Gunilla Klingberg

The prevalence of demarcated opacities in permanent first molars in a group of Swedish children

The permanent teeth of 516 7- and 8-year-old Swedish children from a low-fluoride area were examined for developmental enamel defects. Special attention was paid to demarcated opacities in permanent first molars and permanent incisors (MIH). The examination was done in their schools, using a portable light, a mirror, and a probe. The modified DDE index of 1992 was used for recording the enamel defects, supplemented with a further classification into severe, moderate, and mild defects. Demarcated opacities in permanent first molars were present in 18.4% of the children. The mean number of hypomineralized teeth of the affected children was 3.2 (standard deviation, 1.8), of which 2.4 were first molars. Of the children 6.5% had severe defects, 5% had moderate defects, whereas 7% had only mildly hypomineralized teeth. In conclusion, hypomineralized first molars appeared to be common and require considerable treatment in the Swedish child population.

Reliability and validity of the Swedish version of the Dental Subscale of the Children's Fear Survey Schedule, CFSS-DS

A Swedish version of the Dental Subscale of Childrens Fear Survey Schedule (CFSS-DS) was designed to be answered by parents on behalf of their children. The instrument was administered twice to the parents of 52 children aged 4 to 14 years. The childrens behaviors were rated during the dental appointment immediately after the second administration. The CFSS-DS reached high values for test-retest reliability and validity. Scores equal to or exceeding 38 were found to be related to dental fear.

Dental anxiety and behaviour management problems in paediatric dentistry - a review of background factors and diagnostics

Aim: To review the literature concerning dental anxiety and dental behaviour management in children and adolescents with regards to prevalence, measurement, and aetiological factors. Study design: Review. Results: Dental anxiety and dental behaviour management problems are two different concepts related to each other but not identical. Each affects approximately 9% of the child and adolescence populations and both have a multifactorial background. Aetiological factors include the dental treatment as such (mainly pain, discomfort, and perceived lack of control), general emotional status, and temperament. Conclusions: In order to treat children and adolescents, paediatric dentists need to assess the patient in relation to psychological, personality, and treatment aspects, and assessments may be carried out using well established methods to gain more knowledge about the individual patient.

Molar‐incisor hypomineralization and oral hygiene in 10‐ to‐12‐yr‐old Swedish children born preterm

Although preterm birth is associated with an increased risk of medical problems and impairments, there is limited knowledge of how this affects oral health. It was hypothesized that when 10-12 yr of age, children who were preterm at birth would present with a higher prevalence of molar-incisor hypomineralization (MIH), more dental plaque, and a higher degree of gingival inflammation than full-term control children. Eighty-two preterm children, born between 24 and 32 wk of gestation, and 82 control children, born between 37 and 43 wk of gestation, were clinically examined for developmental defects in enamel, MIH, dental plaque, and gingival health. In addition, behaviour management problems were evaluated. Information on any aetiological factors with a potential influence on MIH and oral health was collected via questionnaires. Molar-incisor hypomineralization was more common in preterm children than in controls (38% vs. 16%), as were enamel developmental defects (69.5% vs. 51%). Low gestational age and low birth weight increased the risk of MIH. Preterm children had more plaque, a higher degree of gingival inflammation, and more behaviour-management problems than controls. In conclusion, oral health problems were more common in preterm children than in control children.

Neonatal lines in the enamel of primary teeth—A morphological and scanning electron microscopic investigation

OBJECTIVE The neonatal line (NNL) is in principle found in all primary teeth and the line represents the time of birth. Earlier findings of the appearance of the NNL in light microscope and in microradiographs have shown not only changes in the prism direction of the enamel, but that the NNL has a hypomineralized character. METHODS The neonatal line was analyzed in un-decalcified sections of primary lower and central incisors, collected from individuals of different ages utilizing polarized light microscopy, microradiography, scanning electron microscopy (SEM) and X-ray analysis (XRMA). RESULTS In polarized light the NNL appeared to have a more porous structure than the enamel in general. The appearance of the NNL as a dark line in microradiographs is interpreted as the NNL being less mineralized than neighbouring enamel. Analysis with ImageJ visualized the reduction of the amount of grey value, indicating that the NNL is less mineralized. Analysis of the NNL in SEM showed a reduction of the diameter of enamel prisms, the more narrow diameters continued through the postnatal enamel. A change of the growth direction of the prisms was also observed at the NNL. In a three-dimensional image the NNL appeared as a grove, however, in non-etched enamel no grove was seen. The elemental analyses with XRMA showed no marked changes in the content of C, Ca, P, N, O or S in the area around the NNL. CONCLUSIONS The NNL is an optical phenomenon due to alterations in height, and degree of mineralization of the enamel prisms.

