Relationship between parental adverse childhood experiences and the prevalence of early childhood caries.

OBJECTIVES: The aim of this study was to examine the behavioural health conditions associated with parents' retrospective adverse childhood experiences (ACEs) scores and their children's early childhood caries (ECC) in parent-child dyads. MATERIALS AND METHODS: Parents with children younger than 72 months were included in the study. A relational screening model was used. Interaction among ACEs, ECC, nutritional habits and oral hygiene habits were evaluated. Chi-square tests and t-tests were used in the study. Multiple variables were evaluated using the artificial neural network (ANN) model. RESULTS: The mean age of the 535 children included in the study was 46.5 months, and 52% were female. Using the ANN model, there was a statistically significant relationship between the educational status of the mothers in both the ECC and severe ECC (S-ECC) groups and the socioeconomic status of the family (p < 0.05). If the number of snacks consumed daily was three or more, the risk of ECC was statistically significantly higher (chi-square test p = 0.034). The parents' ACEs scores had an impact on both ECC and S-ECC formation (p = 0.001, t-test). The higher the ACEs score, the higher the risk of S-ECC. The mean ACEs scores of the parents were also significantly higher in both the ECC and S-ECC groups compared to those of the parents of children without dental caries (p = 0.001, t-test). It was calculated that ACEs scores were effective at a rate of 18.2% on ECC (p = 0.045, ANN). CONCLUSIONS: The ACEs scores of parents have an impact on the oral health of young children and ECC/S-ECC formation. CLINICAL RELEVANCE: The long-term effects of parental ACEs are reflected in their children's oral health. Therefore, reducing the psychosocial determinants ACEs and providing parental support may help in overcoming barriers to the well-being of young children and may facilitate better oral health.

YouTube as an information source in paediatric dentistry education: Reliability and quality analysis.

INTRODUCTION: In the era of Covid 19 pandemic, the audio-visual contents of YouTube™ could be an information source for dental students, practitioners, and patients. The aim of this study was to evaluate the quality, content, and demographics of YouTube™ videos about pediatric dentistry for the education of dentistry students. MATERIALS AND METHODS: A search on YouTube™ was performed using the keywords "pediatric dentistry", "pediatric dental treatments", "primary teeth treatments" in Turkish. The first 50 videos selected for each keyword were evaluated. Parameters of the videos such as the number of views, the days since the upload, the duration of the video, and the number of likes and dislikes were recorded. Videos are categorized by upload source and content categories as an academic, dentist, physician, patient, reporter, and other, and average points are obtained for the Journal of American Medical Association (JAMA) benchmark. The normality of the data was evaluated with the Shapiro-Wilk test. The data were not distributed normally, compared with the Kruskal Wallis test between source and content groups. The Dunn's Post Hoc was used to determine to find out which group caused the difference. The Spearman Correlation coefficient was calculated to assess a possible correlation between JAMA, GQS, and VPI scores. All significance levels were set at 0.05. RESULTS: The duplicates and non-related ones were removed from 150 videos and remaining 119 videos were evaluated. Most of the videos were uploaded by the dentists and other categories, and mainly the videos were uploaded for patient education. JAMA score was 1 out of 4 for 55 videos, 2 for 63 videos, and 3 for only 1 video. When the video source groups were compared, the difference was statistically significant (p = 0.01). The difference between academic and patient groups (p = 0.007); the dentist and patient groups were statistically significant (p = 0.02). CONCLUSION: YouTube platform does not contain videos of appropriate quality to support the education of dentistry students in pediatric dentistry in Turkish.

