UK National Clinical Guidelines in Paediatric Dentistry: stainless steel preformed crowns for primary molars.

This revised Clinical Guideline in Paediatric Dentistry replaces the previously published sixth guideline (Fayle SA. Int J Paediatr Dent 1999; 9: 311-314). The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated widely for consultation to all UK consultants in paediatric dentistry, council members of the British Society of Paediatric Dentistry (BSPD), and to people of related specialities recognized to have expertise in the subject. The final version of this guideline is produced from a combination of this input and thorough review of the published literature. The intention is to encourage improvement in clinical practice and to stimulate research and clinical audit in areas where scientific evidence is inadequate. Evidence underlying recommendations is scored according to the SIGN classification and guidelines should be read in this context. Further details regarding the process of paediatric dentistry guideline production in the UK is described in the Int J Paediatr Dent 1997; 7: 267-268.

Practitioner evaluation of an online oral health and risk assessment tool for young patients.

Aim To test the validity and acceptability of an online oral health assessment and biofeedback tool for young patients (under 17) for use in general dental practice.Methods A convenience sample of thirteen practitioners were recruited to test the functionality of a novel version of the Denplan PreViser Patient Assessment tool (DEPPA) developed for young patients (YDEPPA). Dentists who had completed eight or more assessments during a one month window were sent a link to an online feedback survey, comprising eight statements about YDEPPA, with scoring options of 0-10, where a score of 10 indicated complete agreement with the relevant questions. Verbatim comments were encouraged. The clinical data submitted were held in a central database in an encrypted format so that only the user practice could identify individual patients.Results Twelve practitioners completed eight or more assessments and were included in the survey. A total of 175 patient assessments were received. Ten practitioners completed the on-line survey. The statement 'YDEPPA produces a valid measurement of each patient's oral health' received an average feedback score of 8.8. The statement 'The full YDEPPA report is a valuable communication aid' received a score of 9.6. Feedback was generally very positive with all scores >8.2. Constructive critical feedback was received for the caries risk aspect of the YDEPPA protocol, with suggestions made for improving objectivity of data inputs. Eighty-one percent of the verbatim comments received were positive.Conclusions Once the caries risk issues raised by pilot dentists have been addressed, YDEPPA appears suitable as a pragmatic analytical and biofeedback tool for use in general dental practice to assess the oral health of young patients, and to facilitate education and engagement of young patients and their parents/carers in positive health behaviours.

Teamwork in orthodontics: limiting the risks of root resorption.

Orthodontic treatment is not without risk. The risks may be due to patient factors (which may not always be evident before treatment) or may come about because of the treatment itself. While the common types of risk are well documented, less information is available as to how some of the more unusual problems can best be managed when they arise; often the need for teamwork between the patient, orthodontist and general dental practitioner (GDP) are underestimated. This paper presents three patients in whom various root-related problems existed either before orthodontic treatment or which arose during orthodontic treatment; demonstrates how they were managed; and highlights the need for teamwork to ensure a 'least harmful' outcome. All patients were followed up for over a year.

Salivary levels of anticonvulsants: a practical approach to drug monitoring.

Phenobarbital, phenytoin, carbamazepine, primidone, and ethosuximide were measured in saliva and plasma obtained simultaneoulsy from 115 patients. A method to correct for the effect of salivary pH on phenobarbital concentration of saliva was developed. Salivary concentrations of these drugs were found to be equivalent to the plasma free drug and to correlate closely with the total plasma levels. Expressed as percent of total plasma drug, the salivary (S) and plasma free (P) concentrations were: phenytoin, S 11.1 +/- 2.0 percent (mean +/- SD), P 10.1 +/- 2.4 percent (r = 0.97); carbamazepine, S 26.0 +/- 2.4 percent, P 25.9 +/- 3.4 percent (r = 0.97); phenobarbital, S 43.1 +/- 5.2 percent, P 40.8 +/- 7.9 percent (r = 0.91); primidone, S 75.4 +/- 24.9 percent, P 66.4 +/- 8.8 percent (r = 0.76). Ethosuximide was not bound by plasma proteins, and its plasma and salivary levels were equal.

