Dental Loupe's Role in Detection of Caries of Molars in Children by Student and Dentists.

PURPOSE: The objectives of this study were to examine the effectiveness of diagnosing occlusal caries in molar teeth in children under the use of loupes and, secondarily, to examine whether there is a difference in the diagnosis between permanent and primary teeth using dental loupes. In addition, to check whether the student's diagnosis using loupes improves caries diagnosis compared to dentists' diagnosis in both methods. METHODS: The data were collected from 163 patients aged 6-14 who sought treatment in the Pedodontic Department of the Faculty of Dentistry at Tel-Aviv University during 2020-2021. The first and second permanent molars and second primary molars with deep groves were examined. A student and dentists made the diagnosis with and without loupes while using the ICDAS criteria. RESULTS: The student's examinations without the loupes detected no caries in 60% of the cases compared to 76.9% in the examinations with the loupes and found initial caries without cavitation (ICDAS1) in only 17.6% of teeth without loupes examination compared to 33% using loupes. The dentist correctly diagnosed no caries (ICDAS0) in 82.1% of cases without loupes and initial caries without cavitation (ICDAS1) in 62.5% of cases. The dentist correctly diagnosed distinct caries without cavitation (ICDAS2) in 90.8% of cases. No differences were observed in caries diagnosis between primary and permanent teeth when the examiner was a specialist/intern using loupes; however, there was a statistically significant difference (p = 0.047) when the diagnosis was made by a student using loupes. CLINICAL SIGNIFICANCE: The use of dental loupes is an effective method for the correct and early diagnosis of occlusal caries lesions in children's molar teeth by both dentists and students, and this is in accordance with the principle of minimally invasive dentistry. There is a justification for the use of dental loupes for the diagnosis of initial occlusal caries in primary and permanent molars in children in a precise way. Using loupes especially improves the correct diagnosis of initial caries in primary teeth by students.

Exploring a Paradigm Shift in Primary Teeth Root Canal Preparation: An Ex Vivo Micro-CT Study.

Traditional hand instrumentation is a commonly used technique to perform pulpectomy in deciduous teeth by most specialists in pedodontics. Lately, dentists have embraced rotary instrumentation as a safe and effective alternative. This study aimed to compare the efficacy of root canal preparation in extracted primary molars between manual and two rotary file systems using micro-CT. Thirty-six extracted human second primary mandibular molars were divided into three groups according to the instrumentation method: (1) Manually instrumented (MI) group (n = 9) in which the teeth were treated using K-files up to size 30; (2) Kedo-Ssystem (KS) group (n = 9); (3) ProTaper Gold system (PTG) group (n = 10) and control group (n-8). Each tooth was scanned before and after the retrograde root canal preparation. Residual dentin volume was calculated using micro-CT scans to evaluate the technique's efficacy. Additionally, the preparation time and procedural errors were recorded for each tooth preparation. A one-way ANOVA test was carried out to compare the groups' dentin volume and preparation time. The mean preparation time using the manual method (13.14 min) was more than two times longer than that of the rotary techniques (4.62 min and 6.45 min). The manual preparation method using a K-file removed almost half the root canal material when compared with the rotor method (p = 0.025). Conclusion: our results suggest that rotary instrumentation is more efficient for root canal preparation in primary teeth than the traditional manual method. This finding may call for a paradigm shift in current clinical practices, where manual instrumentation is still commonly preferred.

Bacterial Colonization and Proliferation in Primary Molars following the Use of the Hall Technique: A Confocal Laser Scanning Microscopy Study.

