Gagging and cooperation in 4-12-year-old children over a series of dental appointments.

PURPOSE: The purposes were to evaluate if gagging can affect children's cooperation with treatment, investigate possible changes in gagging and study factors that can predict children's behaviour over dental treatment. METHODS: 255 children aged 4-12 years, needing at least three consecutive dental appointments, completed the Children's Fear Survey Schedule-Dental Subscale before examination. The Gagging Problem Assessment was performed before the initial examination and after the third/final appointment. Frankl's Behaviour Rating Scale (FBRS) was used to rate children's behaviour. Multivariate Mixed Linear and Logistic Regression Models were used. RESULTS: Children with definitely positive behaviour were significantly older, less fearful and less likely to gag before treatment. Girls and older children had lower odds of gagging over time, while fearful children had higher odds. There were no statistically significant associations between gagging over time, FBRS and the type of dental treatment at the third appointment. The percentage of children who gagged after the third appointment (27.05%) was significantly lower as compared to the percentage found at the initial appointment (32.54%; p = 0.004). CONCLUSION: Among the variables studied, age, dental fear, initial GPA and type of treatment were good predictors of children's behaviour during dental treatment.

Oral hygiene and periodontal condition of 12- and 15-year-old Greek adolescents. Socio-behavioural risk indicators, self- rated oral health and changes in 10 years.

AIM: To investigate oral hygiene and periodontal status of 12- and 15-year-old Greek adolescents in relation to socio- demographic and behavioural indicators and identify national trends. MATERIALS AND METHODS: In a stratified cluster sample of 2,478 participants, the Simplified Debris Index (DI-S) and the Community Periodontal Index (CPI) were calculated. Socio- demographic/behavioural data were collected through structured questionnaires. Multivariate ordinary regression examined the effect of socio-behavioural indicators on oral hygiene and periodontal conditions. RESULTS: 51.7% of the 12-year-olds and 56.9% of the 15- year-olds had fair and good oral hygiene, respectively. Approximately 30% of the adolescents had healthy periodontium. Bleeding on probing was detected in 23.6% and 21.6% of the 12- and the 15-year-olds, accordingly. Calculus was found in 46.2% and 44.3% of the 12- and the 15-year-old groups, correspondingly. The prevalence of periodontal pockets ?4mm was 3.2%. Significantly higher DI-S scores were found among 12-year-olds who were males, had lower educated mothers or did not use dental floss and among adolescents who brushed their teeth

Factors associated with gagging during radiographic and intraoral photographic examinations in 4-12-year-old children.

AIMS: No studies are available in paediatric samples evaluating gagging during toothbrushing, radiographic and/or intraoral photographic examinations. The aims were to collectively examine potential factors associated with gagging during radiographs and intraoral photographs in 4-12-year-old children. METHODS: Parents/guardians of 395 children (aged 4-12 years old) completed questionnaires asking about their children's toothbrushing habits. Children completed Greek versions of the Gagging Assessment Scale (GAS) and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), while the dentist used the shorter version of the Gagging Problem Assessment (GPA-de-c/SF) to objectively assess gagging. X-ray and Photo Rating Scales were created to evaluate gagging during X-rays and photographs, respectively. Multivariate logistic regression was used to examine the relationship between the potential factors and gagging. RESULTS: 59 of 275 patients (21%) and 56 of 276 patients (20%) who needed X-rays and intraoral photographs, respectively, gagged. Children who gagged during X-rays had significantly higher GAS scores (p = 0.007). Boys, younger children, and those who gagged on GPA-de-c/SF were more likely to gag during X-rays, and children who gagged on GPA-de-c/SF were more likely to gag during photographs. Brushing habits were not related to dental fear or gagging. CONCLUSION: Of the variables which we studied, GPA-de-c/SF most strongly affected the odds of gagging during taking radiographs and/or intraoral photographs.

Child dental fear and past dental experience: comparison of parents' and children's ratings.

PURPOSE: To compare the parental and child versions of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and the parental and child evaluations of the Child's Past Dental Experience (CPDE) in 4- to 12-year-old children in a sample from Greece. METHODS: 537 families (652 children) with 4- to 12-year-old children seeking dental care either at a University paediatric dental clinic (UC) (50.8%) or a paediatric private practice (PP) participated. Parents completed a sociodemographic questionnaire and the parental Greek version of the CFSS-DS, and children independently completed the child's Greek version. All family members answered questions about CPDE. Statistical analyses were based on multilevel models (p < 0.05). RESULTS: Mothers' and fathers' mean CFSS-DS total scores were not significantly different from each other (p = 0.655), but were significantly higher than the scores of their sons and daughters (p < 0.001), regardless of the child's age. There was a negative association between mother's age and CFSS-DS agreement, but not for fathers. There was poor agreement for CPDE ratings between children and both parents, regardless of gender. Parents' ratings of CPDE were not related to their assessment of their children's dental fear, whilst the children's ratings of their CPDE were significantly related to their current dental fear. Location (UC or PP) had no significant influence on CFSS-DS or CPDE parental-child differences. CONCLUSIONS: Both parents overestimated their sons' and daughters' dental fear. There was poor agreement on CPDE evaluation between parents and children. Parental CFSS-DS and CPDE evaluations are poor indicators of children's dental fear and prior dental experience.

Direct pulp capping of carious primary molars. A specialty practice based study.