Assessment of the validity and reliability of a novel dental trauma index.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are one of the most commonly encountered dental health complications. In order to standardize the evaluations and compare the findings of TDI, a carefully defined dental trauma index may serve as a good tool for the correct recording of dental trauma. A new dental trauma index, the Modified Eden & Baysal dental trauma index (MEBTI), has been introduced. It is an expanded index to record soft tissue injuries in addition to dental injuries. The aim of this study was to assess the validity and reliability of the MEBDTI. MATERIALS AND METHODS: The archival data of 20 patients with different traumatic injuries were selected. A web-based form including the radiographs and photographs of selected cases was created. Following a training session, 12 dentists with a minimum of 10 years of clinical experience were asked to score the cases using the MEBDTI on an online form. The Kolmogorov-Smirnov test was used to test the normality. The Kruskal-Wallis Test was used for intergroup comparisons. Inter-observer agreement was investigated by reliability analysis. The intraclass correlation coefficient (ICC) was used to evaluate the agreement among observers. The Chi-Square test of independence was used to determine if there is a significant relationship between two nominal variables (p < .05). RESULTS: The rate of correctly assessing the alveolar bone fracture was 96.9% followed by apex maturity (92.7%), root fracture (85.4%), luxation injury (76.5%), crown fracture (76.2%), and soft tissue injury (50%). Considering all parameters, the soft tissue injuries were statistically different in terms of the answers given by the 12 dentists (p < .05). CONCLUSION: The accuracy of the scores of participants was high and in accordance with each other except for the identification of soft tissue injuries. In favor of this novel index, the data on dental trauma cases could be recorded practically and reliably.

Caries-Preventive Effect and Retention of Glass-Ionomer and Resin-Based Sealants: A Randomized Clinical Comparative Evaluation.

Background: Deep fissures are highly unprotected from the development of caries. Resin-based materials and glass-ionomer cements for sealing fissures are useful in caries control through physical barrier formation, which prohibits metabolic exchange between fissure microorganisms. Retention is one of the most critical properties of fissure sealants. This in vivo study is aimed at comparing and evaluating the clinical efficacy of resin and glass ionomer-based fissure sealants on first permanent molars with follow-ups at 6-, 12-, and 18-month intervals. Methods: A randomized split-mouth design clinical study was conducted after obtaining the ethical committee approval. A total of 50 patients, aged between 7 and 12 years, were randomized and enrolled in the study to perform a total of 200 sealant placements on all four caries-free and hypoplasia-free first permanent molars having deep fissures, which are susceptible to caries, were included in this study. The four permanent molars were divided into the following four groups: group A (control), B (Grandioseal, Voco, Germany), C (Smartseal & Loc, Detax Gmbh & Co, Germany), and D (Fuji triage capsule, GC, Belgium). The sealed molars were clinically evaluated at intervals of 6, 12, and 18 months to assess sealant retention, surface roughness, marginal coloration, and caries status through visual evaluation of the sealant by two evaluators. Results: Concerning retention, there were statistically significant differences between the sealants in terms of the survival of partial and fully retained sealants as well as in the survival of caries-free teeth. Two resin-based (Smartseal & Loc) and glass-ionomer cement (Fuji triage) sealants showed significantly similar performances in permanent molars for up to 18 months. In terms of retention, one of the resin-based (Grandioseal) sealants performed better as compared to the others and showed better caries prevention in deep fissures. Conclusion: It is concluded that both the sealants had comparable retention and caries-preventive effects in 7 to 12-year-old children and can be considered as suitable sealants for a period of at least 18 months in moderate caries risk patients.

Quality and reliability of web-based information regarding restorative treatment in pediatric patients.

PURPOSE: The aim of the present study is to assess the quality and reliability of web-based information about restorative treatment in pediatric patients on the internet using different scales. MATERIALS AND METHODS: Websites obtained by using keywords about restorative treatment in pediatric patients on Google and Yandex were included in the study. The study was conducted in English on a total of 440 websites. Websites were evaluated using the quality criteria for consumer health information (DISCERN toolkit), Journal of American Medical Association (JAMA) benchmarks, and Health on the Net Code of Conduct Certification (HONCode). RESULTS: The mean DISCERN points of the websites were moderate. Among the evaluated websites, the quality of the knowledge in 20% of the websites was low. The rate of websites with a score below 40 was 37.5%. None of them has reached an excellent score. No websites met all JAMA criteria. There was no HONCode Certificate on any website. CONCLUSION: This study showed that the quality of the web-based information about restorative treatment in pediatric patients was generally inadequate and scientifically imperfect.

Extension of a novel diagnostic index to include soft tissue injuries: Modified Eden Baysal Dental Trauma Index.