Restorative dentistry aims to create a favorable environment to arrest caries with minimal operative intervention. The Hall technique (HT) involves the seating and cementation of stainless steel crowns (SSC) on primary molars without any tooth preparation, caries removal, or local anesthesia. In this manner, it entombs bacteria and arrests caries' progress. We compared bacterial distribution and quantity among primary molars affected with caries and restored with SSC using the HT (n = 10), the conventional technique (CT; n = 10), or not restored at all (control; n = 10). The teeth were contaminated with Enterococcus faecalis to mimic the clinical situation in the oral cavity and then incubated for 21 days. They were then cut mesiodistally and evaluated with confocal laser scanning microscopy. Total bacterial load (live + dead) in the mesial and distal areas of the crown showed no significant difference between the groups (p = 0.711), but there were significantly more dead than live bacteria in the CT and control groups versus the HT group (p = 0.0274 and p = 0.0483, respectively). Inside the pulp chamber and the crown area, the total bacterial load was significantly higher in the HT compared to the CT group (p < 0.001). Significantly more dead than live bacteria were observed in all tooth areas treated with the HT (p = 0.0169). Bacterial penetration depth was significantly correlated with bacterial load (p = 0.0167). In conclusion, although more bacteria were present in teeth that had undergone the HT versus those treated with the CT, they were mainly unviable. Additionally, the CT and the HT showed a similar performance in terms of marginal leakage, indicating that complete caries removal is not essential to achieve good sealing.

Oral Health and Knowledge among Postpartum Women.

Oral health behavior and risks during pregnancy and after birth affect the oral health of babies and toddlers. We examined the oral and gingival health and caries prevalence of 150 postpartum women shortly after giving birth and assessed their knowledge of oral hygiene using a questionnaire. We also compared the oral health knowledge of nulliparous and multiparous women. Although most participants (98.0%) understood the importance of maintaining oral hygiene in children, their overall knowledge of oral health was medium-low, regardless of the number of previous pregnancies. Only 4.6% of women received oral health advice from their obstetrician during their pregnancy. Most participants had a high gingival index score, which correlated with dental pain during pregnancy. In contrast, the number of decayed, missing and filled teeth was significantly lower in first-time mothers. There was a statistically significant positive correlation between women who regularly visit their dentist and those who regularly take their children to the dentist. Expecting mothers should be educated about their own oral health and that of their developing fetus and children. Raising awareness among obstetricians with regards to this topic may be an effective way to achieve this.

Knowledge and Decision-Making among Israeli Dentists Treating Young Patients with Type 1 Diabetes Mellitus: A Cross-Sectional Survey.

OBJECTIVE: To assess decision making process and knowledge level of dentists treating children with type 1 diabetes. STUDY DESIGN: Cross-sectional survey among dentistry residents and dental specialists working in clinics that provide dental care to children with type 1 diabetes. RESULTS: A total of 166 respondents were included. 42% of respondents perceived that they have sufficient knowledge to treat children with diabetes, in correlation with an average score of 1.9 out of 4 on knowledge questions. Over 80% of dentists decided to treat patients by consulting with the treating physician or by checking HbA1c and glucose blood levels independently. Greater knowledge was associated with a significantly higher tendency of the dentists to determine if the child's diabetes is controlled, and to refer less often to the hospital. Furthermore, greater knowledge was also associated with dentists' greater perception that they have enough knowledge, skills and confidence to treat children with diabetes. CONCLUSIONS: The study revealed significant gaps in the knowledge on diabetes among dentists who provide dental care to children. Dentists, pediatricians, endocrinologists, and other healthcare professionals who provide care for children should be encouraged to collaborate to create a mutual knowledgeable work environment for delivering best care to their patients.

Primary Teeth Supported Fixed Prosthesis-A Predictable Treatment Alternative.

