Parental acceptability of silver diamine fluoride: The UK and US experiences.

BACKGROUND: International data suggest that parents may have reservations about the use of silver diamine fluoride (SDF). AIM: The aims of this study were to: (1) examine the acceptance of parents/carers towards the use of SDF for the management of caries in children's primary teeth in secondary care dental settings in the UK and the United States and (2) determine which factors may affect the acceptance of the use of SDF. DESIGN: This was a cross-sectional questionnaire of SDF acceptability, completed by parents of young children. It was validated and adapted to local populations. Data were analysed with descriptive and inferential statistics. RESULTS: Of the 113 Sheffield parents, 73% reported that they would accept SDF treatment of children's posterior teeth, with 58% reporting this for anterior teeth. Parents having less concern about posterior aesthetics had a statistically significant effect on reported acceptance of SDF (p = .013). In the Colorado sample (n = 104), 72% reported that they would accept SDF on posterior teeth, and 58% reported that they would accept SDF on anterior teeth. Concerns about aesthetics had an effect on decreasing SDF acceptance overall (p = .0065) in anterior (p = .023) and posterior teeth (p = .108). CONCLUSION: The majority of parents in the two study populations accepted the treatment using SDF. However, concern about aesthetics had an influence on acceptability.

Do panoramic radiographs offer improved diagnostic accuracy over clinical examination and other radiographic techniques in children?

Aim The aim of this study was to establish the diagnostic efficacy of panoramic radiographs in six clinical situations for paediatric patients: caries, acute dental infections, dental trauma, dental anomalies, developmental disorders and pathological conditions.Data sources The authors searched the following databases: Medline, Embase, the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects and the Cochrane Health Technology Assessment database. Forward citation searches of included studies were carried out. There were no language restrictions. The dates were restricted to include studies published between 1990-2018.Study selection Inclusion criteria: children under the age of 18 for whom the diagnostic accuracy of panoramic radiography was compared to either clinical or an alternative radiographic examination for the six included indications. Exclusion criteria: panoramic radiographs taken for orthodontic indications outwith those stated in the aim. Studies of all designs were included. Screening of titles, abstracts and full texts were completed independently and in duplicate by two authors. Disagreement was resolved by discussion including a third author. A total of 3,420 abstracts were screened, from which 175 full texts were reviewed. Sixteen studies across the six indications were included in the review.Data extraction and synthesis Data extraction was performed independently and in duplicate by two authors, with a third resolving disagreement. A standardised form was used which was initially piloted on ten papers. A narrative synthesis was carried out due to heterogeneity of the included studies precluding data synthesis.Results Assessment of bias was completed using the QUADAS 2 tool. Of 16 included studies, the majority were of high or unclear risk of bias for domains including: patient selection, conduct or interpretation of the index test, reference standard, and patient timing and flow. Regarding detection of caries, one study was included which demonstrated clinical examination detected more carious surfaces than panoramic radiographs (6.0%, 95% CI 4.1-7.8%), but that bitewing radiography combined with panoramic radiography led to a higher diagnosis of approximal lesions than clinical examination alone by 4.3% (p <0.0001). Concerning acute dental infection, one study was included that did not present diagnostic accuracy data. Three studies related to dental trauma were included, all of which examined condylar fractures. Only one study reported diagnostic accuracy data: 70% diagnostic accuracy with panoramic radiography compared to 92% utilising CT scans. Four studies included examined diagnosis of a spectrum of dental anomalies. The only study to provide data on diagnostic accuracy reported a sensitivity of 50% for correct identification of supernumerary teeth on panoramic radiographs, with a specificity of 97.2%. Five included studies pertained to developmental disorders. One study gave data on diagnostic accuracy of panoramic radiographs. This showed sensitivity of 68.2% for identification of abnormalities in familial adenomatous polyposis. Two studies included were related to pathological conditions - one reported that panoramic radiographs gave 75% sensitivity to identify abnormal condylar morphology in patients with TMJ synovitis, with a specificity of 66.7%.Conclusions The study concluded that more research is required concerning the diagnostic accuracy of panoramic radiographs for oral conditions in order to produce clinical guidance based on high-quality evidence.

