Tooth-surface distribution of caries in Greek schoolchildren, using ICDAS-II index. A national pathfinder survey.

AIM: The objective of this cross-sectional nationwide study was to assess the caries status of Greek children, in regard to the severity and the distribution pattern of the lesions in the primary and permanent dentition at a tooth-surface level, based on ICDAS-II criteria. METHODS: Study Design: A national survey was conducted in 15 urban and 9 rural sites and about 50 subjects were examined at each location across the country. Caries data, based on ICDAS-II index, were recorded on 4,410 children aged 5, 12, and 15-years by 10 calibrated dentists. The rankings of the most affected tooth-surfaces, the most vulnerable teeth found cavitated, the right-left symmetry of caries stages and its pattern of distribution shown per jaw or dentition were determined by using descriptive statistics (SPSS v.20). CONCLUSION: Caries lesions were quite frequent in this school aged child population and the most common code of ICDAS-II observed was that of incipient enamel caries, mainly on the occlusal surfaces, indicative of the need for fissure sealant application. For those surfaces with ICDAS-II=3-6, dental care and intensive prevention programmes, both at home and office based, are needed.

Effectiveness of fissure sealants on initial caries lesions (ICDAS 1-3) of permanent molars: A 4-year follow-up.

AIM: The aim of the present prospective study was to evaluate the retention and effectiveness of two types of sealants (clear vs. opaque) on early pit and fissure occlusal non-cavitated ICDAS II #1-3, caries lesions of permanent posterior teeth of children. MATERIALS AND METHODS: Study Design: 6986 pit and fissure occlusal surfaces were randomly sealed with clear or opaque sealants out of which, 5828 sealants were placed on sound and 1158 on questionable surfaces, while 3508 were clear and 3478 opaque sealants. The mean age of the sample at initial sealant placement was 9.5 (±2.9) years and the follow-up time was 12-48 months. The median (IQR, range) follow-up time was 17.9 (8.7-28.6) months. Study inclusion and exclusion criteria applied to the combined database in order to select the study sample. Teethmate™ F-1 natural and opaque sealants (Kuraray, Hattersheim am Main, Germany) were applied following the standard procedure of preparation with moisture control kept by cotton rolls handled Dri-Angles" and a 30 seconds acid-etch with 37% ortho-phosphoric acid gel was used followed by 10 sec air-water spraying washing and polymerization for 20x2 sec. Sealants were applied on sound tooth surfaces (ICDAS #0) with no visible defects or on surfaces with early caries lesions (ICDAS #1-3), randomly and interchangeably on the upper or lower Jaw. Total retention was considered when all pits and fissures were completely sealed, while partial or complete loss was scored as one code, although was registered separately. STATISTICS: Separate analyses were performed for each type of failure (loss of sealant or restoration). Cumulative probabilities of failure over time after sealant placement, overall or by specific characteristics, were calculated using the Kaplan-Meier method. Association between these characteristics and the hazard of failure were investigated using appropriate Cox proportional hazard models. RESULTS: Sealed surfaces with ICDAS II # 1-3, showed 100% higher probability of having a restoration and 60% higher probability of sealant loss, with both differences being statistically significant (aHR=2.03, p=0.046), adjusted for age, sex, type of sealant and location of surface. Opaque sealants presented statistically significant (p 0.009) higher re-application rate, while fissures had 70% statistically significant (p<0.001) higher probability for resealing with time compared to pits, with gender not affecting sealant retention while the earlier a sealant was placed on children's teeth, the more probable it was to need resealing or restoration (p <0.012). CONCLUSIONS: The therapeutic use of sealants on occlusal surfaces of posterior permanent molars with early carious lesions (ICDAS II 1-3) is inferior compared to sound surfaces, showing higher sealant failures and restorations.

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

Histological validation of the automated caries detection system (ACDS) in classifying occlusal caries with the ICDAS II system in vitro.