BACKGROUND: Individuals with tooth agenesis often present a significant clinical challenge for dental practitioners. This retrospective study evaluated clinical and radiological long-term functional and esthetic outcomes following restoration using primary teeth to support fixed all-ceramic prosthesis in patients with teeth agenesis. METHODS: Patients with teeth agenesis and at least one year follow-up were included. Examinations included panoramic X-ray, clinical examination and family history records. Only primary teeth without permanent teeth underneath were chosen. All ceramic fixed restorations were used. All data were collected from patient files. Outcome parameters included: restoration parameters (restoration survival, restoration fractures, restoration detachment, restoration replacement, and secondary caries), plaque index, and gingival index. RESULTS: The study included 58 porcelain restorations inserted in 25 individuals; mean age 12 ± 2.1 years (range 10-19 years); mean number of missing teeth 12.3 ± 9 (range 6-12). Mean follow-up 48 ± 6 months (range 12-60 months). All restorations survived up to last follow-up, rendering a survival rate of 100%. Restorations outcome-porcelain chipping (9%), detachment (2%), no restoration replacement nor secondary caries, mean gingival index-0.7 ± 0.5 and mean plaque index-0.9 ± 0.3. CONCLUSIONS: In tooth agenesis, restoration using primary teeth to support fixed all-ceramic prosthesis is a viable treatment alternative.

Quantifying Coronal Permanent Tooth Discoloration Caused by Different Pulpotomy Materials.

INTRODUCTION: Bioceramic materials, gray and white mineral trioxide aggregate (GMTA, WMTA), have been shown to have high rates of success in various endodontic applications. A major drawback is their tendency to discolor teeth compared to Biodentine (BD), that has been claimed not to discolor teeth. The aim of this study was to compare tooth discoloration after applying different pulpotomy base materials (BD, GMTA and WMTA). STUDY DESIGN: Forty human incisors teeth were used in this study. Coronal access was achieved by a Tungsten Carbide drill, and the pulp chambers were accessed and chemo-mechanically debrided. Each material was placed in the pulp chamber, up to the cervical sectioning level. All specimens were incubated at 37°C and 100% humidity for three months and have been evaluated before the study and weekly. Color was assessed according to the CIE L*a*b* color space system. RESULTS: ΔE of all experimental groups (GMTA, WMTA and BD) were significantly different from the control group at all time points (P<0.05). Color changes in the GMTA and WMTA groups, had no statistically significant differences, but showed higher discoloration compared to BD group in the cervical part of the crown, since week 1 (P<0.05). WMTA group showed significant discoloration in the cervical part as of week 1 (P<0.05), and gradually increased over time (Figure 2). BD group showed no significantly discoloration over time. GMTA group showed the significant discoloration at week 1 and week 14 (P<0.05). CONCLUSIONS: both GMTA and WMTA pulpotomy materials may discolor tooth structure over time in an extracted permanent anterior tooth model. When choosing bioceramic pulpotomy material, BD may be preferable in esthetic area.

Function of the Family Unit, Oral Hygiene Rules and Attitudes to Dental Health in Children During First-Wave 2020 COVID-19 Lockdown.

OBJECTIVE: To examine whether general and dental health and habits of families were affected by the first-wave lockdown due to COVID-19, and whether these habits were related to family functioning, resilience and stress. STUDY DESIGN: A cross-sectional study using an online survey disseminated among families with kindergarten and primary school-aged children during the lockdown of March and April 2020. RESULTS: A total of 361 respondents completed the survey. Most respondents adapted well to the changes imposed by lockdown and reported that they and their children had low anxiety levels and high mental resilience. Family functioning and behavior were positively correlated with nutrition habits and hygiene. General hygiene was positively correlated with oral hygiene. Respondents who reported requiring dental care had difficulties gaining access to it. Most respondents perceived that it is important to improve patients' digital access to pediatricians and dentists during crises. CONCLUSION: The study showed that better family functioning was associated with better family hygiene and nutrition, parental resilience and lower mental stress among children.

Bilateral Symmetry of Number and Size of Dental Caries Lesions among Children.

