Treatment of dental plaque biofilms using photodynamic therapy: a randomised controlled study.

INTRODUCTION: Photodynamic therapy (PDT) is a treatment modality involving a dye that is activated by exposure to light of a specific wavelength in the presence of oxygen to form oxygen species causing localised damage to microorganisms. AIM: To determine the most effective bactericidal incubation and irradiation times of erythrosine-based PDT on in vivo-formed dental plaque biofilms. METHODS: A randomised controlled study; 18-healthy adult participants wearing intraoral appliances with human enamel slabs to collect dental plaque samples in two separate periods of two weeks each for use in arm-1 and arm-2. These accumulated dental plaque samples were treated with PDT under different experimental conditions. Incubation times with photosensitiser (erythrosine) of 15 min and 2 min were used in arm-1 and arm-2, respectively, followed by light irradiation for either 15 min (continuous) or as a fractionated dose (5 × 30 sec). Following treatment, percentage reductions of total bacterial counts were compared between the different groups. In addition, confocal laser scanning microscopy (CLSM) and LIVE/DEAD® BacLight™ Bacterial Viability Kit were used to visualise the effect of PDT on in vivo-formed biofilms. RESULTS: Significant reductions in the percentage of total bacterial counts (~93-95%) of in vivo-formed biofilms were found when using either 2 min or 15min incubation times and applying 15 min continuous light. Although when applying fractionated light, there was more cell death when 15 min incubation time was used (~ 91%) compared with the 2 min incubation time (~ 64%). CLSM results supported these findings. CONCLUSION: Improving the clinical usefulness of PDT by reducing its overall treatment time seems to be promising and effective in killing in vivo-formed dental plaque biofilms.

Using process drama to explore the causes of dental anxiety in primary-school children.

BACKGROUND: Drama and role play can be unlisted as methods to allow children to view problems from a range of different perspectives that may differ from their own experience. Application of drama technique to assess the cause of dental fear and anxiety in a school setting is novel. AIM: The aim of this study was to engage primary school children in the core investigation via participatory arts methodologies, namely, process drama to gain understanding of the causes of dental anxiety. DESIGN: Sixty-three children, aged 7-10 years from three primary schools participated in this study. A 90-min drama workshop was carried in each school. The children were encouraged to identify the causes of dental anxiety using key concepts from process drama. The sessions were audio-recorded and transcribed. RESULTS: Four key concepts emerged: (1) fear of the unknown; (2) unpleasant sensory experience; (3) society's perception and portrayal of the dentist; and (4) learnt negative associations with the dentist. Within each four key concepts, two sub-themes were identified. CONCLUSIONS: Role-playing and use of drama are a novel application and can reveal a considerable amount of information from the child's perspective on the cause of dental fear and anxiety.

The use of behaviour management techniques amongst paediatric dentists working in the Arabian region: a cross-sectional survey study.

PURPOSE: The purposes of this study were to investigate paediatric dental practitioners' training and confidence in using dental behaviour management techniques in the Arabian region and to assess the factors influencing the application of advanced behaviour management techniques. METHODS: An online questionnaire was distributed to paediatric dental practitioners in the Arabian region. Data were analysed using descriptive statistics and Pearson Chi Square. RESULTS: A total of 113 responses were obtained. Of these, the majority were from Egypt (45%, n = 51). Just over half of the respondents were registered as specialists at the country where they were practicing paediatric dentistry (53%, n = 60). The use of behaviour management techniques varied amongst participants with tell-show-do (95%, n = 107) and positive reinforcement (89%, n = 101) being the most routinely used techniques. The majority of participants reported using voice control (83%) and parental separation (68%) techniques. Hand over mouth exercise (HOME) was only used by 24% (n = 27) of participants, whilst just over half of the participants, 53%, reported using protective stabilisation. A significant association was shown between country of practice, country of obtaining paediatric dental training, speciality status and the use of advanced behaviour management techniques, whilst confidence in using HOME and sedation were associated with work setting and country of practice, respectively. CONCLUSION: The use of advanced behaviour management techniques was found to be high amongst respondents in the Arabian region. The lack of training in using these techniques, however, is of concern. Further assessment of the factors affecting the use of and confidence in applying advanced behaviour management techniques in the Arabian region is needed.

Impact of soft drinks to health and economy: a critical review.

