Am Kemoli

Influence of the experience of operator and assistant on the survival rate of proximal ART restorations: two-year results

AIM: The objective of the study was to determine the influence of the experience of the operator and the assistant on the survival rate of proximal ART-restorations after 2 years when placed using two methods of tooth-isolation and three glass ionomer cement-brands. STUDY DESIGN: A clinical intervention study. METHODS: Each of 804 children aged 6–8 years received one proximal restoration in their primary molars. The restorations were placed by ‘experienced/inexperienced’ operators randomly paired with ‘experienced/ inexperienced’ assistants. The atraumatic restorative treatment (ART) approach was used with 3 brands of glass ionomer cements (GIC) and 2 tooth-isolation methods (rubber dam vs cotton rolls). Trained and calibrated evaluators evaluated the restorations, soon after placement and after 2 years. STSTISTICS: The data collected were analyzed using SPSS 14.0, to determine and relate the survival rate of the restorations to the operator and assistant with respect to the other factors such as the restorative material used and the isolation method applied. RESULTS: After 2 years, the survival rate of the restorations was 30.8%. In general, there were no statistical significant differences in the survival rate of the restorations made by the ‘experienced’ vs ‘inexperienced’ operators, but individually, the operator with more experience was associated with a significantly higher survival rate of the restorations. The experienced assistants were associated with significantly higher survival rates of the restorations. The most ‘experienced’ operator paired with any ‘experienced’ assistant and using rubber dam tooth-isolation method, was associated with a significantly higher survival rate of the restorations. CONCLUSION: The combination of the ‘experienced’ operator and assistant using rubber dam tooth-isolation method had the best chance of survival for proximal ART restorations, irrespective of the material-brand used.

Effects of oral hygiene, residual caries and cervical Marginal-gaps on the survival of proximal atraumatic restorative treatment approach restorations

Background: Although Atraumatic restorative treatment (ART) approach has been in existence for a while, the reasons for the poor performance of multisurface ART restorations are not very clear. Aim: The aim of this study is to investigate the effects of oral hygiene, residual caries and cervical marginal-gaps on survival of proximal ART restorations. Settings: Two rural divisions in Kenya were selected for the study. Design: A randomized clinical trial. Material and Methods: The 804 children in the study had their baseline- and 2-year dental plaque levels documented. Each child received one proximal restoration in a primary molar using ART approach, together with trained and pre-tested operators/assistants, three glass ionomer cements (GIC)-brands and two tooth-isolation methods. The restorations were clinically evaluated soon after placement and after 2 years. Post-restorative bite-wing radiographs taken soon after restoration were also evaluated. Statistical analysis: Statistical Package for Social Sciences (SPSS) version 14 computer programme was used and results tested using Pearsons correlation, Cox Proportional Hazards regression analysis and Multiple Logistic regression models tests. Results: At baseline and after 2 years, the mean cumulative survival and plaque index changed from 94.4% to 30.8% and 2.34 (Standard Deviation, or SD of 0.46) to 1.92 (SD 2.1) respectively, with higher plaque indices associated with higher restoration failures. Of the 507 radiographs evaluated, 48 (9.5%), 63 (12.4%) and 9 (1.8%) restorations had residual caries (RC), cervical marginal-gaps (CMG) and both RC/CMG respectively. Survival of the restorations with RC/CMG was significantly lower (p = 0.003) compared to those with RC or without RC. Conclusion: Low survival of proximal restorations in the study was associated with the presence of cervical marginal-gaps.

ART class II restoration loss in primary molars: re-restoration or not?

AIM: The purpose of this study was to find an answer as to what to do with Atraumatic Restorations (ART) failures: re-restore or leave the preparation further unfilled? STUDY DESIGN: Cross sectional study. METHODS: In 2006, 804 children in Kenya each had one proximal cavity treated using the ART approach. Out of the original group of 192 children, who had lost their restorations but still had the treated molars in situ, were selected for further study in 2008. The length of time that the restorations had been in situ was known while the colour, hardness and the extent of infected dentine was then evaluated and documented. STATISTICS: Analysis of the data obtained was conducted using SPSS 16.0. Chi Square tests were performed with the variables of hardness, colour and infected dentine, and a 5% confidence interval was used. The Spearman’s Rank Correlation Coefficient was also calculated. RESULTS: The results showed that 66% of the molars that had lost restorations had hard dentine, 78% of the preparations showed dark dentine and 50.7% appeared to have no infected dentine. These percentages increased with the increase in the survival time of the restorations. CONCLUSIONS: It is not always necessary to re-restore primary molars after ART restoration loss. Further research is necessary to confirm these findings.