AIM: Accurate records of traumatic dental injuries are important for clinical management and data collection for research. Soft tissue injuries often accompany dental trauma and should be appropriately recorded. The Eden Baysal Dental Trauma Index (EBDTI) provides an easy recording system of useful information about traumatic dental injuries on a tooth basis. The aim of this study was to extend the EBDTI index to record soft tissue injuries in a concise format and to approve the face and content validity of this version as the modified EBDTI (MEBDTI). MATERIALS AND METHODS: An extension to EBDTI was developed by adding superscript numbers from 0 to 8 to represent soft tissue injuries related to dental trauma. The Rand e-Delphi method was used to evaluate this version of the index. A definition and two statements about the index were sent to 15 international panel experts to be assessed independently on a 9-point Likert scale where 1 represented "total disagreement," and 9 indicated "total agreement." The panel needed to reach a 75% consensus for validation. A numerical code was suggested using zero to depict no soft tissue injury; 1-4 to record extra-oral injuries; and 5-8 to record intra-oral injuries (for example, gingiva, frenulum, and palate). Traumatic dental injury of the tooth/teeth is recorded using EBDTI in square brackets, and soft tissue codes are used as superscript numbers outside the brackets on a patient basis. RESULTS: The panel reached a consensus on the definition (86.7%) and two statements (86.7% and 93.3%) in one round. Various cases are presented to demonstrate the application of the index. CONCLUSION: The Modified Eden Baysal Dental Trauma Index was developed to record soft tissue. injuries on a patient basis and was approved for face and content validity.

Web-based dental trauma database using Eden Baysal dental trauma index: a turkish multicenter study.

PURPOSE: To describe the prevalence and pattern of traumatic dental injuries (TDIs) among Turkish children in a web-based and multicenter design using Eden Baysal Dental Trauma Index (EBDTI). MATERIALS AND METHODS: The study sample consisted dental trauma patients aging 1-15 years and a webbased form was developed and used to record the information of the patients' clinical and radiographic findings including EBDTI. The obtained data also included patient gender, age at the initial date of trauma, date of trauma, cause of injury and emergency treatment. Data were analyzed using Pearson Chi-square and Fisher's exact tests. RESULTS: A total of 280 traumatized teeth in 252 patients were evaluated. Dental trauma was seen more in boys and 7-10 years age group (p<0.05). There were significant differences between permanent and deciduous teeth with regard to uncomplicated and complicated crown fracture rate (p<0.05). The root fractures were mostly located at the apical third of the root in both dentitions. CONCLUSION: TDI was associated with age, gender, and type of dental trauma. EDBTI provided easy and proper recording of multiple dental injuries and maturity of the apex and it was found to be a very useful tool to facilitate online recordings of dental injuries.

Comparative evaluation of fluoride varnishes, self-assembling peptide-based remineralization agent, and enamel matrix protein derivative on artificial enamel remineralization in vitro.

BACKGROUND: One of the most unfavorable side effects of fixed orthodontic treatment is white spot lesions (WSLs). Although the most important approach is prevention of WSLs, it is also essential to evaluate the efficacy of the remineralization agents. However, there is no concurrence in the literature with respect to the remineralization process of these agents. The objective of the present study was to evaluate the effects of different fluoride varnishes, enamel matrix protein, and self-assembling peptide derivatives with varying chemical compositions on remineralization of artificially created WSLs in vitro using quantitative light-induced fluorescence (QLF). METHODS: Artificial WSLs were created on bovine enamel samples using acidic buffer solution (pH 5, 10 days). Specimens were randomly allocated to six groups (n = 10/group): (1) Emdogain (Straumann, Basel, Switzerland), (2) Curodont Repair (Credentis AG, Switzerland), (3) Duraphat (Colgate-Palmolive, New York, NY), (4) Clinpro XT (3 M ESPE, Pymble, New South Wales, Australia), (5) Enamel Pro Varnish (Premier Dental Products, PA, USA), and (6) control (untreated). The agents were applied to the WSLs according to the manufacturers' instructions. Fluorescence loss (ΔF), lesion area (area), and impact (ΔQ) values of enamel surfaces were quantified by QLF-D BiluminatorTM (Inspektor-Pro, Amsterdam, The Netherlands) at baseline and after 7, 14, and 21 days of application of the respective materials. RESULTS: ΔF value presented a significantly decreasing trend throughout the 21 days for all groups except the Duraphat and Enamel Pro varnishes. The changes between 14th and 21st days of the Clinpro XT varnish application were significantly higher than Emdogain, Curodont, and Enamel Pro. The Curodont group showed higher lesion area changes between the first and second week in comparison to the Emdogain, Clinpro XT, and Enamel Pro groups, whereas Clinpro XT assured the highest reduction from the second to the third week of the observation period. CONCLUSIONS: The fluorescence loss was significantly reduced with enamel matrix protein, self-assembling peptide, and light-curable fluoride varnishes in the analysis for 21 days. Curodont and Clinpro XT were effective in diminishing the fluorescence loss and lesion area compared to the Duraphat, Enamel Pro fluoride varnishes, and Emdogain in different time points.

