K. J. Toumba

Cost-effectiveness of a long-term dental health education program for the prevention of early childhood caries

Aim: To evaluate the benefit-cost (B/C) and cost-effectiveness (C/E) of a long-term dental health education program to prevent early childhood caries (ECC) through home visits. Methods: The data collected over a three year period in a dental health education programme (DHE), previously reported [Kowash et al., 2000] for infants aged 8 months at start, were analysed for B/C and C/E. Dental caries indices (BASCD) for dmft and dmfs were used. Costs were based on British National Health Service (UK) fees for treating children by general dental practitioners and salaries for community dental officers in the Community Dental Services in the UK. Comparisons were made for B/C and C/E with results from a clinical trial of a slow releasing fluoride device (SRFD), community water fluoridation (CMF) and a school based fissure sealant program (FSP) using the hypothetical community of Niessen and Douglass, [1984]. Results: The cavities, as ECC, saved over the three year period indicated a B/C ratio for the DHE of 5.21 compared with SRFD of 4.17; CWF of 1.15 and FSP of 0.42. The C/E results were 1.92, 2.40, 8.66 and 23.74 respectively. Conclusion: A dental health education program of home visits with mothers of young infants to prevent early childhood caries and starting at 8 months of age, gave better benefit-costs and costs effectiveness ratios than other preventive programs.

Restoration of primary teeth: Clinical criteria for assessment of the literature

Aim: To establish a system of clinically based criteria for the assessment of papers published in peer reviewed journals concerning the use of restorative techniques in primary teeth. Background: Various publications that consider the approaches to be taken in setting up assessment criteria within the dental/medical literature were reviewed. These included the so called ‘Cochrane criteria’. On the basis of this review a set of clinically based criteria were drawn up that were then used to produce a list of criteria to be used in a series of systematic reviews of the literature concerning the various restorative techniques, materials and medicaments for pulp therapy and the restoration of primary teeth. Results: There were 25 criteria that were felt to be appropriate of which all criteria were deemed to be appropriate for pulp therapy and 23 for restorative techniques and materials. Conclusion: A set of clinically based criteria is suggested for the systematic review of publications on restorative techniques, materials and medicaments where used for pulp therapy, as used for primary teeth.

An unusual presentation of erythema multiforme in a paediatric patient.

BackgroundErythema multiforme (EM) is an acute, vesiculobullous disease of skin and mucous membranes with symptoms ranging from mild to severe. A complex interaction of different factors has been implicated the condition; the majority with a preceding herpes simplex infection. This report describes an unusual presentation of erythema multiforme affecting the lips and oral mucosa of a healthy 7-year-old boy in the form of lip adherence.Case reportTwo weeks following eruption of oral ulcerations, a 7-year-old healthy boy developed severe erosive ulceration of both lips, causing complete lip adherence. This was accompanied by marked bilateral submandibular and cervical lymphadenopathy, tremor and sweating. Clinical and laboratory investigations led to a diagnosis of erythema multiforme. The patient was treated initially with gentle application of Vaseline between the lips using cotton buds in an attempt to release lip adhesion, followed by surgical release of the lips under general anaesthesia. Analgesics and topical steroid mouthwash were provided.Follow-upSeven months later, the patient presented with a recurrence of his EM which included lesions on the skin. The patient was treated with antivirals, topical and systematic steroids to suppress the recurrent attacks of EM. Eighteen months following the initial presentation the patient and parent reported considerable decrease in the frequency, severity and duration of the occurrence of intra-oral ulcers, with no major episode of target lesions on the skin.ConclusionErythema multiforme is rare in children, however it should be considered in the differential diagnosis of recurrent erosive oral ulcerative lesions especially when the oral lesions resemble those of primary herpetic gingivostomatitis.

The effect of fluoride slow-releasing devices on fluoride in plaque biofilms and saliva: a randomised controlled trial

AIM: To investigate the effect of the fluoride sustained slow-releasing device (FSSRD) on F levels in unstimulated saliva and undisturbed plaque biofilms over 7 days. The investigation also aimed at studying the effect of patient age on fluoride (F) concentrations in dental plaque biofilms and unstimulated saliva while using the FSSRD. STUDY DESIGN: This was a randomised control double-blind crossover study. METHODS: Sixty-five participants between the ages of 6–35 years took part in this study. The mean age of all the participants was 19.2 years with 24 participants aged between 6–16 years (mean age=11.8 years) and 41 participants aged between 16–35 years (mean age=23.6 years). Plaque biofilms were collected using a modification of the plaque generating device (MPGD) [Robinson et al., 1997]. During the whole study period, including a 7 day washout period before the first leg, all participants were asked to use only non-fluoridated toothpaste and to avoid where possible high fluoride containing foods or drinks. Whenever possible, the FSSRD/placebo device (PD) was attached to the second permanent molar, while the MPGD was attached to the first permanent molars in the same upper dental quadrant. At the end of each leg of the study whole, mixed unstimulated saliva was collected from all participants and analysed for F concentration. STATISTICS: Statistical analysis using paired sample t-test was used to compare the results of F level between test and control groups, while, Spearman’s correlation coefficient was used to test the relationship between patient’s age and plaque weight against F concentration in plaque and saliva. RESULTS: There was no statistically significant difference in F concentration in plaque and saliva between the test and control groups when analysed using paired sample t-test (p>0.05). There was no correlation between patient’s age and F concentration in dental plaque and saliva (p>0.05), in both the test and control groups. CONCLUSIONS: Our data showed no effect of the FSSRD in raising F concentrations in dental plaque and unstimulated whole saliva after 7 days. Such levels may require longer periods to become established.

