Efficacy of two behavioural management techniques during inferior alveolar nerve block administration in pre-school children: a randomised clinical trial.

PURPOSE: To evaluate and compare the efficacy of the hands-eyes-mouth distraction technique (HEM-DT) in reducing anxiety and pain levels and improving the behaviour of pre-school children during inferior alveolar nerve block (IANB) administration to that of the covering patient's vision technique (CPV-T). METHODS: This study included 52 children aged 3-5 years old with primary dentition, no history of receiving local anaesthesia, and whose treatments required an IANB. These children were randomly assigned into two groups: HEM-DT (G1; n = 26) and CPV-T (G2; n = 26). Anxiety and pain levels were assessed using the Facial Image Scale and the Wong-Baker Scale, respectively, while the patient's behaviour was evaluated using the Frankl Behaviour Scale. This study was divided into two sessions including the treatment session (administration of IANB) and the control session (7 days after anaesthesia). Chi-square test, the Mann-Whitney U test and Wilcoxon test were used for statistical analyses. RESULTS: The patients' anxiety levels did not increase 7 days after IANB in G1 (p value = 0.798); however, higher anxiety levels were observed in the G2 group (p value = 0.039). No significant differences in pain levels and behaviour were observed between the groups during administration of anaesthesia (p value > 0.005). CONCLUSION: HEM-DT and CPV-T showed efficacy in terms of pain and behaviour during IANB administration. Pre-school children in the HEM-DT group exhibited lower anxiety levels in the control session. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: ClinicalTrials.gov (NCT02591797). October 28, 2015.

Influencia de la saliva en la erosión dental en niños. Estudio transversal / Influence of saliva on dental erosion in children. A cross-sectional study

Introducción: La erosión dental es la pérdida patológica, crónica, localizada e indolora de los tejidos dentarios duros, producido por la acción química de ácidos, donde no está involucrada la acción de microorganismos. En los últimos años se ha observado un incremento significativo de la prevalencia de esta patología, especialmente en niños y adolescentes. El objetivo fue establecer la relación del flujo, el pH y la capacidad buffer de la saliva estimulada con el desarrollo de erosión dental en una muestra de 400 niños valencianos de edades comprendidas entre 6 y 14 años. Material y métodos: Se realizó un estudio transversal. Mediante una exploración clínica se determinó con el índice BEWE la presencia o no de erosión en cada paciente, así como la gravedad en caso de ser detectada. Además, se determinó el flujo de saliva estimulado, la capacidad buffer y el pH salival. Resultados: La prevalencia de erosión dental en la muestra estudiada fue del 22,3%. Se observó que los pacientes con un pH moderadamente ácido presentaron un mayor índice BEWE (p<0,001). Además, cuanto menor fue la capacidad buffer salival menor fue la gravedad de las lesiones erosivas presentes (p<0,001) en los pacientes. No se pudo establecer una relación positiva entre el flujo salival y el índice BEWE. Discusión: Una baja capacidad buffer, así como un pH moderadamente ácido salival parecen ser factores asociados positivamente con el desarrollo de lesiones erosivas. (AU)

Introduction: Dental erosion is the pathological, chronic, localized and painless loss of hard dental tissues, produced by the chemical action of acids, where the action of microorganisms is not involved. In recent years, a significant increase in the prevalence of this pathology has been observed, especially in children and adolescents. The objective was to establish the relationship between flow, pH and buffer capacity of stimulated saliva with the development of dental erosion in a sample of 400 Valencian children aged between 6 and 14 years. Material and methods: A cross-sectional study was carried out. A clinical examination was used to determine the presence or absence of erosion in each patient, as well as the severity of erosion, if detected. In addition, stimulated saliva flow, buffer capacity and salivary pH were determined. Results: The prevalence of dental erosion in the studied sample was 22.3%. It was observed that the patients with a moderately acid pH had a higher BEWE index (p <0.001). Furthermore, the lower the salivary buffer capacity was, the lower the severity of the erosive lesions present (p <0.001) in the patients. A positive relationship between salivary flow and BEWE index could not be established. Discussion: A low buffer capacity, as well as a moderately salivary acid pH seem to be factors positively associated with the development of erosive lesions. (AU)

Dental erosion. Etiologic factors in a sample of Valencian children and adolescents. Cross-sectional study.

AIM: To establish the relationship between dental erosion prevalence in children aged 6-14 and all the aetiological factors that lead to the development of the lesions. MATERIALS AND METHODS: Study design: A correlational cross-sectional study of a sample of 400 Valencian children was conducted. First, a questionnaire was completed to analyse the patients' health status, their dietary and oral hygiene habits, the kind of school they attended and their parents' academic level. Then, a clinical exploration of the permanent dentition was done, calculating the BEWE index and the risk of erosion for each patient. RESULTS: The prevalence of dental erosion of the studied sample was 22.3%. A positive correlation was observed between the presence of dental erosion and the frequent intake of fruit juices, carbonated and isotonic drinks (p<0.05), presenting a higher correlation if the liquid was kept in the mouth before swallowing. Aetiological factors such as the use of inhalers in patients with asthma (p=0.006), frequency of vomiting and regurgitation (p<0.001), frequent swimmers (p<0.001) or a low socioeconomic status (p<0.05) were also positively associated to the development of erosive lesions. STATISTICS: A descriptive and inferential statistical analysis was performed, using the Mann-Whitney U and the Kruskal-Wallis tests in the latter. CONCLUSION: The results of this study suggest that the frequent intake of fruit juices, carbonated and isotonic drinks, the use of inhalers and belonging to a low socioeconomic level family are factors positively associated to the development of erosive lesions.

Effects of xylitol chewing gum on salivary flow rate, pH, buffering capacity and presence of Streptococcus mutans in saliva.

AIM: The first studies on the use of chewing gum in dentistry were done in the 1970s. The Turku Sugar Studies, carried out between 1970 and 1973, showed the excellent anticaries properties of xylitol chewing gums. Since then, many dentists, particularly in Scandinavian countries, have studied the role of chewing xylitol-sweetened chewing gums as another preventive strategy in the control of dental caries. OBJECTIVE: To compare variations in salivary flow rate, pH, buffering capacity, and levels of Streptococcus mutans in baseline conditions and after chewing paraffin pellets or xylitol chewing gum in children between the ages of 6 and 12 years who eat lunch in a school canteen. MATERIALS AND METHODS: The study sample consisted of 90 children divided into 2 study groups, and a control group. The children ate lunch at the canteen of the Escultor Ortells state school in the town of Vila-real (Castellón, Spain). The baseline data recorded in the first phase of the study were compared with the data recorded in the second phase, after 15 minutes of chewing xylitol- sweetened chewing gums or paraffin pellets, depending on the study group. Salivary flow rate was measured by collecting the stimulated saliva in a graduated beaker. Levels of pH were measured using a Cyberscan pH 110 pH meter (Eutech Instruments). CRT buffer strips and the CRT bacteria test (Ivoclar-Vivadent) were used to measure buffering capacity and levels of S. mutans, respectively. RESULTS: The data obtained after sample collection were compared by means of a 1-way analysis of variance using the StatGraphics Plus statistical software package, version 5.0. Statistically significant differences were found (p<.05) when pH, buffering capacity and levels of S. mutans were compared between the 3 groups. Comparison of salivary flow rates revealed no statistically significant differences (p>.05), though salivary flow rates were higher in the groups where gum was chewed. CONCLUSION: The effect of chewing is essential to the stimulation of salivary flow and the resulting recovery of pH levels and reduction of levels of S. mutans in saliva.