Background.  Abnormally, large teeth are often referred to as ‘double teeth’. These can pose numerous challenges for the clinician. There is no published protocol on the management of double teeth.

Aim.  To review the published literature and also patients managed at the Eastman Dental Hospital (EDH) and to develop a clinical protocol for the management of double teeth in children and adolescents.

Design.  Literature was searched (Medline and Embase) and data collated. Patient notes of cases managed at the EDH were reviewed.

Results.  Eighty-one teeth from 53 papers and 22 patients were included in the review. Success criteria were only reported in 32 papers and were variable. Twenty-three papers had no follow-up period. The main factor in determining the management of a double tooth was root and root canal system morphology. The treatment of choice in teeth with separate roots was hemisection and in those with a single root was crown modification or extraction.

Conclusion.  It was not possible to determine the best management strategies because of the variable reporting in the literature. The authors have proposed a protocol for management and a data collection sheet for essential information needed when reporting on double teeth cases.

Background.  In Chile, no information is available regarding the soluble fluoride (F) content in the toothpastes commercialized for children and the country’s guidelines recommend the use of F in toothpastes in an age-dependent concentration. No global consensus has been reached on this subject.

Aim.  To determine the soluble F concentration in dentifrices for children sold in Chile and to discuss Chilean guidelines and professional recommendations of use.

Design.  Three samples of twelve different dentifrices were purchased from drugstores. Toothpastes were analysed in duplicate using an ion-specific electrode. The concentrations of total F (TF) and total soluble F (TSF) were determined (μg F/g).

Results.  Measured TF was consistent with that declared by the manufacturer in eight products. Two dentifrices showed lower TF and two higher F concentrations than declared. A toothpaste, marketed as low-F (450 ppm), showed F concentration threefold higher. Most dentifrices exhibited TSF concentrations similar to the TF content, except one sample that displayed considerably lower TSF than TF. Recommendations on F toothpastes use in children widely vary from country to country.

Conclusions.  Most dentifrices for children match F content in the labelling, but recommendations are not supported by the best evidence available on the benefit/risk of F toothpastes use.

Background  Salivary levels of Bifidobacteria have been shown to be significantly correlated with caries experience in adults but not as yet in children.

Hypothesis.  Salivary levels of Bifidobacteria are positively associated with caries experience in children.

Aim.  To compare the salivary concentrations of Bifidobacteria of caries-free and caries-active children.

Design.  Saliva was collected using the tongue-loop method from 38 caries-active children and from 22 clinically caries-free children, and the numbers of Bifidobacteria, mutans streptococci, lactobacilli and yeasts were determined. Additionally, the age and gender of the children, a plaque index, sugar amount in diet, sugar frequency in diet, hygiene practice and fluoride toothpaste usage were recorded.

Results.  Bifidobacteria were isolated from 95% of the caries-active children and from only 9% of the caries-free children (P < 0.001). Salivary levels of Bifidobacteria were significantly correlated with amount of sugar in the diet, frequency of sugar consumption and oral hygiene practice. The significant variables that discriminated between the caries-free and caries-active subjects were salivary levels of Bifidobacteria, salivary levels of mutans streptococci and oral hygiene practice (χ² = 72.57, P < 0.001) and overall 90.0% of cases were correctly classified.

Conclusions.  Salivary levels of Bifidobacteria are significantly associated with caries experience in children. The salivary levels of this genus may be a useful marker of caries risk.

Objective.  To compare clinical and radiographic outcomes of pulpotomy treatment using calcium-enriched mixture (CEM) cement and mineral trioxide aggregate (MTA) in carious-exposed vital immature permanent first molars.

Design.  Fifty-one immature molars with clinical carious exposure with symptomatic/asymptomatic pulpitis met the inclusion criteria and randomly assigned to one of the treatment groups (CEM [26 teeth; 59 roots], MTA [25 teeth; 59 roots]). After performing pulpotomy and covering the radicular pulps with the biomaterials, all teeth were permanently restored. Blinded clinical and radiographic evaluations were performed at 6 and 12 months after operation for signs of success or failure. Radiographs were evaluated for complete/partial apical closure. The data were analysed using chi-square test and generalized estimating equation (GEE) model.

Results.  There was no significant difference at the baseline between the two experimental groups. All available cases (49 teeth) showed pulp survival and signs of continuous root development after 12 months. Overall, complete apical closure (apexogenesis) occurred in 76.8% and 73.8% of radiographically interpreted roots in CEM cement and MTA groups, respectively. There was no statistical difference in terms of radiographic outcomes between two groups.

Conclusions.  Calcium-enriched mixture cement and MTA showed similar performance in pulpotomy of immature caries-exposed permanent molars.

Background.  Dental sealants are an effective treatment for the prevention and management of caries.

Objective.  To determine the retention of sealants placed in a rural setting in Mexico as part of an international service-learning (ISL) programme and to determine associations between dental sealant’s retention and caries diagnosis at the time of sealant placement.

Methods.  Children aged 6–15 were examined for dental caries, received sealants by dental students as part of an ISL programme, and were re-examined 4, 2, or 1 years after placement to assess sealant survival. Sealants were placed on permanent sound surfaces and enamel caries lesions [International Caries Assessment and Detection System (ICDAS) criteria]. Sealant survival was explored using Cochran–Mantel–Haenszel tests and multivariate prediction models.

Results.  219 (46%) of 478 (mean age = 10.53 SD = 5.11) children who had received sealants returned for a recall examination (mean age = 10.89 SD = 3.11). After 1–4 years, 96.4% to 60.6% of the sealants placed on sound teeth had survived, and for sealants placed on surfaces with enamel caries lesions (ICDAS 1–3), 94.2% to 55.6% had survived. Differences were not statistically significant.

Conclusions.  Sealants had survival rates comparable to those previously reported in the literature. Sealants placed on sound and enamel caries lesions had similar survival rates.

Aim.  This qualitative study sought to explore children’s perspectives on their participation in the cleft lip and palate care pathway.

Design.  Eight boys and nine girls (aged 8–17 years), with a range of cleft types and who were patients at a British dental hospital each took part in two child-centred interviews which incorporated participatory activities. An initial interview focused on children’s general life stories, and these often encompassed a discussion about cleft lip and/or palate. A follow-up interview explored specific aspects of the condition and its related treatment.

Results.  Data revealed the varying roles that young people can play in decision-making, which can be described as active or passive. In addition, the dynamic degree of participation was highlighted with patients occupying different roles throughout the care pathway.

Conclusion.  The research provides an insight into treatment decisions, and how young people, their families, and clinicians interact to arrive at these. Findings provide further evidence to support the important contribution young patients can make in their own treatment choices.

Background.  Caries in preschool children remains an important public health issue.

Aim.  To determine (i) which teeth and tooth surfaces are most susceptible to dental caries by age 3, (ii) where do caries lesions develop during 2-year follow-up, and (iii) to evaluate the impact of caries onset on the distribution of new caries experience.

Design.  One thousand and fifty seven consecutively born children were recruited in Flanders (Belgium). Parents completed validated questionnaires on oral health-related behaviour and trained dentists examined the children at ages 3 and 5.

Results.  Children with visible caries experience at age 3 were significantly more vulnerable in developing additional caries during follow-up. In this group, new caries experience developed primarily in the occlusal and distal surfaces of the mandibular first molars and the occlusal surfaces of the maxillary second and first molars, whereas in the caries-free group, the occlusal surfaces of both mandibular and maxillary second molars ranked first.

Conclusions.  This paper confirms the higher vulnerability for further caries development in those children with caries experience at age 3. Visible caries develops most frequently in the occlusal surfaces of the second molars: in high-risk children already by age 3 and in children who were caries free at baseline by age 5.

Background.  In our previous study of oral health intervention in children, laser fluorescence (LF) values of occlusal surfaces were reduced after 1 year.

Aim.  The aim of this study was to explore the relationship between DIAGNOdent pen values and clinical status of the occlusal surfaces.

Design.  The study conducted in 2007 and 2008 in 700 children aged 13–14 included a clinical examination and LFpen measurement of the occlusal surfaces of first and second molars. Four teams consisting of a dental hygienist and a dental nurse performed the examinations on school premises. The dental hygienist scored the surfaces using the Nyvad criteria for caries assessment; the surfaces were then scanned using a DIAGNOdent pen^® device.

