Postoperative pain profile in 10-15-year-olds after bilateral extraction of maxillary premolars.

PURPOSE: To study pain perception in 10-15-year-olds, during and after uncomplicated extractions of bilateral maxillary premolars. The study investigated pain's natural course and made comparisons between the first and second extractions. METHODS: 31 Swedish children in need of orthodontic treatment were identified and consecutively enrolled. Tooth extractions followed a standardised protocol and the two teeth were extracted with at least 10 days between. The participants rated pain intensity using visual analogue scale (VAS) at 14 different time points from treatment and 7 days forward. RESULTS: The pain intensity profile followed the same pattern for all patients. Pain intensity peaked 2 h after extractions (mean VASPI 27.3, SD 20.8; median 23.0) when moderate pain intensity (VASPI ≥ 40) was registered for 16 (28%) of 57 cases. After that, there was a rapid decrease in pain intensity notable already at 4 h after extractions. There were no statistically significant differences in any VASPI measurements between the first and second extractions, sexes, or different age groups. CONCLUSIONS: The majority of the participants who undergo uncomplicated bilateral extraction of maxillary premolars experience mild to moderate levels of postoperative pain during a short period of time, with no differences between the first and second extractions. Bilateral tooth extractions is a suitable model for further studies on pain management.

Best clinical practice guidance for local analgesia in paediatric dentistry: an EAPD policy document.

BACKGROUND: The European Academy of Paediatric Dentistry (EAPD) proposes this best-practice guidance to help practitioners to decide when and how to use local analgesia to control pain in children, adolescents, and medically compromised individuals during the delivery of oral health care. METHODS: A search of different databases was conducted using all terms relevant to the subject. Relevant papers were identified after a review of their titles, abstracts or full papers. Three workshops were held during the corresponding EAPD interim seminar in Torino (Italy) in 2017. Several statements were agreed upon and, furthermore, knowledge gaps were identified. RESULTS: An important outcome was that when local analgesia administered appropriately-correct choice of agent(s) and dosage, proper route of administration-it is, firstly, clinically effective for pain-control in treating children and, secondly, it carries a very low risk of morbidity including adverse or side-effects. Furthermore, several gaps in knowledge were identified during the workshop which indicates future research needs. Most importantly it remains unsatisfactory that in several European countries the most frequently used injectable local analgesic agent, articaine, is not approved for usage in children below the age of 4 years. CONCLUSION: When considering the dental demand to treat vulnerable (medically compromised) children and adolescents in a safe, painless, less-invasive and effective way, there seems to be an urgent need to close these gaps in knowledge.

Local analgesia in paediatric dentistry: a systematic review of techniques and pharmacologic agents.

PURPOSE: To evaluate the evidence supporting effects and adverse effects of local analgesia using different pharmacological agents and injection techniques during dental treatment in children and adolescents aged 3-19 years. METHODS: A systematic literature search of databases including PubMed, Cochrane, and Scopus was conducted in November 2016. The PRISMA-statement was followed. Two review authors independently assessed the selected randomised control trials for risk of bias and quality. RESULTS: 725 scientific papers were identified. 89 papers were identified to be read in full text of which 80 were excluded. Finally, 9 papers were evaluated for quality and risk of bias. Many of the included papers had methodological shortcomings affecting the possibility to draw conclusions. Information about ethical clearance and consent were missing in some of the included papers. No alarming adverse effects were identified. One study was assessed as having low risk of bias. This reported inferior alveolar nerve block to be more effective than buccal infiltration for dental treatment of mandibular molars, while no differences were found regarding pharmacological agents. CONCLUSIONS: At present, there is insufficient evidence in support of any pharmacologic agent or injection technique as being superior compared to others. There is a need for more rigorous studies which also handle the ethical issues of including children in potentially painful studies.

Sweet Taste Perception and Dental Caries in 13- to 15-Year-Olds: A Multicenter Cross-Sectional Study.