AIM: To compare the diagnostic performance of the automated caries detection system (ACDS) for the detection and diagnosis of occlusal caries with the histological appearance of the lesions. METHODS: Eighteen posterior permanent teeth were used, out of which 40 sections were made and 53 areas were evaluated. Teeth with hypoplastic and/or hypomineralised areas or sealants on the occlusal surfaces were excluded from the study. The teeth that were used for this study were a subgroup of the teeth used in the study that introduced ACDS system. This subgroup consisted of teeth having in their occlusal surfaces early carious lesions classified as international caries detection and scoring system (ICDAS) 0, 1, 2 and 3 after clinical examination by the examiners. Histological preparations were classified by experienced examiners based on the Ekstrand, Ricketts and Kidd (ERK) system and for the respective occlusal surfaces by the ACDS system based on ICDAS II system. There were two threshold limits considered as carious in either system ICDAS ≥ 2 or ≥ 3 and ERK index ≥ 2 or ≥ 3 and all possible combinations were analysed. Statistical methods of weighted version of kappa coefficient, Kendall's tau-b correlation coefficient and p-values using the Fisher's exact method were used at the confidence level of 0.05. RESULTS: Intra-examiner kappa coefficient agreement was 0.87 and 0.89 while the inter-examiner for the two trials were 0.87 and 0.92. The ICDAS3-ERK3 combination between the ACDS and histological sections presented the best agreement with kappa coefficient 0.76, agreement 92.5%, sensitivity 100% and specificity 91.1%. ICDAS3-ERK3 combination between the optical examination of the examiners compared to the histological preparations showed kappa coefficient 0.87, agreement 96.2%, sensitivity 100%, Specificity 95.6%. CONCLUSION: The evidence supports the view that ACDS classification of occlusal surfaces based on the ICDAS system are comparable with classification to that of an examiner and with the histology of the lesion. The use of ACDS has the distinct advantage though of removing the subjectivity of the examiner since it performs the classification without any intervention by him.

Recognizing Occlusal Caries in Dental Intraoral Images Using Deep Learning.

Based on an image dataset of 88 in-vivo dental images taken with an intra-oral camera, we show that a Deep Learning model (Mask R-CNN) can detect and classify dental caries on occlusal surfaces across the whole 7-class ICDAS (International Caries Detection and Assessment System) scale. This is accomplished without any image pre-processing method and by utilizing superpixels segmentation for the experts' annotations and the evaluation of the classifier. In the proposed methodology, transfer learning and data augmentation are employed during the training of the model. The paper discusses technical details, provides initial results and denotes points for further improvement by fine-tuning the classifier along with an extended dataset.

Histochemical changes of occlusal surface enamel of permanent teeth, where dental caries is questionable vs sound enamel surfaces.

AIM: This in vitro study was to classify questionable for caries occlusal surfaces (QCOS) of permanent teeth according to ICDAS codes 1, 2, and 3 and to compare them in terms of enamel mineral composition with the areas of sound tissue of the same tooth. METHODS: Partially impacted human molars (60) extracted for therapeutic reasons with QCOS were used in the study, photographed via a polarised light microscope and classified according to the ICDAS II (into codes 1, 2, or 3). The crowns were embedded in clear self-cured acrylic resin and longitudinally sectioned at the levels of the characterised lesions and studied by SEM/EDX, to assess enamel mineral composition of the QCOS. Univariate and multivariate random effect regressions were used for Ca (wt%), P (wt%), and Ca/P (wt%). RESULTS: The EDX analysis indicated changes in the Ca and P contents that were more prominent in ICDAS-II code 3 lesions compared to codes 1 and 2 lesions. In these lesions, Ca (wt%) and P (wt%) concentrations were significantly decreased (p = 0.01) in comparison with sound areas. Ca and P (wt%) contents were significantly lower (p = 0.02 and p = 0.01 respectively) for code 3 areas in comparison with codes 1 and 2 areas. Significantly higher (p = 0.01) Ca (wt%) and P (wt%) contents were found on sound areas compared to the lesion areas. CONCLUSIONS: The enamel of occlusal surfaces of permanent teeth with ICDAS 1, 2, and 3 lesions was found to have different Ca/P compositions, necessitating further investigation on whether these altered surfaces might behave differently on etching preparation before fissure sealant placement, compared to sound surfaces.