OBJECTIVE: Recommendations against direct pulp capping (DPC) for carious primary teeth are based on old, low level evidence. This study investigates the medium to long-term clinical and radiographic outcomes of such treatment. STUDY DESIGN: Each of 62 3-9 year old children with any deep, primary molar cavity was included if a pulp exposure occurred during caries excavation. Exclusion criteria were irreversible pulp damage/uncontrolled hemorrhage. Using rubber-dam, fast setting calcium hydroxide (CH) and tooth restoration were placed. Patients were followed up for signs/symptoms. Survival analysis, the Kaplan-Meier method and the Mantel-Cox test were usedfor statistically analyzing the data. RESULTS: Seven patients (11.3%) dropped out. Controlled hemorrhage occurred in 25 exposures. Fourteen exposures were large and 46 were pin point. Out of 60 primary molars with DPC (in 55 patients), 7 failed by clinical and/or radiographic criteria. The remaining 53/60 (88.3%) teeth survived for 21.0 (±9.0) months. The 4 year cumulative survival rate by Kaplan-Meier analysis was 80%. All restorations remained in place with 3 needing replacement without affecting pulp survival. CONCLUSION: The CH success rate of carious primary molar DPC justifies further research based on careful initial diagnosis ofpulp inflammation reversibility.

Psychometric properties of the Greek version of the Toronto Composite Empathy Scale in Greek dental students.

INTRODUCTION: Empathy levels of health practitioners are related to patient satisfaction and treatment outcomes. The Toronto Composite Empathy Scale (TCES) was recently developed to assess cognitive and emotional empathy levels in both professional and personal spheres, and tested in an English-speaking sample of dental students. The aim of this study was to examine the psychometrics of the Greek version of the TCES. MATERIALS AND METHODS: The TCES was translated into Greek and administered to all of the dental students at Aristotle University of Thessaloniki. A random subset of students completed the questionnaire twice for test-retest analysis. RESULTS: Nearly all (96.5%) of the students completed the questionnaire. The internal consistencies of each of the four subscales were generally acceptable (Cronbach's alphas: 0.676-0.805), and the scale showed good discriminant and convergent validities (r's for discriminant validity: 0.217 and 0.103; r's for convergent validity: 0.595 and 0.700). Test-retest reliabilities ranged from 0.478 to 0.779. After eliminating items that fell on both cognitive and emotional factors, a rotated factor analysis indicated that the items loaded on two cognitive and three emotional factors. DISCUSSION: Our results indicate that the Greek version of the TCES has good psychometric properties. The factor analysis indicates that the emotional and cognitive aspects of empathy are distinct, supporting the need to address both aspects in studies of empathy. CONCLUSIONS: The Greek version of the TCES is a reliable and valid tool for the measurement of cognitive and emotional empathy, in both professional and personal life, in Greek dental students.

A form of 'parental presence/absence' (PPA) technique for the child patient with dental behaviour management problems.

AIM: This paper reports on the use of early introduction of a specific parental presence/absence (PPA) behavioural technique to manage the initially uncooperative child. METHODS: Using a prospective design, 440 healthy children aged 3 to 10 years visited a paediatric dental practice within 33 months. Children exhibiting initially Frankl 'negative' and 'definitely negative' behaviour were empathically offered parental presence only if they were cooperative. Otherwise, the parent stepped out until behaviour improvement. STATISTICS: t-tests and Chi-square tests were used to compare characteristics of initially cooperative and uncooperative children, as well as proportions of parents who were asked to leave the surgery. The technique's success was assessed by a one sample binomial test. RESULTS: 75 of the children presented as Frankl either 'negative' (30) or 'definitely negative' (45) at their first visit; 70 (93.3%, p<0.001) responded to the PPA technique by displaying positive behaviour as their first visit progressed. 38 responded without the need to ask the parent to exit the practice room, while the other 32 responded only after their parent exited. 52 children had additional appointments, and 8 required an application of PPA at a second appointment; all children cooperated in all subsequent appointments. CONCLUSION: Early and empathic application of the PPA technique appears very successful in managing initially uncooperative child patients, suggesting that a randomised controlled trial of the technique is warranted.

Periodontal conditions and subgingival microflora in Down syndrome patients. A case-control study.

OBJECTIVES: The periodontal conditions and the subgingival microflora of children, adolescents and young adults (8-28 years old) with Down syndrome were investigated in the present cross-sectional study and compared with those of healthy individuals and subjects with cerebral palsy. MATERIAL AND METHODS: Seventy Down syndrome patients, 121 age-matched healthy individuals and 76 patients with cerebral palsy participated in the present study. Full-mouth recordings of clinical parameters (probing depth, probing attachment level, bleeding on probing, hygiene index) and the community periodontal index of treatment needs were assessed and subgingival plaque samples were taken from the Ramfjord teeth and analysed for 14 species using "checkerboard" DNA-DNA hybridization. RESULTS: Clinical indices of periodontal inflammation and treatment needs were statistically significant higher among Down syndrome patients compared with the other two groups (ANOVA, p=0.000). Important periodontal pathogens colonize these subjects earlier and at higher levels (chi-squared test, p=0.000). DISCUSSION: Down syndrome patients display more severe periodontal destruction earlier, and heavier colonization with periodontal pathogens compared with age-matched healthy individuals and patients with cerebral palsy.