Managing dental caries against the backdrop of COVID-19: approaches to reduce aerosol generation.

The COVID-19 pandemic resulted in severe limitation and closure of dental practices in many countries. Outside of the acute (peak) phases of the disease, dentistry has begun to be practised again. However, there is emerging evidence that SARS-CoV-2 can be transmitted via airborne routes, carrying implications for dental procedures that produce aerosol. At the time of writing, additional precautions are required when a procedure considered to generate aerosol is undertaken.This paper aims to present evidence-based treatments that remove or reduce the generation of aerosols during the management of carious lesions. It maps aerosol generating procedures (AGPs), where possible, to alternative non-AGPs or low AGPs. This risk reduction approach overcomes the less favourable outcomes associated with temporary solutions or extraction-only approaches. Even if this risk reduction approach for aerosol generation becomes unnecessary in the future, these procedures are not only suitable but desirable for use as part of general dental care post-COVID-19.

Psychometric evaluation of the child oral impacts on daily performances (C-OIDP) for use in Turkish primary school children: a cross sectional validation study.

BACKGROUND: As patient-reported outcome, the Child Oral Impacts on Daily Performances (C-OIDP) has been commonly used for assessing children's oral health needs in order to facilitate oral health service planning. It was translated and cross-culturally adapted into Turkish in 2008. Since then, there is no study to assess its psychometric properties in Turkish child population. This cross-sectional study aimed to investigate the psychometric properties and factor structure of the Turkish version of the C-OIDP for use in Turkish primary school children. METHODS: The Turkish translated version was tested on a convenience sample of primary school children aged 11 to 12 years attending two public schools in Istanbul. Data were collected by clinical examinations, face-to-face interviews and self-completed questionnaires. The internal consistency, test-retest reliability, construct validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), criterion related validity (concurrent and discriminant) were evaluated. RESULTS: A total of 208 children were subjected to the tested the C-OIDP. Overall, 93.7% of them reported at least one oral impact in the last 3 months. The most frequently affected performances were "eating" (72.1%) and "cleaning mouth", while the performance with the lowest impact was "studying" (13%). The internal consistency and reproducibility of the C-OIDP were acceptable, with a Cronbach's alpha of 0.73 and an intra-class correlation coefficient of 0.83. The EFA yielded a two-factor model termed "functional limitation" and "psychosocial limitation". CFA identified the two- factor model which fit the data better than the previously proposed three-factor model, namely physical, psychological and social health. Having malocclusion, the presence of gum disease, reported history of oral problems in the mouth, dissatisfaction with oral health, bad self-rated oral health and having a problem-oriented pattern of dental attendance were found to be the most important factors related to worse oral health- related quality of life, supporting its criterion-related validity. CONCLUSION: This study provided preliminary evidence the psychometric properties of the C-OIDP index among Turkish school children aged 11-12 years. It may be applied to evaluate the oral health impact on quality of life in this population.

Effects of an oral health program: Community-based education among mothers of young children living in socioeconomically disadvantaged neighborhoods.

