The Hall Technique 10 years on: its effect and influence.

Dental caries in early childhood can have a very significant effect not only on the oral health of young children but on their quality of life and that of their families. Added to this are the long-term infective risks to the host of untreated caries in primary teeth but also the risk of damage to successor permanent teeth. Traditional restoration of damaged primary teeth has been shown to have only moderate outcomes depending on the techniques and materials used and the ability of children to cooperate because of age or other factors. The Hall technique has outperformed other techniques in randomised clinical trials. In this Opinion Article I will take a look back at the Innes et al. paper, first published in this Journal in 2006, that introduced the Hall Technique and the subsequent scientific literature which provided us with high quality scientific evidence of the efficacy of the technique. I will evaluate how this new technique has affected the management of early childhood caries and hence its influence on wider oral and general health.

Dietary and social characteristics of children with severe tooth decay.

BACKGROUND AND AIMS: Dental decay remains a major public health problem in Scottish children. The aim of this study was to investigate the relationship between diet, bowel habit, social class, and body mass index (BMI) in children with severe tooth decay. CHILDREN AND METHODS: A cross sectional study of 165 children aged 3 -11 years attending Glasgow Dental Hospital for extraction of teeth under dental general anaesthesia (DGA), was undertaken. A structured questionnaire was used to obtain information from each child on diet, bowel habit, and social status of their parents. Fibre and sugar scores were calculated from the frequency of consumption of a range of relevant foods. RESULTS: The children (mean age 5.7 (SD1.8) years) had between 1 and 20 decayed, missing or filled primary teeth (dmft) with a mean dmft of 7.9 (SD 3.5). 37% ate a chocolate bar daily, and 29% regularly drank a sugary drink after brushing their teeth. An excess of children were from the most deprived parts of the city and they had the worst decay. Children with the worst decay were also significantly thinner. No relationship was found between tooth decay and bowel habit. CONCLUSIONS: In this selected group of children with poor dental health, those from deprived families were over-represented and had significantly more decay. Severe dental decay was also associated with underweight.

Treatment of aesthetic problems in paediatric dentistry.

Aesthetic problems in childhood and adolescence can have a significant effect on psychosocial development and interaction with peers. Abnormalities of shape, size, colour and structure of the whole or part of the anterior dentition of children can lead to such problems. This article outlines the most appropriate options for the clinical management of different aetiological categories of aesthetic problems, and develops a hierarchy of intervention that should be pursued in a logical order until a satisfactory cosmetic outcome is achieved. These techniques are readily available to most dental practitioners and there is no reason for a child to have to wait until late adolescence for treatment. Dent Update 2003; 30: 307-313 CLINICAL RELEVANCE: Aesthetic problems in children and adolescents may be treated by a variety of techniques.

The dental practitioner and child protection in Scotland.

OBJECTIVES: To identify from general dental practitioners: undergraduate and postgraduate training experience in child protection; numbers of suspected cases of child physical abuse; reasons for failing to report suspicious cases of child physical abuse; knowledge of local child protection protocols and procedures for referral. MATERIALS AND METHODS: Postal questionnaires were sent to 500 randomly selected general dental practitioners in Scotland, with a further 200 sent to a random sample of the original 500 to increase response rate. RESULTS: Sixty-one per cent (306) of the original 500 questionnaires, and 35% (69) of the second random mail shot of 200 questionnaires were returned. Only 19% could remember any undergraduate training and 16% had been to a postgraduate lecture or seminar in child protection. Twenty-nine per cent of dentists had seen at least one suspicious case in their career. Only 8% of suspicious cases were referred on to the appropriate authorities. Reasons for failure to refer revealed that 11% were concerned about a negative impact on their practice, 34% feared family violence towards the child, 31% feared violence directed against them, and 48% feared litigation. Only 10% of dentists had been sent a copy of the local child protection guidelines on commencing work and only 15% had seen their Area Child Protection Committee (ACPC) Guidelines via any route. CONCLUSIONS: Due to lack of training or clear guidelines for dentists in Scotland, most practitioners were unsure what to do in the event of a suspicion of child abuse. Twenty-one per cent of dentists had encountered suspicious cases but failed to take any action. Dentists overwhelmingly requested appropriate training. This training should address dental competence in assessment of suspicious indicators and involve dentists in inter-agency child protection training.

Retrospective analysis of factors influencing the eruption of delayed permanent incisors after supernumerary tooth removal.