Results.  The more severe the visual caries category was, the higher the mean LFpen values were. Correlation coefficients between LF values and NY categories were 0.542 and 0.408 in years 2007 and 2008, respectively (all examiners combined). The LFpen values of active and inactive lesions did not differ significantly.

Conclusions.  The correlation between the mean LFpen values and the NY categories was significant. Fissures can be reliably examined with LF and by visual inspection on school premises if certain special arrangements are made.

Background.  Optimal pit and fissure sealing is determined by surface preparation techniques and choice of materials.

Aim.  This study aimed (i) to compare the microleakage and penetration depth of a hydrophilic sealant and a conventional resin-based sealant using one of the following preparation techniques: acid etching (AE) only, a diamond bur + AE, and Er:YAG laser combined with AE, and (ii) to evaluate the microleakage and penetration depth of the hydrophilic pit and fissure sealant on different surface conditions.

Design.  Eighty recently extracted 3rd molars were randomly assigned to eight groups of ten teeth according to the material, preparation technique, and surface condition. For saliva contamination, 0.1 mL of fresh whole human saliva was used. All samples were submitted to 1000 thermal cycles and immersed in 2% methylene blue dye for 4 h. Sections were examined by a light microscope and analysed using image analysis software (Sigmascan^®).

Results.  The combination of Er:YAG + AE + conventional sealant showed the least microleakage. The sealing ability of the hydrophilic sealant was influenced by the surface condition.

Conclusion.  Er:YAG ablation significantly decreased the microleakage at the tooth–sealant interface compared to the non-invasive technique. The hydrophilic sealant applied on different surface conditions showed comparable result to the conventional resin-based sealant.

Aim.  This in vitro study aimed to test the performance of fluorescence-based methods in detecting occlusal caries lesions in primary molars compared to conventional methods.

Design.  Two examiners assessed 113 sites on 77 occlusal surfaces of primary molars using three fluorescence devices: DIAGNOdent (LF), DIAGNOdent pen (LFpen), and fluorescence camera (VistaProof-FC). Visual inspection (ICDAS) and radiographic methods were also evaluated. One examiner repeated the evaluations after one month. As reference standard method, the lesion depth was determined after sectioning and evaluation in stereomicroscope. The area under the ROC curve (Az), sensitivity, specificity, and accuracy of the methods were calculated at enamel (D1) and dentine caries (D3) lesions thresholds. The intra and interexaminer reproducibility were calculated using the intraclass correlation coefficient (ICC) and kappa statistics.

Results.  At D1, visual inspection presented higher sensitivities (0.97–0.99) but lower specificities (0.18–0.25). At D3, all the methods demonstrated similar performance (Az values around 0.90). Visual and radiographic methods showed a slightly higher specificity (values higher than 0.96) than the fluorescence based ones (values around 0.88). In general, all methods presented high reproducibility (ICC higher than 0.79).

Conclusions.  Although fluorescence-based and conventional methods present similar performance in detecting occlusal caries lesions in primary teeth, visual inspection alone seems to be sufficient to be used in clinical practice.

Background.  Demarcated hypomineralization lesions are not uncommon in second primary molars. Data on the prevalence of hypomineralized second primary molars (HSPM) are scarce.

Aim.  To investigate the prevalence of HSPM, assess the relationship between HSPM and first permanent molars previously diagnosed with demarcated lesions and to determine the severity of HSPM in relation to dental caries severity.

Design.  A cluster sample of 809, 7- to 9-year-old children was examined. The scoring criteria proposed by the European Academy of Paediatric Dentistry for hypomineralization in permanent dentition were adapted to score HSPMs. The International Caries Detection and Assessment System was used to assess caries status in the second primary molar of the children diagnosed with demarcated defects. The examination was carried out in schools by a calibrated dentist.

Results.  Of the children examined, 53 (6.6%) had hypomineralization defects in at least one second primary molar. Combinations of affected first permanent and second primary molars were reported in 21 (39.6%) of cases. Severe carious lesions were found mostly in teeth with enamel breakdown.

Conclusions.  The prevalence of HSPM was 6.6%. Over one-third of affected second primary molars were associated with demarcated lesions in the first permanent molars. The chance of severe caries increased with the increase in the demarcated lesion severity.

Background.  Home visits (HV) provide excellent opportunities for health promotion.

Aim.  This longitudinal study compared the effects of HV and telephone contacts (TC) in preventing early childhood caries (ECC) and colonisation of mutans streptococci (MS) and lactobacilli (LB) from 0 to 24 months.

Design.  A total of 325 children were recruited from community health centres at mean age of 42 days, and randomly assigned to receive either HV or TC. A total of 188 children completed three, 6 monthly HV, and another 58 had three, 6 monthly TC. An additional 40 age-matched children from childcare facilities served as reference controls (RC). At 24 months, all groups were examined at a community dental clinic.

Results.  At 24 months, three HV children of 188 (1.5%) had caries, compared to four TC of 58 (6.8%) and nine RC of 40 (22.5%) (P < 0.001 for HV versus RC; P = 0.05 for HV versus TC and P = 0.03 for TC versus RC). There were also more children with MS in the TC (47%) and RC (35%) compared to HV (28%) group (P = 0.01 and P = 0.02).

Conclusions.  Home visits and telephone contacts conducted 6 monthly from birth are effective in reducing ECC prevalence by 24 months.

Aims.  To ascertain whether deproteinization pretreatment of molar-incisor hypomineralization (MIH) enamel affects resin sealant infiltration.

Design.  Thirty one extracted MIH teeth were divided into three sections and randomly allocated into the Control (etch and FS), Treatment 1 (5% NaOCl, etched and fissure sealed), and Treatment 2 (5% NaOCl and fissure sealed with no etch) groups. Two hundred seventy nine sealant tag/enamel grade observations were recorded by scanning electron microscopy.

Results.  Control and Treatment 1 were similar in their outcomes, and Treatment 2 was markedly different. There was no statistical evidence to suggest that there was any difference between Treatment 1 and the Control Treatment (95% CI, 0.52, 1.51; P = 0.6). There was a marked difference between Treatment 2 and the Control Treatment (95% CI, 0.07, 0.25; P < 0.001). All treatments also demonstrated a high-predicted probability of obtaining ‘poor’ sealant tags (Control = 47%, Treatment 1 = 49%, and Treatment 2 = 40%).

Conclusions.  The findings suggest that there was no significant difference in the tag quality between the conventional technique (Control) and the ‘bleach-etch-seal’ technique (Treatment 1). There was no benefit in pre-treating with NaOCl alone (without etch) before sealing. This research also showed that there was a high-predicted probability of obtaining ‘poor’ sealant tags in MIH enamel, regardless of which of the three treatments was used.

Background.  Hypomineralised enamel is a prevalent, congenital defect vulnerable to deteriorate post-eruptively particularly in the presence of an unfavourable oral environment.

Aims.  To assess the influence of salivary characteristics on the clinical presentation of hypomineralisation lesions diagnosed in first permanent and second primary molars and to evaluate caries severity in relation to the defect’s clinical presentation.

Design.  Recruitment consisted of 445 seven- to nine-year-old participants, of whom 152 were diagnosed as having molar hypomineralisation (MH); the remaining unaffected subjects (N = 293) were considered their controls for saliva analysis. Dental caries status was assessed in 300 subjects of saliva sub-sample, equally divided as MH-affected and non-affected children. The International Caries Detection and Assessment System was used for caries detection. Salivary flow rates, viscosity, pH, and buffering capacity were determined.

Results.  Molar hypomineralisation-affected children have significantly higher mean caries scores compared to the non-affected group. Dentinal carious lesions were ten times more frequent in teeth with post-eruptive breakdown (PEB) than with teeth with opacities only. Low salivary flow rates (LSFR), moderately viscous saliva, and low pH were significantly more common in the affected group. LSFR and moderate and highly acidic saliva were more likely associated with PEB.

Conclusion.  Demarcated hypomineralised enamel is a dynamic defect highly influenced by individual characteristics of the oral environment.