INTRODUCTION: An oral health program for mothers starting from pregnancy in a disadvantaged district of Izmir was performed in 2013-2016. Dental behaviors and their determinants among intervention and control groups were compared in the third phase of the program. METHODS: This nonrandomized-controlled study was conducted in Phase 3. The intervention group began with 248 pregnant women; 69.4% (n = 172) of mothers with 6-9-month-old babies participated in Phase 2, 2014. At Phase 3 (18-24 months), 68.6% (n = 118) of mothers in the intervention group and 113 mothers living in another district as controls were included. Sociodemographic characteristics, determinants of behaviors, and outcomes defined as dental behaviors in the last week were assessed using a questionnaire. RESULTS: Regarding knowledge, perceived severity, and fatalistic beliefs, the intervention group had higher correct answer percentages. The percentage of mothers who could clean their children's teeth before sleep was higher in the intervention group (76.3%; P < 0.05), but the difference was lost by a child's resistance. The significant difference on avoiding bedtime nursing (65.3%) and sugary snacks (74.4%) in the intervention group disappeared with the obstacle of a child's protests or interference from relatives. In the intervention group, 32.2% of the mothers reported that they did not give any sugary snacks, 43.2% had never fed during sleep, and 26.3% cleaned their children's teeth during the last week. The results in the control group were 24.8%, 18.6%, and 8.8%, respectively (P < 0.05). CONCLUSIONS: The program improved the mothers' views regarding the determinants of dental behaviors, but greater support against obstacles was needed. Social environmental support is planned for the following stages of the program.

Success of Two Caries Risk Assessment Tools in Children: A Pilot Study With a 3-Year Follow-Up.

Caries risk is defined as the dental caries probability under the individual bacteriological environment, dietary habits, and environmental factors. Assessment of caries risk plays a major role in the prevention of dental caries. The aim of this study was to compare the effectiveness of two different caries risk assessment methods on caries-free preschool children. A sample of 90 caries-free 4- to 6-year-old children were selected from 400 preschool children. The selection was limited to children who had no dental caries, visible plaque, and systemic disease. American Academy of Pediatric Dentistry's Caries Risk Assessment Tool (CAT) and Clinpro Cario L-Pop (CCLP; 3M ESPE, Germany) were used to categorize children into caries risk groups. Children were classified as being in high-, medium-, or low-risk groups by two methods. Determining risk factors according to CAT were examined. The compliance among the two methods was evaluated. Sixty-eight children were reevaluated intraorally after 3 years. The compliance between CAT and CCLP was sought using Kappa test. Statistical evaluation revealed moderate compliance among methods at baseline. The three most determinant factors in the high-risk group according to CAT were no topical fluoride exposure, no use of dental services, and active caries in mother. CAT is found statistically more successful than CCLP in predicting caries risk 3 years later. Caries risk assessment is effective to predict future caries and can be helpful for the clinician to choose the right tailor-made caries prevention plans.

Eden Baysal Dental Trauma Index: Face and content validation.

BACKGROUND/AIM: Recording of traumatic dental injuries in the emergency situation with a simple and easily recordable index that will also enable computer registration is advantageous. The aim of this paper is to present a new index to facilitate recording traumatic dental injuries and assess its face and content validity. MATERIALS AND METHODS: The index included information on the type of injury related to the affected structures (enamel, dentin, cement, pulp, periodontal ligament, and alveolar bone) in accordance with Andreasen's classification. In addition, injuries to the alveolar bone and the maturity of the root were included. Fifteen dental trauma experts from 11 different countries rated the codes and content of the "Eden Baysal Dental Trauma Index" using the RAND modified e-Delphi consensus method. A statement was considered valid after reaching 75% consensus among panel members. Two rounds were necessary for reaching consensus on seven statements and the definition. The last version of the index was then presented online to a feedback group that included 10 experts from five countries to determine the external validity by representative cases. RESULTS: The wording of the definition showed 92.8% agreement in the first round. Statements 1 and 2 gave information about the structure of the index and both reached 90% agreement in the first round. Definition and statements from 1 to 7 reached agreement as 93.3%, 93.3%, 100%, 93.3%, 80%, 93.3%, 80%, and 93.3%, respectively, in the second round. Most of the experts in the feedback group reported that the index was useful and user-friendly. CONCLUSION: After a total of two rounds with the panel members and one round with the feedback group, the "Eden Baysal Dental Trauma Index" was approved for face and content validity and external validity was obtained.