AIM: This was to assess the predictability of eruption of delayed permanent incisors after supernumerary removal and creation of adequate space, in relation to: root maturity, degree of vertical impaction, and degree of angulation of impaction. METHODS: The dental records of children with supernumerary teeth delaying the eruption of permanent incisors were analysed. The type of a supernumerary tooth, its location and position were recorded, along with the stage of root maturation, angulation and vertical distance of impaction of the permanent incisor. At the initial surgery, the unerupted supernumerary tooth and any retained primary incisors were removed. The unerupted permanent incisor was not exposed. If necessary, the maxillary primary canines were removed to create sufficient space for eruption of the delayed permanent tooth. A secondary surgical procedure was planned after 18 months if there was no significant progress of the permanent tooth towards eruption. STATISTICS: All data were entered onto a Microsoft Excel spread sheet and analysed using Fisher's Exact Tests throughout due to the small numbers. RESULTS: Sixty-six supernumerary teeth were removed, 22 from boys and 44 from girls with ages ranging from 6 to 10 years 6 months at the time of surgery. Primary canines were extracted in 59.1% of cases. Spontaneous eruption occurred in 89.4% of delayed permanent teeth. The mean time to eruption was 9.2 months (median = 7 months). There was no statistically significant association between tooth eruption and root maturity or the degree of vertical impaction. There was an association between eruption and the degree of the angle of impaction of the permanent incisor (p<0.05). CONCLUSION: The majority of delayed permanent teeth erupt spontaneously if sufficient space is available or created at the time of removal of the unerupted supernumerary. The angulation of impaction of the permanent incisor is associated with a delay in eruption.

The dental attitudes, knowledge and health practices of patients with Juvenile Idiopathic Arthritis.

AIM: To investigate the dental attitudes, knowledge and dental health practices of children and adults with a previous diagnosis of Juvenile Idiopathic Arthritis (JIA). STUDY DESIGN: A self-completion questionnaire. METHODS: Ninety-one children and 82 adults with JIA were age and gender matched with 152 healthy controls. For those below the age of 16 years, the parents' attitude, knowledge and dental health practices were investigated by the questionnaire. The adult subjects and controls completed an identical questionnaire assessing their own attitude, knowledge and dental health practices. RESULTS: Response rates of 84% and 75% were achieved for the subject and controls respectively. Both groups responded similarly to questions assessing perception of different medical conditions. The majority of respondents thought leukaemia was a very serious condition. Twenty-seven percent of subjects and 34% of controls felt dental decay was "slightly or not serious". Ninety percent of subjects and 93% of controls knew having sweet snacks during the day would harm teeth, but fewer were sure that eating sweet foods at mealtimes only would help reduce decay. The majority of respondents (63% and 56% respectively) did not know whether children should receive fluoride tablets but the majority of subjects in both groups had attended a dentist within the last year. STATISTICS: Descriptive analyses and chi-squared analysis were undertaken. A p-value of < or =0.01 was taken as strong evidence of a difference between groups. CONCLUSION: The perception of health and illness by both groups was appropriate. The questions investigating dental knowledge revealed understanding of the basic messages of prevention of dental disease, but finer detail appeared less well understood. Responses concerning dental health confirmed positive attitudes towards good dental health habits. The benefits of brushing with fluoride toothpaste were known, and the majority toothbrushed daily and received dental care within the previous year.

Dental manifestations in severe combined immunodeficiency following bone marrow transplantation.

Severe combined immunodeficiency (SCID) is a rare primary immunodeficiency disorder with an estimated overall frequency of 1 in 75 000 live births. Bone marrow transplantation is the only curative treatment available. Using T cell-depleted HLA non-identical bone marrow requires preconditioning with a short course of cytotoxic chemotherapy. We report severe dental developmental anomalies in three such patients under long-term follow up.

The use of patient-controlled transcutaneous electronic nerve stimulation (TENS) to decrease the discomfort of regional anaesthesia in dentistry: a randomised controlled clinical trial.