Caries prevalence of 5, 12 and 15-year-old Greek children: a national pathfinder survey.

AIM: To study the caries prevalence and caries experience of 5, 12 and 15-year-old children in Greece and evaluate how the disease pattern is related to their sociodemographic parameters. METHODS: A stratified cluster sample of 1209, 1224 and 1257 of five, twelve and fifteen-year-old Greek children were randomly selected according to WHO guidelines for national pathfinder surveys and examined for dental caries, according to the BASCD criteria and standards. d3mft, D3MFT and their components, as well as d3mfs, D3MFS, Care Index (CI) and SiC were recorded and related to the demographic data collected concerning age, gender, counties, urban/rural areas and parents' educational status. RESULTS: Dental caries varied considerably between the different districts, with a mean dmft/DMFT value for each age group being 1.77, 2.05 and 3.19 respectively, while 64%, 37% and 29% of them, were with no obvious dentinal caries. Children living in rural areas demonstrated significantly higher dmft/DMFT values and less dental restorative care (CI), whereas children with fathers of a higher educational level showed significantly lower dmft/DMFT values. The significant caries (SIC) index value for the three age groups was 5.01, 4.83 and 7.07 respectively. Posterior occlusal surfaces of the permanent teeth presented most of the caries in the 12 (68%) and 15-year-old group (78%). CONCLUSIONS: Despite the decrease in the prevalence of caries in Greek children disparities remain. Children in rural areas and children with less educated parents had more caries and more untreated caries. All the above call for immediate intervention with comprehensive preventive programs and better geographic targeting of the dental services at a national level including targeted prevention of pit and fissure sealants on posterior permanent molars.

Oral hygiene and periodontal status of 12 and 15-year-old Greek adolescents. A national pathfinder survey.

AIM: To investigate oral hygiene and periodontal status of 12- and 15-year old Greek adolescents, in relation to sociodemographic and behavioural parameters. METHODS: A stratified cluster sample of 1,224 12-year old and 1,257 15-year old adolescents of Greek nationality were selected and examined by calibrated examiners. Periodontal and oral hygiene status were assessed using the Community Periodontal Index (CPI) and the simplified Debris Index (DIs) respectively. The socio-demographic and behavioural data collected included region, location, gender, parental educational level, tooth brushing frequency and reason for dental attendance. RESULTS: The majority of adolescents aged 12 (75.0%) and 15-years (61.4%) had fair oral hygiene levels. The most frequently observed condition in both ages was calculus with or without bleeding (42.8% in the younger and 53.3% in the older age group). Bleeding on probing was found in 41.5% of the 12-year-olds and in 30.0% of the 15-year-olds. The occurrence of shallow and/ or deep periodontal pockets was very low (0.2%). Multivariable modelling revealed that gender, location and tooth brushing frequency were strongly associated with oral hygiene status in both ages; girls, those living in urban areas and brushing teeth more frequently had significantly lower DI-s. Tooth brushing frequency was also associated with periodontal status in both ages, while living in urban areas was associated with better periodontal health only in the 15-year-olds. CONCLUSIONS: The study demonstrated that oral hygiene conditions among Greek children and adolescents are not satisfactory and that the occurrence of gingivitis is high. More efforts on oral health education and oral hygiene instruction are needed to improve their periodontal and oral hygiene status.

Oral health related quality of life of Greek adolescents: a cross-sectional study.