Access to health care after dental trauma in children: A quantitative and qualitative evaluation.

BACKGROUND/AIMS: The aim of this study was to evaluate the accessibility of proper and on-time treatment after dental trauma in children and to explore the affecting factors via parents' and health professionals' perspectives. The study is important to understand how to improve access to dental treatment after trauma. MATERIALS AND METHOD: The method included quantitative and qualitative parts. For the quantitative method, parents of dental trauma patients who applied to Ege University, Department of Pedodontics during January 2015-June 2016 were the target group. One hundred and forty parents answered the questionnaire on trauma experiences. The participation rate was 62.78%. Questions covered variables such as first admitted health institution, time to go there, access to diagnostics, treatment methods, referral from institution, and sociodemographic characteristics of the family. On-time and proper treatment access was defined using an algorithm for treatment priority of the case, total time to reach treatment, and the correct intervention. For the qualitative method, ten parents and thirty health professionals were interviewed in-depth using a semi-structured question guide. Thematic analysis was applied to the interview texts. RESULTS: The percentage of patients who accessed on-time and proper treatment was 19.29%. Logistic regression analysis showed that admission to the university clinic first increased the access to treatment by 14.135 times. For the qualitative evaluation, treatment access was summarized into three main themes: (a) physical accessibility of dental health services, (b) a quality dental health service as an outcome, and (c) communication among parties. CONCLUSION: The level of accessing proper and on-time treatment was quite inadequate. It is suggested that distribution of dental care centers should be increased and dental centers where competent dentists work should be established. Performance-based payment should be reorganized and cooperation between medical and dental institutions should be encouraged.

Comparison of Two School-Based Oral Health Education Programs in 9-Year-Old Children.

This study evaluated the effectiveness of two school-based oral health education (OHE) programs on the oral health knowledge and behavior and oral hygiene of 9-year-old children in Turkey. The study included 1,053 school children aged 9 years in Aydin, Turkey. This study was a prospective, two-arm, and parallel-group clinical trial between two different OHE programs. The dentist group received one lecture on OHE given by dentists in the classroom. The teacher group had a similar lecture given by school teachers, including supporting materials which were available throughout the academic year. Oral health knowledge and behavior were evaluated with a questionnaire at baseline, and then at 1 and 6 months. In total, 110 students were randomly selected to undergo a plaque accumulation assessment according to the Silness-Löe Index at baseline and 1 month later to determine the effects of the education programs on oral hygiene. At baseline, tooth-brushing frequency was similar in the study groups. Compared with baseline, the frequency of brushing increased significantly after 1 and 6 months in both groups ( p < .001). Teacher education was more effective for teaching correct brushing techniques ( p < .001). A significant decrease in plaque accumulation has been evaluated in both study groups at the 1-month examination after the education session ( p < .05). Both OHE programs were found to generate improvements in knowledge and behavior of children on oral health and plaque control in the short term.

Color assessment after bleaching with hydrogen peroxide versus ozone: a randomized controlled clinical trial.

This randomized controlled clinical trial evaluated the color change of teeth bleached with either hydrogen peroxide (HP) or ozone (OZ). A total of 26 patients with a mean age of 36.2 years (SD, 8.7 years) who met the inclusion criteria were enrolled in the study. The subjects were randomly assigned to receive chairside bleaching using 40% HP or gaseous OZ. Maxillary dental arch vacuum trays were constructed with circumferential openings in the middle portion of the maxillary incisors at their labial surfaces. These trays were used for measuring color-first at baseline and then immediately and 48 hours after postbleaching-and were not used in bleaching. Changes in color were determined using CIE L*a*b* coordinates. Analysis of the data revealed that, while overall color change (ΔE*) values of the HP and OZ groups did not show statistically significant differences immediately after bleaching (P = 0.114), ΔE* values were significantly different 48 hours postbleaching (P = 0.00). Visible color changes were not obtained with either HP or OZ immediately postbleaching. The greatest visible color change occurred with HP 48 hours postbleaching.