AIMS: To provide information regarding the different types of soft drinks and critically reviewing their risk on the dental and general health of children and adolescents, as well as the cost associated with such drinks. METHODS: The literature was reviewed using electronic databases, Medline, Embase, Cochrane library, and was complemented by cross-referencing using published references list from reviewed articles. Search words; soft drinks, juices, carbonated drinks, sports and energy drinks, soft drink and dental diseases, soft drink and health, cost of soft drinks, soft drink advertising, sugar tax on soft drinks were used for this review. In total, 104 papers were reviewed by both authors; of these, 62 papers were found to have relevant information. RESULTS: The consumption of soft drinks was found to have increased dramatically over the past several decades. The greatest increase in soft drink consumption has been among children and adolescents. Some commercial soft drinks are high in sugar content and acidity. In addition, they supply energy only and are of little nutritional benefit and lack micro-nutrients, vitamins and minerals. Soft drink consumption can contribute to detrimental oral and general health. Efforts have been made by manufacturers and government agencies to reduce the potential harmful effects of sugar-containing soft drinks on teeth and general health. These include banning the sale of soft drinks in schools, restricting soft drinks advertising, modifying the composition of soft drinks and introducing tax on sugar-containing soft drinks. CONCLUSIONS: The consumption of soft drinks with high sugar content and acidity can contribute to detrimental oral health and may also affect general health. Therefore, it is necessary to educate patients about the harmful effects of different types of soft drinks as it is not always easy for individuals to identify from drink labelling the ingredients which they contain.

A review of the effect of music on dental anxiety in children.

AIM: To review the current literature on the effectiveness of using music as an intervention to reduce dental anxiety in children. METHODS: At the University of Leeds, the School of Music and the School of Dentistry collaborated to conduct an online search strategy. The Cochrane Library and Medline databases were used to find the current available evidence. RESULTS: Systematic reviews and clinical trial studies as well as cohort studies containing pertinent information on the effect of music on anxiety in the clinical setting were reviewed. The literature showed that music can have a biological and psychological impact on emotion and consequently has been used effectively as an aid to moderate anxiety in the clinical setting. With regard to paediatric dentistry, majority of studies were found to support the use of music in reducing dental anxiety in children, however several additional studies showed that music did not significantly reduce the children's dental anxiety. The studies employed a number of methods to measure dental anxiety including the Venham's Picture Test, the Venham's clinical anxiety rating scale and pulse oximetry. They also used a range of music types; some studies allowed for patient self-selection of music whereas others dictated the music the children listened to. CONCLUSIONS: There is an increasing body of evidence to support the use of music to moderate anxiety within the clinical setting in both medicine and dentistry. However, the current evidence for the effectiveness of using music to reduce dental anxiety in children is inconclusive and of limited quality.

Treatment outcomes of using inhalation sedation for comprehensive dental care.

AIM: To assess the outcomes of dental treatment under inhalation sedation within a UK specialist hospital setting. METHODS: This was a retrospective cohort study of the case notes of patients under 17 years of age who received dental treatment using inhalation sedation at a UK specialist setting during the period 2006-2011. Treatment outcomes were categorised into five groups: (1) treatment completed as planned, (2) modified treatment completed, (3) treatment abandoned in sedation unit and patient referred for treatment under general analgesia (GA), (4) treatment abandoned in sedation unit and patient referred for treatment under local analgesia (LA), (5) child failed to return to complete treatment. RESULTS: In total, the case notes of 453 patients were evaluated. The mean age of the patients was 10.3 ± 2.9 years. Treatment was completed successfully in 63.6% of the cases, 15.9% were referred for treatment under GA, 11.2% failed to return to complete the treatment, 7.1% received modified treatment completed, and only 2.2% were referred for treatment under LA. Treatment outcomes were significantly associated with patient`s age (p = 0.002). The treatment outcome "treatment abandoned and child referred to be treated under GA" had significantly lower mean patient ages than the other outcomes. CONCLUSIONS: The majority of children referred for inhalation sedation, completed their course of treatment. A significantly higher proportion of those in the younger age group required GA to complete their treatment.

Comparison of the newer preventive therapies on remineralisation of enamel in vitro.