AIM: To determine the bilateral occurrence of caries lesions in 5-12-year-old children, and to assess whether one bitewing photograph can predict caries size and occurrence in the homologous tooth on the other side of the mouth. STUDY DESIGN: The study was carried out on 222 medical files of children 5-12 years old who were first examined in the university dental clinic. The presence and size of the caries lesions in the first and second primary molars and first permanent molars were recorded. RESULTS: No correlation was found when comparing the caries lesion distribution of each tooth's proximal surface. Seventy-one of the X-rays demonstrated a single caries lesion in a first or second primary molar or in a first permanent molar on one side of the mouth, of which 21.3% demonstrated a single caries lesion in the collateral side, 43.6% demonstrated 2 or more lesions, and 35.21% did not have any caries lesion on the collateral side of the mouth. CONCLUSION: One bitewing cannot determine the presence and size of a caries lesion on the same site of the homologous tooth.

Dental Anxiety, Fear and Anxiety of Performing Dental Treatments among Dental Students during Clinical Studies.

PURPOSE: Dental student's dental anxiety may negatively affect patient's attitude towards dental treatment. We evaluated dental anxiety among dental students in different clinical stage of their studies. We assessed the student's anxiety prior to treating patients. STUDY DESIGN: A cross-sectional study. Fourth to sixth-year dental students completed questionnaires containing: 1) Dental Anxiety Scale (DAS); 2) Dental Fear Survey (DFS); and 3) visual analogue scale questions relating to the student's anxiety when performing dental treatments in children and adults. RESULTS: 124 dental students completed the questionnaires (mean age, 26.4±3.1 years, 59.7% women). Average DAS in the study population was 7.55±2.15 with similar scores observed across the years. Average DFS score was highest among fourth-year students (1.62±0.65) and lowest among sixth year students (1.36±0.32). DFS scores decreased as the students progressed through the clinical years (p=0.059). The students' average anxiety scores prior to treating children were significantly higher than the anxiety scores prior to treating adults (3.82±2.42 vs. 2.67±1.9, p<0.001). Fifth-year students had significantly higher anxiety scores prior to treating children and adults compared to fourth and sixth-year students. CONCLUSION: Dental anxiety among dental students is relatively low and decreases gradually as they progress through the clinical years. Anxiety prior to treating patients, particularly children, is at its highest just before starting to treat patients for the first time. As dental students are future healthcare providers, it is important that they learn techniques to help them manage their own dental anxiety and fear as well as deal with anxiety related to treating patients.

The effect of television distraction versus Tell-Show-Do as behavioral management techniques in children undergoing dental treatments.

OBJECTIVE: Distraction is a highly acceptable technique for diverting a patient's attention from what may be perceived as an unpleasant procedure, reducing anxiety and helping the patient relax. The objective of the present study was to evaluate the effect of watching television during dental treatment on pediatric patients' anxiety and cooperation compared to the commonly used conventional Tell-Show-Do (TSD) behavioral management method. METHOD AND MATERIALS: Sixty-nine children (mean age 6.8 years) scheduled to undergo restorative dental treatment were randomly divided into two intervention groups: a group that was managed by television distraction and a control group that was managed by TSD. During treatment, anxiety was assessed by the Facial Image Scale and cooperative behavior was assessed by the Frankl scale. Pulse rate and oxygen saturation were also measured during the treatment. RESULTS: Compared to TSD, television distraction significantly reduced anxiety by 1.27 (95% confidence interval [CI] 0.798 to 1.744, adjusted P < .001), decreased pulse rate by 6.44 beats per minute (bpm) (95% CI 4.60 to 8.28, adjusted P < .001), and significantly increased cooperation by 1.17 (95% CI -1.318 to -1.020, adjusted P < .001). A greater effect of television distraction on reduced anxiety and increased cooperation was observed during administration of the anesthetic injection. No effect of television distraction on saturation levels was noted. CONCLUSIONS: Television distraction is an effective method for reducing anxiety and improving cooperative behavior in children during dental treatments.

Success of Dental Treatments under Behavior Management, Sedation and General Anesthesia.