Influence of different isolation methods on the survival of proximal ART restorations in primary molars after two years

AIM: This was to evaluate the influence of two methods of tooth-isolation on the survival rate of proximal ART restorations in the primary molars. METHODS: The study was conducted in two rural divisions in Kenya, with 7 operators randomly paired to a group of 8 assistants. A total of 804 children each had one proximal cavity in a primary molar restored using the ART approach. During restorations 2 isolation methods, rubber dam or cotton wool rolls, and 3 brands of glass ionomer cements were used by the operators. The restorations were then followed for a period of 2 years. STATISTICS: SPSS 14.0 was used to analyse and relate the data obtained to the method of isolation used. RESULTS: After 2 years 30.8% of the ART restorations had survived. Higher survival rates of the restorations were obtained when using rubber dam irrespective of the GIC material or the operator. CONCLUSION: Generally the survival rate of the proximal restorations in the present study was very low, but the use of rubber dam resulted in a higher survival rate of the restorations.

Child abuse: A classic case report with literature review

Child abuse and neglect are serious global problems and can be in the form of physical, sexual, emotional or just neglect in providing for the childs needs. These factors can leave the child with serious, long-lasting psychological damage. In the present case report, a 12-year-old orphaned boy was physically abused by a close relative who caused actual bodily and emotional trauma to the boy. After satisfactorily managing the trauma and emotional effects to the patient, in addition to the counseling services provided to the caregiver, the patient made a steady recovery. He was also referred to a child support group for social support, and prepare him together with his siblings for placement in a childrens home in view of the hostile environment in which they were living.

Raising the awareness of infant ora mutilation - myths and facts.

The earliest literature report on infant oral mutilation (IOM) was recorded in the year 1932 and related to the Nilotic people of Sudan. Since then, there have been more reports on the practice of IOM coming from more countries in the Eastern region of Africa. Among these countries mentioned in relation with this practice are Sudan, South Sudan, Ethiopia, Somalia, Kenya, Tanzania, Uganda, Democratic Republic of Congo, Burundi, and Rwanda. Other than Eastern Africa countries that have reported on the practice of IOM, the other countries are Burkinafaso and Chad. Many studies have not been extensively done on this practice, but few that have been done have shown the prevalence of this practice to be relatively high, with Uganda having reported a prevalence of 35% in the Acholi tribe and Tanzania reported a prevalence of between 5.2% and 16.9% in some of the tribes. In Kenya, a study in 1988 showed the prevalence of IOM in the Maasai tribe to be 35%. Indeed, IOM appears to be an issue that needs addressing by the dental fraternity. The most commonly practiced IOM is the extraction of the primary canines. It is believed that by extracting the primary canines in children, the children will be rid of all childhood illness and fevers. These illnesses include diarrhea and fevers in the child. The myths behind IOM lies in the fact that the people in these tribes believe that the swelling in the gum pads of the child, corresponding to the developing primary canines, is growing “worms” or “maggots,” and that this should be removed to heal or prevent the child from having diarrhea and fevers. To them, if the removal of the canine buds is not done, the child will suffer from this illness caused by the “worms” and will lead to premature deaths of the children. The traditional healers within the tribes that practice the IOM are the ones who are responsible for advising the parents on this and also in the removal of the “worms.” These traditional healers have no background medical training, but within the communities in which they live, they are regarded as the most competent advisers on health matters and the ones to provide the best medical care for the children in the community. They are, therefore, respected by the community and provide various cures to many of the diseases found within the community they serve. Given that, most people from the countries where IOM is practiced are poor and live in the rural areas with poor communication networks; their first call for any medical help will be at the traditional healer home. The community will most likely take the advice given by the traditional healer as the Bible, and since the majority of these people are unlikely to financially or on grounds of communication technicalities afford proper medical consultation. Nonetheless, sometimes the tradition in some tribes is so entrenched that, in a study done in Kenya in 2010, the results showed that even the traditional birth attendance, who have had some education and awareness training in health care, also provided IOM services to the communities that they served. It can only be speculated that they were probably doing this because they believed and wanted to be associated with their traditions and cultures, and or the financial benefits derived from the service helped alleviate their livelihood. How infant oral mutilation is undertaken and its consequences The age at which the canine mutilation is undertaken has been around 5 months of age of the child. This is also the time that the growing primary canine buds show clear bulges within the gum pads of the child. It is also the time that the growing child is establishing its humoral immunity, transitioning from the humoral immunity provided by the mother through the placenta at birth. During this period, the child is susceptible to infections and fevers. This could be the reasons for the practicing people who believe that the child will have fevers caused by the “worms.” And that by removing this worm, the child become cured of the diseases. Prior to the mutilation of the canines, the mother will normally be advised to rub certain herbs on the gum pads of the child and also rub the same on her breast for a week. On the day of the removal of the teeth, the mother assisted by an assistant helps to pin down the child and at the same time force to open the childs mouth. With the use of unsterile traditional instrument, in the form of a chisel-shaped instrument made from nails or other metals, the traditional healer excavates the bud out, after which some other herbs are rubbed on the areas where the removal has been done, presumably to help in the control of bleeding and the healing of the wound. During the surgical procedure to remove the primary canines, no kind of anesthetic is used to prevent the pains. After the removal, the mother/parent is shown the milky looking extracted canine that nearly resembles a worm, and told that the child would be free from all the childhood diseases and fevers. In some tribes, the disposal of the extracted teeth is important, and proper disposal should help other children in the family not to get the childhood diseases. The assumption of a connection between the “worm” and the common symptoms of childhood is febrile illness and diarrhea, and in particular, as it relates to the eruption of primary teeth, it has been with these traditional people for many years. Arising through the manner, IOM is conducted including the unhygienic environment, in which it is undertaken, the child becomes susceptible to inflammation, swelling of the affected areas of surgery, various infections, septicemia, Ludwigs angina, tetanus, and even disease transmission such as HIV/AIDS. Further, there is the likelihood of the child contracting anemia due to the blood loss through the procedure or infections thereafter, and also the expenses arising from the hospitalization that may ensue. The practice can also result in the damage to the permanent canines, later impaction of permanent canines due to space loss. This early loss of the primary canines can result in a general loss of space for the Succedeneous teeth with the child ending up with expensive orthodontic treatment later on in life.