Background.  As a result of numerous rapid and exciting developments in tissue engineering technology, scientists are able to regenerate a fully functional tooth in animal models, from a bioengineered tooth germ. Advances in technology, together with our understanding of the mechanisms of tooth development and studies dealing with dentally derived stem cells, have led to significant progress in the field of tooth regeneration.

Aim and design.  This review focuses on some of the recent advances in tooth bioengineering technology, the signalling pathways in tooth development, and in dental stem cell biology. These factors are highlighted in respect of our current knowledge of tooth regeneration.

Results and conclusion.  An understanding of these new approaches in tooth regeneration should help to prepare clinicians to use this new and somewhat revolutionary therapy while also enabling them to partake in future clinical trials. Tooth bioengineering promises to be at the forefront of the next generation of dental treatments.

Background. Streptococcus mutans and Streptococcus sobrinus are known to be associated with dental caries in humans.

Aim.  We used a polymerase chain reaction method to detect S. mutans and S. sobrinus in 128 Japanese schoolchildren and then compared their presence with the dental caries experience.

Design.  Plaque samples were collected from all erupted tooth sites with a sterile toothbrush, and dental examinations were performed to determine the numbers of decayed and filled teeth in primary (dft) and permanent (DFT) dentition using the WHO caries diagnostic criteria. Fisher’s PLSD test was employed to compare caries scores between combinations of the detected bacteria.

Results. Streptococcus mutans and S. sobrinus were present in 38.3% and 68.0%, respectively, whereas 14.8% were positive for S. mutans alone, 44.5% for S. sobrinus alone, and 23.5% for both S. mutans and S. sobrinus, with 17.2% negative for both. The DFT, dft, and total (DFT + dft) scores for subjects positive for both S. mutans and S. sobrinus were significantly higher than those positive for S. mutans alone (P < 0.05, in triplicate).

Conclusion.  These results suggest that schoolchildren harbouring both S. mutans and S. sobrinus have a significant higher dental caries experience in both permanent and primary teeth as compared to those with S. mutans alone.

Aims.  The aim of this study was to assess the internal stress of children during dental treatment based on autonomic nerve activity and facial muscle activity.

Methods.  We recorded the electrocardiogram of children during the treatment of composite resin restoration and analysed autonomic nerve activity by means of power spectral analysis of heart rate variability. Simultaneously, electromyography (EMG) activity of the corrugator muscle was recorded in children during dental treatment, and the relationship between sympathetic nerve activity and corrugator EMG activity was analysed.

Results.  In all subjects, the mean sympathetic nerve activity was significantly higher during oral examination and after treatment compared with pre-treatment. Depending on the sympathetic nerve responses to the other treatment procedures, the subjects could be classified into two groups: the stress group and the nonstress group. Sympathetic nerve activity was significantly higher during infiltration anaesthesia and cavity preparation compared with pre-treatment activity in the stress group, whereas it was consistently lower than the pre-treatment levels during most treatment procedures in the nonstress group. The mean amplitudes of the averaged corrugator muscle EMG during dental treatment did not differ between the stress and nonstress groups.

Conclusion.  The present results suggest that the measurement of autonomic nervous activity, especially sympathetic nervous activity, is quite useful in assessing the internal stress of children, even when no expressed sign of unease are present during dental treatment.

Background.  Hydrophilic adhesives may be used as pit and fissure sealants (sealants), but there is concern about the ability of self-etching adhesives to bond sealants to enamel.

Aim.  To study the bond strength (BS) and morphology of adhesive systems used as sealants.

Design.  OptiBond FL, OptiBond All-in-One, combined OptiBond All-in-One + OptiBond FL adhesive, and Fluroshield were applied to the occlusal surfaces of 16 primary molars (n = 4). Teeth were stored in distilled water (24 h at 37°C) and sectioned through the interface to obtain sticks (0.8 mm²) tested under a tensile load (0.5 mm/min). Failure modes were observed. Data were analysed by ANOVA and Tukey’s tests (α = 5%). The morphology of 12 primary molars was examined in terms of the etching pattern and resin reproduction.

Results.  Differences in the BS were found (P = 0.001), with OptiBond FL showing the highest (36.84 ± 5.7 MPa), Fluroshield (24.26 ± 2.13 MPa) and OptiBond All-in-One (17.12 ± 4.97 MPa) similar, and OptiBond All-in-One + OptiBond FL adhesive the lowest (9.8 ± 2.94 MPA). OptiBond FL showed the best results in terms of morphology.

Conclusion.  Under the conditions of this study, OptiBond FL was the best material to be used for sealing.

Background.  Dental anxiety is a common problem, which can affect people of all ages, but appears to develop mostly in childhood and adolescence. Childhood dental anxiety is not only distressing for the child and their family but is also associated with poor oral health outcomes and an increased reliance on costly specialist dental services.

Aim.  This article will consider the prevalence, development, and implications of children’s dental anxiety. It will also discuss the opportunities for and challenges of psychological approaches such as cognitive behavioural therapy aimed at the reduction of dental anxiety in children.

Background.  Effective caries control and management requires identification of susceptible children for timely intervention. Streptococcus mutans (S. mutans) is an important biomarker of caries risk.

Aim.  This study aimed to comparatively evaluate the validities of a novel immunoassay and a conventional culture-based assay in detecting salivary S. mutans in a paediatric cohort.

Methods.  190 children aged 3–4 years were recruited. The abundance of S. mutans in their saliva samples was analysed with three assay systems viz. a conventional culture-based assay (Dentocult SM), a novel immunoassay system (Saliva-Check MUTANS) based on monoclonal antibody technology and a Taqman real-time PCR assay taken as a gold standard.

Results.  The novel immunoassay accurately differentiated saliva samples with high (≥5 × 10⁵ CFU/mL) and low (<5 × 10⁵ CFU/mL) S. mutans levels. The sensitivity/specificity was 97.6%/90.6%. The conventional culture-based assay reached a reasonably high sensitivity/specificity (92.8%/81.3%) in identifying children with moderate (≥10⁴ CFU/mL) S. mutans level. Its sensitivity/ specificity in selecting children with high (≥10⁵ CFU/mL) and very high (>10⁶ CFU/mL) S. mutans levels were not sufficient (78.7%/79.8% and 25.8%/91.8%, respectively).

Conclusion.  The monoclonal antibody-based immunoassay accurately and rapidly determines S. mutans abundance in saliva and could be useful for chairside assessment of children’s caries risk.

Background.  The effect of smear layer (SL) removal on primary tooth pulpectomy outcome has not been well elucidated.

Aim.  To determine the effect of SL removal on primary tooth pulpectomy outcome.

Methods.  This is a double-blind, randomized, and controlled clinical trial. Forty-eight patients were randomly divided into SL removal (G1 = 40 teeth) or smear layer nonremoval (G2 = 42 teeth) groups. Following the chemomechanical preparation with K-files and 2.5% sodium hypochlorite (NaOCl), teeth were irrigated with either 6% citric acid and 0.9% physiologic solution (G1) or only 0.9% physiologic solution (G2). Camphorated paramonochlorophenol was used as intracanal medication. At the second appointment, 1 week after, root canals were filled with zinc oxide–eugenol paste. Clinical and radiographical baseline criteria were stipulated equally for both groups.

Results.  The success rate (G1  =  91.2%; G2  =  70.0%) was statistically different (P = 0.04) between the groups. In G2, the outcome was affected significantly by pulpal necrosis (P = 0.02), pre-operatory symptoms (P = 0.02), and periapical/inter-radicular radiolucency (P = 0.04).

Conclusion.  The pulpectomy outcome was improved by smear layer removal. The outcome for teeth with pulpal necrosis, pre-operatory symptoms, or periapical/inter-radicular radiolucency was significantly improved by removal of the smear layer.

Background.  In a randomized double-blinded clinical trial, preschool children used sucrose or xylitol chewing gum regularly for 2 months to study the preventive effect of xylitol on acute otitis media (AOM). Salivary mutans streptococci (sm) levels of the children were measured before the exposure. Those with ≥10⁵sm CFU in 1 mL saliva were considered to have high sm levels (sm+); and those with <10⁵ CFU low sm levels (sm−).

Aim.  This practice-based study aims to evaluate long-term dental effects of the sucrose/xylitol exposure on primary teeth.