In Vitro and ln Vivo Assessment of Newly Developed Slow-Release Fluoride Glass Device

BACKGROUND: The concept of constant and low levels of F intra-orally has been applied in dentistry using a controlled-release delivery system in different forms of slow-release F intra-oral devices. AIM: To investigate the effect of newly shaped plastic brackets on the level of fluoride released by the devices in vitro and to compare the level of fluoride released by unilateral versus bilateral slow-release fluoride glass devices in adults in vivo. STUDY DESIGN: The phase I, in vitro assessment involved 15 slow-release fluoride glass devices divided into three groups. Group A contained five glass beads, Group B, five fluoride devices placed with the plastic brackets facing down, and Group C, five fluoride devices placed with the plastic brackets facing up. Evaluation of fluoride release was carried out daily for a week, weekly for a month, and monthly for 18 months. The In vivo phase II involved 20 adults (mean age 29.7 ± 2.3 years) randomly divided and had unilateral or bilateral slow-release fluoride glass devices placed for six months. RESULTS: Groups A and B released fluoride for up to ten months. In Group C, the glass beads became loose at the end of the first month and were excluded from further analysis. There was no statistical significant difference in the mean of total fluoride released by Groups A and B. All participants showed higher salivary fluoride levels than at baseline. There was no statistically significant difference in the level of fluoride released by the bilateral and unilateral groups. CONCLUSIONS: The newly shaped slow-release fluoride glass devices showed continuous, safe, and effective fluoride release.

European Academy of Paediatric Dentistry guideline production

One of the important functions of the European Academy of Paediatric Dentistry (EAPD) is to produce guidelines on important topics of paediatric dentistry. These guidelines are freely available online at the EAPD website (http:// www.eapd.eu) to EAPD members, paediatric dentistry specialists from all over the world, general dental practitioners and of course to parents and the general public. Guidelines help both dentists and the public on important topics in dentistry by presenting the evidence for any recommendations, and where this is not possible expert opinion on good practice points are given. The production of EAPD guidelines is a lengthy process and takes place at the EAPD interim seminars and workshops, of which the latest guideline on ‘‘The management of early caries lesions in the primary and young permanent dentition’’ was framed during the ninth EAPD interim seminar and workshop in Brussels, Belgium, between 8 and 9 May 2015. The Belgium organising and scientific committees that included Professor Dominique Declerck, Professor Luc Marks, and Dr. Jeroen Vandenbulcke amongst others in conjunction with the EAPD clinical affairs committee chaired by Dr. Jan Kuhnisch worked very hard and for a long time both before, during and after the interim seminar and workshop to ensure that the event was a great success and that the resulting guideline was evidenced based. The EAPD format for guideline production is that three important topics related to the guideline are presented by experts in the field at the interim seminar for all delegates. The experts prepare systematic reviews of their topics beforehand and these are circulated to each of the selected workshop participants in advance of the workshop. The workshop participants are selected from each of the European member countries by the local EAPD councillors. Each of the three workshops has between 15 and 20 participants contributing to the discussions and production of the guideline in relation to their specific topics. The three experts for this interim seminar and workshop were firstly Professor Kim Ekstrand (Copenhagen, Denmark) and Professor Iain Pretty (Manchester, UK) who spoke on ‘‘Detection and monitoring of early caries lesions’’. The second expert was Professor Svante Twetman (Copenhagen, Denmark) who spoke on ‘‘Caries-risk assessment in children—how accurate are we?’’ The third expert was Professor Cor van Loveren (Amsterdam, The Netherlands) who spoke on ‘‘Non-invasive methods’’. Following the presentations the workshop participants together with the invited experts had their group discussions whilst the other delegates had more lectures. The following day, the provisional guidelines were presented to all delegates. The experts produced review papers which contributed to the topic guidelines and were submitted to the European Archives of Paediatric Dentistry for publication. Each of these review papers were peer reviewed in the normal way and when accepted appeared online until the guideline was ready for publication. The guideline had input from the experts, workshop participants and EAPD members as this was available for member’s comments. In this special issue the completed guideline paper is the first article by Kuhnisch et al. entitled ‘‘Best clinical practice guidance for management of early caries lesions in children and young adults—an EAPD policy document’’. The next three papers are the review papers related to the production of the guidelines. The second article in the issue is by Pretty and & K. J. Toumba K.J.Toumba@leeds.ac.uk