Regenerative endodontic therapy: a follow-up of 47 anterior traumatised teeth.

PURPOSE: To collect long-term survival data in anterior traumatised teeth on the outcome of Regenerative Endodontic Treatments (RET) with a network of dentists working in different clinics to overcome the problem of anecdotical evidence. METHODS: The seven dentists from Paediatric REsearch Project (PREP) performed RET treatments following the same protocol in five different secondary dental care clinics in the Netherlands. Treatment resulting in pain, apical problems, sinus tracts, resorption or fracture were considered as failure of treatment. RESULTS: 47 teeth in 38 children were treated between January 2009 and September 2017 and had at least 6 month follow-up (mean 35 months). Apical closure was seen in 27 teeth (25 cases) and root length growth in 6 teeth (6 cases). Thickening of the root walls was seen in 20 teeth (20 cases) and obliteration of the root canal in 30 teeth (25 cases). Of 38 teeth with apical inflammation at the start of treatment, no radiographic sign of apical inflammation was visible at 3 months in 13 of 28 teeth; taking up to 42 months for radiographic signs of apical inflammation to be not visible. Nineteen of 35 teeth showed discoloration at the beginning of treatment. After 18 months two teeth showed signs of ankylosis, but were still functional. After 36 months one more tooth showed signs of new apical inflammation and 2 months later it was extracted. CONCLUSIONS: With three failures in 47 treated teeth, RET seems to be a promising treatment for difficult to treat anterior traumatised teeth with an open apex.

Child dental anxiety, parental rearing style and dental history reported by parents.

AIM: To examine the relationship between self-reported parental rearing style, parent's assessment of their child's dental anxiety and the dental history of children. MATERIALS AND METHODS: Parents of primary school children were asked to complete questionnaires about their parenting style, using four different questionnaires. Parents also completed the Child Fear Survey Schedule Dental Subscale (CFSS-DS) on behalf of their child and a questionnaire about the dental history of their child. RESULTS: 454 interview forms were available for analysis. Minor associations were found between dental anxiety and parenting style. Anxious parents were more permissive and less restrictive in their parenting style. Parents of children who did not visit their dentist for regular check-ups reported more laxness and less restrictiveness. Children who had a cavity at the time of investigation, children who had suffered from toothache in the past and children who did not have a nice and friendly dentist reported more dental anxiety. CONCLUSION: No clear associations between parenting style and dental anxiety were found. Known causes of dental anxiety were confirmed.

Child dental anxiety, parental rearing style and referral status of children.

OBJECTIVE: Treating children can be difficult for both dentist and child. In some cases treatment fails and those children are referred to a specialist paediatric dentist. Different factors can be put forward for referral of children, such as factors relating to the child, dentist and parent. Possible child-related factors can be dental anxiety and the child's temperament. A possible parental factor is the parental rearing style. The objective of this study was to assess the possible associations between dental anxiety, parental rearing style and referral status of children. METHODS: Parents of 120 non-referred and 335 referred paediatric dental patients were asked to fill out the Child Rearing Practices Report (CRPR) and the Child Fear Survey Schedule Dental Subscale (CFSS-DS) on behalf of their children. RESULTS: The questionnaires were filled out by 115 (96%) parents of primary schoolchildren and by 331 (99%) parents of referred children. Referred children were younger than non-referred children, t(442) = 6.9, p < 0.01, and had significantly more dental anxiety, t(430) = -8.7, p < 0.01. No differences existed between parents of referred children and parents of non-referred children on parental rearing-style. No differences existed between fearful and non-fearful children on parental rearing-style and also no correlation existed between children's dental anxiety and their parent's rearing style. However, non-referred children with parents using an authoritarian parenting style were more anxious than the other non-referred children. CONCLUSIONS: In the present study, referral status and dental anxiety of 4-12 year old children were not associated with parental rearing style.

Influence of parental presence on the child's perception of, and behaviour, during dental treatment.

AIM: To analyse the influence of the presence of the parent in the dental operatory on their child's behaviour during dental treatment. METHODS: This study was a randomised controlled trial performed in a secondary paediatric dental care clinic. The child's perception of the dental treatment and its behaviour during treatment according to the parent and dentist were compared with parental presence in the operatory as independent variable. Age and dental anxiety were also calculated as co-variable. The child's perception of the treatment was assessed using the Wong-Baker Faces Rating Scale. The behaviour of the child according to parent and dentist was measured using Venham`s (modified) clinical rating of anxiety and cooperative behaviour. Statistical analysis was performed using Mann Whitney U tests and Independent Samples T Test. RESULTS: 90 children participated (50% girls, mean age 6.21 years old, SD ± 1.56). During the habituation session child's behaviour was better according to the dentist when the parents were not present in the operatory during treatment (p<0.01). There were no significant differences in a child's perception of the treatment in relation to parental presence or absence. Dentally anxious children behaved better according to the parent (treatment session 2) and the dentist (habituation session and treatment session 2) when the parent was not present in the operatory (p<0.05). CONCLUSION: Relying on a child's perception of dental treatment, a made no difference whether the child was treated with or without the parent(s) in the dental operatory. For anxious children it was mainly the dentist who was aware of the disadvantages of the parental presence.