AIM: To investigate the impact of oral health status on the quality of life of a cross-section of adolescents belonging to different population groups in different regions of Greece, using the oral health impact profile-short form (OHIP-14), one of the most widely known instruments used for the measurement of disability and discomfort due to oral conditions. METHODS: A random sample consisting of a total of 515 Greek adolescents between the ages of 15-18 years (mean 16.1±0.9) were selected from different urban and rural areas according to the last census. A self-administrated questionnaire was designed including the OHIP-14 validated for the Greek language, and face to- face interviews were conducted by one dentist trained in oral health related quality of life (OHRQoL) terms. Associations of the total OHIP-14 score and its seven subscales along with the self-perceived quality of life were evaluated with Spearman correlations. RESULTS: Internal reliability returned a very good internal consistency with a Cronbach alpha of 0.86. The subjects had an overall weighted OHIP-14 score of 1.24 (SD 2.04) meaning that there was an impact of oral health on the overall quality of life. Five of the seven subscales of the OHIP-14 tool were found to have significant correlations for the inhabitants of the different areas. Specifically, important and significant correlations were discovered for functional limitation (p<0.01), handicap (p<0.05) and social disability (p<0.01) both for the metropolitan/non-metropolitan as well as the urban rural distinction. No correlations were found between the OHIP-14 scores, or of any of its sub-scales, with the parental education level and occupation. When self-assessed oral and general health statuses were considered to be 'bad' the OHIP-14 returned increased scores. CONCLUSIONS: Dental and oral health conditions are factors that do impact on the quality of life of adolescents.

Socio-behavioural factors influencing oral health of 12 and 15 year old Greek adolescents. A national pathfinder survey.

AIM: To estimate the frequency in use of oral health services, oral health self-assessment, oral hygiene practices of 12- and 15-year-old Greek children and adolescents, to investigate possible influences of these factors and other socio-demographic parameters on oral health. METHODS: A stratified cluster sample of 1224 12 year old and 1257 15 year old children and adolescents of Greek nationality were selected and examined by calibrated examiners. Clinical examination included recording of caries according to the British association for the study of community dentistry diagnostic criteria, while oral hygiene and periodontal status were assessed by means of the simplified debris and the community periodontal index. Subjects were interviewed to answer questions on socio-behavioural risk factors through a structured questionnaire. The student's t-test and ANOVA were used for statistical evaluation of the means and the chi-square test was applied for statistical comparison of the proportions. Multiple linear regression analysis was performed to assess the statistical association between variables. RESULTS: Caries experience and untreated caries were significantly higher among children and adolescents who visited the dentist only when in pain or for restoring a tooth, compared to those visiting for check-ups or prevention and having more frequent application of topical fluorides. Tooth brushing, at least twice a day, and flossing were significantly associated with periodontal and oral hygiene status, but not with caries presence. The multivariate analysis revealed that parental educational status and reason for visiting a dentist were strong determinants for caries experience and oral hygiene status but not for periodontal health of children and adolescents. CONCLUSIONS: This study has identified several socio-demographic and behavioural determinants for dental caries, oral hygiene and periodontal health of Greek children and adolescents.

Attitudes, knowledge and utilization of fissure sealants among Greek dentists: a national survey.