OBJECTIVES: To investigate in vitro the effect of MI Paste, MI Paste Plus and 2800ppm fluoride (F) toothpaste (TP) on the remineralisation of enamel subsurface lesions and to compare these to the effect of 1450ppm and 0ppm F toothpastes. METHODS: Enamel subsurface lesions were created in bovine enamel slabs (n=120) which were assigned randomly to five groups; (1) 0ppm F TP, (2) 1450ppm F TP, (3) 2800ppm F TP, (4) 1450ppm F TP+MI Paste (Tooth Mousse-TM,10% w/v CPP-ACP) and (5) 1450ppm F TP+MI Paste Plus (Tooth Mousse Plus,10% w/v CPP-ACP, 900ppm F as 0.2% w/w sodium fluoride). The enamel slabs were subjected to a pH cycling regimen for 21days. Quantitative Light-induced Fluorescence (QLF) images were taken and analysed. Data analysis was carried out using one way ANOVA. RESULTS: In all groups, both ΔF (percentage fluorescence loss) and ΔQ (ΔF times the area) values improved significantly within the same group after the treatment. In addition, the mean difference in ΔF of the non-fluoride control group was significantly lower than all other groups but not for the 2800ppm F- group. Whereas the mean difference in ΔQ of the non-fluoride control of group was significantly lower when compared with all other groups (p<0.05). CONCLUSIONS: Both MI Paste and MI Paste Plus when used in conjunction with 1450ppm F did not show a significant increase in efficacy for the remineralisation of bovine enamel subsurface lesions in the model used in this study. CLINICAL SIGNIFICANCE: Newer preventive agents such as MI paste and MI paste plus are advocated as promoting remineralisation when used in addition to routine oral care. This in vitro study shows that they may have a limited value in promoting remineralisation over and above that of 1450ppm F toothpaste used twice a day.

Utilising a paediatric version of the indicator of sedation need for children's dental care: a pilot study.

AIM: To assess the treatment outcomes of using inhalation sedation for comprehensive dental care in children by utilising a modified version of the indicator of sedation need tool. METHODS: Investigating the outcomes of dental treatment of patients referred to the sedation unit at the Leeds Dental Institute when the paediatric version of the indicator of sedation need (p-IOSN) was utilised. RESULTS: Forty patients of mean age 9.99 (SD = 3.14) years were followed up to ascertain treatment outcomes when the p-IOSN was used. Of the total of 40 children included, 20 scored 6 on p-IOSN. Treatment completion rate was 72.5 %. Although major differences existed between age and treatment outcomes, they failed to achieve statistical significance. No significant association was found between gender and p-IOSN of any score with any treatment outcome. CONCLUSIONS: p-IOSN may be a useful tool that can be used to predict those child patients who would benefit from sedation for their dental treatment. However, the p-IOSN is still in a developmental stage and further research is required prior to its use on clinical grounds.

A study of the control of oral plaque biofilms via antibacterial photodynamic therapy.

AIM: The aim of this study was to provide preliminary data on the most effective erythrosine concentration and light dose for the erythrosine-based photodynamic therapy (PDT) of oral plaque biofilms formed in vivo. METHOD: A randomised controlled study with 15 volunteers was carried out to investigate the effect of photo-sensitiser and light dose on the killing of bacteria in oral plaque biofilms formed in vivo. All volunteers wore a removable in situ appliance carrying six enamel slabs for two phases of 2 weeks each. During this time, plaque biofilms accumulated on the enamel slabs. The slabs were then removed from the appliances for PDT treatment in vitro. In the first phase of the study, erythrosine doses of 22 and 220 µM were used for the photodynamic treatment of the biofilms. In the second phase, the erythrosine concentration was kept constant, and the light dose was varied. Following treatment, the biofilms were disaggregated, and the total bacterial killing was determined using colony counting. RESULTS: The erythrosine dose of 220 µM caused the most cell killing relative to controls. Fifteen minutes of continuous irradiation with light and light fractionation of 5 × 1 min irradiation separated by 2-min-dark recovery periods were found to be the most effective bactericidal regimes. CONCLUSION: Erythrosine-based PDT shows promise as an antibacterial treatment for oral plaque biofilms. Further research is needed to prove its clinical and cost-effectiveness compared with current best practice.

Management of a child with severe hypodontia in the mixed dentition stage of development.