Body mass index (BMI) and dental caries in 5-year-old children from southern Sweden.

OBJECTIVES The aim of the present survey was to study the association between dental caries and body mass index (BMI) in Swedish preschool children (born in 1999). METHODS A population-based and cross-sectional study design was used comprising all 920 5-year-old children in a defined area in and around the city of Lund. Anthropometric measures for the calculation of BMI were retrieved for each child from recordings at Child Health Care Centers (CHC). The occurrence of caries and fillings in the primary dentition, defined as deft (decayed, extracted, or filled primary teeth) and dt (decayed primary teeth), was collected from the childrens dental records. RESULTS The mean BMI was 16.1 (no differences between boys and girls). About 19.2% were overweight, of which 5.1% were obese. Overweight or obese children did not have higher deft or dt than others. However, children with low BMI (below -1 SD of national mean values for Swedish 5-year-olds) had statistically significantly higher deft and dt than children with normal BMI. CONCLUSIONS Children with low BMI may be at risk of caries development. Low BMI may be associated with eating habits endangering dental health.

Intubation and mineralization disturbances in the enamel of primary teeth

This study was undertaken to examine the effects of intubation on the enamel development of primary teeth in children intubated during the first 3 months of life. The teeth of 35 children were examined clinically for signs of defects. Dental enamel defects were seen in 26 (74%) patients; enamel hypoplasia was seen in 15 and enamel hypomineralization in 19 cases. In eight patients both enamel hypoplasia and hypomineralization were found. There was a preponderance of enamel defects in the right maxilla, which supports the hypothesis that an early trauma to mineralizing primary teeth caused by laryngoscope may lead to dental enamel hypoplasia.

A Systematic Map of Systematic Reviews in Pediatric Dentistry—What Do We Really Know?

Objectives To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry. Methods A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps. Results Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low. Conclusion There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.

Machine learning methods applied on dental fear and behavior management problems in children

The etiologies of dental fear and dental behavior management problems in children were investigated in a database of information on 2,257 Swedish children 4-6 and 9-11 years old. The analyses were performed using computerized inductive techniques within the field of artificial intelligence. The database held information regarding dental fear levels and behavior management problems, which were defined as outcomes, i.e. dependent variables. The attributes, i.e. independent variables, included data on dental health and dental treatments, information about parental dental fear, general anxiety, socioeconomic variables, etc. The data contained both numerical and discrete variables. The analyses were performed using an inductive analysis program (XpertRule Analyser, Attar Software Ltd, Lancashire, UK) that presents the results in a hierarchic diagram called a knowledge tree. The importance of the different attributes is represented by their position in this diagram. The results show that inductive methods are well suited for analyzing multifactorial and complex relationships in large data sets, and are thus a useful complement to multivariate statistical techniques. The knowledge trees for the two outcomes, dental fear and behavior management problems, were very different from each other, suggesting that the two phenomena are not equivalent. Dental fear was found to be more related to non-dental variables, whereas dental behavior management problems seemed connected to dental variables.

Specialist paediatric dentistry in Sweden 2008 - a 25-year perspective.

International Journal of Paediatric Dentistry 2010; 20: 313-321 Background. Paediatric dentistry in Sweden has been surveyed four times over the past 25 years. During this period postgraduate training, dental health, and the organization of child dental care have changed considerably. Aim. To investigate services provided by specialists in paediatric dentistry in Sweden in 2008, and to compare with data from previous surveys. Design. The same questionnaire was sent to all 30 specialist paediatric dental clinics in Sweden that had been used in previous surveys. Comparisons were made with data from 1983, 1989, 1996 and 2003. Results. Despite an unchanged number of specialists (N = 81 in 2008), the number of referrals had increased by 16% since 2003 and by almost 50% since 1983. There was greater variation in reasons for referrals. The main reason was still dental anxiety/behaviour management problems in combination with dental treatment needs (27%), followed by medical conditions/disability (18%), and high caries activity (15%). The use of different techniques for conscious sedation as well as general anaesthesia had also increased. Conclusions. The referrals to paediatric dentistry continue to increase, leading to a heavy work load for the same number of specialists. Thus, the need for more paediatric dentists remains.