AIM: This was to evaluate the attitudes and knowledge of Greek Dentists concerning fissure sealants (FS) and other preventive measurements, together with the extent and the reasons for using or not using FS in their clinical practice. METHODS: 1,221 general dental practitioners (GDPs) including 50 Paediatric Dentists (PD) were randomly selected from 35 local dental societies of Greece and asked to answer a telephone questionnaire regarding their attitudes to prevention, use of FS and variables influencing their placement. Non parametric Pearson's Chi square test and multifactorial logistic regression models were used for analysing the data. RESULTS: Although 87.6% of all Greek dentists believe and apply prevention, only 35.8% are using them routinely. Factors highly correlated with FS usage for all dentists were using fluoride regimens (p<0.001), being in practice for 5-14 years (p=0.004) and practicing in urban areas (p<0.001). By contrast, all PD were using FS, regardless of any parameter (p>0.01). Concerning the type of surfaces sealed, 45.6% of GDP used FS on intact surfaces and 41.1% on questionable, while only 15% of them sealed incipient caries. Overall, fewer GDPs compared with PD sealed premolars, primary teeth, questionable surfaces, incipient enamel caries and molars in high risk patients (p<0.001), while fewer PD sealed intact surfaces (p<0.001). The reasons mentioned for not using FS were: 76.3% that parents were unwilling to pay, 61.9% did not know how to use them, while 43.0% believed that oral hygiene was sufficient in order to reduce caries. CONCLUSIONS: Insufficient knowledge and lack of clinical practice guidelines for the use of FS by GDPs in Greece, leads to low usage rates. Appropriate professional and scientific authorities should join efforts to improve knowledge of GDP and instil confidence in using FS.

Validation of a Greek version of the oral health impact profile (OHIP-14) in adolescents.

AIM: To evaluate the validity and reliability of the Greek version of the Oral Health Impact Profile (OHIP-14) (short form) in adolescents. METHODS: A total of 112 healthy adolescents (15-18 years) from various socioeconomic backgrounds were randomly selected and participated in a clinical oral examination conducted by a calibrated dentist and on the same day a face to face interview was held for assessing the psychometric properties of the OHIP-14 in Greek adolescents. RESULTS: Cronbach's coefficient, was used to evaluate the internal consistency of the instrument and a value of a=0.8 was found indicating exceptional internal consistency. Discriminant validity and convergent validity was assessed and the inter-item correlation coefficients ranged from -0.01 to 0.8 and the item-total correlation coefficients varied from 0.17 to 0.6. Important statistical correlations were also observed between the OHIP-14 and all the clinical measures, confirming that the questionnaire can distinguish between individuals with and without impacts on their oral health. The OHIP-14 total score proved to have high associations with both self-perceived oral health status (rs=0.36; p=0.01) and self-assessment of oral satisfaction (rs=0.4; p=0.01). Examination of the relationship between these parameters and the score of each domain also lead to similar results. CONCLUSIONS: The Greek version of OHIP-14 instrument was found to be a valid and reliable instrument for assessing oral health-related quality of life in Greek adolescents.

Microleakage of three different sealants on sound and questionable occlusal surfaces of permanent molars: an in vitro study.

AIM: This was to evaluate the microleakage of 3 different sealants, applied on sound and questionably carious occlusal surfaces with and without a bonding agent. METHODS: A total of 120 human molars were selected, photographed with a digital video microscope, and assigned by 3 independent examiners, according to the criteria of ICDAS II, in 2 groups of 60 teeth each. Group A: teeth with deep, clear, sound occlusal surfaces (ICDAS II, code 0). Group B: teeth with questionable occlusal surfaces, having deep, stained pits and fissures with probable incipient, but non-cavitated carious lesions (ICDAS II, codes 1 and 2). Each group was divided into 2 subgroups of 30 teeth each (bonding or no bonding) and then into 3 subgroups of 10 teeth each according to the type of sealant used: one conventional (Conseal) and 2 fluoridated (Conseal F and Teethmate F). After the application of the bonding agent and the sealant to the appropriate teeth, all specimens were subjected to thermal cycling and immersed in a 10% methylene blue dye solution for 4 hours. Average and summed microleakage for each sample were estimated from dye penetration scores on 3 mesiodistal sections of the tooth across the sealed occlusal surface. Non-parametric Friedman's 2-way ANOVA by ranks and Conover-Inman pair wise comparisons were used for differences at the 0.05 level of significance. RESULTS: According to Friedman's 2-way ANOVA by ranks analysis, although there were no significant differences between the different sealants (chi(2) = 0.048, df = 2, P = .976), there were significant differences between the sound and questionably carious occlusal surfaces (chi(2) = 24, df = 3, P = .000). Conover- Inman pair wise comparisons showed no differences between the groups using and not using bonding agents, on sound (SNB-SWB, P = .4561) or questionable occlusal surfaces (QNB-QWB, P = .0842). CONCLUSIONS: Sealant microleakage on questionably carious occlusal surfaces was statistically significantly higher than that of sound occlusal surfaces. Using a bonding agent or fluoridated FS did not influence microleakage significantly, either on sound or on questionable fissured surfaces.