Dietary habits and, in particular, the intake frequency of sucrose are of major importance for the development of dental caries. The perception of sweet taste is believed to have an influence on sucrose intake and therefore affects the predisposition to dental caries. The aim was to study the caries experience and sweet taste perception and to further analyze the possible relationship between the 2 tested variables in 13- to 15-year-old children from 3 different geographical areas. A cross-sectional survey comprising 669 children (220 Italian, 224 Mexican, and 225 Saudi Arabian) was conducted. The children were examined in their school setting. A sweet taste perception level was determined by the sweet taste threshold (TT) and sweet taste preference (TP). The sweet test was performed with sucrose solutions varying in concentration from 1.63 to 821.52 g/L. The International Caries Detection and Assessment System (ICDAS) and DMFS indices were used to diagnose caries. The highest mean value for TT was found for Italian children followed by Saudi and Mexican. Saudi schoolchildren showed the highest mean values for TP and DMFS, followed by Italian and Mexican. A statistically significant difference for TP, TT, DMFS, and initial caries was found between the 3 countries. A weak yet positive correlation was found between taste perception (TT and TP) versus DMFS and manifest caries in all 3 countries (r = 0.137-0.313). The findings of the present study showed a variation in sweet taste perception between the 3 countries, which may influence the caries outcome of the children in the individual countries.

Perceived oral discomfort and pain in children and adolescents with intellectual or physical disabilities as reported by their legal guardians.

AIM: This was, firstly, to study the occurrence of oral pain and discomfort, using the Dental Discomfort Questionnaire (DDQ), in children and adolescents with intellectual or physical disabilities, compared with controls. Secondly, was to analyse the relationship between pain and discomfort, as measured by the DDQ, and dental health, as well as oral hygiene habits and dietary habits. METHODS: The study included 135 children and adolescents (12-18 years), registered at the Child and Adolescent Habilitation Unit in Göteborg and Södra Bohuslän, Sweden, and 135 gender- and age-matched controls. The children's legal guardians completed a questionnaire comprising the DDQ and questions on oral hygiene and dietary habits. Data on dental health were retrieved from dental records. RESULTS: The DDQ total mean score was higher for the study group, compared with the control group, 3.2 (SD 2.9) vs. 1.6 (SD 2.0), respectively (p = 0.001). Furthermore, children and adolescents with a severe intellectual disability had higher total mean DDQ scores than children with a mild intellectual disability, 4.8 (SD 4.2) vs. 2.4 (SD 2.9), respectively (p = 0.034), and also higher than children with a physical disability, 2.2 (SD 2.1) (p = 0.012). There were no differences in DMFT between children with disabilities and age-matched controls. There was no relationship between the DDQ scores and oral hygiene/dietary habits in children with disabilities. CONCLUSIONS: Children and adolescents with intellectual or physical disabilities experienced oral discomfort and pain more often than matched controls. Dental health expressed as DMFT could not be related to the DDQ responses.

22q11 deletion syndrome - the meaning of a diagnosis. A qualitative study on parental perspectives.

BACKGROUND: The 22q11 deletion syndrome (22q11DS) is one of the most common multiple anomaly syndromes, with an incidence of approximately one per 4000 newborns. Although a patient may have several not too severe symptoms, the cumulative effect may be substantial disability. The aim of this study was to explore and describe parents' experiences of the diagnostic process and of being parents of a child with 22q11DS. METHODS: Open, tape-recorded interviews were carried out with 12 parents. The interviews were analysed in accordance with classical grounded theory. RESULTS: The analysis show that parents describe the disclosure of their child's medical diagnosis as two-sided, ambivalence between relief and sorrow, and the differences between these two aspects were related to the age of the child at time of diagnosis as well as to the problems and symptoms that had led to the diagnosis. Different strategies for handling this ambivalence are presented in the categories. CONCLUSIONS: Our conclusions are that information must be individually tailored, and there is no standard format for how to describe the syndrome to the parents. After disclosure, scheduled appointments for follow-up on diagnosis-related information is essential.

A survey of specialist paediatric dental services in Sweden: results from 2003, and trends since 1983.

UNLABELLED: The child population in Sweden has changed dramatically during the last 20 years. Changes have also occurred within the Public Dental Service (PDS), regarding the provision of dental care to children and adolescents. All these changes may affect the referral pattern and provision of specialist dental care for children and adolescents. OBJECTIVES: The primary aim of this study was to survey the services provided by specialists in paediatric dentistry in Sweden during 2003. A secondary aim was to compare the results with previous surveys. METHODS: A Web-based survey was sent to all 34 specialist paediatric dentistry clinics and was answered by all clinics. Data were compared with results from the surveys performed in 1983, 1989, and 1996. RESULTS: The number of paediatric dentists had been relatively constant over the last 20 years, whereas the number of children referred to paediatric dentists had increased by 28% since 1983. It was estimated that 1.3% of all children in Sweden are treated at a specialist paediatric dental clinic in 2003. Dental treatment need in combination with behaviour management problems (BMP) was the main reason for referral and occurred in 37% of all referrals. The proportion of medically compromised children/children with disabilities had increased from 6% in 1983 to 22% in 2003. The number of patients treated using sedation and general anaesthesia had increased since 1983, and particularly since 1996. CONCLUSIONS: Despite improvements in dental health among children and adolescents in Sweden during the last 20 years, an increasing number of children are referred for specialist paediatric dental treatment. There is an urgent need to increase the number of specialist paediatric dentists in Sweden in order to ensure the continuation of high quality of dental care for children and adolescents.