Covalent protein adduct formation and protein cross-linking resulting from the maillard reaction between cyclotene and a model food protein.

Covalent Maillard products of the reactions of carbonyl compounds with proteins are often described in the literature, but, until recently, evidence for their existence has been indirect. Cyclotene (2-hydroxy-3-methylcyclopent-2-enone), a common flavor compound, was incubated with a model food protein, ribonuclease, and found to cross-link the protein. Size exclusion high-performance liquid chromatrography and electrospray mass spectrometry of the early stages of the reaction provide strong evidence for covalent adducts that we believe to be intermediates in the cross-linking reaction.

Decontamination of dental unit water systems: a review of current recommendations.

It is now recognised that water delivered to dental handpieces and air/water syringes via dental unit water systems may become significantly contaminated with micro-organisms which originate from the incoming water supply and, to a lesser extent, with oral micro-organisms. The purpose of this article is to review the literature relating to the risks associated with contamination of dental unit water systems and methods which may be used to minimise these risks.

Congenital erythropoietic porphyria--oral manifestations and dental treatment in childhood: a case report.

Congenital erythropoietic porphyria is a rare condition resulting from an inborn error in prophyrin metabolism. This deficiency leads to hemolytic anemia, photosensitivity, blistering of the skin, and deposition of red-brown pigments in the bones and teeth. The literature regarding the dental aspects of this disorder is briefly reviewed and the preventive, restorative, and esthetic dental management of a 4-year-old child with congenital erythropoietic porphyria is described.

Oral complications in pediatric oncology patients.

This study investigated the oral problems occurring in children receiving treatment for malignant disease at a regional oncology center. Forty-three children 2 to 14 years old were followed longitudinally from initial diagnosis for periods ranging from eight to 30 weeks for the development of oral and dental problems. Fifteen children had untreated decay; two required the removal of primary teeth before they began chemotherapy. Three children developed acute dental infections during treatment. Forty (93%) developed oral problems associated with their disease or treatment during the study period. Oral mucosal ulceration was the most frequently encountered problem; it was observed in 28 (65%) patients. In light of the high prevalence of dental and oral problems in these patients, this study emphasizes the need for positive dental involvement, both in pretreatment assessment and in the ongoing care of the pediatric oncology patient.

The longevity of space maintainers: a retrospective study.

METHODS: This retrospective study investigated the longevity of 301 space maintainers fitted in 141 patients aged 3.4-22.1 years in the Department of Pediatric Dentistry at Leeds Dental Institute between 1991 and 1995. RESULTS: Failure occurred in 190 space maintainers (63%), of which 36% were due to cement loss, 24% breakage, 10% design problems, and 9% were lost. Using the life table method, the median survival time (MST) for space maintainers was found to be 7 months. Band and loop (B&L) appliances had the highest MST of 13 months, while the lower lingual holding arch (LLHA) had the lowest of 4 months. Unilateral space maintainers survived longer than bilateral space maintainers (MST of 13 months vs. 5 months). Left B&Ls had a MST of 16 months, compared to only 4 months for right B&Ls, Gender, age, arch in which the appliance was placed, the operator planning it, fixed vs. removable, and adequacy of pretreatment assessment did not have a significant effect on survival time.

Comparison of two methods of space prediction in the mixed dentition.