Fluoride varnish and dental caries in preschoolers: a systematic review and meta-analysis.

Aim This systematic review aimed to assess the effectiveness of fluoride varnish in preschool children for reducing the incidence of caries into dentine.Data sources Data came from published and grey literature. Databases searched were: CDSR, Medline, EMBASE, Web of Science, SCOPUS, LILACS and BBO. Hand-searching was done of nine dental journals and two medical journals. Backward citation searches were carried out on the reference lists of identified trials and relevant systematic reviews. Trials registers (Current Controlled Trials, ClinicalTrials.gov, EU Clinical Trials Register, Australia New Zealand Clinical Trials Registry, and Registro Brasileiro de Ensaios Clínicos) were searched for ongoing trials. Grey literature was searched via a number of resources including International Association for Dental Research (2001-2018) and European Organisation for Caries Research (1998-2018) conference abstracts and Open Grey, EThOS, the New York Academy of Medicine (GreyLit Report) and Banco de Teses CAPES.Study selection Inclusion criteria were; the use of fluoride varnish (different regimes and doses were included), randomised controlled trials, preschool age (under 71 months) and over 12 months follow up. Outcomes were caries into dentine and hospitalisations due to caries. A combination of free text and controlled terms were used based on the study question. A total of 2441 studies were identified at initial search, 20 were included for narrative and quantitative analysis after full text reviews of 79 studies.Data extraction and synthesis Data was extracted independently by two reviewers with a third resolving any disagreement. Data was combined by subgroup to compare different interventions and controls, with a global random effects meta-analysis performed on 16 studies to provide a relative risk (RR) of dentinal caries at the individual level. At the individual level meta-analysis was by RR, at the tooth and surface level this was prevented fraction (PF) and weighted mean difference (WMD).Results Only one study was determined at low risk of bias, with four unclear and 14 at high risk based on the Cochrane risk of bias tool. Studies were from 13 different countries. Children at baseline were from 0-100% caries free, with a dmft of 0-6.57 and aged 6 months - 5 years. There were no studies reporting hospitalisation due to caries. The combined RR for the outcome of dentine caries for an individual was 0.88 (95% CI 0.81-0.95) based on 16 studies with considerable heterogeneity (I2 = 75.7%). Tooth level results gave a PF of 31.13% (95% CI 21.08, 41.18) and a WMD of -0.30 (95% CI-0.69, 0.09) for fluoride varnish. At surface level the PF was 24.15% (95% CI 12.91-35.38) and WMD of -0.77 (95%CI; -1.23, -0.31).Conclusions The conclusions of the paper were that there is modest and uncertain evidence for fluoride varnish reducing the risk of developing dentine caries in pre-school children.

What is the impact on families of children having dental treatment under general anaesthetic?

Data sources PubMed, Medline, CINAHL, Cochrane Library, and Web of Science databases.Study selection Studies involving patients aged between 0-16 years of age having dental general anaesthetic (DGA), where Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) pre- and post-operative assessments were made, were considered.Data extraction and synthesis The quality of studies was assessed by two reviewers using the Newcastle-Ottawa Scale for cohort studies. Information on study design and instruments used to record family impact scale (FIS) were extracted. The main outcome was changes in the FIS section presented as mean difference (MD).Results After an initial search of 105 studies in the database, 21 articles were included in the analysis. A positive outcome in the FIS changes was identified in all studies. The combined MD for FIS using ECOHIS and COHRQoL was 1.52 (95% CI 1.15-1.89; P <0.00001; I2 = 87%) and 1.10 (95% CI 0.68-1.52; P <0.00001; I2 = 79%), respectively.Conclusions Dental treatment with general anaesthesia for children had a significant positive impact on parental emotions, activity, and conflict. Following DGA, there was significant improvement in the FIS, with large MD.

Silver diamine fluoride for the management of dental caries in children in primary dental care: protocol for a feasibility study.