Oral manifestations in 22q11 deletion syndrome.

OBJECTIVES: The aims of this study were to investigate and describe oral manifestations in 22q11 deletion syndrome, and to relate the findings to medical conditions. DESIGN: Cross-sectional. SAMPLE AND METHODS: Fifty-three consecutive patients from Sweden referred to the Sahlgrenska University Hospital during a 3-year period were included, median age 8 yrs (range 2-43; mean age 11.09). All but six patients were children 3-19-years-old. The patients were examined concerning oral mucosa, dental anomalies, dental caries, occlusal development, and eruption of the teeth. The clinical findings were compared to medical data and case history. RESULTS: Dental anomalies were registered in high numbers. Enamel hypoplasia was found in 16 patients. In 13 cases this was documented in primary teeth, of which 10 patients had symmetrical and chronological defects. Enamel hypomineralization was found in 23 patients and was equally common in both primary and permanent teeth. The use of computerized inductive analyses revealed that enamel hypoplasia was associated with medical conditions like preterm birth and congenital heart malformation while hypomineralization was associated with more diffuse conditions like frequent infections. Hypodontia was registered in seven patients, while eight had aberrant tooth shape, and nine patients presented delayed tooth eruption. The patients had an average of 4.6 carious or filled teeth and the oral health was assessed as impaired in 15 patients who had severe dental caries (5-18 carious teeth or multiple active incipient caries lesions). CONCLUSIONS: In 22q11 deletion syndrome the oral cavity is affected by anomalies in dental enamel, tooth shape, numbers of teeth, and eruption. Dental health problems due to caries are common. This is of special importance as patients with 22q11 deletion syndrome frequently present with congenital heart malformations and immunological problems.

Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars.

OBJECTIVES: To assess the demand for restorative treatment, dental anxiety and dental behaviour management problems among children with severe hypomineralization of their first molars (MIH). DESIGN: Case control study. SAMPLE AND METHODS: Data were compiled from the dental records of 32 9-year-old children with severe enamel hypomineralization of their first molars and from 41 controls of the same age group concerning dental health, a number of restorative treatments, use of local anaesthesia and clinical behaviour management problems (BMP). A questionnaire containing specific questions on children's experiences of dental care and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), was answered by the parents. RESULTS: The children in the study group had undergone dental treatment of their first molars nearly 10 times as often as the children in the control group. Repeated treatments of these teeth at brief intervals were common. The dental treatment was often undertaken without the use of local anaesthesia, and BMP, and dental fear and anxiety (DFA) were more common than in the controls. CONCLUSIONS: Children with severe enamel hypomineralization of their first molars had had to undergo a considerable amount of dental treatment. It is reasonable to assume that experiences of pain and discomfort on repeated occasions were related to the occurrence of BMP in patients with MIH. An early treatment planning and prognostication based on increased knowledge of hypomineralized first molars is desirable. Local anaesthesia and other pain-reducing techniques, e.g. sedation, should be used when treating these teeth. Extraction should be considered in cases of extensive disintegration of the crown, in cases of frequently repeated treatments or when pulpal symptoms are hard to cure.

The prevalence of demarcated opacities in permanent first molars in a group of Swedish children.

The permanent teeth of 516 7- and 8-year-old Swedish children from a low-fluoride area were examined for developmental enamel defects. Special attention was paid to demarcated opacities in permanent first molars and permanent incisors (MIH). The examination was done in their schools, using a portable light, a mirror, and a probe. The modified DDE index of 1992 was used for recording the enamel defects, supplemented with a further classification into severe, moderate, and mild defects. Demarcated opacities in permanent first molars were present in 18.4% of the children. The mean number of hypomineralized teeth of the affected children was 3.2 (standard deviation, 1.8), of which 2.4 were first molars. Of the children 6.5% had severe defects, 5% had moderate defects, whereas 7% had only mildly hypomineralized teeth. In conclusion, hypomineralized first molars appeared to be common and require considerable treatment in the Swedish child population.

