J. S. J. Veerkamp

Young children's oral health-related quality of life and dental fear after treatment under general anaesthesia: a randomized controlled trial

During the past decade the research interest in Oral Health-Related Quality of Life (OHRQoL) has been prospering. This study was performed to test (using a randomized controlled trial design) the hypothesis that young childrens OHRQoL improves after oral rehabilitation under general anaesthesia (GA). A further aim of this study was to explore whether dental fear also changes. One-hundred and four children (54 boys; mean age 4.08 yr, standard deviation = 1.09), who had been referred to a specialized clinic in paediatric dentistry, were randomly assigned, based on a Solomon four-group design, to two treatment (GA) and two control conditions. The Early Childhood Oral Health Impact Scale (ECOHIS) and the Childrens Fear Survey Schedule-Dental Subscale (CFSS-DS) were used to assess OHRQoL and dental fear, respectively, before and after the rehabilitation procedures. A 2 x 2 analysis of variance revealed that the total ECOHIS score after GA was more positive in the GA group than in the control group. There was no effect found of the pre-test and there was also no interaction between the pre-test and treatment. In the total CFSS-DS scores no effects were found. The results of this study showed that the childs OHRQoL improved after treatment under GA. Furthermore, children need guidance in reducing dental fear after treatment under GA.

Validity of scoring caries and primary molar hypomineralization (DMH) on intraoral photographs

AIM: The aims of this study were to assess whether intraoral photographs could be used to score caries and hypomineralization on primary molars (Using adapted Molar Incisor Hypomineralization (MIH)-criteria), and also to assess the reliability and validity in 3–7 year-old Dutch children of these scores by comparing them to direct clinical scorings. STUDY DESIGN: Cross-sectional study. METHODS: In this study 62 children (38.7% girls) with a mean age of 4.96 years (SD 1.27) participated. The children were rated clinically by their own dentist (authors JV or ME) for caries reaching the dentine in their primary molars (WHO criteria) and also for primary molar hypomineralization using the adapted MIH-criteria. For the intraoral photographs, a digital intraoral camera was used. The two paediatric dentists rated all the intraoral photographs on caries and hypomineralizations on the second primary molars, using the same criteria for the clinical scoring as for the scoring of the photographs. They scored independently, at least 2 weeks after the initial clinical scoring to avoid observational bias with the clinical scoring. STATISTICS: This clinical observation was used as the gold standard from which sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and the Positive and Negative Likelihood Ratio were computed. To test the intra-observer agreement 25 % of the photographs were scored again, at least 2 weeks after the initial scoring of the images. Inter- and intra-observer agreement were tested using Cohen’s Kappa. RESULTS: The mean prevalence of clinically detected caries at tooth level was 46.7% and the mean prevalence of clinically detected hypomineralizations in second primary molars at tooth level was 21.8%. The sensitivity of assessing caries using intraoral photographs was 85.5%, the specificity 83.6%, the positive likelihood ratio 5.2 and the negative likelihood ratio was 0.17. For Primary Molar Hypomineralization (DMH) the sensitivity was 72.3%, the specificity 92.8%, the positive likelihood ratio 10.1 and the negative likelihood ratio was 0.30. The inter-observer agreement yielded the following Cohen’s Kappa scores: for caries 0.76 and for DMH 0.62. The intra-observer agreement was for caries 0.80 (ME) and 0.72 (JV) and for DMH 0.95 (both ME and JV). CONCLUSIONS: From this investigation it was concluded that the sensitivity, specificity and the likelihood ratio of scoring caries and DMH on photographs made with an intraoral camera were good. The inter- and intra-observer reliability for caries and DMH were good to excellent. These findings suggest that intraoral photographs may be used in clinical practice and large epidemiological studies.

Dental treatment under general anaesthesia: the short-term change in young children’s oral-health-related quality of life

Aim: This was to assess the short-term change in children’s oral-health-related quality of life (OHRQoL) and family impact after dental treatment under general anaesthesia (GA) in the Netherlands. Study design: A pretest-posttest design was used. Methods: Children (<8 years) referred to a clinic for specialized paediatric dentistry and who needed treatment under GA were selected to participate and divided across two groups. Fifty out of 80 parents/children couples participated, one group of parents filled out the questionnaires on behalf of their child before and after treatment (N=31), and the other group only after treatment (N=19). The questionnaires used were the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and Parental Perceptions Questionnaire and Family Impact Scale (PPQ and FIS, forming the OHRQoL score). The oral health was assessed using the decayed-missing-filled surfaces or teeth index (dmfs/dmft) for the primary dentition from the status praesens after treatment. Results: There was a significant difference between the pre- and posttest-scores in group A for both the short version and the long version (short: t=5.088, df=20, p<0.001 and long: t=6.279, df=20, p<0.001). There was no statistically significant difference in CFSS-DS scores before and after treatment (group A) (t=1.815, df=13, p=0.093). Conclusions: The children’s OHRQoL improved after treatment under GA according to their parents. As expected, dental fear did not change and should be dealt with after treatment to avoid a child’s dental fear to persist in the future. A shorter version of the PPQ and FIS seems useful to assess OHRQoL in very young children.