Objective: To present comparative data with the aim of assisting the practitioner to choose between behavior modification (BM) techniques, pharmacologic sedation (N2O-O2 alone or combined with midazolam 0.5 mg/kg) or routine general anesthesia (GA) for the most successful approach in enabling pediatric dental care. Study design: Dental records of 56 children treated in a university dental clinic between 2006-2016 were reviewed, and data on age, gender, required treatment (amalgam restorations, composite restorations, pulpotomy, and stainless steel crowns [SSC]), treatment approaches and therapeutic success at final follow-up were retrieved. Results: Treatment under GA had the best success rates compared to both BM and pharmacologic sedation. N2O-O2 alone had a 6.1-fold greater risk of failure compared to N2O-O2+midazolam (p- <0.008). Amalgam restorations had a 2.61-fold greater risk of failure than SSC (p- <0.008). Conclusions: The GA mode yielded significantly greater success than the N2O-O2 mode alone. There were no significant differences in success rates between GA and combined midazolam 0.5 mg/kg+N2O-O2. When choosing restoration material, it is important to remember the high success rate of SSC compared to amalgam restoration.

Dental Anxiety among Israeli Postgraduate Pediatric Dental Students and their Instructors.

Objective: To measure the dental anxiety levels of post-graduate pediatric dental students (PGS) and their instructors, and their ranking of the most anxiety provoking situations in the dental situation; to investigate gender differences with regard to dental anxiety. Study design: Twenty-four PGS and 31 of their instructors completed a three-section questionnaire on sociodemographic information, dental anxiety scale (DAS) and dental fear survey (DFS). Results: The overall mean DAS and DFS scores were similar for both groups. The scores of the PGS were significantly higher on the DFS for perspiration when dental work was done (p = 0.032), the smell of the dentist's office (p = 0.009), and seeing the dentist enter the treatment room (p = 0.005). The total DAS score was significantly higher among females than among males (8.03 ± 3.08 and 6.63 ± 1.77, p = 0.037), and for item on waiting for the dentist to scrape the teeth, (p = 0.05). The DAS and DFS scores were strongly correlated (r = 0.768, p = 0.000). The highest DAS score was for the item on anticipation of dental treatment before arrival to the clinic and waiting for the drilling. The response pattern for both groups was similar. Conclusions: Overall dental anxiety of PGS and their instructors was similar. Female PGS and instructors had higher dental anxiety levels than males.

Maternal Knowledge of Oral Health of Children Aged 1-4 Years.

INTRODUCTION: Knowledge of oral health (KOH) among mothers has an important influence on their children's oral habits and routines. Lack of maternal KOH had been related to the development of early childhood caries among preschool children. AIM: To assess KOH among mothers of 1-4 year-olds. STUDY DESIGN: Participating mothers completed a 3-part questionnaire on general demographic information, KOH of their children, and ranking of six food items according to their cariogenic potential. RESULTS: Most of the 285 participating mothers had an academic education. Only 47% of the mothers correctly answered seven questions on KOH. The dentist was the main source for KOH. Most of the mothers (94.39%) were aware of the need to brush their children's teeth twice daily. Most of them (72.29%) did not know the correct fluoride concentration in their child's toothpaste. They ranked salty snacks as the least cariogenic food item. Most of the mothers were not aware that snacks and sweetened drinks should be consumed during meals, and two-thirds reported tasting food from their child's spoon. CONCLUSION: Overall, mothers of toddlers lacked basic knowledge of oral health issues and practices to follow for the prevention of their children's caries.

Prevalence of dental trauma in individuals with special needs participating in local Special Olympics games.

