Bitewing radiography for caries diagnosis in children: when and why?

Untreated dental caries affects children in the UK, with significant burden to the child, family and health service. High quality bitewing radiography is more effective than clinical observation alone at detecting proximal caries in children. Accurate diagnosis before cavitation allows preventive rather than operative management. Research has demonstrated that most children find bitewing radiography acceptable. It is therefore vital that bitewing radiographs of children are taken as per national guidance in general practice. CPD/Clinical Relevance: Timely and high quality bitewing radiography is required for accurate diagnosis and treatment planning in children

No difference in surgical outcomes between Open and Closed exposure of palatally displaced maxillary canines

Purpose: To investigate differences in the surgical outcomes between Open and Closed exposure for palatally displaced maxillary cuspids (PDC). Methods: A multicenter, RCT involving two parallel groups. The settings were one dental teaching hospital in, and two hospital units near Sheffield, UK. Participants were aged <20 years with a unilateral PDC, who provided informed consent. They were randomly allocated to either receive the Open (O) or the Closed (C) surgical procedure. The outcomes were time spent in the operating room and 10-day post-operative patient questionnaire. Statistical differences between the two techniques were tested using independent t tests for continuous variables and chi-squared tests for frequencies. Results: The final study sample was composed of 71 participants (64% females). There were no differences in the gender ratios (O: F=27, M=13; C: F=25, M=16) or mean ages of the two groups (O: 14.3 yrs SD 1.3; C: 14.1 yrs SD 1.6) at the start. The mean operating times for the Open and Closed techniques were 34.3 mins (SD 11.2) and 34.3 mins (SD 11.9) respectively (p=.986). There were no statistically significant differences between the two treatment groups for any of the patient-assessed outcomes (p>.05). Conclusions: There were no differences in the surgical outcomes investigated in this study between Open and Closed exposure for PDC

School-based educational intervention to improve children’s oral health-related knowledge

Objective. To evaluate a brief oral health promotion intervention delivered in schools by a primary care dental practice, aimed at changing oral health care knowledge and oral health–related behaviors in children. Design. Cohort study with pretest–posttest design. Setting. Three primary schools. Participants. One hundred and fifty children (aged 9-12 years). Intervention. Children received a 60-minute theory-driven classroom-based interactive educational session delivered by a dental care professional and received take-home literature on oral health. Main Outcome Measures. All children completed a questionnaire on oral health–related knowledge and self-reported oral health–related behaviors before, immediately after, and 6 weeks following the intervention. Results. Children’s dental knowledge significantly improved following the intervention, with improvement evident at immediate follow-up and maintained 6 weeks later. Significantly more children reported using dental floss 6 weeks after the intervention compared with baseline. No significant differences were detected in toothbrushing or dietary behaviors. Conclusions. School-based preventative oral health education delivered by primary care dental practices can generate short-term improvements in children’s knowledge of oral health and some aspects of oral hygiene behavior. Future research should engage parents/carers and include objective clinical and behavioral outcomes in controlled study designs

Manual versus powered toothbrushes for oral health; an update

Background: Plaque removal is a cornerstone in the prevention and treatment of periodontal diseases. Powered toothbrushes have been devised to assist in plaque removal. An earlier Cochrane systematic review found that only powered toothbrushes with a rotation-oscillation action were more effective at removing plaque and reducing gingivitis. That review requires updating to include recent trials. Objective: To compare the effects of manual and powered toothbrushes on plaque removal and gingival health. Method: We searched the Cochrane Oral Health Group Trials Register, CENTRAL; MEDLINE, EMBASE and CINAHL to 9 March 2011. Manufacturers and authors were contacted for additional data. Trials were selected for random allocation of participants to use a manual or powered toothbrush. Participants were members of the public with uncompromised manual dexterity who brushed unsupervised for at least 4 weeks. There was no language restriction. Primary outcomes were plaque and gingivitis scores at the end of the trial. Assessment of methodological quality and data extraction were conducted in duplicate. Potential sources of heterogeneity were examined, along with sensitivity analyses for quality and publication bias. Results: Fifty trials, involving 4326 participants, provided data. Effect sizes, calculated as standardized mean difference (95% confidence intervals) for brushes with a rotation oscillation action were: 1 to 3 months >3 months Plaque -0.53 (-0.74 to -0.31) -0.66 (-1.28 to -0.03) Gingivitis -0.49 (-0.73 to -0.26) -0.34 (-0.56 to -0.11) This represents approximately 27% fewer sites with bleeding on probing in the long term. No other powered designs were consistently superior to manual toothbrushes. There was considerable heterogeneity between trials. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. Conclusion: Rotation-oscillation powered toothbrushes remove plaque and reduce gingivitis more than manual brushes in the short and long term

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

Caries OUT: Caries management in children with CariesCare International adapted to the pandemic