Changes in children’s dental fear: a longitudinal study

Aim: The study aimed to evaluate the development of dental fear in a low fear group and a fearful group of children aged between 8 and 13 years of age and to assess the differences between these groups over time taking into account general variables, such as gender, and treatment variables, such as restorations. Furthermore it was evaluated to what extent general and treatment variables predict the change in dental fear or dental fear at later age. Study design: A three-year longitudinal study. Methods: 401 parents completed the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS), 218 of them repeating this after a 3-year interval. Dental records were used to collect the clinical data, starting from the children’s first dental appointment, and the CFSS-DS was used to assess the child’s dental fear. Results/statistics: Analysis of variance for repeated measures showed an interaction effect between fear level and mean total CFSS-DS score. Regression analyses applied to the mean total CFSS-DS score at the second measurement and the change in total CFSS-DS score between both measurement moments revealed that little variance could be explained by the treatment variables over the various periods, such as extractions in the first period. Also that child-characteristic variables could not predict much variance. Independent-samples t-tests showed a significant difference in means for extractions over the whole period between the fearful group (mean=1.73, SD±1.18) and low fear group (mean= 0.68, SD±2.01) (t=−4.05, p<0.001, n=218). Also the frequency of Behavioural Management Problems over the whole period differed between these groups (fearful group: mean=1.40, SD±1.90 and low fear group: mean= 0.40, SD±0.93) (t= −4.58, p<0.001, n=218). Conclusion: The effect of treatment variables and subjective experiences on child dental fear seems to diminish over time. Findings support the theoretical framework of conditioning and gradual exposure in children to prevent dental fear.

Effects of Dental Treatment and Single Application of a 40% Chlorhexidine Varnish on Mutans Streptococci in Young Children under Intravenous Anaesthesia

Clinical studies suggest that application of a highly concentrated chlorhexidine varnish results in a decrease in the number of mutans streptococci and thereby a decrease in the caries risks. The aim of this study was to determine the effect of dental treatment on the levels of mutans streptococci (MS) and lactobacilli (LB) and the additional effect of a single application of 40% chlorhexidine varnish (EC40) on the level of MS. Twenty–three children under the age of 5 years scheduled for full dental treatment were selected. Of these 23 children (mean dmf–s 27.1, SD 19.3), 11 children had nursing bottle caries. The mean sugar exposure was 6.4. Subjects were randomly distributed into two groups of approximately equal size. One group received an EC40 application after dental treatment, while the other group received only full dental treatment, both with intravenous anaesthesia with propofol as a single drug. An unstimulated saliva sample and a plaque sample were taken prior to dental treatment. The saliva and plaque sampling of the subjects was repeated after 6 weeks. MS and LB were isolated and counted. The number of children harbouring more than 106 MS in a pooled plaque sample decreased significantly from 8 to 2 children 6 weeks after dental treatment. No additional effect of EC40 was found. The number of salivary MS did not change significantly between the groups or before and after treatment. The figures for LB remained at a high level of more than 104/ml saliva before (21 children) and 6 weeks after treatment (17 children). The results of this study indicate that dental treatment results in a significant suppression of plaque MS, while a single application of EC40 showed no significant additional suppression after 6 weeks.

Mineral content in teeth with Deciduous Molar Hypomineralisation (DMH)

OBJECTIVES We report the mineral (hydroxyapatite) density of sound and opaque areas in DMH molars with sound parts of (carious) deciduous teeth serving as controls. METHODS Twenty-nine extracted second primary molars obtained from 15 children were studied. Thirteen of these molars were DMH molars with yellow opacities, seven were DMH molars with white opacities, three DMH molars with brown opacities and eleven were molars without DMH. Prior to microCT scanning, the teeth were mounted in impression material (Impregum(®)) and stored in water with a thymol crystal. Spot analysis and line scans were performed in areas with opacities and in sound areas. An ANOVA test and t-tests were used to test if there were significant differences between the groups. RESULTS The average densities of the hydroxyapatite in yellow and brown opacities (1368mg HA/cm(2) and 1407mg HA/cm(2), respectively) were significantly lower than in clinically unaffected enamel (1747mg HA/cm(2)) of DMH molars or of sound molars (1758mg HA/cm(2)). The mineral density in white opacities (1737mg HA/cm(2)) was not different from that in the enamel of sound molars. The mineral density values in yellow and brown enamel opacities were in between those of dentine (1018mg HA/cm(2)) and enamel. CONCLUSIONS DMH molars with yellow or brown opacities had a 20-22% lower mineral density in the hypomineralised enamel compared with sound molars. White opacities do not show a lower mineral content. The reduction in enamel mineral content in DMH molars stressed the need for a preventive approach in DMH.