OBJECTIVES: The Special Olympics Special Smiles (SOSS) Program provides oral health screening and data collection for athletes with intellectual disabilities who participate in Special Olympics events. AIM: This study evaluated the prevalence and severity of dental trauma among Special Olympics athletes with intellectual disabilities who participated in the 2016 Israeli Special Olympics games. METHODS: A free voluntary dental examination was offered to all participating athletes. The examination was performed by volunteer dentists who completed a standard SOSS examination form, which included questions on oral health status and evidence of dental trauma in the anterior teeth. The dental traumas were categorized by a modified clinical version of the Ellis classification for dental traumas, and they were combined into three main categories according to their severity. Chi-square analysis was used to find differences between gender and age in regard to the prevalence of dental trauma. RESULTS: The sample consisted of 249 athletes with intellectual disabilities aged 10-65 years (mean 29.2 ± 11.24). The prevalence of dental trauma was 27.3%, of which 9.64% were categorized as mild and 17.67% as severe. Most of the traumas (94%) involved the maxillary incisors. CONCLUSIONS: The relatively high prevalence of dental trauma in special needs athletes revealed by this study's findings supports the need for using preventive measures, such as mouth guards, during sport activities.

Oxygen Saturation and Pulse Rate Change in Children during Sedation with Oral Midazolam and Nitrous Oxide.

OBJECTIVE: We aimed to examine if changes in oxygen saturation and pulse rate of pediatric patients during conscious sedation with midazolam and nitrous oxide are associated with child's behavior, midazolam dose, the type and duration of the treatment and demographic parameters. STUDY DESIGN: This study was a retrospective chart review of consecutive pediatric patients, aged 2.5-12.5 years, who had undergone conscious sedation for dental treatment with oral midazolam (with or without nitrous oxide) between January 2011 and September 2015 at the Department of Pediatric Dentistry of Tel Aviv University. Oral midazolam was administered according to the patients' weight, either at 0.4 mg/kg, 0.5 mg/kg or at a maximum dose of 10 mg. In all cases pulse rate and oxygen saturation were monitored every 15 minutes during treatment, Results: 147 sedation sessions (82 of females and 65 of males) were included in the study. Sedation was successful in 80% of cases. Children with poor behavior scores had statistically significant different mean saturation levels, albeit within normal range, during the treatment (p<0.012) as well as a clinically significant higher mean pulse rate (p=0.0001), compared to children with good or excellent behavior scores. Treatment duration, the type of dental procedure or the patients' weight were not correlated with the change in oxygen saturation or pulse rate during the treatment. CONCLUSIONS: Poor behavior of pediatric patients does not affect oxygen saturation, but it increases the pulse rate of children under sedation with midazolam and nitrous oxide.

First Permanent Molars and Permanent Incisors Teeth by Tooth Prevalence of Molar-Incisor-Hypomineralisation in a Group of Spanish Schoolchildren.

BACKGROUND: Molar-incisor-hypomineralisation (MIH) is a disturbance in dental development that commonly involves first permanent molars but permanent incisors may also be compromised. The prevalence of MIH in the literature varies between 2.5% and 40% of the world child population. Little information is gained on the prevalence of MIH among children in Spain. AIM: The aim of this study was to investigate the prevalence of MIH among school children from Barcelona, Spain. MATERIAL AND METHODS: A cross-sectional study which included 705 children, aged 6 -14 years and 11 months was carried out. Full mouth examinations were performed using the European Academy of Paediatric Dentistry (EAPD) criteria for the diagnosis of MIH. RESULTS: A total of 56 cases of MIH were found, 22 (39.3%) boys and 34 (60.7%) girls. The prevalence was 7.94% (6.39% for boys and 9.41% for girls). MIH lesions were seen more often in girls than boys (χ2 = 4.9, p= 0.023) the male/female ratio being 1:1.54. Upper teeth were more prevalent than lower teeth in both genders with an upper/lower ratio of 1.86/1 for boys and 1.68/1 for girls. CONCLUSION: Considered either by gender or by teeth, upper teeth and girls were ahead in our sample.

Molar-Incisor Hypomineralization: Positive Correlation with Atopic Dermatitis and Food Allergies.