Child dental fear and general emotional problems: a pilot study.

AIM: This was to investigate the relation between general emotional and behavioural problems of the child and dental anxiety and dental behavioural management problems. BACKGROUND: Dental treatment involves many potentially unpleasant stimuli, which all may lead to the development of dental anxiety and behavioural management problems (BMP). It is still unclear why some children get anxious in the dental situation while others, with a comparable dental history, do not. Besides the latent inhibition theory it is suggested that this can be explained by differences in child rearing and personality traits. METHODS: The sample consisted of 50 children (4-12 years old) and their parents participated in this study. Parents filled out the Child Fear Survey Schedule Dental Subscale (CFSS-DS) and the Child Behaviour Checklist (CBCL) on behalf of their child. Child behaviour during consecutive dental treatments was assessed using the Venham scale. RESULTS: There were 39 children subject to analysis (21 boys) with a mean CFSS score of 40.4. Children aged 4 and 5 years who had sleeping problems, attention problems and aggressive behaviour, as scored by parents on the CBCL, displayed more disruptive behaviour during dental treatment. Children with emotionally/ reactive and attention problems were more anxious. CONCLUSION: In this pilot study a possible relation between general emotional and behavioural problems of young children and dental anxiety was shown. Also a relation between emotional and behavioural problems and dental behavioural management problems was shown. Because of the small number of subjects in our study, further research will be needed to confirm these results.

[Principles of oral health care for children]. / Uitgangspunten van mondzorg voor kinderen.

In this article the principles of child oral health care in the Netherlands and the consequences of cariological principals of oral health care delivery to children are described. First of all the age of the child plays a very significant role in decisions concerning prevention and restoration. In addition, the combination of a positive attitude on the part of the dentist and a pain-free treatment can prevent fear of treatment and avoidance behaviour of the children. In the treatment of carious lesions, moreover, the oral health care provider should consider to what extent the problem is related to behaviour and fits in the multi-factorial caries model. Restorative treatments should be considered as supporting prevention, reducing caries activity and eliminating the effects of neglected oral health care. Prevention has to be seen as an essential element of the treatment model and it should start early from the standpoint of habit formation and the rapid demineralization process in the deciduous dentition which results from failed preventive care.

Child rearing styles, dental anxiety and disruptive behaviour; an exploratory study.

AIM: This was to explore the relation between children's dental anxiety, their behaviour during treatment and their parent's rearing style. Also the parents' preparation of the child for dental treatment was related to behaviour and parental rearing style. METHODS: The parents of 100 children, referred to a secondary dental care clinic were asked to fill out the Child Rearing Practices Report (CRPR), the Child Fear Survey Schedule (CFSS) on behalf of their children and an additional questionnaire on child preparation prior to dental treatment. Four rearing styles were constructed by using the results of the Nurturance and the Restrictiveness domain of the CRPR. Dentists were asked to assess the behaviour of the child during dental habituation and dental treatment using the Venham scale. The dentists were unaware of the child's CFSS score. Parents were not present during actual dental treatment. RESULTS: Each child's dental anxiety was related to their behaviour displayed during dental treatment. Highly anxious children showed more disruptive behaviour than their low anxious counterparts did, especially during familiarisation. Parental rearing style was neither related to child dental anxiety prior to or to behaviour during dental treatment. Parents who use a permissive rearing style were less likely to tell their children that the dentist will not hurt them compared with authoritarian parents. Parents with an authoritative rearing style were more convinced that the behaviour of their child could be managed by the dentist than parents with a permissive and neglectful rearing style. After their children's dental rehabilitation parents were less inclined to accompany their child during treatment. CONCLUSIONS: Dental anxiety correlated positively with the behaviour displayed during treatment. No relation was found between parenting style and dental anxiety and behaviour during treatment. Parents showed more confidence in the child-dentist dyad after the rehabilitation of their child's teeth.

Monitoring dental erosion by colour measurement: an in vitro study.

OBJECTIVES: The aim of this study was to develop a method to monitor dental erosion by evaluation of the colour change of teeth as a function of enamel loss, and to evaluate the reproducibility of the method used. METHODS: Light reflectance spectra of 12 extracted human incisors were measured using a spectroradiometer and diffuse illumination. From these spectra CIELab colour parameters L*, a* and b* were calculated. Erosive dental wear was simulated by incrementally removing enamel layers. We monitored the change of the colour parameters as a function of the enamel thickness removed. A clinical situation using a phantom head and ambient illumination was simulated with 8 incisors. In this set-up colour change due to polishing was evaluated. The teeth were immersed in coffee and tea to estimate the effects of nutritional dyes, and so, to determine reproducibility of the method used in clinical situations. RESULTS: A relationship between tooth colour measured and enamel loss was found, in particular for the b* value. The relation between the b*-value and the enamel thickness removed showed a slope of 15+/-3mm(-1), if the remaining enamel layer had a thickness of less than 0.5mm. Polishing of the teeth made them less yellow. Immersion in coffee darkened the teeth, but immersion in tea had no significant effect. CONCLUSIONS: Due to individual variation, it was impossible to use this relationship to estimate the remaining enamel thickness, but the method presented may be suitable for monitoring progression of erosive enamel loss.