OBJECTIVE: To compare the use of topical anaesthesia and transcutaneous electronic nerve stimulation (TENS) as means of reducing the discomfort of inferior dental block injections. METHODS: One hundred adult dental patients received 2% lignocaine with 1:80,000 adrenaline for long buccal and inferior dental block anaesthesia. The long buccal injections were given first with no prior mucosal preparation. Patients received inferior dental blocks after one of the following mucosal preparations: (1) no pretreatment; (2) a 2 min application of 20% benzocaine topical anaesthetic; (3) application of patient-controlled TENS at the injection site. Patients scored injection discomfort after each administration on a 100 mm visual analogue scale. RESULTS: The discomfort of the long buccal injection did not differ between the three groups of patients (F2,97 = 1.0). There were significant differences in the pain scores for the inferior dental block injections (F2,97 = 5.3; p < 0.01). Injection discomfort following TENS was less than that following no pretreatment (p < 0.01) and after topical anaesthetic application (p < 0.05). The use of topical anaesthesia did not produce a significant change in injection discomfort compared with no pretreatment. CONCLUSION: The use of TENS reduces injection discomfort during inferior dental block anaesthesia.

Dental health of children in an integrated urban development programme for destitute mothers with twins in Addis Ababa.

The Ethiopian Gemini Trust in Addis Ababa is a charitable organisation which cares for mothers who have delivered twins or triplets. A dental preventive programme for the disadvantaged children in the Trust was begun and this paper describes the first objective of the programme, the determination of the levels of dental disease. Caries, periodontal disease, malocclusion and enamel opacities were recorded.

PIP: Twin births are associated with pre-term delivery and low birth weight. In poor populations, these factors can seriously threaten child survival. The Ethiopian Gemini Trust was therefore established in 1983 as a charitable organization to care for mothers who have delivered twins or triplets. Given the scarcity of dental services in Ethiopia, the Trust added a dental preventive component for disadvantaged children to its services. This paper describes findings from the program's 1st objective of determining levels of dental disease in the population. 976 children and youths aged 6 months to 17.9 years were examined. 367 of this sample were aged 3-6 years. The prevalence of caries was generally low and within global goals set by the World Health Organization for the year 2000. The level of caries was greatest among 3-6 year olds exposed to an intensive feeding program in which their normal diets were supplemented with a sweetened commercial mix and sweet digestive biscuits. Only 27% of 6-9 year olds and 20% of 12-18 year olds had no periodontal problems. The study also found a generally low prevalence of enamel opacities. These findings point to the direct negative effects of poor dental hygiene and the indirect negative effects of the feeding program.

The dental health of adults in an integrated urban development in Addis Ababa, Ethiopia.

Two hundred and forty-three Ethiopian adults (18 years-old and over) were examined for caries, periodontal disease, malocclusions and enamel opacities. These adults were the parents of children cared for by an independent charitable organisation, the Ethiopian Gemini Trust. The prevalence of dental caries was generally low with a mean DMFT for the sample of 2.7 (+/- 0.2) and a mean DMFS of 6.7 (+/- 0.6), although one adult had a DMFS of 62. A high proportion of the adults (83.5 per cent) had calculus, but only 2 per cent had deep pocketing. Twenty-three per cent of the adults had a malocclusion and for 6 per cent of these this was moderate to severe. The most prevalent enamel defects were hypoplasias and diffuse opacities with 22 per cent of adults having one or more index teeth affected. Access to dental services was virtually non-existent as judged by the clinical status of these adults.

Dental epidemiology in Ethiopia.

First thoughts often assume that dental health is unlikely to be a priority for some time to come in a war stricken country like Ethiopia. Paradoxically the very success of specialised feeding programmes, in some groups in particular, has accelerated the onset of the sort of dental disease that is becoming a feature of developing countries.

Root extrusion, a practical solution in complicated crown-root incisor fractures.

Implants and fixed and removable prostheses are very successful in replacing missing units but their cost can be inhibitory to a number of patients. In addition fixed and removable prostheses can be destructive to sound abutment teeth and can result in damage to dental and soft tissue. This report describes the restoration of a tooth with a complicated incisor crown-root fracture that extended below both the gingival cuff and the alveolar crest, by using remaining tooth tissue. The restoration was completed after root extrusion with a cast post, diaphragm and core, and porcelain crown.

The dental practitioner's role in protecting children from abuse. 2. The orofacial signs of abuse.

The types of prevalence of the various orofacial injuries that may be sustained in child abuse have been presented. Table 2 gives the dental practitioner a summary check-list of five questions they must ask themselves and five observations they must make whenever doubts and suspicions of child abuse arise.

An unusual seat belt injury in a 7-year-old boy.

A luxation injury of a lower primary incisor in a 7-year-old boy was caused by the shoulder component of a seat belt. This highlights the increased risk of injury in children who are too large for safety seats but still too small for adult seat belts.