Evaluation of children's dental anxiety levels at a kindergarten and at a dental clinic.

This study evaluated the dental anxiety levels of preschool children at a kindergarten and at a dental clinic. The anxiety levels of ninety 4-6-year-old (4.99 ± 0.81) preschool children were evaluated according to pulse rates, the facial image scale (FIS), the Venham picture test (VPT), and the Frankl behavior rating scale. The children's mothers were asked to complete the state-trait anxiety inventory (STAI) forms 1 and 2 (STAI 2 and STAI 2). The sample t-test, Mann-Whitney U test, and Pearson's correlation test were used. A statistically significant difference was observed between the children's pulse rates when measured at the dental clinic and those when measured at the kindergarten (p < 0.001). Although the results were not statistically significant, more negative facial expressions were observed in the children at the dental clinic than in those at the kindergarten when assessed using FIS and VPT (p = 0.090 and p = 0.108, respectively). There was a statistically significant correlation between the transient anxiety levels (STAI 1) of mothers and the VPT scores of their children evaluated at the dental clinic (r = 0.506, p < 0.001). The continuous anxiety level of the mothers of males was found to be significantly higher (p = 0.033) than that of the mothers of females (STAI 2). Although the children had been informed about dentistry and were introduced to a dentist at the kindergarten, their anxiety levels seemingly increased as they arrived at the dental clinic. The significant increase observed in the children's pulse rates was a physical indicator that their anxiety levels had increased. It can be concluded that the children felt more anxious at the dental clinic that at the kindergarten.

AGE AND REASONS OF THE FIRST DENTAL VISIT OF CHILDREN IN LEBANON.

BACKGROUND: The American Academy of Pediatrics and the American Academy of Pediatric Dentistry have recommended that the child's first dental visit should be during the child's first year of life for dental disease prevention and to decrease the invasive restorative interventions. In Lebanon, no study has been conducted to determine the age and the reasons of the first dental visit of children and who requested the first dental screening. OBJECTIVES: To assess at what age occurred the first dental visit in a group of Lebanese children visiting a private pediatric dental clinic and to explore the reasons for their first dental consultation. MATERIALS AND METHODS: An observational cross-sectional study was conducted. During a five-year period, all children visiting the pediatric clinic were invited to participate in the study. Parents were asked about the general health status of their child, the use of antibiotics before the age of 2 years. Parents were also requested to give the dental reasons for their initial visit to a pedodontist. RESULTS: Two hundred and twenty children (mean age 4.24 ± 1.35 years) visited the pedodontic care office for the first time and were included in the study. All participants had visited a pediatrician before the age of 1 year. Fifty-seven (25.9%) children were referred by a dentist and 163 (74.1%) came with their parents without referral. All participants had at least one reason for the first consultation; the most common were the presence of decayed teeth (50.9%) and a dental pain perception (29.5%). CONCLUSION: All participants had visited a pediatrician at an earlier age but none was referred to a pedodontist by a pediatrician for check-up or prevention. Children came upon the decision of their parents. A dental problem was the major reason which triggered the first visit. Therefore, pediatricians in Lebanon need to keep themselves updated on recommendations regarding children oral health and be encouraged to play an important role in prompting oral health and first dental visits.

Restoring crown fractures by direct composite layering using transparent strip crowns.

Traumatic dental injuries are mostly seen at childhood and adolescence. The most common fracture in permanent anterior teeth is crown fracture. Esthetic and easy rehabilitation of these anterior teeth is possible using layering techniques and direct composite resin restorations. Shape, color and surface texture are the most important factors in restoring crown fractures esthetically. This article illustrates how to perform an esthetic composite resin restoration of crown fractures using strip crowns. The technique suggests using a strip crown as a mold for direct resin composite restoration. This provides a cost-effective treatment with operator friendly approach where most outstanding advantage is the minimum chair-side time with a single visit that is very important for young trauma patients.