BACKGROUND: Dental caries remains a significant problem in England, affecting 11% of 3-year-olds and 23% of 5-year-olds. While current approaches have been extensively investigated, their ability to (1) control pain and infection; (2) prevent hospital admissions, and (3) be implemented within the National Health Service (NHS) contractual arrangements, remains unsatisfactory. Silver diamine fluoride (SDF) is an alternative, non-invasive approach that has proven efficacy in arresting caries progression in primary teeth, principally from studies conducted outside of Europe. Its use in primary dental care in the UK is limited, despite the acknowledged need. The clinical and cost-effectiveness of SDF has not been compared to usual care in the UK. Before a pragmatic randomised controlled trial (RCT) can be conducted to compare SDF to usual care for caries management in young children, there are several uncertainties that require investigation. This study aims to establish whether such an RCT is feasible. METHODS: This mixed-method parallel design study is a feasibility study with an embedded process evaluation, to compare SDF with usual treatment in primary dental care in the UK. It will be individually randomised, with 13 dentists and therapists, in 8 different dental primary care sites with a sample size of 80 child participants aged 1-8 years old. The aim will be to recruit ten participants per site with equal arm allocation. Follow-up will be for 1 year. The study will inform whether an RCT is feasible by resolving several key uncertainties. The acceptability and implementation of SDF and the research processes will be explored. Patient and Public Involvement and Engagement representatives will be involved throughout recruitment and retention strategies, participant documentation, analysis, engagement and dissemination. DISCUSSION: The ability to conduct an RCT will be evaluated. If feasible, this RCT has the potential to evaluate the effectiveness of a non-invasive approach for the management of untreated caries in young children. A feasibility study also offers the opportunity to consider factors associated with the implementation of SDF at an early stage through a process evaluation that will inform the definitive trial and an implementation strategy for SDF by identifying relevant barriers and facilitators. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT06092151. Date: 19/10/2023.

The great urban shift: Climate change is predicted to drive mass species turnover in cities.

Human experiences with nature are important for our culture, economy, and health. Anthropogenically-driven climate change is causing widespread shifts in biodiversity and resident urban wildlife are no exception. We modelled over 2,000 animal species to predict how climate change will impact terrestrial wildlife within 60 Canadian and American cities. We found evidence of an impending great urban shift where thousands of species will disappear across the selected cities, being replaced by new species, or not replaced at all. Effects were largely species-specific, with the most negatively impacted taxa being amphibians, canines, and loons. These predicted shifts were consistent across scenarios of greenhouse gas emissions, but our results show that the severity of change will be defined by our action or inaction to mitigate climate change. An impending massive shift in urban wildlife will impact the cultural experiences of human residents, the delivery of ecosystem services, and our relationship with nature.

'You just don't have the time to keep bringing them back, bringing them back': the experience of primary care dental professionals in England when treating young children with carious teeth.

Introduction Caries in the primary dentition affects around one-quarter of children in England. There is uncertainty and varying practice regarding the management of these children within NHS primary dental care. Silver diamine fluoride (SDF) is an approach that is not well-adopted nationally. This study aims to explore the factors affecting treatment choices for caries management in young children within primary dental care, including the use of SDF.Methods Semi-structured interviews were carried out via video conferencing with general dental practitioners and therapists working in NHS primary care. The topic guide covered factors which influence the management of caries in primary teeth, with SDF-specific questions. These were transcribed verbatim and analysed using thematic analysis.Results A total of 13 interviews were conducted with dental professionals working across Yorkshire and the East Midlands. Decision-making for caries management was dependent on inter-related factors, which also influenced SDF use. Treatment decisions were taken on a case-by-case basis, but were influenced by the child, their parents, the dental professional and service factors, along with the clinical technique.Conclusion Many individual- and system-level factors influence treatment decisions for early childhood caries. However, issues relating to remuneration and governance appear to be specific barriers to adoption of SDF in primary dental care.

A multi-site service evaluation of silver diamine fluoride use for children.

