: To study the fluoride release and retention of new-shaped glass slow-release F devices (SRFD) in vivo in children. METHODS: A group of 15 children had a SRFD with 17.4% or 14.8 mgm F with a relative solubility of 294, attached intra-orally on the buccal surface of one of their maxillary permanent molars. The devices were monitored for six months. RESULTS: The retention rate of the devices was 93% and the mean salivary F levels in the child volunteers was 01.17+/-0.1 ppm F compared with 0.025 ppm F baseline levels. The difference was statistically significant (p<0.01). There were no systemic or local side effects. CONCLUSIONS: The devices were well tolerated by children and released fluoride intra-orally for the whole period of six months to a level consistent with inhibition of demineralisation.

Soft drinks and dental health: a review of the current literature.

In recent years there has been increased interest in the role of commercial soft drinks in dental diseases namely as dental caries and erosion. The objective of this paper has been to review the past and current literature to determine the present knowledge on this subject. The literature related to dental caries, erosion, drinks, soft drinks and fruit juices was reviewed. The literature shows efforts have been taken to modify soft drinks by either adding or deleting certain components so as to reduce their harmful effects on teeth. A rational protocol to encourage the sensible use of drinks and the modification of drinks to render them less harmful would be advisable.

A clinical trial of a slow-releasing fluoride device in children.

The objective was to test a fluoride-containing slow-release device in preventing dental caries in children. Accordingly a population of 174 children aged 8 years living in a high-caries, low socio-economic area of Leeds (UK) was assembled. Two slow-release/dissolving glass (SFG) pellets, one with fluoride (F) and one without, were randomly attached to the maxillary molars of the children. Baseline caries as dmft/s, DMFT/S, periodontal disease, plaque and calculus were recorded using standard indices. Unstimulated saliva samples were collected 2 h postprandial for F analysis. All parameters were measured at 6-month intervals for 2 years. There were 132 children completing the trial of whom 63 (test n = 31, control n = 32) still retained the glass devices at the end. Comparison of mean values for gingival health and calculus showed no differences between groups throughout the trial. Mean caries as dmfs at the end of the trial (2.26) was significantly lower for the test (SFG, 2.26) compared with that for the control children (8.41; p < or = 0.001). DMFS was significantly lower at 0.84 and 2.34, respectively (p < or = 0.05). Mean salivary fluoride concentrations were 0.11 and 0.03 mg/l for test and control groups. It was concluded that placement of a glass slow-releasing fluoride device significantly reduced caries incidence in a group of low socio-economic schoolchildren over 2 years.

A prospective comparison between findings from a clinical examination and results of bitewing and panoramic radiographs for dental caries diagnosis in children.

AIM: To compare the findings of a clinical examination with those from bitewing (BW), panoramic (Pan) and panoramic plus bitewing (PanBW) radiographs for dental caries in children. METHOD: A population of 39 children, aged 3.8 to 11.9 years, who required radiographs as part of their initial assessment for care in the Department of Paediatric Dentistry (Leeds), was selected. Each subject was examined clinically for dental caries. Subsequently, a paediatric dentist and a specialist in dental radiography read the radiographs. ANALYSIS: A database in Microsoft Access was used to compare the examiners readings for each radiographic view; agreements were taken to be a consensus. Disagreements were re-viewed by both examiners to arrive at a consensus. Radiographic results were compared with those of the clinical examination. RESULTS: The clinical examination identified 6.0% (95% CI 4.1 to 7.8, p<0.001) more carious surfaces than Pan. Clinical examinations also identified more carious surfaces than BW 1.2% (95% CI -0.7 to 3.2, p<0.247) and PanBW 0.6% (95% CI -1.1 to 2.3, p<0.533) but these differences were not statistically significant. When occlusal surfaces only were compared, the clinical examination identified significantly more carious occlusal surfaces then BW (15.2%, p<0.001), Pan (17.1%, p<0.001) and PanBW (13.5%, p<0.001). Comparing the approximal surfaces only, the BW and PanBW identified significantly more carious surfaces than the clinical examination, 5.1% (p<0.001) and 4.3% (p<0.001) respectively. CONCLUSION: The use of a clinical examination with PanBW provided the maximum information on dental caries in the primary and mixed dentitions, particularly for approximal surfaces. This is important in planning comprehensive dental care for children.