Design.  For analyses, individuals were divided into sub groups according to their study group in the original AOM trial and baseline sm levels. Outcome events owing to dental caries of their all primary teeth were followed from dental records up to 12 years. Survival of teeth caries free was determined by Kaplan–Meier method and analysed statistically by Wilcoxon testing.

Results.  Survival of primary teeth caries free of children with high sm levels in the sucrose group was significantly shorter compared with all other groups when followed until shedding.

Conclusions.  Two months’ regular exposure to sucrose was sufficient to induce dental caries in primary teeth of children with elevated sm levels at baseline.

Background.  Considering formocresol’s toxicity, Ca(OH)₂ partial pulpotomy (PP) was studied as a treatment alternative.

Aim.  To compare success rates of Ca(OH)₂ PP versus formocresol pulpotomy (FP) treatment of pulpally exposed lower primary molars.

Design.  A total of 84 lower primary molars, which met study criteria, from 56 child patients were randomly assigned for each treatment. After treatment, blinded clinical and radiographic evaluation with 96.9% and 90% reliability was performed at 6-month intervals to determine treatment success/failure. Chi-squared test was used to compare success rates between the two treatments.

Results.  The success rates from 6 to 36 months for PP ranged from 95.03% to 75%, whereas for FP, it was 92.7–74.2%. The success rates for the two treatments at each 6-month interval were not different (P ≥ 0.05). The most frequent failure was internal resorption, affecting five FP teeth and three PP teeth. The resorption was arrested in five of the teeth and was replaced by a radiopaque calcified tissue in one case.

Conclusion.  Considering the favourable clinical and radiographic success rate of PP and the potentially toxic effects of formocresol leads us to recommend the use of PP instead of FP in primary teeth with deep carious lesions.

Background.  Caries infiltration aims to inhibit lesion progression, by occluding the porosities within the lesion body with low-viscosity resins. The ability in hampering lesion progression is correlated with the penetration depth (PD) of the infiltrant.

Aim.  This study aimed to compare the infiltration depths into proximal lesions in primary molars after different application times.

Design.  Noncavitated natural caries lesions (n = 83) were etched with 15% HCl for 2 min and infiltrated for 0.5, 1, 3, or 5 min. Specimens were sectioned and PD at the maximum lesion depth (LD_max) were analysed using dual fluorescence confocal microscopy.

Results.  Percentage penetrations (PD/LD_max) were significantly higher after 3 or 5 min compared with 0.5-min application (P < 0.05; Mann–Whitney test). For LD_max <400 μm, no significant differences were observed between application times (P > 0.05). For LD_max≥400 μm, 3- and 5-min application resulted in significantly deeper infiltration compared with 0.5 min (P < 0.05). After 1-min application, PD was significantly lower than 5 min (P < 0.05), PD/LD_max did not differ from all other groups (P > 0.05).

Conclusions.  Natural noncavitated proximal lesions in primary molars were deeply infiltrated after 1-min application in vitro. For deeper lesions, however, more consistent results were obtained after 3 min.

Background.  In dentistry, clinical practice is directed towards attitudes that promote oral health and the paediatricians occupy a privileged position in this process.

Aim.  To assess the knowledge and attitudes of paediatricians in relation to the oral health of their patients.

Design.  A cross-sectional study was carried out at the Institute of Integrative Medicine Professor Fernando Figueira, Recife, Brazil. A total of 182 paediatricians participated by filling out a questionnaire.

Results.  A total of 63.9% believed the first visit to the dentist should occur before the child completes 1 year of life. Moreover, 67.8% considered their knowledge on oral health to be insufficient. Approximately 78% of the paediatricians diagnosed caries through an analysis of cavities. Only 29.9% always recommended fluoride dentifrice. The term ‘fluorosis’ was unknown by 48.3% of the respondents. Concerning pacifiers, 32.6% did not allow it and 66.9% did not either recommend it or restrict it. A total of 83.4% classified the oral health content in their medical education as either nonexistent or deficient; this figure remained high (72.4%) in relation to residency.

Conclusions.  It is important to develop oral health information programmes to paediatricians. Information on oral health should be included in medical curricula and residency.

Background.  Adverse long-term general and dental health effects of cancer and cancer therapy during childhood have been reported.

Aim.  To examine the association between chemotherapy before the age of 8 years and (1): microdontia; (2): hypodontia of premolars and permanent molars.

Material and methods.  In The Danish Registry of Childhood Cancer (DBCR), we identified 203 children who met the following inclusion criteria: (1) age below 8 years at the start of treatment; (2) age between 12 to 18 years upon dental examination; (3) had received chemotherapy The exclusion criterion was radiotherapy to the head and neck. A total of 150 children fulfilled the inclusion criteria. As controls, a random sample of 193 age-matched unexposed children was included.

Results.  Microdontia was found in a total of 88 teeth in 29 (19.3%) of the 150 children who had been exposed to chemotherapy, while none of the controls had microdontia of premolars or permanent molars (difference: 19.3%; 95% CL: 13.5%; 26.4%). The earlier the exposure, the more frequent was microdontia. We found a total of 27 missing premolars and permanent molars in 14 (9.3%) of the exposed children and a total of 18 missing premolars and permanent molars in 8 (4.1%) of the controls (difference: 5.2%; 95% CL: −0.1%; 11.3%).

Conclusion.  The present study confirms findings from previous studies that chemotherapy, especially in very young children, causes microdontia and hypodontia of premolars and permanent molars.

Background.  Dental fear is considered to be one of the most frequent problems in paediatric dentistry. According to literature, parents’ levels of dental fear play a key role in the development of child’s dental anxiety.

Hypothesis or Aim.  We have tried to identify the presence of emotional transmission of dental fear among family members and to analyse the different roles that mothers and fathers might play concerning the contagion of dental fear to children. We have hypothesized a key role of the father in the transfer of dental fear from mother to child.

Design.  A questionnaire-based survey (Children’s Fear Survey Schedule-Dental Subscale) has been distributed among 183 schoolchildren and their parents in Madrid (Spain). Inferential statistical analyses, i.e. correlation and hierarchical multiple regression, were carried out and possible mediating effects between variables have been tested.

Results.  Our results support the hypothesis that family members’ levels of dental fear are significantly correlated, and they also allow us to affirm that fathers’ dental fear is a mediating variable in the relationship between mothers and children’s fear scores.

Conclusions.  Together with the presence of emotional transmission of dental fear among family members, we identified the relevant role that fathers play as regards the transfer of dental fear from parents to children.

Background.  Mucocele is a common oral lesion in children and adolescents. Different techniques have been described for the treatment; however, all of them are invasive.

Aim.  This work studied the efficacy of micro-marsupialization for the treatment for mucoceles in paediatric patients.

Design.  A retrospective review was performed using the clinical records of patients aged between 0 and 18 years with a clinical diagnosis of mucocele. The following data were obtained: age, gender, location and size of the lesion, duration of mucocele development, and type of treatment and its results.

Results.  The mean age of the patients was 11.1 ± 3.95 years. Mucoceles were found in the lower lip (83.7%), buccal mucosa (11.6%), and tongue (4.7%). From the overall cohort of 86 cases, 33 were treated by micro-marsupialization, of which five developed a recurrence that required surgical excision. The other 53 cases were treated by surgical excision, and three of these had recurrent disease. No statistically significant difference was found between the treatment methods.

Conclusions.  Micro-marsupialization can be used to treat mucoceles in paediatric dentistry. It is simpler to perform, minimally invasive, requires no local infiltration of anaesthesia, has a lower postoperative complications rate, and is well-tolerated by patients.

Objectives.  The purpose of this study was to assess reliability, discriminant validity, and convergent validity of the Oral Health Impact Profile (COHIP) Korean version in a representative community sample of 8- to 15-year-old Korean children.

Methods.  A Korean version of COHIP was developed according to the standard procedure of cross-cultural adaptation of self-reported instruments. A representative community sample of 2236 schoolchildren was selected by cluster sampling method.