AIM: Molar-incisor hypomineralization is a disturbance in dental development that involves first permanent molars as well as permanent incisors with a prevalence that ranges from 2.5% to 40%. The objective of this study was to investigate the etiology of molar-incisor hypomineralization among school children from two randomly selected towns in the province of Barcelona, Spain. STUDY DESIGN: A cross-sectional study was conducted with 705 children ranging in age from six years-old to 14 years and 11 months-old. Full mouth examinations were carried out in accordance with the European Academy of Paediatric Dentistry criteria for the diagnosis of molar-incisor hypomineralization, from April to July 2016. RESULTS: A total of 56 cases of molar-incisor hypomineralization were found in 22 (39.3%) boys and 34 (60.7%) girls. MIH was significantly more prevalent among those who had atopic dermatitis (OR=90.9; 33.4-247.1 CI 95%), food allergies (OR=104.2; 12.2-887.5 CI 95%), bronchitis/asthma (OR=5.3; 2.7-10.1 CI 95%), varicella (OR=96.3; 41.9-221.1 CI 95%), otitis media (OR=12.2; 6.3-23.5 CI 95%), pneumonia (OR=276.7; 35.1-2183.7 CI 95%), and febrile syndrome (OR=7.8; 4.1-14.8 CI 95%). CONCLUSIONS: The present research reveals for the first time a statistically significant relationship between atopic dermatitis and food allergies with the presence of molar-incisor hypomineralization.

The Prevalence of ADHD Patients among Pediatric Dentists in Israel and Knowledge of Dental and Behavioral Aspects of Treating Them.

OBJECTIVE: There are no clear guidelines for managing the dental treatment of children with attention deficit hyperactivity disorder (ADHD). The use of sedation in combination with chronic ADHD medication use is also not well defined. This study surveyed the prevalence of ADHD children, management techniques and knowledge of pharmacologic therapies of these children among Israeli dentists. STUDY DESIGN: A specially designed questionnaire was distributed to all Israeli dentists attending a national conference in 2016. RESULTS: Of the 160 dentists who attended the conference, 96 completed the survey (60% response rate), and they included 46 (51%) pediatric dental specialists and 50 (49%) general dental practitioners. The medications Ritalin and Concerta were most familiar to the respondents (98.9%). Eighty-seven (91.1%) of the practitioners responded that their ADHD patients take their usual doses of any drug for treating ADHD symptoms, regardless of whether or not the dentists intended to use sedatives. The practitioners invented their own behavior management techniques with varying degrees of success. CONCLUSIONS: There are no specific guidelines for the most effective pharmacologic protocol (co-administration of ADHD drugs and dental sedatives) or behavior management techniques for the provision of optimal dental care to children with ADHD.

Dental Anxiety Among Israeli Postgraduate Pediatric Dental Students and their Instructors.

OBJECTIVE: To measure the dental anxiety levels of post-graduate pediatric dental students (PGS) and their instructors, and their ranking of the most anxiety provoking situations in the dental situation; to investigate gender differences with regard to dental anxiety. STUDY DESIGN: Twenty-four PGS and 31 of their instructors completed a three-section questionnaire on socio demographic information, dental anxiety scale (DAS) and dental fear survey (DFS). RESULTS: The overall mean DAS and DFS scores were similar for both groups. The scores of the PGS were significantly higher on the DFS for perspiration when dental work was done (p = 0.032), the smell of the dentist's office (p = 0.009), and seeing the dentist enter the treatment room (p = 0.005). The total DAS score was significantly higher among females than among males (8.03 ± 3.08 and 6.63 ± 1.77, p = 0.037), and for item on waiting for the dentist to scrape the teeth, (p = 0.05). The DAS and DFS scores were strongly correlated (r = 0.768, p = 0.000). The highest DAS score was for the item on anticipation of dental treatment before arrival to the clinic and waiting for the drilling. The response pattern for both groups was similar. CONCLUSIONS: Overall dental anxiety of PGS and their instructors was similar. Female PGS and instructors had higher dental anxiety levels than males.