Fissure sealant retention and caries development after resealing on first permanent molars of children with low, moderate and high caries risk.

AIM: This was to evaluate the retention of fissure sealants (FS) and their effectiveness after resealing on caries reduction applied to first permanent molars, in a sample of children stratified according to their caries risk status in a private practice setting. METHODS: The sample was 1,274 FS applied on first permanent molars (FPM) of 380 children (6 to 8 years old). Follow-up and monitoring for resealing was 3 years after FS placement, having at least one recall visit per year. Caries risk was based on baseline dmft index: low (dmft=0), moderate (dmft=1-4), high (dmft >4), with almost half of the teeth belonging to the high-risk group. All sealed teeth were evaluated and recorded for FS failure and resealing in case of partial/total loss, as well as caries development. Survival analysis using the Cox Proportional Hazards regression model was used for data evaluation. RESULTS: Of the 1,274 sealed surfaces, 927 (72.8%) needed no intervention 185 (14.5%) needed only resealing and 162 (12.7%) developed caries during the study. Of 162 carious surfaces, 107/ 675 (15.9%) were from the high caries risk children, compared with 17/144 (11.8%) and 38/455 (8.3%) from the moderate and low caries risk group respectively. The highest number of failures, 4.9% and resealing were found at first recall, declining to 1.4% at the end of the study. Development of caries followed a steady rate of 6-8% per year. Cox proportional hazards model indicated, regardless if resealing or caries development was considered a failure or resealing was a success and caries development a failure, only the high dmft index appeared in both cases to significantly increase the chance (158% and 173% respectively) of FS failure and caries development compared with moderate and low dmft index. Other variables when inserted into the hazard model, such as age, sex and number of visits, either did not show a significant effect or only marginally affected FS retention, without modifying the association between caries risk and sealant failure. CONCLUSIONS: Children of a high baseline caries risk status showed lower FS retention rates and higher occlusal caries prevalence following FS loss compared with those of moderate and low risk status. Resealing does not seem to dramatically change the final outcome of the higher risk group to develop more caries, necessitating other more effective measures to increase the retention of FS on these highly vulnerable areas.

Garre's osteomyelitis of an unusual origin in a 8-year-old child. A case report.

Garre's osteomyelitis is a type of chronic osteomyelitis that primarily affects children and adolescents. Although the disease is well described in the dental literature and is usually associated with an odontogenic infection resulting from caries, a number of other causative factors have been occasionally reported, such as a dental extraction or a mild periodontitis. There have also been cases of unknown aetiology. This paper describes a case of Garre's osteomyelitis in an 8-year-old child, in whom the condition arose following a local periodontal infection in an ectopically erupting first permanent molar that was in infraocclusion. The lesion remained unresolved for a period of over 6 months as a result of misdiagnosis, following a number of unsuccessful treatment attempts. Identification of the true cause and treatment through periodontal surgery resulted in lesion resolution and resolved the diagnostic problem. Dentists should be aware that the periodontium may be a potential source of infection for Garre's osteomyelitis in children, particularly in the presence of ectopically erupting posterior teeth. In such cases, periodontal treatment should be sufficient to treat the disease and extraction of the tooth involved may not be necessary.

Feeding practices of Greek children with and without nursing caries.