Results.  Mean age of the participants was 11.8  years. Mean and median of the overall COHIP score were 103.3 (SD 13.3) and 106, respectively. Internal reliability and retest reliability were excellent with Chronbach’s alpha 0.88 and intraclass correlation coefficient 0.88. Face validity was confirmed with 98% of participants reporting the COHIP questionnaire was easy to answer. Nonclinical factors such as self-rated oral health or satisfaction with oral health were significantly related with overall COHIP score and five subscale scores (P <  0.001) in a consistent manner. Children with carious permanent teeth and with orthodontic treatment need had highly significantly lower overall COHIP score (P < 0.01).

Conclusion.  The Korean version of the COHIP was successfully developed. The internal reliability, retest reliability, face validity, discriminant validity, and convergent validity of the COHIP Korean version were confirmed.

Background.  Early Childhood Caries is a significant public health issue worldwide. Although much is known about the aetiology of dental caries, there is limited evidence on the understanding of caregivers on readily available early childhood oral health education materials.

Aim.  The purpose of this study was to record how parents cope with dental health education materials for preschool children commonly available in New South Wales, Australia.

Design.  This qualitative study was nested within a large cohort study in South Western Sydney. English-speaking mothers (n = 24) with young children were approached for a face-to-face, semi-structured interview at their homes. Two dental leaflets designed by NSW Health to give advice on monitoring young children’s oral health were sent to mothers prior to the interview. Interviews were recorded and subsequently transcribed verbatim. Transcripts were analysed by interview debriefing and a thematic coding.

Results.  Mothers generally reported that the leaflets were easy to read but noted that the information pertaining to bottle feeding was confusing. Furthermore, they were unable to understand terms such as ‘fluoride’ and ‘fissure sealants’. Early childhood nutrition and infant teething were inadequately addressed, and mothers preferred pictorial presentations to improve their understanding of oral health.

Conclusions.  Producers of health education leaflets should keep the messages simple and straightforward, avoid the use of medical jargon, and use pictorial aids to improve communication with parents.

Background.  Generalized aggressive periodontitis (GAP) in primary teeth is a rare periodontal disease that occurs during or soon after eruption of the primary teeth. An association with systemic diseases is a possibility.

Case Report.  A 4-year-old Brazilian girl presented with GAP involving the entire primary dentition. The patient and her parents and sister were subjected to microbiological testing to identify the microorganisms involved in the disease. The patient underwent tooth extraction to eradicate the disease and received a prosthesis for the restoration of masticatory function. After the permanent teeth erupted, fixed orthodontic appliances were place to restore dental arch form and occlusion.

Conclusions.  The results show the importance of an early diagnosis of GAP and of a multidisciplinary approach involving laboratory and clinical management to treat the disease and to restore masticatory function, providing a better quality of life for patients.

Background.  Midazolam sedation poses a significant dilemma in paediatric dentistry, which is to find out the optimal dosing with minimal undesirable adverse events. In this study, we aimed to compare the effect of three doses of oral midazolam (0.5, 0.75, and 1 mg/kg) on the sedative state and cooperative behaviour of children during dental treatment. We further compared completion rates, parent satisfaction, and all adverse events.

Design.  Ninety children aged 3–10 years were randomised to three equal groups. Groups A, B, and C received 0.5, 0.75, and 1 mg/kg of oral midazolam, respectively. Levels of sedation, cooperative behaviour, procedures completion rates, parent satisfaction, and adverse events were prospectively recorded.

Results.  Sedation scores in B and C were higher (P < 0.001) than in A. Cooperation scores (CS) in B and C were higher (P < 0.001) than in A. Significant increase in completion rates was observed between A and C (P = 0.025). Parent satisfaction was greater in B and C (P < 0.001) compared to A. Adverse events were higher in C (P < 0.05) than in A or B.

Conclusion.  Amount of 0.75 mg/kg oral midazolam appears to be the optimal oral dose in terms of effectiveness, acceptability, and safety for dental treatments in paediatric patients, when administered by an experienced, paediatric anaesthetist.

Background.  Based on measurements on dental casts, smaller permanent teeth in children with cleft palate have previously been reported in the literature; however, the early maturation of teeth and the size of the follicles and crowns have not been investigated.

Hypothesis.  The maturation of the mandibular permanent first molar (M1_inf) is delayed, and the mesiodistal diameters of the follicle and crown of M1_inf, respectively, are reduced in children with isolated cleft palate (ICP).

Design.  Retrospective, longitudinal. Cephalometric X-rays were available for 2 and 22 months old children with clefts (64 children with ICP, and a control group of 38 children with unilateral incomplete cleft lip). The width of the follicle and the crown of M1_inf, and the maturation of M1_inf were assessed. Intra-observer error was acceptable.

Results.  M1_inf maturation was delayed in children with ICP at both 2 and 22 months of age. The mesiodistal diameter of the crown of M1_inf in the ICP group was reduced. Thus, the two hypotheses could not be refuted.

Conclusions.  Children with ICP showed smaller dimensions of the M1_inf, and in addition, the maturation of M1_inf was delayed.

Background.  Molar incisor hypomineralisation (MIH) is a condition which has significant implications for patients and service provision.

Aims.  The aim of this survey was to determine the prevalence of MIH in 12-year olds in Northern England and to consider the relationship with socioeconomic status and background water fluoridation.

Design.  Twelve-year-old children were examined for the presence of MIH. Participating dentists were trained and calibrated in the use of the modified Developmental Defects of Enamel index. Children were examined at school under direct vision with the aid of a dental mirror. A diagnosis of MIH was attributed to a child if they had a demarcated defect in one or more of their first permanent molars.

Results.  Of 4795 children that were selected, 3233 (67.4%) were examined. Overall prevalence of MIH was 15.9% (14.5–17.1%). There was an association between prevalence of MIH and deprivation quintiles with a positive correlation in the first 4 quintiles (P < 0.05). There was no difference in prevalence between fluoridated Newcastle and other areas.

Conclusion.  Prevalence of MIH is equivalent to other European populations. Prevalence was related to socioeconomic status but not to background water fluoridation.

Objective.  The aim of this study was to use an Arabic version of the Early Childhood Oral Health Impact Scale (ECOHIS) in a pilot study, to evaluate differences in parental perception of the oral health-related quality of life (OHRQoL) of their children below 71 months of age and assess their suitability as proxy assessors.

Methods.  A translated version of the ECOHIS was administered to the parents (both fathers and mothers) of 97 children aged between 2 and 6 years. The overall ECOHIS scores and the mean number of ‘don’t know’ responses between parents were compared using a paired t-test. The correlation of the ECOHIS scores to the dft was compared using a linear regression model. The reliability of the parents’ responses was compared using the Cronbach’s alpha and the intraclass correlation coefficient (ICC).

Results.  Early Childhood Oral Health Impact Scale responses and their relation to the dft of the child seem to suggest that fathers have significantly less accurate knowledge of the OHRQoL of their children than mothers.

Conclusion.  The concern showed by Saudi fathers does not correlate to the oral status of their child. Saudi fathers may not be apt as proxies to assess the OHRQoL of their children.

Background.  A device based on infrared laser fluorescence (IRLF) has become available as an adjunct for the diagnosis of dental caries.

Aims.  The objective of this study was to clarify the differences of IRLF readings in the mesial, central and distal occlusal pits of first permanent molars.

Design.  Sixty-four children (average age 8.0 years) were examined using IRLF. The mesial, central and distal pits of clinically healthy first permanent molars were measured. The instrument provides measurements in arbitrary units on an open-ended interval scale.

Results.  Mean (± SE) IRLF values in the mesial pits were 4.9 ± 0.4 (upper) and 6.5 ± 0.4 (lower) and were significantly lower than those in the central (8.8 ± 0.6 and 11.5 ± 0.9) and distal (9.6 ± 0.7 and 10.4 ± 0.8) pits in the maxilla and mandible. There was no significant difference between the right (7.3 ± 0.5, 9.4 ± 0.6) and left (8.2 ± 0.5, 9.5 ± 0.6) dental arches. IRLF measurements in the mesial pits of human first permanent sound molars were lower than the central and distal pits in children whose second molars had not erupted.

Conclusions.  The inherently higher IRLF values of some sites should not be misinterpreted and trigger early invasive treatment.

Objective.  To use the Parental-Caregivers Perceptions Questionnaire (P-CPQ) and Family Impact Scale (FIS) to determine whether dental treatment of young Auckland children under general anaesthesia (GA) improved oral-health-related quality of life (OHRQoL) for them and their families.