PURPOSE: This study compares the accuracy of space prediction for the unerupted permanent canines and premolars by a recognized method of mixed dentition space analysis (Moyers technique) vs estimation by simple visual observation (SVO). METHODS: Twenty clinicians with varying levels of dental experience and training blindly assessed study models of 4 intact arches (2 maxillary and 2 mandibular) from 3 patients in the mixed dentition using both Moyers and SVO space prediction methods. Corresponding full-mouth panoramic radiographs were available for each case. Follow-up records of the eventual outcome in the permanent dentition for each case available (ie, study models prior to any form of orthodontic intervention) served as the standard for further comparison of the space predictions made. Predictions by both methods were compared with each other as well as with the eventual space situation in the permanent dentition. RESULTS: The differences in overall mean space prediction between the Moyers technique (excluding molar shift) and SVO ranged between 3.67 mm to 6.9 mm (lower arches) and 4.3 mm to 4.8 mm (upper arches). Diagnostic consistency between both methods' predictions was highly variable, with correlation ranging from moderate (r = 0.53, P = .01) to very weak (r = -0.1). Generally, more crowding was estimated with the SVO method's predictions. However, the inclusion of molar shift in the Moyers analysis resulted in the prediction of more crowding in the mandible compared to SVO and eventual outcome in the permanent dentition. The range and variability in predictions were always smaller with the Moyers technique compared to SVO. Neither technique's mean space prediction more closely resembled the eventual space situation in the permanent dentition. CONCLUSIONS: This study demonstrated that although the Moyers technique demonstrated less variation and more reproducibility than SVO in its space predictions, neither of the techniques was any more accurate in predicting the final space outcome in the permanent dentition.

Molar incisor hypomineralisation: restorative management.

AIM: The methods for the restoration of permanent molars and incisors affected by Molar Incisor Hypomineralisation are reviewed. The special problems associated with restoring these teeth, such as sensitivity, occlusion and aesthetics are discussed. The various options for restoration are outlined and recommendations made as to the appropriate types of restoration.

The use of the local analgesia syringe in children. Should it be kept out of sight? A clinical trial of two methods of presentation.

AIM: The study was carried out to determine whether showing a local analgesia (LA) syringe to a child would influence behaviour during subsequent administration of LA, as opposed to concealing it. MATERIALS AND METHODS: 25 children were randomly assigned to either a show (13) or no-show (12) group. The children were aged 4 years and 3 months to 8 years and 9 months, mean age 7 years and 9 months. One operator carried out all LA administrations. The procedure and dialogue were strictly standardised. Each child was filmed during LA administration. Three paediatric dentists scored the video recorded behaviours, using the Frankl Behaviour Rating Scale. The raters were blind as to which group the child belonged to. RESULTS: No statistical difference was found between the behaviour ratings of the no-show and the show groups during LA administration (p>0.05). CONCLUSION: Overall, the behaviour of the children in the show group did not differ from the behaviour of children in the no-show group. Whether to show or not to show the LA syringe is probably dependent on the behavioural skills of the operator.

A clinical trial comparing the effectiveness of a three-headed versus a conventional toothbrush for oral hygiene in children.

AIM: The study was designed to compare the efficacy of the Superbrush three-headed with a conventional brush for oral hygiene in children. MATERIALS AND METHODS: The study population was 78 children attending three primary schools in Leeds (UK). The clinical trial consisted of a single blind, randomized, four visits, crossover and single use toothbrush design. Subjects were randomized to one of two test groups (A and B). The 16-week trial consisted of four visits with a washout period of four weeks between the second and third visits. Both brushes were used with a horizontal mini-scrubbing strokes technique. Plaque scores were recorded at each visit using the Quigley and Hein Plaque Index as modified by Turesky et al. [1970]. RESULTS: Using a paired t-test the results from the outcome measures of the four visits indicated that buccally the conventional brush was superior in plaque removal to the three- headed brush, lingually there was no difference between brushes. Although over-all plaque removal was similar for both brushes, 85% of the children preferred the Superbrush. CONCLUSION: Significant improvements in plaque removal in children can be achieved following good tooth brushing instructions regardless of the design of toothbrush used.

A prospective clinical trial comparing preformed metal crowns and cast restorations for defective first permanent molars.

AIM: This study investigated two methods for the restoration of permanent molars affected by amelogenesis imperfecta (AI) or severe enamel defects. METHODS: A prospective clinical trial was carried out on 17 subjects affected by AI or severe enamel defects of first permanent molars. A split mouth design was used so that each right or left permanent molar in both jaws was restored using either a preformed metal crown (SSC) or a cast adhesive coping (CAC). Subjects were followed for up to 24 months and assessed for longevity and quality of the restorations. Sequential analysis was used to compare longevity. RESULTS: Records for 42 restorations (19 SSC; 23 CAC) were kept. The split mouth design was possible on 24 occasions (right versus left=14; maxilla versus mandible=10). Three restorations, one SSC (at 6 months) and two CAC (at 2 and 19 months) failed and required replacement. There was no significant statistical difference between the two types of restorations. CONCLUSION: While there was no difference between the two restorations for quality and longevity, the SSC was considerably cheaper to use and needed only one visit, but more tooth tissue was lost in preparation and fitting. The CAC was significantly more expensive but left nearly all of the tooth crown intact. The choice of which restoration to use is indicated by the immediate and long-term needs of each individual patient.

