Does the length of dental procedure influence children's behavior during and after treatment? A systematic review and critical appraisal.

The aim of this systematic review was to investigate the effect of treatment duration on children's behavior and/or anxiety in the dental setting. To this end, a systematic search was conducted in Pubmed/Medline and Scopus from 1970 to march 2017 for English language articles that assessed the relationship between dental treatment duration or length, and fear/anxiety or behavior in children aged <12 with no confounding medical and/or psychological history and neuro-psychiatric disabilities. Four studies investigating the effect of treatment duration on children's behavior during and/or after treatment were included. None of the reviewed studies investigated the effect of treatment duration on children's dental anxiety or fear. There was a general tendency towards deterioration of children's behavior with an increase in treatment duration. In conclusion, our results undermine the validity of current suggestions about the appropriate treatment duration. Further clinical trials are needed to establish appropriate treatment duration for more effective behavioral management of pediatric patients during dental proce-dures.

Randomized Controlled Trial of Pulpotomy in Primary Molars using MTA and Formocresol Compared to 3Mixtatin: A Novel Biomaterial.

OBJECTIVE: This study was conducted to compare the efficacy of 3Mixtatin (a combination of simvastatin and 3Mix antibiotic) with MTA and Formocresol for the pulpotomy of primary molars. STUDY DESIGN: 114 children aged 3-6 years old with 150 primary molars were randomly allocated to three groups. MTA, Formocresol or 3Mixtatin were used for Pulpotomies. Hard setting zinc oxide eugenol was used to cover these materials. The teeth were restored with amalgam. Blinded radiographic and clinical examinations were conducted at 6, 12 and 24 months after treatment for the presence of pain, tenderness to palpation and percussion, sinus tract, swelling, presence of internal or external root resorption, inter-radicular radiolucency, and periapical lesion. RESULTS: 122 teeth were available for 24-month follow-up study. The overall success rate was 78.9% for FC, 90.5% for 3Mixtatin and 88.1% for MTA group. There was no significant difference in overall success rate among the groups after 24-month follow-up (X2=2.43, df = 2, P =0.27). CONCLUSION: Our findings demonstrated remarkable results of 3Mixtatin in pulpotomy of primary teeth at the 24-month follow-up. Therefore, 3Mixtatin may be considered as an effective material in pulpotomy of primary teeth because of its successful results.

Can galvanic skin conductance be used as an objective indicator of children's anxiety in the dental setting?

BACKGROUND: Assessment of procedural distress is essential at assisting children during invasive dental treatments. This study aimed to determine the validity and reliability of galvanic skin response as a measure for assessment of dental anxiety in children. MATERIAL AND METHODS: 151 children, aged 5-7 years, participated in this study. Similar dental treatments were rendered to all subjects. At the beginning and end of the session, modified child dental anxiety scale (MCDAS), clinical anxiety rating scale (CARS) and galvanic skin response (GSR) were used to determine children's anxiety. RESULTS: GSR was significantly correlated with both MCDAS (rs=0.62, p=0.02) and CARS (rs=0.44, p=0.032). The correlation between MCDAS and CARS was also significant (rs = 0.9, P<0.001). Anxiety decreased during the session in both GSR (rs=0.52, p=0.001) and MCDAS scales (rs=0.77, p=0.001). CARS also showed a reduction between the initial and second assessment, but it was not statistically significant (rs=0.12, P=0.36). CONCLUSIONS: The findings suggest that GSR is a reliable and valid measure for assessment of children's dental anxiety in the clinical context. GSR may help to identify clinically anxious children before dental treatment to provide appropriate interventions. Key words:Dental anxiety, reliability, validity, galvanic skin response.

Oral health status, dental anxiety, and behavior-management problems in children with oppositional defiant disorder.

Mental disorders have been shown to affect children's oral health. This study was carried out to investigate the oral health status, dental anxiety (DA), and behavior-management problems (BMPs) during dental treatment in 6- to 9-yr-old children with oppositional defiant disorder (ODD)/attention-deficit hyperactivity disorder (ADHD). The study and control groups included 40 children with ODD/ADHD and 80 normal children, respectively. All participants received an amalgam restoration. During the procedure, the children's behavior was assessed using the Frankl Rating Scale and the Verbal Skill Scale. Parents rated their children's DA using the parental version of the Children's Fear Survey Schedule-Dental subscale (CFSS-DS). Comorbid anxiety disorders were assessed using the Kiddie-Sads-Present and Lifetime Version questionnaire. Oral health status was assessed using the gingival index and the decayed, missing, and filled teeth score for permanent (DMFT) and primary (dmft) teeth. The findings showed that DA and BMPs were significantly higher in children with ODD/ADHD than in the controls. Furthermore, the frequency of DA and BMPs was higher in children with both ODD/ADHD and a comorbid anxiety disorder than in those without comorbid anxiety disorder. Children with ODD/ADHD had significantly higher DMFT/dmft scores than those in the control group, whereas the difference in gingival index was not statistically significant. In conclusion, children with ODD/ADHD had higher levels of DA, BMP and poorer oral health status.