PURPOSE: This study was performed to examine the feeding practices and demographic and nursing characteristics of Greek children with and without nursing caries. It was also intended to evaluate what dentists and pediatricians tell parents when they examine children with nursing caries. METHODS: 260 children, ages 3-5 (130 with nursing caries, NC group, and 130 without, NNC group) participated in the study. RESULTS: 95% of the NC group used the bottle at night. In the control, although 85% of the group used the bottle, none of the children developed nursing caries. CONCLUSIONS: 1) The nursing habit of bottle feeding is not the only factor determining the development of nursing caries. 2) Falling asleep with the bottle seems to be the most determinant factor associated with the development of nursing caries. 3) Breastfeeding of the child for more than 40 days may act preventively and inhibit the development of nursing caries in children.

Profile of non-nutritive sucking habits in relation to nursing behavior in pre-school children.

Although a number of investigators have studied the prevalence and etiology of non-nutritive sucking habits in children, no consensus exists among dental and medical experts in respect to the contributing factors and preventing behaviors. Furthermore, changes in the rearing practices of children make management of such habits even more complicated. The purpose of the present study was to investigate finger and pacifier sucking habits among pre-school children, and its possible relationship to nursing behavior. Parental attitudes towards sucking habits were also registered. Questionnaires were sent to parents of 600 children, three to five years old, following an oral examination in a private office. Children attended kindergartens that were randomly selected from the area of Athens, Greece. Questions regarding the nursing patterns-breast or bottle feeding-characteristics of finger and pacifier sucking habits, parental attitudes towards sucking habits, as well as recommendations of the pediatricians were included. Three hundred and sixteen questionnaires were returned by parents. Results indicated that pre-school children discontinued a pacifier sucking habit earlier compared to a finger habit. Pacifiers showed a preventive effect against finger sucking, since only 2% of the sample examined practiced both habits. Breast feeding was not clearly associated with sucking habits; however, long bottle feeding periods were related with decreased finger sucking and high figures of pacifier sucking. The majority of pediatricians were not in favor of an intervention in breaking a finger sucking habit of the child.

The effectiveness of mandibular infiltration compared to mandibular block anesthesia in treating primary molars in children.

Mandibular infiltration has been routinely avoided in treating mandibular molars because of its questionable adequacy. The purpose of our investigation was to determine the effectiveness of mandibular infiltration compared with mandibular block in treating primary molars in children, and to relate the effectiveness to age and type of treatment performed. The study population consisted of 89 cooperative children, 3 to 9 years old, requiring the same type of treatment on contralateral mandibular molars. The half-mouth study design was used. Dental procedures included class I and II amalgam restorations, stainless steel crowns, formocresol pulpotomies, and extractions. Evaluations of pain and behavior for each anesthesia technique and type of treatment were made using sounds, motor, and ocular changes indicating pain and the Frankl Behavior Rating Scale. Evaluations were made upon probing, rubber dam placement, and during tooth preparation and extraction. No statistically significant differences was found between the two anesthetic techniques for either behavior or pain when performing amalgam or stainless steel crown restorations (P = 0.05). Mandibular infiltration was less effective than mandibular block for pulpotomy and extraction (P = 0.05). No significant relationship to age as determined by primary or mixed dentition, for effectiveness was noticed.

Management of intrusive luxation injuries.

Traumatic intrusion of permanent teeth is a relatively infrequent but serious type of dental injury, due to the complicated picture it involves. Various treatment approaches have been suggested, so far, regarding management of intrusive luxation. Techniques aiming to reposition the intruded tooth include observation for spontaneous reeruption, surgical as well as orthodontic repositioning. However, development of complications such as pulp necrosis, inflammatory root resorption, replacement resorption and ankylosis and loss of marginal bone support makes selection of the most favorable technique controversial. In this paper, a critical review of the existing treatment modalities is attempted and treatment approaches based on diagnostic parameters that are indicative of the severity of an intrusive injury are presented. Recommendations are made after taking into consideration experimental and clinical study findings and observations from other author's and our own clinical experience. Two cases of intrusive luxation in children are presented and management of the dental injuries as well as the complications which occurred are being discussed.