Kinirons Mj

Dental trauma: Variations in the presenting and treatment features in reimplanted permanent incisors in children and their effect on the prevalence of root resorption

Objective To examine variations in the presentation and treatment of reimplanted incisors in children and to determine the effect of these on the prevalence of external root resorption.Setting Departments of Paediatric Dentistry, Belfast and Newcastle upon Tyne.Design Recording of the timing of the injury and the storage mediums (including air) and of reimplantation, the stage of root development, the degree of contamination and the time of commencement of root treatment. Cases were reviewed clinically and radiographically at intervals of 3 months. Root resorption was classified as present or absent. Logistic regression and cross-tabulations were produced with the presence of resorption set as the outcome.Results 128 reimplanted permanent incisor teeth, their median dry time prior to reimplantation being 15 minutes (range 4-52 mins), the median time in a liquid medium being 45 minutes (range 0-650 mins), with a median splinting time of 15 days (range 4-52 days) and a median pulp extirpation time of 15 days (range 0-612 days). There was a lower prevalence of resorption when the period of dryness was less than or equal to 5 minutes (p=0.025). The prevalence of resorption in teeth with no visible contamination was 57.1%, for those with contamination which were washed clean it was 75%, in those rubbed clean it was 87.5%, and it was 100% for those reimplanted with visible contamination still present (p=0.014). The corrected odds ratio for contamination was 2.99 and for an extension of 10 minutes of dryness it was 1.29.Conclusion The degree of contamination and the period of dryness were the major risk factors for resorption in this study of reimplanted teeth in children.

Traumatically intruded permanent incisors: a study of treatment and outcome

Twenty-nine traumatically intruded permanent maxillary incisors from 20 patients were examined, treated and monitored for 2 years. There was a higher proportion of males than females. The teeth intruded furthest were more frequently extracted. Those which were surgically repositioned were more frequently retained and were associated with marginal bone loss significantly less frequently than those which were passively observed, while external root resorption occurred in similar proportions in both groups. A significantly higher proportion of those teeth that were delayed in presentation were subsequently extracted, and a similar trend was found for those with immature roots at the time of the initial examination

Post thermoforming dimensional changes of ethylene vinyl acetate used in custom-made mouthguards for trauma prevention – a pilot study

It is important that mouthguards have an adequate thickness of material if they are to be effective in the prevention of trauma. The aim of this study was to quantify dimensional changes that occur on thermoforming ethylene vinyl acetate (EVA) sheets used in the construction of mouthguards. Fourteen batches of 3 mm thick sheet EVA were thermoformed over dental models under a number of common processing conditions including, model height, inclination, shape and model temperature, model position on thermoforming platform, plasticizing time and evacuation method. Thickness of thermoformed material was determined at anterior and posterior sites and measurements were compared to determine the magnitude and patterns of stretching collectively and within each processing condition. Overall, sheets of 3-mm EVA stretched by 52% during the thermoforming conditions tested. Incisal/cuspal sites were found to be significantly thinner when compared with all other locations measured. A number of thermoforming conditions were demonstrated to have a significant effect on the degree to which the EVA material stretched. For the combination of materials and equipment tested in this study, current thermoforming practices may cause excessive thinning of EVA in critical areas including incisal edges and cusp tips, thereby reducing the protective effect for professionally made mouthguards. To optimize protection in vulnerable areas, it is important that clinicians distinguish between EVA sheet thickness and the cross-sectional dimensions achieved in the finished mouthguards. They need to be specific in their prescription of the thickness of material they require especially in critical areas.

Effectiveness of the school dental screening programme in stimulating dental attendance for children in need of treatment in Northern Ireland.

UNLABELLED The school dental screening programme has been in existence from the beginning of the 20th century yet its value in encouraging attendance among children with a dental health need is not fully established. OBJECTIVE To evaluate the effectiveness of school dental screening in promoting dental attendance among children with a treatment need and to examine the relative importance of screening, social class and other factors in dental attendance. METHODS Sixty-four participating schools were assigned to study and control groups using a stratified, blocked randomisation technique. The study group children received the standard school dental screening and the dental attendance of those with a positive screening result was assessed after 2 months by means of a questionnaire issued to the childrens parents. The control group children were not, at this stage, screened, yet their parents received the same questionnaire assessing dental attendance over the 2-month period. However, only questionnaires from control group children who had a positive result at a subsequent screening were retained for analysis. RESULTS A total of 2,321 children were screened, with 980 having a positive result. The mean dmft of those screening positive was 4.85. In all, 664 completed questionnaires were returned, giving a response rate of 67.8%. Dental attendance was reported among 45.5% of the study group (n=352) in the 2 months following screening. In the same period, 27.6% of the control group (n=312) claimed attendance. The effect was found to be significant among the high employed group (P<0.01) and the unemployed group (P<0.05). CONCLUSION School dental screening was capable of stimulating dental attendance. The strong effect among the lowest socio-economic group shows that school dental screening may be used to decrease dental health inequalities.