BACKGROUND: Severe hypodontia is a condition characterized by developmental absence of six or more teeth and affects 0.14-0.3% of the overall population. Hypodontia can have a marked psychosocial effect and functional implications for a growing child. CASE REPORT: A 10-year-old girl with a medical history of hypothyroidism and repaired spinal bifida was referred to the Leeds Dental Institute as she was becoming increasingly concerned about her appearance. On clinical examination, the patient had severe wear of her over-retained maxillary primary central incisors, microdontia of mandibular anterior teeth (32, 34, 41, 42, 43), and loss of anterior vertical dimension. Radiographic examination revealed that the patient had 11 missing permanent teeth (14, 13, 12, 11, 21, 22, 23, 24, 31, 35, 44), an ectopic mandibular left canine and taurodontism of the permanent molars. TREATMENT: Management of the patient included an intensive preventive programme with placement of fissure sealants; scaling of calculus deposition on microdont teeth; composite resin reconstruction of microdont teeth; fabrication of removable partial overdentures tailored aesthetically to match the patient's age; orthodontic consultation and monitoring for the eruption of ectopic canine and permanent dentition. The patient and her parents reported marked improvement in self-esteem following dental treatment. FOLLOW-UP: After 2 years of follow-up, a new pair of dentures were made and designed to allow ease of eruption of the existing permanent dentition. All permanent teeth have erupted. The patient is ready for further assessment and planning for future orthodontic and restorative/implant treatment. CONCLUSION: This case illustrates the essential role of the paediatric dentist in the management of hypodontia in the mixed dentition stage.

Analysis of dental care of children receiving comprehensive care under general anaesthesia at a teaching hospital in England.

OBJECTIVES: This study aimed to analyse the characteristics of comprehensive dental care provided under general anaesthesia (CDGA) and to review the additional treatment required by children over the 6 years subsequent to CDGA. METHOD: Information collected from hospital records for the 6-year period following the first CDGA included the types of dental treatment performed at CDGA, the return rates for follow-up appointments, further treatment required subsequent to CDGA and the types of dental treatment performed at repeat DGA. RESULTS: The study population consisted of 263 children, of whom 129 had a significant medical history, with mean age of 6.7 years. The results revealed that the waiting time for CDGA was significantly shorter in children who had a significant medical history, with 49% being admitted for CDGA within 3 months of pre-GA assessment, as compared to 29% of healthy children. 67% of children had follow-up care recorded, with a slightly higher proportion of children with significant medical history returning for follow-up [70% (90/129)] compared with 65% (87/134) of healthy children. Re-treatment rates were 34% (88/263), the majority of cases being treated under local analgesia (42/88). 34 of 263 children had repeat DGA (12.9%). Of these 71% (24/34) were children with significant medical history. The mean age at repeat DGA was 9 years. In 25 of 34 children (74%), repeat DGA was due to trauma, oral pathology, supernumerary removal, hypomineralized teeth or new caries of previously sound or un-erupted teeth at CDGA. The ratio of extraction over restoration (excluding fissure sealants) performed at repeat DGA was 2.8, compared with the ratio of 1.3 in the initial CDGA. CONCLUSIONS: There was a higher ratio of extraction over restorations at the repeat DGA. This suggests that the prescribed treatments at repeat DGA were more aggressive as compared to the initial CDGA in 1997. The majority of the treatment required at repeat DGA was to treat new disease.

The effects of fruit smoothies on enamel erosion.

OBJECTIVES: This prospective, randomised in vitro study was to investigate the pH and titratable acidity of fruit smoothie drinks and to assess the effect of these drinks on enamel erosion. METHOD: Fifty enamel slabs were divided into five groups which were allocated to the sample solutions groups: Innocent(®) smoothie strawberries and bananas (SB), Innocent(®) smoothie mangoes and passion fruit (MP) and Diet Coke. Distilled deionised water (DD) was used as negative control and citric acid 0.3% as positive control. All the slabs were subjected to a 21-day pH cycling regime involving 2 min of immersions, five times a day with appropriate remineralization periods in between. Measurement of surface loss was assessed using profilometry. Independent sample t tests were used to compare mean. RESULTS: The titratable acidity for both test smoothies were 3.5-4 times more than that needed to neutralise Diet Coke and citric acid 0.3%. The pH of SB, MP smoothie and Diet Coke was found to be 3.73, 3.59 and 2.95, respectively. MP smoothie caused the greatest amount of surface loss followed by Diet Coke. Both smoothies were found to cause significant surface loss. MP smoothie resulted in significantly higher surface loss compared with MB smoothie and citric acid 3 %. CONCLUSION: The smoothies tested were acidic and had high titratable acidity. They produced a significant erosion of enamel in vitro. The results of this study suggest that there should be increased awareness of the erosive effects of smoothies especially as their consumption seems to be on the increase.

The effect of ozone on progression or regression of artificial caries-like enamel lesions in vitro.