A randomized trial of direct pulp capping in primary molars using MTA compared to 3Mixtatin: a novel pulp capping biomaterial.

OBJECTIVE: This study aimed to examine the efficacy of 3Mixtatin (a combination of simvastatin and 3Mix antibiotic) as a novel pulp capping biomaterial in DPC of human primary molars. METHODS: In this randomized clinical trial, 160 primary molars from 83 healthy children aged 3-6 years were randomly allocated into four groups. Small traumatic non-caries pulpal exposures were treated by DPC using simvastatin, 3Mix, 3Mixtatin, or MTA. Capping materials were covered with hard-setting zinc oxide eugenol (ZOE) cement, and then, teeth were restored with amalgam. Clinical and radiographic examinations were conducted at 2, 6, and 12 months after treatment. The data were compared using chi-square test at a significance level of 0.05. RESULTS: One hundred and twenty-nine teeth were available for follow-up study. By the end of 12 months, the overall success rates were 93.8% in MTA, 91.9% in 3Mixtatin, 62.5% in 3Mix, and 57.1% in simvastatingroups. No statistically significant difference was found between the outcomes of MTA and 3Mixtatin groups (P > 0.05). 3Mixtatin had statistically superior results compared to 3Mix and simvastatin (P < 0.01). CONCLUSION: Radiographic and clinical outcomes in 3Mixtatin group could suggest it as an acceptable alternative in DPC of primary molar teeth.

Laser-Casein phosphopeptide effect on remineralization of early enamel lesions in primary teeth.

BACKGROUND: The aim of this study was to assess the effect of Nd:YAG laser irradiation following casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application on calcium and phosphate concentration and surface microhardness (SMH) of enamel surface in artificial white spot lesions of primary teeth. MATERIAL AND METHODS: Eighty teeth with artificial white spot lesions were randomly divided into four groups: (A) distilled and deionized water, (B) Nd:YAG laser, (C) CPP-ACP crème, & (D) CPP-ACP plus laser. SMH was measured using Vickers diamond indenter in Vickers Hardness Number (VHN). Two samples of each group were analyzed using scanning electron microscope (SEM). The results were analyzed with the SPSS 17/win. RESULTS: The subjects of group D demonstrated a significant increase in the calcium and phosphate contents of enamel surface compared to those of groups A (P < 0.001, P < 0.001), B (P < 0.001, P < 0.001) and C (P = 0.024, P = 0.04), respectively. A statistically significant difference was seen for mean VHN between groups A and B (P = 0.002). SEM evaluations confirmed the results. CONCLUSIONS: The combination of Nd:YAG laser and CPP-ACP crème could be recommended as an effective preventive modality for remineralizing of white spot lesions in primary teeth. Key words:CPP-ACP, enamel remineralization, microhardness, Nd:YAG, primary teeth, SEM.

Class III Restoration of Anterior Primary Teeth: In Vitro Retention Comparison of Conventional, Modified and Air-abrasion Treated Preparations.

Background and aims. Anterior esthetic restoration is challenging in pediatric dentistry, due to limited durability and poor retention of the restoration.This study assessed the effect of air abrasion on tensile failure load of composite class III restorations using different preparation techniques. Materials and methods. 100 extracted human anterior primary teeth were divided, based on the preparation methods, into four groups each consisting of 25 subjects : conventional (A), labial surface bevel (B), conventional + air abrasion (C), and labial surface bevel + air abrasion (D). After restoring cavities, tensile failure load of samples was measured in Newton by Universal testing machine at a crosshead speed of 1 mm per minute. The data were analyzed by Kruskal-Wallis and Mann Whitney U tests using SPSS software. Results. There were statistically significant differences between groups A and C (P = 0.003), groups A and B (P & 0.001), groups A and D (P & 0.001), groups B and C (P = 0.028), groups B and D (P = 0.027), and also groups C and D (P& 0.001). Group D demonstrated the highest mean tensile failure load. Conclusion. Labial surface bevel treated by air abrasion showed significantly more retention of composite restoration.

Linear reciprocal interaction between dental caries and salivary characteristics.

Carious tooth surfaces can alter saliva in various ways. We investigated whether salivary parameters were affected by elimination of existing active dental caries in 99 children (age 6-12 years) with more than five carious tooth surfaces. Unstimulated saliva samples were obtained from each child, and salivary characteristics were evaluated. One month after caries treatment that eliminated all existing dental caries, saliva sampling and analysis were repeated. Saliva viscosity significantly decreased (P = 0.04), while pH and saliva buffering capacity significantly increased (P < 0.001). There was no significant difference in unstimulated salivary production at the start of the study and 1 month after caries elimination (P > 0.05). The relationship between dental caries and salivary condition is reciprocal. Treatment of existing dental caries can prevent future caries by improving saliva quality.