The effects of ambient temperature and mixing time of glass ionomer cement material on the survival rate of proximal ART restorations in primary molars.

Objective: Temperature fluctuations and material mixing times are likely to affect the consistency and integrity of the material mixture, and hence the restoration made out of it. The purpose of the present study was to determine the influence of the ambient temperature and the mixing time of glass ionomer cement (GIC) restorative material on the survival rate of proximal atraumatic restorative treatment (ART) restorations placed in primary molars. Materials and Methods: A total of 804 restorations were placed in the primary molars of 6-8-year-olds using the ART approach. The restorations were then followed for a period of 2 years and evaluated at given intervals. The data collected were analyzed using SPSS computer statistical program, and the results tested and compared using the Chi-square, Kaplan Meier survival analysis and Cox Proportional hazard statistical tests. Results: The cumulative survival rate of the restorations dropped from the initial 94.4% to 30.8% at the end of 2 years. The higher survival rate of the restorations was associated with the experienced operators and assistants when using the rubber dam isolation method. However, there was no statistically significant difference in the survival rate of the restorations when related to the room temperature and the mixing time of the GIC materials used in spite of the variations in the temperature recoded and the methods used in mixing the materials. Conclusion: The ambient temperature and mixing time of GIC did not have a significant effect on the survival of the proximal ART restorations.

Bilateral second premolars agenesia together with a unilateral canine radiculomegaly

Congenitally missing teeth is a common feature for the third molars. However, missing teeth, macrodontia and radiculomegaly occurring in a single patient is very rare. This article describes a case of agenesis of mandibular second premolars, radiculomegaly with dilacerations of a canine tooth together with elongated roots of other canines. All these features had been discerned through diagnostic radiographs taken during a routine treatment planning.

Applying Bayesian Model to Predict Socio-demographic and Occlusal Determinants of Early Childhood Caries (ECC).

Objective: To use the Bayesian statistical Model approach to predict the most important socio-demographic and occlusal factors pertinent to high prevalence of ECC. Material and Methods: A questionnaire and an oral examination was conducted on children who attended a pediatric dental clinic in Nairobi during the period of study. The parents provided information on socio-demographic and oral habits of the children. The oral examination for presence of dental caries was recorded for each child. Descriptive statistics were obtained for dental caries, oral hygiene, using plaque score, and malocclusion. The results of the questionnaire and presence of dental caries were analyzed and the results subjected to Bayesian statistical analysis to determine any predictive factors for ECC. Results: 55% of the children had plaque accumulating on more than one third but less than two thirds of tooth surfaces. The highest plaque scores were reported among children whose fathers (48.2%) and mothers (42.0%) had completed secondary, and whose fathers were in non-formal employment 73.2%. The overall prevalence of dental caries in the study group was 95.5% with a mean dmft of 8.53 (+ 5.52 SD), with the male children having higher dmft 8.65 (SD+5.54) than the female children 8.37 (SD+ 5.50). The prevalence of malocclusion among children in the study was 55%. The majority had mesial step, 51.5% (n=140) and flush terminal plane 28.3% (n=77). Conclusion: The Bayesian Model, with a correct assumption, can be used to determine the important factors involved in high prevalence of ECC.