OBJECTIVE: This study investigated the effect of ozone on the progression or regression of artificial caries-like lesions on enamel following pH cycling conditions in vitro. METHODS: A randomized, single blind, four legs design was used. 20 full thickness enamel slabs were allocated to each of the four groups which were: Fluoride free toothpaste (control); ozone alone; Reductant/Patient Kit alone and a combination of both ozone/Reductant/Patient Kit. Artificial lesions were created and subjected to the pH cycling regime for a 14 days period. Assessments were carried out before and after the pH cycling on the slabs using the microhardness testing and Quantitative Light-induced Fluorescence (QLF). RESULTS: Statistical significant difference were found in the percentage change of enamel microhardness before and after pH cycling between ozone/Reductant/Patient Kit group and all the other three groups of the study, as well as between Reductant/Patient Kit group and control. There was a statistical significant difference in the change of size and severity of the lesion (ΔQ) between all the three regimes tested and the control with a trend favouring ozone/Reductant/Patient Kit group. CONCLUSIONS: In our model, it appeared that ozone treatment alone is not effective in protecting the enamel against demineralisation or promoting remineralisation, unless combined with the Reductant/Patient Kit, which contain high levels of fluoride.

Comparing the onset of maxillary infiltration local anaesthesia and pain experience using the conventional technique vs. the Wand in children.

AIM: This prospective, randomised, parallel, controlled study was conducted firstly to compare the onset of local anaesthesia (LA) when using the conventional technique versus the Wand computer-controlled LA and secondly to assess the pain experience in children. METHOD: Thirty children were randomly allocated to the treatment group (Wand) or the control group (conventional). Lidocaine 2% with adrenaline (1:80,000) was given as a buccal infiltration. The onset of pulpal anaesthesia was tested using an analytic electric pulp tester (EPT). The pain experience during the LA was recorded using a modified visual analogue score (VAS). RESULTS: Median time for the onset of LA was 6.30 minutes for the control and 7.25 minutes for the Wand group. Mean pain experience score for the control group was 9.78% as opposed to 8.46% in the Wand group. Statistical analysis showed that there was no statistically significant difference in the onset of LA (p = 0.486) and the pain experience (p = 0.713) between the two groups. CONCLUSION: When placing a buccal infiltration on upper first permanent molars, the onset of LA and the pain experience was no different using the Wand and the conventional technique.

The additional effect of ozone in combination with adjunct remineralisation products on inhibition of demineralisation of the dental hard tissues in situ.

OBJECTIVES: In the United Kingdom Ozone therapy combines the use of ozone gas and adjunct products called Reductant and the Patient Kit, which all contain fluoride. We studied the effect of these products with and without the use of ozone in inhibiting demineralisation of human enamel and dentine under a cariogenic challenge in situ. METHODS: A single-blind, randomised, three arms, cross-over study design was used. Fourteen volunteers were provided with a lower removable intra-oral appliance carrying one enamel and one dentine slabs. Baseline measurements of enamel and dentine hardness slabs were recorded. The study regime of 14 days of dipping into 10% sucrose solution 5 times a day was applied. The three arms were two test groups Ozone/Reductant/Patient Kit, Reductant/Patient Kit, and a fluoride free toothpaste group as a control. At the end of the 2nd week the slabs were collected, microhardness measured and the differences from the baselines were calculated. RESULTS: There were statistically significant differences in the mean changes of enamel and dentine hardness when both the test groups were compared individually with the control. However, no statistical significant differences in either parameter were found when Ozone/Reductant/Patient Kit group was compared with Reductant/Patient Kit treatment. CONCLUSIONS: We conclude from these results that ozone had no additional effect on the inhibition of enamel and dentine demineralisation than when Reductant/Patient Kit, containing high concentrations of fluoride, were used on their own.

In vitro and in vivo assessment of newly developed slow-release fluoride glass device.

BACKGROUND: The concept of constant and low levels of F intra-orally has been applied in dentistry using a controlled release delivery system in different forms of slow-release F intra-oral devices. AIM: To investigate the effect of newly shaped plastic brackets on the level of fluoride released by the devices in vitro and to compare the level of fluoride released by unilateral versus bilateral slow-release fluoride glass devices in adults in vivo. STUDY DESIGN: The phase I, in vitro assessment involved 15 slow-release fluoride glass devices divided into three groups. Group A contained five glass beads, Group B, five fluoride devices placed with the plastic brackets facing down, and Group C, five fluoride devices placed with the plastic brackets facing up. Evaluation of fluoride release was carried out daily for a week, weekly for a month, and monthly for 18 months. The In vivo phase II involved 20 adults (mean age 29.7+/-2.3 years) randomly divided and had unilateral or bilateral slow-release fluoride glass devices placed for six months. RESULTS: Groups A and B released fluoride for up to ten months. In Group C, the glass beads became loose at the end of the first month and were excluded from further analysis. There was no statistical significant difference in the mean of total fluoride released by Groups A and B. All participants showed higher salivary fluoride levels than at baseline. There was no statistically significant difference in the level of fluoride released by the bilateral and unilateral groups. CONCLUSIONS: The newly shaped slow-release fluoride glass devices showed continuous, safe, and effective fluoride release.