The dental practitioner's role in protecting children from abuse. 3. Reporting and subsequent management of abuse.

The third and final article of the series covers the mechanism a general dental practitioner should follow when alerting the authorities to a child at risk, and the subsequent investigations and actions that follow such a report.

The management of porphyria in dental practice.

From time to time a patient may attend your practice with a systemic condition that you may or may not remember from the small print of your undergraduate text books. This paper describes one such systemic condition, porphyria, and its dental management. This paper also describes the use of relative analgesia as an aid to anxiety management in porphyria.

The use of resin-bonded porcelain crowns for primary molars in infra-occlusion.

Infra-occluded primary molars without permanent successors may require restorative treatment to maintain occlusal stability and periodontal health in addition to creating an aesthetic result. This paper describes the use of two resin-bonded porcelain crowns to provide a simple, minimally invasive technique using a material with good wear resistance and high strength to create an aesthetic and functional occlusion.

The dental practitioner's role in protecting children from abuse. 1. The child protection system.

The last British Dental Journal article on child protection was in 1986. Since then there have been major changes in both legislation and approaches to child protection. A local authority child protection specialist and a consultant in paediatric dentistry outline the development of child protection and the dental practitioner's role in the inter-agency child protection system in this, the first of three inter-related articles.

The influence of two different dental local anaesthetic solutions on the haemodynamic responses of children undergoing restorative dentistry: a randomised, single-blind, split-mouth study.

OBJECTIVES: This investigation was designed to study the haemodynamic effects of two different local anaesthetic solutions during restorative dental treatment in children. DESIGN: A randomised, single-blind, split-mouth cross-over design was employed using children undergoing bilaterally similar restorative treatments over two visits. SETTING: The study was performed in a dental hospital paediatric dentistry department. METHODS: Ten children participated. At one visit the local anaesthetic was 2% lidocaine (lignocaine) with 1:80,000 epinephrine (adrenaline); at the other the anaesthetic was 3% prilocaine with 0.03IU/ml felypressin. Local anaesthetic was administered at a dose of 0.5 ml/10 kg body weight. Blood pressure and heart rate were measured before and during treatment with an automatic blood pressure recorder. Data were analysed by ANOVA and Student's paired t test. RESULTS: Significant differences between treatments in diastolic blood pressure (F = 2.37; P = 0.05) and heart rate (F = 2.98; P< 0.02) were noted. The heart rate increased ten minutes following the injection of the epinephrine-containing solution. The diastolic blood pressure fell 20 minutes after injection of lidocaine with epinephrine. CONCLUSION: The choice of local anaesthetic solution influences the haemodynamic response during restorative treatment in children.

A study of the effectiveness of oral midazolam sedation for orthodontic extraction of permanent teeth in children: a prospective, randomised, controlled, crossover trial.

OBJECTIVES: To assess the safety, effectiveness and acceptability of o:ral midazolam sedation for orthodontic extraction of permanent teeth in children. DESIGN: A prospective, randomised, controlled, crossover trial. METHODS: A total of 26 children aged 10-16 (ASA I), referred for orthodontic extraction of premolar or canine teeth under sedation, were included in the study. Each child required two treatment sessions for the extraction of equivalent teeth on opposite sides of the mouth. Each subject was sedated with either ora midazolam (0.5 mg/kg) or nitrous oxide and oxygen (30%/70%) at the first visit and the alternative form at the second visit. At each visit two teeth were extracted, one upper and one lower. Heart rate, arterial oxygen saturation, respiration rate, sedation and behavioural scores were recorded every five minutes. Overall behaviour, patient acceptance and patient satisfaction were recorded at the end of treatment. RESULTS: Of the 26 children included in the study there were 12 males and 14 females. The mean age was 12.5 years. The mean heart rate and respiratory rate for both groups were similar and within acceptable clinical limits. The lowest mean arterial oxygen saturation levels for nitrous oxide and midazolam sedation were 97.7% and 95.0% respectively. Although midazolam caused greater oxygen desaturation, the range (91%-100%) was within safe limits for conscious sedation. The mean level of sedation was greater in the midazolam group compared with the nitrous oxide group and all but one case completed treatment. A total of 23 patients (88%) said they would be prepared to have ora midazolam sedation again and 17 (65%) actually preferred oral midazolam to nitrous oxide sedation. CONCLUSION: Oral midazolam (0.5mg/kg) appears to be a safe and acceptable form of sedation for 10-16 year old paediatric dental patients.