Design.  A pretest/post-test design, with a consecutive clinical sample of parents/caregivers of children (10 years or younger) treated under GA. More than half of the children were Māori or Pacific Islanders.

Results.  Of the 157 children in the baseline sample, 144 (91.7%) were followed up. The overall P-CPQ score showed a large decrease following treatment, along with an increase in the number scoring 0 (no impact). Similar relative changes were observed in the oral symptoms and emotional well-being subscales, whereas the other two subscales showed moderate decreases. All post-treatment FIS scores were lower than pre-treatment ones; all showed moderate effect sizes. The greatest relative changes were seen in the parental/family activity and parental emotions subscales.

Conclusions.  The dental treatment of young children under GA is associated with considerable improvement in their OHRQoL. The P-CPQ and the FIS are valid and responsive to treatment-associated changes in young children with early childhood caries (ECC).

Background.  Mexican-American children have a higher caries prevalence than the US average. The Mothers and Youth Access (MAYA) study was a randomized clinical trial initiated to address this problem.

Aim.  Comparison of the efficacy of two prevention interventions in reducing early childhood caries (ECC).

Design.  All 361 randomized mother–child dyads received oral health counselling. Beginning at 4 months postpartum, intervention mothers received chlorhexidine (CHX) mouthrinse for 3 months beginning 4 months postpartum and children received fluoride varnish (FV) every 6 months from age 12–36 months. Control group children received FV if precavitated lesions developed. Salivary mutans streptococci (MS) and lactobacilli were assessed.

Results.  No significant difference in children’s 36-month caries incidence between groups; 34% in each group developed caries [(d₂₊fs) > 0]. About half of control group developed precavitated lesions and received therapeutic FV. Maternal MS levels declined during CHX use, but increased when discontinued.

Conclusions.  Maternal postpartum CHX regimen, oral health counselling and preventive child FV applications were not more efficacious than maternal counselling with child therapeutic FV for precavitated lesions for ECC prevention. FV for young children with brief maternal CHX use and oral health counselling may need to be combined with additional or longer-term therapies to significantly reduce ECC in high-risk populations.

Aims.  This study was conducted to examine the nature, content, and duration of advertisements broadcasted during children’s Tamil television channels and to determine the extent to which television advertising changes during school holiday and non-holiday periods and between prime time and non-prime time broadcast.

Methods.  Television broadcasts on two main children’s Tamil television channels were video-recorded over 16 days between 17.00–19.00 hours (non-prime time) and 19.00–21.00 hours (prime time). For each commercial, the type of product advertised, as well as the duration (in seconds), was recorded. Advertisements were categorized as ‘food’ and ‘non-food’. The former category was further subdivided into ‘sugar-rich foods’ and ‘other foods’. The sugar-rich foods were further categorized as liquid, solid and sticky, and slowly dissolving sugars. Commercials related to the promotion of oral health products and non-food products were also recorded.

Results.  Among the total of 128 h of television programmes recorded, advertising accounted for 10.15% (13.01 hours). The advertisement of sugar-rich food products, non-food and oral hygiene products occupied 50.36%, 38.41% and 1.90%, respectively, of the total advertising time. Solid and sticky products made up 100% of advertisements in this category on Chithiram television channel, compared with 62.5% of advertisements on Chutti television channel.

Conclusion.  It was concluded that the advertising of sugar-rich foods, particularly solid and sticky food products, was broadcasted more in Chithiram television channel, during school holidays and during prime time.

Background.  Nonsyndromic cleft lip/palate (NSCLP) is a common congenital anomaly with significant medical, psychological, social, and economic ramifications. It is an example of complex genetic trait. There is sufficient evidence to hypothesise that disease locus for this condition can be identified by candidate genes. The purpose of this study was to test whether MSX1 (799 G>T) gene variant was involved in the aetiology of NSCLP.

Methods.  Blood samples were collected with informed consent from 25 subjects having NSCLP and 25 controls. Genomic DNA was extracted from the blood samples, polymerase chain reaction was performed (PCR), and digestion products were evaluated.

Results.  The Results showed a positive correlation between MSX1 (799 G>T) gene variant and NSCLP patients.

Conclusion.  MSX1 (799 G>T) gene variants may be a good screening marker for NSCLP.

Objectives.  Although the general pathways connecting the external social environment and child risk factors of early childhood caries (ECC) have been previously identified, the maternal and other links to ECC are not well understood.

The aim of this paper is to propose a unifying conceptual model that ties together the broad social environmental, maternal, and child factors that are commonly associated with ECC.

Methods.  The aetiological factors of ECC are first reviewed individually to demonstrate their connections with ECC risk followed by presentation of the unifying conceptual model.

Results.  In severe ECC cases, there is usually a background of social disadvantage associated with low socioeconomic status, ethnicity or immigrant status, and low maternal educational level. These factors are commonly associated with economic and familial stresses which may in turn result in maternal psychological distress. The distress may be compounded by difficult temperaments of the children and can lead to dysfunctional parenting behaviours that place a child at risk for ECC.

Conclusions.  The proposed conceptual model provides a framework that connects the social, psychological, and behavioural mediating factors involved in ECC. It demonstrates that the causative pathways involved are best explored using a combination of quantitative and qualitative research.

Objective.  To evaluate the clinical and radiographic success rates of three mixed antibiotics in the non-instrumentation endodontic treatment of primary mandibular molars at 24–27 months postoperatively.

Methods.  Eighty cariously involved lower primary molars from 58 children (ages 3–8 years) received a 3Mix medicament by non-instrumentation endodontic treatment and were then sealed with glass-ionomer cement and composite resin before permanent restoration with stainless steel crowns. The patients received a clinical and radiographic assessment every 6 months over a 2-year follow-up period with an intra-examiner reliability of 0.83–1.00 (κ value).

Results.  In 60 cases at 24- to 27-month follow-up, the success rates as determined by clinical and radiographic evaluation were 75% and 36.7%, respectively; however, the overall success rate of 3Mix non-instrumentation endodontic treatment was 36.7% with 15.8% of cases demonstrating a pulpal response of internal resorption.

Conclusions.  Non-instrumentation endodontic treatment using 3Mix-MP showed good clinical success but had a low success rate based on radiographic evaluation at 2-year follow-up. Hence, 3Mix antibiotic treatment cannot replace a conventional root canal treatment agent as a long-term therapy.

Objective.  Xylitol studies suggest caries reductions in the order of 50%. Based on animal/microbial studies, erythritol potentially has caries-preventive properties. However, clinical studies are required to confirm this.The aim of the study was to investigate the additional caries-preventive effect of xylitol/maltitol and erythritol/maltitol lozenges delivered at school, relative to controls receiving comprehensive prevention, in a low-caries prevalence population.

Methods.  A 4-year, cluster-randomized, double-blinded clinical trial. Five hundred and seventy-nine 10-year-old consenting subjects from 21 schools were randomly assigned to one of five groups. Four groups used the lozenges on school days, in three teacher-supervised sessions daily, over 1 or 2 years. The daily amount was 4.7 g/4.6 g for xylitol/maltitol and 4.5 g/4.2 g for erythritol/maltitol. The groups received free examinations and care in the public health centre. Four hundred and ninety-six children were analysed. The main outcome measure was dentin caries increment based on a clinical examination at 4 years since the start. The groups were compared in relation to the increment using hierarchical logistic regression to adjust for potential clustering.

Results.  Use of xylitol/maltitol or erythritol/maltitol lozenges did not result in caries reduction. A strong relationship between baseline caries prevalence and the 4-year increment was observed (OR = 7.38; 95% CI: 3.78–14.41).

Conclusions.  The results suggest that in relatively low-caries conditions the school-based use of xylitol/maltitol or erythritol/maltitol lozenges would not have additional caries-preventive effect when compared with comprehensive prevention.

Objective.  The aim of the study was to compare the production of proinflammatory cytokines during the initial phase of mucositis in patients with acute lymphoblastic leukaemia.

Methods.  A randomized, controlled clinical trial was carried out. Cytokine levels were determined in blood and saliva using ELISA, three times after the administration of methotrexate and only once in the control group.

Results.  Comparison of the results showed significant differences for IL-6 and TNF-α in blood and IL-6 in saliva.