Etiologic factors influencing the prevalence of demarcated opacities in permanent first molars in a group of Swedish children.

The aim of this study was to determine possible etiological factors for a developmental enamel defect, i.e. demarcated opacities, affecting the permanent first molars. A questionnaire about possible etiological factors of enamel developmental defects was filled in by the parents of 8-yr-old children (n=516) prior to a dental examination of permanent teeth. Demarcated opacities of permanent first molars had been found in 18.4% of the children in a previous study of these children. Fifteen % had more than one tooth affected indicating systemic causation. Questions were asked about mother's health and medication during pregnancy, birth complications, health and medication of the child during the first 3 yr of life, breast-feeding, heredity, and fluoride supplements. The affected children, especially the boys, were reported to have had more health problems, in particular asthma (but only 4 cases), during the first year of life. Use of antibiotics was also more common among the affected children, but owing to a strong co-variance with health problems these factors could not be separated. Breast-feeding history was similar in children with and without enamel defects. The etiology of hypomineralized first molars is not yet fully understood, but based on the results of this retrospective study, health problems in infancy, especially respiratory diseases, seem to be involved.

Aetiology of dental anxiety in children: a review of the literature.

Dental anxiety has long been identified as a factor that affects the effective provision and acceptance of dental treatments by patients. For children, this becomes a handicap especially when they have not developed an ability to cope with the problem. This paper reviews factors that have been identified as aetiological factors for dental anxiety in children. Also a note has been made on a possible concomitant factor to other identified aetiological factors in Nigerian children though there is the need for more studies in the country on this subject. An understanding of the various aetiological factors in dental anxiety would help in the child-patient management with there being the possibility of a multidisciplinary approach to this multidimensional problem.

Machine learning methods applied on dental fear and behavior management problems in children.

The etiologies of dental fear and dental behavior management problems in children were investigated in a database of information on 2,257 Swedish children 4-6 and 9-11 years old. The analyses were performed using computerized inductive techniques within the field of artificial intelligence. The database held information regarding dental fear levels and behavior management problems, which were defined as outcomes, i.e. dependent variables. The attributes, i.e. independent variables, included data on dental health and dental treatments, information about parental dental fear, general anxiety, socioeconomic variables, etc. The data contained both numerical and discrete variables. The analyses were performed using an inductive analysis program (XpertRule Analyser, Attar Software Ltd, Lancashire, UK) that presents the results in a hierarchic diagram called a knowledge tree. The importance of the different attributes is represented by their position in this diagram. The results show that inductive methods are well suited for analyzing multifactorial and complex relationships in large data sets, and are thus a useful complement to multivariate statistical techniques. The knowledge trees for the two outcomes, dental fear and behavior management problems, were very different from each other, suggesting that the two phenomena are not equivalent. Dental fear was found to be more related to non-dental variables, whereas dental behavior management problems seemed connected to dental variables.

Temperament and child dental fear.

PURPOSE: The relationship between dental fear and temperament in children was investigated in 124 Swedish children aged 5-7 and 10-12 years. They represented dentally fearful (65) and not fearful (81) children, and were drawn from a larger population-based patient pod. The aims of the investigation were to study the relationships between temperament on one hand, and dental fear and dental behavior-management problems on the other hand. METHODS: Dental fear was measured by the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) and the Children's Dental Fear Picture test (CDFP), while the Emotionality, Activity, Sociability (EAS) Temperamental Survey was used to assess four aspects of temperament: negative emotionality, shyness, sociability, and activity. RESULTS: Using Student's t test, children with dental fear had statistically significantly higher scores on shyness compared with normative data on EAS from Sweden. When fearful children were compared with the others in the study group by the use of Student's t test, children with dental fear scored statistically significantly higher on both shyness and negative emotionality. CONCLUSION: Thus, children expressing shyness and/or tendencies of negative emotionality should be considered patients at risk for developing dental fear problems.

Child dental fear: cause-related factors and clinical effects.