Oral problems and the dentist's role in the management of paediatric oncology patients.

Child cancer patients require a great deal of intensive treatment and support. This paper provides an account of the dental problems a practitioner will encounter with these children and discusses how they may be managed.

Analysis of dental care of children receiving comprehensive care under general anaesthesia at a teaching hospital in England.

OBJECTIVES: This study aimed to analyse the characteristics of comprehensive dental care provided under general anaesthesia (CDGA) and to review the additional treatment required by children over the 6 years subsequent to CDGA. METHOD: Information collected from hospital records for the 6-year period following the first CDGA included the types of dental treatment performed at CDGA, the return rates for follow-up appointments, further treatment required subsequent to CDGA and the types of dental treatment performed at repeat DGA. RESULTS: The study population consisted of 263 children, of whom 129 had a significant medical history, with mean age of 6.7 years. The results revealed that the waiting time for CDGA was significantly shorter in children who had a significant medical history, with 49% being admitted for CDGA within 3 months of pre-GA assessment, as compared to 29% of healthy children. 67% of children had follow-up care recorded, with a slightly higher proportion of children with significant medical history returning for follow-up [70% (90/129)] compared with 65% (87/134) of healthy children. Re-treatment rates were 34% (88/263), the majority of cases being treated under local analgesia (42/88). 34 of 263 children had repeat DGA (12.9%). Of these 71% (24/34) were children with significant medical history. The mean age at repeat DGA was 9 years. In 25 of 34 children (74%), repeat DGA was due to trauma, oral pathology, supernumerary removal, hypomineralized teeth or new caries of previously sound or un-erupted teeth at CDGA. The ratio of extraction over restoration (excluding fissure sealants) performed at repeat DGA was 2.8, compared with the ratio of 1.3 in the initial CDGA. CONCLUSIONS: There was a higher ratio of extraction over restorations at the repeat DGA. This suggests that the prescribed treatments at repeat DGA were more aggressive as compared to the initial CDGA in 1997. The majority of the treatment required at repeat DGA was to treat new disease.

Improving oral healthcare for children--a great opportunity.

Changes in commissioning and contracting of NHS dental services will impact on oral healthcare delivery, providing new challenges and opportunities for children's oral healthcare. Now is the time to assess clinical networks and specialised services to understand how the oral healthcare needs of all children can be met appropriately and effectively so that when change comes it can be embraced for the better.

An evaluation of paediatric dental general anaesthesia in Yorkshire and the Humber.

BACKGROUND: Following major change in UK policy regarding dental general anaesthesia (DGA) in 2001, there appears to be little information available about paediatric DGA services, their organisation, availability and utilisation. AIMS: To establish the location, organisation and monitoring systems of paediatric DGA services in Yorkshire and the Humber Strategic Health Authority and to audit these services against existing standards of best practice. DESIGN: A postal survey of all potential paediatric DGA providers in Yorkshire and the Humber. RESULTS: Thirty-one possible DGA service providers were identified, 24 of which provided paediatric DGAs. Of 84 DGA lists identified, 75 regularly treated children, and nine were run on an ad hoc basis. The lists were held in 20 centres. The number of patients treated per list varied depending on treatment provided, ranging from 3.9 to 7.5 patients per list. Maximum waiting times varied from three to 84 weeks. Outcome data recording methods varied. Just over half of respondents used the Hospital Episode Statistics system; the remainder used other systems, or none. CONCLUSIONS: There was much variation in how DGA lists were organised. Most lists met some of the accepted standards, but very few met all. Waiting times were largely in accordance with national targets.