Conclusion.  It would seem that 96 h is an ideal time for determining the parameters evaluated both in blood and in saliva.

Objective.  The aim of this study was to evaluate the knowledge of emergency medical physicians employed in hospital emergency rooms as to their potential role in the treatment for traumatic teeth avulsion injuries (TTAI).

Methods.  A 15-item questionnaire was distributed to the emergency rooms of one university and 10 public hospitals. The questionnaire gathered data on the respondents’ professional profiles and self-assessed perceived knowledge and actual knowledge of the emergency management of TTAIs.

Results.  The study was implemented with 69 emergency physicians present at their workplaces during the time of data collection. Of these, 55 (79.7%) were employed at public hospitals and 14 (20.3%) at a university hospital. The professional profiles indicated that 47 (68.1%) of the participants were general practitioners and the remaining 22 (31.9%) were distributed among various other medical specialties. Overall, 28 respondents (40.6%) assessed their knowledge regarding medical treatment for TTAI as insufficient, and the majority (78.3%) stated that they would like further education. Importantly, a large majority of practitioners could not provide correct answers to questions related to the emergency management of TTAI.

Conclusion.  There is a need to improve the knowledge of emergency medical physicians regarding the emergency treatment for TTAI.

Objective.  It is a well-established fact that colonization of S. mutans occurs early in life. The purpose of this study is to determine the correlation between mode of delivery and other associating factors with colonization of oral S. mutans in the infants.

Methods.  The newborns were divided into two groups according to the mode of delivery: Infants who were delivered by either caesarean section (Group-C) or vaginally (Group-V). A total number of 60 mother–infant pairs were included and followed for 1 year. The swab samples were collected for the detection of S. mutans.

Results.  Analysis of data demonstrated the possible influence of prolonged bottle feeding (P = 0.007), socioeconomic status (P = 0.00030) and tasting of food by the mothers (P = 0.0065) on the initial acquisition of S. mutans in the oral cavity of infants.

Conclusion.  The causes for initial acquisition of oral S. mutans in infants were postnatal factors like feeding and oral hygiene practices.

Objectives.  To assess the effectiveness of a school-based dental programme (SBDP) in controlling caries by measuring the relationship between the SBDP performance and caries experience in children aged 12 in Yogyakarta Province, Indonesia, by taking into account influencing factors.

Methods.  A cross-sectional survey was undertaken of 1906 children participating in SBDPs. Four SBDPs were chosen by good and poor performances in urban and rural areas. Caries was assessed using WHO criteria whereas behaviour and socio-demographic factors were collected using a questionnaire administered to the children.

Results.  The decayed, missed, and filled teeth (DMFT) of children in good SBDPs (2.8 ± 2.4) was lower than that of the counterparts (3.8 ± 3.4). From path analysis using a structural equation model (SEM), place of residence (OR = 4.0) was shown to have a strongest direct relationship to caries experience, whereas SBDP performance showed no direct relationship. At the same time, SBDP performance was significantly related to frequencies of dental visits (OR = 0.3), sugar consumption (OR = 0.8), and tooth brushing (OR = 3.2), which in turn are interrelated with place of residence, gender, and mother’s education.

Conclusions.  The study suggests that the differences in DMFT of children in good and poor performance SBDPs were caused by relation to social factors rather than by relation to oral health service activities.

Summary.  The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated to all Consultants in Paediatric Dentistry in the UK, to the Council of the British Society of Paediatric Dentistry, and to people of related specialties recognised to have expertise in the subject. The final version of the 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. For those wishing further detail, the process of guideline production in the UK is described in the International Journal of Paediatric Dentistry 1997; 7: 267–268.

Summary.  The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated to all Consultants in Paediatric Dentistry in the UK, to the Council of the British Society of Paediatric Dentistry (BSPD), and to people of related specialties recognised to have expertise in the subject. The final version of the 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. For those wishing further detail, the process of guideline production in the UK is described in the International Journal of Paediatric Dentistry 1997; 7: 267–268. This guideline is an update on the previously published BSPD policy document on fissure sealants. (Nunn et al., Int J Paed Dent 2000; 10: 174–177)

Background.  Longitudinal study to investigate how the dental caries in primary teeth progress with increasing age is still lacking.

Aims.  To describe the development of new caries over 2 years and to identify risk factors that can predict new caries development.

Design.  A random sample of preschool children aged 3–4 years was surveyed and followed up when they reached 5–6 years of age in Hong Kong. Dental caries status was assessed using the dmft index. Negative binomial regression was performed to investigate the factors collected at baseline that could predict the caries increment over 2 years.

Results.  Totally 358 children attended both examinations. The mean caries increment over 2 years was 0.9. Results of the negative binomial regression showed that children who used nursing bottles during sleep when they were young (P = 0.013), whose toothbrushing began after 12 months (P = 0.005), who took snack once or more daily (P < 0.001), and whose parents had 9 or fewer years of education attainment (P = 0.002) had significantly higher caries increment.

Conclusions.  New caries development of Hong Kong preschool children was low. Children’s feeding, snaking and brushing habits, and parents’ education attainment were the significant predictors for new caries development of preschool children.

Background.  In a previous study, 9-year-old children with severe Molar Incisor Hypomineralization (MIH) had undergone dental treatment of their first molars nearly ten times as often as children in a control group. They also showed more management problems (BMP) and fear and anxiety (DFA).

Aim.  To assess the long-term outcomes of dental treatments, dental anxiety, and patients’ satisfaction in adolescents with MIH.

Design.  Sixty-seven patients, identical with those in the baseline study, were studied at age 18-years. The participants answered the Children’s Fear Survey Schedule – Dental Subscale the Dental Visit Satisfaction Scale (DVSS). Data were compiled from the dental records concerning dental health, number of restorative treatments and BMP.

Results.  Molar Incisor Hypomineralization group had a significantly higher DMFT, and had undergone treatment of their permanent first molars 4.2 times as often as the controls. BMP was still significantly more common in the MIH group. However, DFS was reduced in MIH group and increased in the control groups. The DVSS scores did not differ between the groups.

Conclusions.  Patients with severe MIH had a poorer dental health and were still more treatment consuming at age 18-years. However, their dental fear was now at the same level as the controls.

Background.  The prevalence of early childhood caries (ECC) is high in developing countries; thus, sensitive methods for the early diagnosis of ECC are of prime importance to implement the appropriate preventive measures.

Aim.  To investigate the effects of the addition of early caries lesions (ECL) into WHO threshold caries detection methods on the prevalence of caries in primary teeth and the epidemiological profile of the studied population.

Design.  In total, 351 3- to 4-year-old preschoolers participated in this cross-sectional study. Clinical exams were conducted by one calibrated examiner using WHO and WHO + ECL criteria. During the exams, a mirror, a ball-ended probe, gauze, and an artificial light were used. The data were analysed by Wilcoxon and Mc-Nemar’s tests (α = 0.05).

Results.  Good intra-examiner Kappa values at tooth/surface levels were obtained for WHO and WHO + ECL criteria (0.93/0.87 and 0.75/0.78, respectively). The dmfs scores were significantly higher (P < 0.05) when WHO + ECL criteria were used. ECLs were the predominant caries lesions in the majority of teeth.

Conclusions.  The results strongly suggest that the WHO + ECL diagnosis method could be used to identify ECL in young children under field conditions, increasing the prevalence and classification of caries activity and providing valuable information for the early establishment of preventive measures.

Objectives.  The objectives were to investigate the prevalence of the condition, by using transillumination, in a group of children. Analysed the prevalence with regard to gender, jaw affected, and the teeth that exhibited dysplasia most commonly.

Methods.  A sample of 550 children aged 6 to 14 years was selected at the Department of Paediatric Dentistry at the Universitat Internacional de Catalunya, but among those selected only 505 children were eligible for inclusion in the study. The gender and age of the child, number of permanent teeth, number of teeth affected by MIH and their position were registered.

Results.  Ninety patients (17.85%) had MIH. Of these, 45 were girls (50%) and 45 were boys (50%). A total of 8062 permanent teeth were observed. Of these, 344 (4.2%) were affected by MIH. Of the teeth affected, 198 (57.7%) were located in the maxilla and 146 (42.4%) in the mandible. This result was statistically significant (P = 0.003).