Fil: Carletto-Körber, Fabiana. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Vázquez, Fernando Rafael. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Oña, Jennifer Ann. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Martin, Anabella. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Martinez Cortes, Angie Carolina. Universidad El Bosque. Vicerrectoría de Investigaciones; Colombia.Fil: Douglas, Gail. University of Leeds. Dental Public Health. Leeds Dental Institute; United Kindom.Fil: Newton, Tim. King’s College London. Dental Innovation and Impact. Faculty of Dentistry, Oral and Craniofacial Sciences; United Kindom.Fil: Pitts, Nigel. King’s College London. Dental Innovation and Impact. Faculty of Dentistry, Oral and Craniofacial Sciences; United Kindom.Fil: Deery, Chris. University of Sheffield. School of Clinical Dentistry; United Kindom.Fil: Martignon, Stefania. University of Sheffield. School of Clinical Dentistry; United Kindom.OBJECTIVES: To describe caries risk status, caries lesions and management decisions for both, using the CariesCare International (CCI) approach in children aged 3 to 8 years from Córdoba, as part of the multicenter interventional trial of a Caries OUT group, without aerosol generating procedures (AGP) and reducing face-to-face consultation. METHODS: Under informed consent (parents) and assent (children) and, with ethical approval (FO-UNC-4275/2021), 28 children participated (males n = 9; females n = 19), in a public institution and a private one (2020). The clinical history was applied using the framework project software, including the four dimensions (D) of the adapted CCI system: 1D-Determination of caries risk, including diet and tooth brushing practices; 2D-Detection and assessment of severity and activity of caries lesions (ICDAS epi-combined); 3D-Management decisions at individual and dental levels; 4D-Development (plan) of caries management (individual and dental levels) without AGP. RESULTS: 1D: 92.9% presented high risk; 2D: 2709 tooth surfaces were evaluated, finding caries lesions: Initial Active (n = 134), Inactive (n = 6); Moderate-Microcavity Active (n = 34), Shadow-underlying Active (n = 34); Severe Active (n = 52), Inactive (n = 2). 3D and 4D: Individual on-site/remote risk management (92.9%); dental: active monitoring (n = 25); non-operative management (Naf, SDF) (n = 154); operative management with dental preservation (ART) (n = 52); extraction/referral (n = 50). CONCLUSIONS: With CCI, a high risk and burden of caries was found, with according individual and dental management needs, without AGP and less consultation time, representing an alternative for children's dental care during the pandemic.OBJETIVO: Describir el estado de riesgo de caries, lesiones de caries y decisiones de manejo de ambas, mediante el abordaje con CariesCare International (CCI), en niños de 3 a 8 años de Córdoba, como parte del ensayo multicéntrico intervencional de un grupo Caries OUT, sin procedimientos generadores de aerosoles (PGA) y disminuyendo consulta presencial. MATERIALES Y MÉTODOS: Bajo consentimiento (padres) y asentimiento (niños) informado y, con aprobación ética (FO-UNC-4275/2021), participaron 28 niños (varones: n=9; mujeres: n=19), en una institución pública y una privada (2020).Se aplicó la historia clínica utilizando el software del proyecto marco, incluyendo las cuatro dimensiones (D) del sistema CCI adaptado:1D-Determinación del riesgo de caries, incluyendo prácticas de dieta y de cepillado dental; 2D-Detección y valoración de severidad y actividad de lesiones de caries (ICDAS epi-combinado); 3D-Decisiones de manejo a niveles individual y dental; 4D: Desarrollo (plan) de manejo de caries (niveles individual y dental) sin procedimientos generadores de aerosoles (PGA). RESULTADOS: 1D:92.9% presentó riesgo alto; 2D: se valoraron 2709 superficies dentarias, encontrándose lesiones de caries: Iniciales Activas (n=134), Inactivas (n=6); Moderadas-Microcavidad Activas (n=34), Sombra-subyacente Activas (n=34); Severas Activas (n=52), Inactivas (n=2). 3D y 4D: Manejo individual de riesgo presencial/remoto (92.9%); dental: monitoreo activo (n=25); manejo no operatorio (Naf, SDF) (n=154); manejo operatorio con preservación dental (TRA) (n=52); exodoncia/derivación (n=50). CONCLUSIÓN: Con CCI se encontró alto riesgo y carga de caries, con necesidades de manejo individual y dental acordes, sin PGA y menor tiempo de consulta, representando una alternativa de atención de niños durante la pandemia.Fil: Carletto-Körber, Fabiana. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Vázquez, Fernando Rafael. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Oña, Jennifer Ann. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Martin, Anabella. Universidad Nacional de Córdoba. Facultad de Odontología. Cátedra de Integral Niños y Adolescentes; Argentina.Fil: Martinez Cortes, Angie Carolina. Universidad El Bosque. Vicerrectoría de Investigaciones; Colombia.Fil: Douglas, Gail. University of Leeds. Dental Public Health. Leeds Dental Institute; United Kindom.Fil: Newton, Tim. King’s College London. Dental Innovation and Impact. Faculty of Dentistry, Oral and Craniofacial Sciences; United Kindom.Fil: Pitts, Nigel. King’s College London. Dental Innovation and Impact. Faculty of Dentistry, Oral and Craniofacial Sciences; United Kindom.Fil: Deery, Chris. University of Sheffield. School of Clinical Dentistry; United Kindom.Fil: Martignon, Stefania. University of Sheffield. School of Clinical Dentistry; United Kindom.Otras Ciencias de la Salu

Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions:a randomised controlled clinical trial in primary care

Background Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth. Method This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes. Discussion SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN. Trial registration number: ISRCTN76503940. Date of Registration: 30.10.2019