UK National Clinical Guidelines in Paediatric Dentistry: treatment of traumatically intruded permanent incisor teeth in children

International Journal of Paediatric Dentistry 2010 Summary.  The process of guideline production began in 1994, resulting in first publication in 1997. Each guideline has been circulated to all Consultants in Paediatric Dentistry in the UK, to the Council of the British Society of Paediatric Dentistry, and to people of related specialties recognised to have expertise in the subject. The final version of the guideline is produced from a combination of this input and thorough review of the published literature. The intention is to encourage improvement in clinical practice and to stimulate research and clinical audit in areas where scientific evidence is inadequate. Evidence underlying recommendations is scored according to the SIGN classification and guidelines should be read in this context. For those wishing further detail, the process of guideline production in the UK is described in the International Journal of Paediatric Dentistry 1997; 7: 267–268.

Factors affecting the timing of pulp extirpation in a sample of 66 replanted avulsed teeth in children and adolescents

The management of 66 replanted avulsed permanent teeth in 46 patients over a 4-year period was studied. Treatment was compared with the recommendations in published guidelines for the management of avulsed permanent teeth. For total extra-alveolar times longer than 45 min, the pulps were extirpated in 96% of teeth. Extra-alveolar times longer than 45 min were associated with earlier pulp extirpation (median 16 days) compared with teeth with shorter extra-alveolar times (median 25 days). Endodontic treatment was postponed in teeth with open apices (median 27 days) compared with closed apices (median 15 days). Teeth in which pulps were removed within 10 days post-trauma had a lower prevalence of inflammatory root resorption compared with teeth in which pulps were removed later. Where inflammatory root resorption did occur, onset was significantly delayed when the pulp had been removed within the first 10 days. This study indicates that clinicians are following the guidelines in key areas of endodontic management of traumatized incisors resulting in more favourable outcomes.

Clinical findings in 12 patients with MPS IV A (Morquio's disease). Further evidence for heterogeneity. Part II: Dental findings.

Typical dental changes were present in all cases, although they were of variable degree. However, the tooth morphology would appear to be highly specific for MPS IV A, and is not found in MPS IV B (β‐galactosidase deficiency) or the recently delineated MPS IV C (enzyme defect unknown). Thus the dental changes have a very useful diagnostic potential in mild atypical cases of MPS IV A, although they may only be demonstrable radiologically in some such cases.

Regional odontodysplasia: an evaluation of three cases based on clinical, microradiographic and histopathological findings

Regional odontodysplasia: an evaluation of three cases based on clinical, microradiographic and histopathological findings

Clinical audit of children with permanent tooth injuries treated at a dental hospital in Ireland

AIM: To audit key demographic and clinical factors relating to treatment of trauma to the permanent dentition at the Paediatric Dental Department, Cork University Dental School and Hospital, Ireland and to compare clinical management with guideline recommendations. STUDY DESIGN: Clinical audit. METHODS: Consecutive clinical records for children attending for treatment of dental trauma were audited with regard to age, gender and distance travelled. The number of teeth per patient, the cause, type and prevalence of injury were examined. Splinting of mobilisation injuries and the prevalence of pulp extirpation were compared with published guidelines. RESULTS: Records were available for 94 children (65 male, 29 female) with a mean age at time of injury of 10.1 (SD±2.64) years. There were 82% of children living within 50 km of the Hospital. A total of 168 teeth were involved. Dental injuries comprised 39 uncomplicated crown fractures, 18 complicated crown fractures, 37 subluxations, 9 root fractures, 10 extrusions, 14 lateral luxations, 7 intrusions, 30 avulsions and 4 were unclassified. Sport injuries accounted for 23.2% of injuries to teeth, falls for 22.6%, bicycles were involved in 15.5%, other domestic accidents 6.5%, assault 4.2%, vehicles 3.0%, swimming 0.6%. and the remaining 24.4% were unclassified. In some instances of avulsion, lateral luxation, subluxation and extrusion injuries, a tendency to splint for durations longer than that recommended in guidelines was observed. Prevalence of pulpal extirpation for replanted teeth was in keeping with recommendations. CONCLUSION: General adherence to guidelines in respect of splinting and prevalence of pulp extirpation was demonstrated. Utilising a standardised recording system would facilitate the clinical audit process.

A study of the management of 55 traumatically intruded permanent incisor teeth in children

AIMS: These were to examine the main presenting, treatment and outcome factors for intruded permanent incisors in children, the effect of apical development and degree of intrusion on decisions on repositioning, the effect of apical development status on the maintenance of pulp vitality and the time of pulp extirpation and to compare the decisions made to the advice given in existing clinical guidelines. METHODS: A sample of 55 intruded incisor teeth in 40 children aged between 6 and 14 years of age was reviewed in respect of management of their intrusive dental injuries. Of these teeth 17 were intruded in females and 38 in males. Mean (±SD) age was 9.3 (±1.99) and mean follow-up time was 2.3 years (±1.60). Included in the sample were 42 maxillary central incisors and 13 maxillary lateral incisors. RESULTS: Immature apicies were noted in 34 whilst 21 teeth had mature apices. Clinical and radiographic assessment categorised 4 teeth as mildly intruded with displacement of less than 3 mms; 10 teeth, intruded by 3–6 mm, were considered as moderately intruded whilst a further 11 teeth with intrusion of more than 6mm were considered to have experienced a severe intrusive injury. There were 19 teeth (35%) that were allowed to re-erupt spontaneously, 22 (40%) were repositioned by orthodontic means and 14 teeth (25%) received surgical repositioning. CONCLUSION: There was a statistically significant difference between the repositioning decisions with a more conservative approach for teeth with immature apices (P = 0.0009). Apical completion was a significant predictor of earlier pulp extirpation (p=0.01).