The relationship between child dental fear and clinical effects, and the importance of some etiological factors related to the development of dental fear in children, were studied in 3,204 urban Swedish children aged 4 to 6 and 9 to 11 yr. Information concerning child dental fear (as measured by the Dental Subscale of Children's Fear Survey Schedule), general fears, parental dental fear, parents' employment and native language was obtained through questionnaires. Data regarding dental health, behavior management problems (BMP) and modes of dental treatment were compiled from dental records. The results showed that child dental fear was associated with missing appointments and dental caries. A proportion of 27% of the children with BMP were dentally fearful, while 61% of the children with dental fear reacted with BMP. A model for stepwise regression analysis showed that general fears, maternal dental fear, and age were important etiological factors in the development of dental fear in children.

Validity of the Children's Dental Fear Picture test (CDFP).

The validity of the Children's Dental Fear Picture test (CDFP) was investigated in 146 Swedish children aged 5-12 yr. The CDFP was compared with dental fear scores on Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), selection criteria for testings (dentally fearful/not dentally fearful), and with level of general fear measured by the Short Form of Children's Fear Survey Schedule (CFSS-SF). Dental fear in the CDFP was closely related to high scores on CFSS-DS and CFSS-SF. The CDFP proved to be a valid instrument to diagnose dental fear in children with values of sensitivity up to 98.5%.

Dental fear and behavior management problems in children. A study of measurement, prevalence, concomitant factors, and clinical effects.

A Swedish parental version of the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) was administered twice to the parents of 52 children aged 4-14 yr, and CFSS-DS was compared with child behavior during treatment. CFSS-DS reached high values for validity and reliability, and scores of 38 or more were found to be related to dental fear. The prevalences, concomitant factors, and clinical effects of dental fear and behavior management problems (BMP) were studied in a representative study population of 4,505 children aged 4-6 and 9-11 yr. Parents of 3,204 of the children (71%) answered a questionnaire containing CFSS-DS, a Short Form of Children's Fear Survey Schedule (CFSS-SF) measuring general emotional status, Corah Dental Anxiety Scale (DAS) to measure maternal and paternal dental fear. The dental records were retrieved from the Public Dental Service, and 4,061 complete dental records provided information regarding behavior management problems, caries, fillings, dental treatments and number of missed appointments. The study population had a mean score of 23.1 on CFSS-DS (sd 8.1; range 15-71). Dental fear (CFSS-DS scores > or = 38) was found in 6.7%, and BMP in 10.5% of the children. Both dental fear and BMP decreased with age. Age, general emotional status, and maternal dental anxiety were identified as concomitant factors in the development of dental fear. Experiences of pain during dental treatment increased the risk of developing dental fear and BMP. Dental fear and BMP were associated with missing of dental appointments and deterioration of dental health. A new method using projective techniques to measure child dental fear, the Children's Dental Fear Picture test (CDFP), was developed. Data regarding reliability and validity of CDFP was established in a group of 146 children selected from the questionnaire survey. The testings with CDFP were performed by two trained dentists. CDFP proved to have high interexaminer reliability (88.9%), and to be a valid test. Sensitivity was calculated to 98.5%.

Dental fear in an urban Swedish child population: prevalence and concomitant factors.

In order to establish normative data on the dental subscale of children's fear survey schedule (CFSS-DS), measuring child dental fear, and to study the influence of general fears, parental fears and socio-economic correlates on children's dental fear levels, a questionnaire was sent to parents of a representative sample of 4,505 children aged 4-6, and 9-11-years-old in Göteborg, Sweden. The questionnaire contained the CFSS-DS, a short form of the CFSS measuring general fears, Corah's dental anxiety scale (DAS) (measuring parents' dental fear) and specific questions on parents' employment and the native language in the family. A total of 3,204 responses was received. The overall mean score on CFSS-DS was 23.1, and 6.7 per cent of the children were found to be fearful. Dental fear decreased with increasing age and was positively correlated to general fears. Three variables: age, general fears and maternal dental fear, were found to have a significant impact on the variance of CFSS-DS.

Reliability and validity of the Swedish version of the Dental Subscale of the Children's Fear Survey Schedule, CFSS-DS.

A Swedish version of the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) was designed to be answered by parents on behalf of their children. The instrument was administered twice to the parents of 52 children aged 4 to 14 years. The children's behaviors were rated during the dental appointment immediately after the second administration. The CFSS-DS reached high values for test-retest reliability and validity. Scores equal to or exceeding 38 were found to be related to dental fear.