Simvastatin versus Calcium Hydroxide Direct Pulp Capping of Human Primary Molars: A Randomized Clinical Trial.

BACKGROUND AND AIMS: The aim of present study was to investigate pulp-dentin complex reactions following direct pulp capping (DPC) with calcium hydroxide [Ca(OH)2] and simvastatin as pulp-capping materials in the primary human molars. MATERIALS AND METHODS: 120 primary molar teeth which had to be extracted for orthodontic reasons were randomly allocated into four groups. Group Ι as a control, underwent DPC with calcium hydroxide. The dental pulp in group ІІ, ІІІ and ІV were directly capped with simvastatin-based materials at concentrations of 1, 5 and 10 µM, respectively. All of the teeth were restored with stainless steel crown. After a mean period of 7.41 months teeth were extracted and processed for histological examination and categorized in terms of hard tissue formation and pulp inflammation. RESULTS: Teeth in group I had statistically favorable outcomes in hard tissue formation and pulp inflammation than did the groups ІІ, ІІІ and ІV (P < 0.001). Considering three different concentrations of simvastatin, the result showed a dose dependent trend. Teeth in group ІV showed significantly lower rates of hard tissue formation and higher rates of pulp inflammation and necrosis compared to those of groups ІІ (P < 0.05). CONCLUSION: The findings of this study depicted that healing with no inflammation and hard tissue formation following statin treatment occurs with a lower rate than that with the calcium hydroxide.

Emotional intelligence subscales: are they correlated with child anxiety and behavior in the dental setting?

OBJECTIVES: The present study aimed at evaluating the correlation between emotional intelligence subscales and childs anxiety and behavior in the dental setting. STUDY DESIGN: The study included 123 children aged 7-12 years, who were scheduled to attend two consecutive sessions. In the first session, the Bar-On Emotional Quotient Inventory: Youth Version (Bar-on EQ-I: YV) was administered to participants. The anxiety and behavior in children was evaluated during similar dental procedures in the second session using the Clinical Anxiety Rating Scale and the Frankl scale, respectively. RESULTS: 23 children were eliminated from the study, leaving 100 participants (47 boys and 53 girls) with a mean age of 9.32 +/- 1.59 years for study. There were statistically significant positive correlations between Frankl score and EQ total score (p < 0.001), interpersonal scale (p < 0.001), intrapersonal scale (p < 0.001), stress management (p = 0.03) and adaptability scale (p < 0.001). Significant negative correlations were found between anxiety score and, EQ total score (p < 0.001), interpersonal scale (p < 0.001), intrapersonal scale (p < 0.001), and adaptability scale (p < 0.001). Anxiety and stress management were not correlated (p = 0.16). Total EQ and EQ subscales can predict significance variance of Frankl score (p < 0.05) and anxiety score (p < 0.05) without confounding effect of age and sex (p > 0.05). CONCLUSIONS: The results provide evidence that children with higher total EQ as well as higher scores of intrapersonal, interpersonal, adaptability and stress management scales can generally be flexible and effective in coping in the dental setting. Higher score in stress management subscale seems to be related to better control over affective information including anxiety compared with other subscales in stressful situations. Overall, they behave and cooperate better than children with lower scores.

Impact of temperament on child behavior in the dental setting.

BACKGROUND AND AIMS: Temperament has been suggested to be a predictive factor for the child's reaction to dental treatment especially in young ages. The aim of this study was to assess the relationship between temperament and child behavior in relation to age in the dental setting. MATERIALS AND METHODS: In this descriptive-analytical study, 190 children, aged 1 to 7years, who visited dentist for the first time, were included. Early Childhood Behavior Questionnaire (ECBQ) for 18-36 month-olds and Child Behavioral Questionnaire (CBQ) for 3-7 year-old children were completed. Child behavior was rated during dental treatmentusing Frankl scale. Kolmogorov-Smirnov test was used to examine normal distribution of the population. The data were analyzed using descriptive statistics and ANOVA, Chi Square and Pearson's correlation coefficient. P< 0.05 was considered as sig-nificance level. RESULTS: 58 children (29.6%) had completely negative behavior and 27 children (13.8%) had completely positive behaviorduring the treatment. 65% of the children aged 1 to 3 years had completely negative behavior while this figure was 20% for the children aged 6 to 7 years. Temperament score for the children with completely positive behavior was 257.95 while it was 299.37 for children with completely negative behavior. As the temperament score increased, child behavior rank waslower. CONCLUSION: Age and temperament seem to act as predictors of child behavior in the dental setting.