Dental Discomfort Questionnaire for young children following full mouth rehabilitation under general anaesthesia: a Follow-up report

Aim: The aim of the present study was firstly to assess the persistence of pain-related behaviours of the Dental Discomfort Questionnaire (DDQ) and secondly to complete a follow-up study to assess the effect of dental treatment on pain-related behaviours in preschool children. Methods: The 9-question DDQ instrument was used to assess toothache-related behaviours in a group of preverbal children. The test-retest analysis questionnaire was filled out twice by 44 parents on behalf of their referred child. The follow-up study questionnaire was filled out by 71 parents before and after all dental disease was treated. Results: A strong correlation for the test-retest was found over a 2 month period before treatment. When the behaviour items were compared independently before and after treatment it appeared that after treatment all but one behaviour (i.e. bites with molars instead of teeth) was displayed less often. Overall, after treatment all children had a lower mean DDQ score. Conclusions: Dental treatment of children leads to reduced toothache-related behaviours and subsequently to a better quality of life. The DDQ is a sensitive instrument to measure dental discomfort before and after restorative treatment if and when the follow-up period is short. The DDQ can possibly support healthcare providers, teachers and parents in their assessment of toothache in young children.

The Dental Discomfort Questionnaire: The basis of a ‘Toothache Traffic Light’

AIM: Firstly to provide an overview of the combined results of the studies done with the Dental Discomfort Questionnaires (DDQ) and second to present a behaviour checklist, a ‘Toothache Traffic Light’, based on the DDQ, which could possibly be used to raise awareness for toothache among parents and healthcare providers and to improve communication. METHODS: A total of 652 DDQ were analysed to compare the prevalence of toothache related behaviours between children without caries, children with caries but without toothache, and children with caries and toothache. The children had a mean age of 44.6 months (SD±10.9). STATISTICS: Chi-square tests were conducted to compare the items of the DDQ between the three groups and predictors of toothache were determined using a binary logistic regression analysis. RESULTS: All items of the DDQ were displayed more often by the children with caries and toothache than by children with only caries or without both caries or toothache. The behaviours: “Reaching for the cheek while eating”, “Pushing away something nice to eat”, “Problems brushing upper or lower teeth” and “Problems chewing” were found to be the most indicative for the presence of toothache. Finally, 7 toothache related behaviours were combined in the checklist. Using the results of this survey the ‘Toothache Traffic Light’ was developed as a possible tool for determining toothache in very young children. CONCLUSIONS: All behaviours together could form a checklist that can possibly teach parents, guardians and teachers which behaviours to look for when they suspect a child to have toothache.

Transmission of “Streptococcus mutans” in Nursing Bottle Caries and Cleft Palate Patients

Mutans streptococci are associated with dental caries. S. mutans and S. sobrinus are commonly found in humans (Loesche, 1986, de Soet et al. 1991). Transmission studies on S. mutans can give information on the etiology of dental caries (Caufield and Walker, 1989; Genco and Loos, 1991). Early acquisition of S. mutans is supposed to be dependent upon mainly maternal transmission (Kohler and Andreen, 1994). It is not clear yet whether transmission of S. mutans occurs also from mother to child in children with an oral disorder, such as nursing bottle caries (NBC) or a congenital malformation due to a cleft palate (CP).

32 Behandeling van (diepe) cariës in melkelementen

Voor de meeste kinderen is caries de belangrijkste oorzaak voor mondproblemen. Ook al is er in het algemeen een matige correlatie tussen de aanwezige hoeveelheid plaque en cariesactiviteit, is het toch van belang regelmatig een plaquescore te doen om een indruk te krijgen van de mate waarin het individuele kind (en zijn ouders/verzorgers) in staat zijn een goede mondhygiene te handhaven. Een regelmatige controle van de gebitssituatie is van belang voor een juiste en adequate diagnostiek van de cariesactiviteit en voor het vervolgen van carieuze aantastingen van gebitselementen in de tijd (monitoring).