Children's and parents' attitudes towards dentists' attire.

AIM: To assess children and parental attitudes towards dental attire. METHODS: A convenience sample of paediatric dental patients and their parents attending the Paediatric Dentistry Dept. (Leeds, UK). Data was collected using a questionnaire accompanied by a series of photographs of female and male dental students in different modes of attire. RESULTS: 100 parents with a mean age of 40.4 years (SD+/-8.8) and range 23-60 years, and 100 children with a mean age of 9.8 years (SD+/-3.5) and range 4-16 years responded. Participants preferred females in white coat and mask (15.5%) and white coat (10.5%); males in white coat and mask (11.0%), white coat and glasses (9.0%) and formal shirt (8.5%). Parents significantly preferred formal attire and children informal attire (x2=25.417, p<0.022). Comparing white coat vs paediatric coats, both parents and children ranked white coats in favour of paediatric coats (x2= 1.476, p=0.347). A highly significant difference was found between the male participants who favoured the male dental student and female participants the female dental student (x2= 30.600, p<0.000). CONCLUSIONS: Parents favoured traditional dress as it gives an air of professionalism. Children preferred dental students in casual attire, both children and parents ranked formal white in favour of a paediatric coat. There was a highly significant difference in preference of the participants towards the sex of their dental health care provider, male participants favoured male student and females female students.

A comparison of pain and anxiety associated with the administration of maxillary local analgesia with Wand and conventional technique.

AIM: This was to compare the sensation of pain when injections were given using the Wand computer controlled local analgesia (LA) system and a conventional technique in children of pre-school and school age. METHODS: 38 children were randomly assigned to either a treatment or control group. The treatment (Wand) group consisted of 20 children, while the control group (conventional LA technique) consisted of 18 children. The children were aged between 39.0 and 120.0 months with a mean age of 81.9 months (SD- 23.2). One operator carried out all local analgesia administrations. Pain sensation was rated using the VAS scale by the operator, each child and their parent. Anxiety was rated using the Venham scale. RESULTS: No statistical difference in pain sensation and anxiety was found when the Wand was used, compared with the conventional technique (P=0.710, P=0.976). The results also showed no significant difference in anxiety change between males and females in the two groups (P=0.714). CONCLUSION: There was no difference in the pain or anxiety experienced by the children in the conventional and Wand group.

Further dental treatment needs of children receiving exodontia under general anaesthesia at a teaching hospital in the UK.

OBJECTIVES: The aim of this study was to investigate the subsequent dental treatment needs of children who had dental extractions under general anaesthesia (GA) in 1997 in the Day Case Unit at Leeds Dental Institute (LDI), Leeds, UK, and the reasons for repeat dental GAs (DGAs). STUDY DESIGN: The authors conducted a retrospective longitudinal analysis. SUBJECTS AND METHODS: Information collected from hospital records for the 6-year period following the first DGA included: reasons for the DGA in 1997 and teeth extracted; the number of subsequent DGAs, reasons and treatment; incidents of and reasons for toothache or swelling after 1997; treatment under local anaesthesia (LA) or inhalation sedation (IS) at LDI during the 6 years following the DGA in 1997. RESULTS: The study population consisted of 484 children, who received GA exodontia at LDI with a mean age of 6.35 years [95% confidence interval (CI) = 6.1, 6.6] and age range of 1-16 years. The most common reason for extractions at the original DGA in 1997 was dental caries, and the mean number of extractions was 4.24 (95% CI = 4.05, 4.43). Primary teeth extractions accounted for 82% of the cases. In total, 143 children (27.5%) had a record of follow-up treatment at LDI. Of these children, 32% had treatment under LA, 7% under LA and IS, and 15% received preventive care only. The overall repeat rate for DGA was 10.7%, with caries (84%) being the main reason for this. Of the teeth subsequently extracted, 72% were recorded as caries-free or unerupted at the time of the DGA in 1997. CONCLUSIONS: A large proportion of the follow-up visits were to treat newly developed dental disease during the 6 years following the DGA in 1997. A more proactive approach towards preventive care may have resulted in the reduction of the development of new dental disease.