Conclusions.  The population studied showed a prevalence of MIH of 17.8%. The presence of the defect did not differ according to sex in this population. Defects were more common among teeth in the maxilla.

Background.  The use of external sources of energy may accelerate the setting rate of glass ionomer cements (GICs) allowing better initial mechanical properties.

Aim.  To investigate the influence of ultrasound and halogen light on the microleakage and hardness of enamel adjacent to GIC restorations, after artificial caries challenge.

Design.  Cavities were prepared in 60 primary canines, restored with GIC, and randomly distributed into three groups: control group (CG), light group (LG) – irradiation with a halogen light-curing unit for 60 s, and ultrasonic group (UG) – application of ultrasonic scaler device for 15 s. All specimens were then submitted to a cariogenic challenge in a pH cycling model. Half of sample in each group were immersed in methylene blue for 4 h and sectioned for dye penetration analysis. The remaining specimens were submitted to Knoop cross-sectional microhardness assessments, and mineral changes were calculated for adjacent enamel.

Results.  Data were compared using Kruskal–Wallis test and two-way ANOVA with 5% significance. Higher dye penetration was observed for the UG (P < 0.01). No significant mineral changes were observed between groups (P = 0.844).

Conclusion.  The use of halogen light-curing unit does not seem to interfere with the properties of GICs, whereas the use of ultrasound can affect its marginal sealing.

Background.  Intracanal medication is important for endodontic treatment success as it eliminates microorganisms that persist after biomechanical preparation.

Aim.  To evaluate the effect of two intracanal medications against Porphyromonas gingivalis and Enterococcus faecalis in the root canals of human primary teeth with necrotic pulp with and without furcal/periapical lesion, using quantitative real-time polymerase chain reaction (qRT-PCR).

Design.  Thirty-two teeth with necrotic pulp were used. Twelve teeth did not present lesion, and 20 teeth presented radiographically visible furca/periapical lesion. Microbiological samples were collected after coronal access and biomechanical preparation. The teeth were medicated with calcium hydroxide pastes prepared with either polyethylene glycol or chlorhexidine. After 30 days, the medication was removed and a third collection was performed. Microbiological samples were processed using qRT-PCR. Data were analysed by Wilcoxon and Mann–Whitney tests (α = 0.05).

Results.  There was no significant difference in the microbiota present in the primary teeth with and without furcal/periapical lesion. Biomechanical preparation was effective in reducing the number of microorganisms (P < 0.05). The intracanal medications had similar antibacterial activity.

Conclusion.  The association of chlorhexidine with calcium hydroxide did not increase the antibacterial activity of the intracanal medication in the treatment of primary teeth with necrotic pulp with and without furcal/periapical lesion.

Background.  The Demirjian eight-stage method is one of the principal methods used to quantify the degree of maturity from age 3 to 17.

Aim.  The objective of this study was to compare the accuracy of dental age of different population-specific curves, derived using the Demirjian method, to the chronological age of Saudi children aged between 4 and 14.

Design.  Panoramic radiographic records of 176 children (91 boys and 85 girls), without any history of systemic disease, were assessed using the Demirjian method, and the dental age was calculated using curves designed for French-Canadian, Belgian, Kuwaiti, and Saudi children. The difference from chronological age (DA–CA) for each curve was then statistically compared using ANOVA, and each of the curves was compared to the chronological age using multinomial regression modelling.

Results.  The results suggest that although population-specific curves are more accurate in the prediction of age, a considerable variation within each population still exists.

Conclusions.  The Demirjian method offers great scope in fields that require the study of the pattern of growth rather than the accuracy of age estimation.

Objective.  To evaluate the efficacy of laser fluorescence (LF) device in detecting approximal caries in primary molars.

Methods.  Two hundred and sixteen primary molars from 96 children were inspected visually to identify possible caries with contact approximal surfaces. Target molars and their contralateral molars were examined using bitewing radiographs (BR) and LF. Depending on the examination findings, invasive treatments were performed on molars to identify the presence of cavitation.

Results.  Of 256 surfaces evaluated from 216 primary molars, 128 were intact, 39 had white spots, and 89 had cavities. At the white-spot threshold, sensitivity and specificity, respectively, were 2.56% and 94.87% for visual inspection (VI); 64.10% and 97.43% for BR; and 56.41% and 94.87% for LF. At the cavity threshold, sensitivity and specificity, respectively, were 70.79% and 95.51% for VI; 97.75% and 93.26% for BR; and 92.14% and 97.75% for LF. Significant differences between intact surfaces and white spots, and white spots and cavities were shown through LF readings.

Conclusions.  Both LF and BR can detect cavitations on approximal surfaces of primary molars. LF could be an alternative to radiographs in detecting approximal caries in primary molars.

Objective.  For paediatric dentists, an indicator to assess caries risk of infants is very important. Conventionally, the number and/or proportions of Streptococcus mutans have been employed as risk indicator; however, because such figures reflect the existing situation, they are not suitable for assessing caries risk of infants that have not yet been infected with S. mutans. Thus, we searched for an indicator for the establishment of S. mutans.

Methods.  To evaluate the changes caused by the establishment of S. mutans in the microbiota of the infant oral cavity, we monitored changes in the oral microbiota of two pre-dentate infants over a 3-year period and in a cross-sectional study of 40 nursery school-aged children by cultivation of saliva on nonselective blood agar, Mitis-Salivarius agar, and Mitis-Salivarius agar supplemented with bacitracin combined with identification of selected isolates.

Results.  Two longitudinal observations suggested that the establishment of S. mutans would induce a decrease in α-haemolytic bacteria in the microbial population of the oral cavity. This suggestion was compensated with the results of cross-sectional study, and it was revealed that the establishment of 10³ CFU/mL of mutans streptococci in saliva might be predicted by a microbiota comprising less than approximately 55% of α-haemolytic.

Conclusion.  Decrease in the proportion of α-haemolytic bacteria in saliva of infant was found to be applicable as an indicator to predict the establishment of S. mutans and to assess dental caries risk as a background for planning of dental care and treatment in the infants before infection with S. mutans.

Background.  Mastication is a developing function affected by various factors. There is a need for further research on methods of promoting masticatory function in young children.

Aim.  The aim of this study was to evaluate the effects of gum chewing exercise on the maximum bite force (MBF) and the masticatory performance of preschool children.

Design.  The study population included 98 preschool children age 4–6 years. MBF was measured by Occlusal Force-Meter^®, and masticatory performance values were evaluated by using the colour-changeable chewing gum. The examinations were performed four times with an interval of 4 weeks. An exercise group of 70 subjects was instructed to chew the exercise gum twice daily for 5 min during a 4-week period. The chewing gum used for this study was specially developed with the physical property of maintaining hardness during chewing. A control group of 28 subjects was instructed not to chew any gum during the study period.

Results.  No significant differences were found between the exercise group and the control group in MBF and a* values at the start of the study. After 4 weeks of chewing exercise, MBF and a* values were significantly increased in the exercise group compared with those of the control group. These increases were maintained for 4 weeks after exercise had finished.

Conclusions.  Gum chewing exercise is effective to increase MBF and a* values of preschool children and the effects are maintained after exercise completion.

Background.  Coffin–Lowry syndrome (CLS) is a rare genetic disorder. The syndrome presents with psychomotor retardation, short stature, skeletal deformations, digit abnormalities, and distinctive facial features. Oral and dental findings in CLS are common and they include thick prominent lips, high palate, midline lingual furrow, hypodontia, microdontia, delayed eruption, and early tooth loss. Only one earlier case suggesting hypoplastic root cementum as cause for primary loss of teeth in CLS has been published.

Case Report.  This case describes a 3-year-old boy with premature loss of primary incisors without preceding root resorption. In addition to the dental findings, the boy had several general signs and symptoms and the dental findings together with the other characteristics led to the clinical diagnosis of CLS, which later was genetically verified. Histological analysis of an extracted primary incisor showed hypoplastic root cementum.

Conclusion.  Hypoplastic root cementum may explain early tooth loss in CLS. As early loss of primary teeth is rare, especially when there is no previous root resorption, the individual is likely to seek dental care. Thus, the dentist may play an important role in assisting in the diagnosing of CLS.