Introduction The use of silver diamine fluoride (SDF) is relatively new to the UK. It is unknown how it is being used and for what indications in UK paediatric dental services.Aim To: 1) establish how SDF is being used across different paediatric dental settings in the UK; and 2) consider parental and patient views on the treatment experience and side effect of discolouration.Method A multi-site service evaluation was carried out across six paediatric dentistry units covering hospital and community services. Data were collected prospectively from 17/02/2020 to 02/03/2022. Simple descriptive statistics were used to analyse the data.Results Data were collected for 54 patients. The included patients had an age range of 2-13 years, with a mean of 4.9 years. The reason SDF was chosen was reported as: to avoid general anaesthetic (n = 25); to avoid extractions (n = 8); stabilisation (n = 25); acclimatisation (n = 24); and insufficient cooperation for other treatment (n = 17). In total, 42 cases had SDF applied to the primary dentition. This was in the anterior dentition for 18 patients and the posterior dentition for 15, with nine patients having SDF applied both anteriorly and posteriorly. The majority of children and parents were accepting of the technique and immediate aesthetic outcome.Conclusion In the services involved in this multi-site service evaluation, SDF is used for young patients in the primary dentition for the purpose of caries arrest. The technique was viewed positively by the majority of parents and children.

Molar Incisor Hypomineralisation: Current Knowledge and Practice.

BACKGROUND: Molar incisor hypomineralisation (MIH) is a common developmental dental condition that presents in childhood. Areas of poorly formed enamel affect one or more first permanent molars and can cause opacities on the anterior teeth. MIH presents a variety of challenges for the dental team as well as functional and social impacts for affected children. OBJECTIVES: Here, we provide an up-to-date review of the epidemiology, aetiology, diagnosis and clinical management of MIH. MATERIALS AND METHODS: A review of the contemporary basic science and clinical literature, relating to MIH, was undertaken using information obtained (up to 10 April 2020) from the electronic databases PubMed, Scopus, Web of Science and the Cochrane Library. RESULTS: There is a growing body of evidence relating to the aetiology, presentation and clinical management of MIH. Current knowledge appears to be focused on potential genetic aspects, as well as the development and validation of indices for the diagnosis and management of MIH. There has also been increasing recognition of the global and individual burden of this common condition. CONCLUSIONS: Dental health professionals should regularly appraise the basic science and clinical MIH literature to ensure that they provide the best possible short- and long-term care for their young patients.

'Message to Dentist': Facilitating Communication with Dentally Anxious Children.

Dental anxiety affects children worldwide and can have negative consequences on oral health. This study aimed to evaluate a novel communication aid 'message to dentist' (MTD), as part of a wider cognitive behavioural therapy approach to reduce dental anxiety in young patients. Dentally anxious children, aged 9-16 years, were invited to complete the MTD proforma, before and following their course of treatment. They scored how worried they were and their anticipated pain levels on a scale of 1-10 (10 being the worst outcome). They also wrote down their coping plans and post-treatment reflections. One hundred and five children, from a UK general dental practice and a hospital clinic, were included. They had a mean age of 11.6 years, and 65% were female. There was a significant reduction in self-report worry (from 4.9 to 2.1) and anticipated pain (from 5.1 to 2.0) scores (p < 0.05, paired t-test). Many children (30%) used listening to music/audiobook as a coping strategy. Thematic analysis revealed concerns around pain, uncertainty, errors and specific procedures. The MTD proforma proved an effective means of facilitating communication between anxious children and the dental team, allowing them to identify their worries and make personalised coping plans.

Vertical heterogeneity in predation pressure in a temperate forest canopy.

The forest canopy offers a vertical gradient across which variation in predation pressure implies variation in refuge quality for arthropods. Direct and indirect experimental approaches were combined to assess whether canopy strata differ in ability to offer refuge to various arthropod groups. Vertical heterogeneity in impact of avian predators was quantified using exclosure cages in the understory, lower, mid, and upper canopy of a north-temperate deciduous forest near Montreal, Quebec. Bait trials were completed in the same strata to investigate the effects of invertebrate predators. Exclusion of birds yielded higher arthropod densities across all strata, although treatment effects were small for some taxa. Observed gradients in predation pressure were similar for both birds and invertebrate predators; the highest predation pressure was observed in the understory and decreased with height. Our findings support a view of the forest canopy that is heterogeneous with respect to arthropod refuge from natural enemies.