Jack Toumba

The prevalence of molar incisor hypomineralisation in Northern England and its relationship to socioeconomic status and water fluoridation

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.

Bite force measurement in children with primary dentition.

OBJECTIVES To determine the magnitude of the biting forces in young children aged 3-6 years in the primary dentition and analyse the potential effects of caries and malocclusion on maximum bite force. METHODS Children aged 3-6 years of age attending primary schools within a major city in the UK were recruited to participate in this study. The magnitude of the bite force in Newtons (N) was measured bilaterally corresponding with the 1st and 2nd primary molars and central incisors using a new specifically designed single tooth bite force gauge. RESULTS Two-hundred and five children were included in the study. The prevalence of dental caries and malocclusion was found to be 30.4% and 17.1% respectively. The levels of bite force recorded showed comparatively wide intra- and inter-individual variation with the maximum of the three bite force measurements ranging from 12.61 (N) to 353.64 (N) (M=196.60, SD=69.77). CONCLUSION Bite forces of young children show comparatively wide intra- and inter-individual variation with some similarities with those found in the limited number of previous primary dentition studies undertaken elsewhere. The results will serve to provide key reference values for use both in paediatric dental clinical practice and wider research community.

Outcomes of the conventional and biological treatment approaches for the management of caries in the primary dentition

BACKGROUND In the last few years, conventional restorations including complete removal of carious tissue (CT) with or without pulp therapy for the treatment of carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves the use of less invasive techniques which alter the environment of the CL isolating it from the cariogenic biofilm and substrate. Two of these treatment approaches that are becoming increasingly widely accepted and used in paediatric dentistry are the Hall Technique and indirect pulp capping (IPC). AIM To investigate the outcome of the conventional versus the biological approaches for the treatment of deep CL in the primary teeth in children, delivered in a specialist paediatric dentistry training environment. DESIGN This was a retrospective cohort study of 246 children aged 4-9 years, treated with either approach, conventional and biological, in two UK specialist hospital settings. Data were extracted from clinical dental records and post-operative radiographs of patients treated during the period 2006-2012. The outcome of the treatment in this study was categorised into three main categories: clinical, radiographic, and final outcome. Clinical and final outcomes were further described as success, minor, and major failure. RESULTS In total, 836 primary teeth were included. In the conventional approach, 324 teeth had complete CT removal and 104 teeth had a pulpotomy. In the biological approach, 388 teeth had Hall Technique preformed metal crowns (PMC) placed and 20 teeth received indirect pulp capping. PMC were the restoration of choice for most of the cases where a pulpotomy had been carried out, and resin composite was most frequently used restorative material for the complete CT removal group. The majority of the primary teeth treated with either approach remained asymptomatic after a follow-up period of up to 77 months, 95.3% in the conventional and 95.8% in the biological. No significant association was found between the final outcome and the approach used for treatment, age of the patient, gender and number of carious surfaces or tooth type. CONCLUSION Both the conventional and biological treatment approaches had similar final outcomes and were equally successful for management of CL in the primary dentition.

Effectiveness, Costs and Patient Acceptance of a Conventional and a Biological Treatment Approach for Carious Primary Teeth in Children

Background: Over the last years, conventional restorations for the treatment of active carious lesions (CL) in primary teeth have been challenged and a more biological approach has been suggested. This approach involves less invasive techniques that alter the environment of the CL isolating it from the cariogenic biofilm and substrate. Aim: To investigate the cost-effectiveness and patient acceptance of 2 treatment approaches for the treatment of deep CLs in primary teeth in children. Methods: This was a retrospective/prospective cohort study carried out in 2 UK specialist hospital settings. Data on cost-effectiveness was extracted retrospectively from clinical dental records of 246 patients aged 4–9 years. A prospective study design was used to explore patient acceptance of the 2 treatment approaches. One hundred and ten patients aged 4–9 years and their carers completed 2 questionnaires on treatment acceptance. Results: In total, 836 primary teeth that had received treatment with either approach were included. More than 2 thirds (75.7%) of the restorations in the conventional approach were of non-selective removal to hard dentine followed by pulpotomy (24.3%). In the biological approach, most of the restorations were stainless steel crowns placed with the Hall Technique (95%) followed by selective removal to firm dentine (5%). The majority of the primary teeth remained asymptomatic after a follow-up period of up to 77 months; 95.3% in the conventional and 95.8% in the biological arm. When the treatment costs were analysed, a statistically significant difference was found between the mean costs of the 2 approaches with a mean difference of GBP 45.20 (Pound Sterling; p < 0.001), in favour of the biological approach. The majority of the children and carers were happy with the conventional or biological restorations. Conclusion: Although both approaches had similar successful outcomes, the biological approach consisting mainly of Hall Technique was associated with reduced treatment costs. Both approaches were accepted favourably by the children and carers.

Pulsed laser sintering of photo-active calcium phosphates for dental enamel restoration

Acid erosion and wear of natural enamel leading to sensitivity of teeth is a common condition amongst large population worldwide. It is a lifestyle related condition, resulting from the progressive loss of mineral phase from enamel surface. Unlike bone, the dental enamel is a dead tissue and cannot regenerate itself and it must be restored for preventing exposure of softer dentinal tubules and nerves [1], which is the root cause of pain. At present there is no long-term treatment except the daily use of brand tooth pastes, regular use of which provide some protection. Consequently, the dental condition globally is on rise.