N. Kotsanos

An intraoral study of caries induced on enamel in contact with fluoride-releasing restorative materials.

The aim was to study the effect of three fluoride–releasing restorative materials on sound enamel of approximal teeth under cariogenic conditions intraorally. Bovine enamel slabs were paired with four hemispherical samples from each of three test materials (Ketac Molar, ESPE; Vitremer, F–2000, both from 3M) and one control material (Pertac II, ESPE). Their curved surface touched enamel at a contact point allowing space for plaque accumulation. Pairs were inserted in the buccal flanges of 2 lower dentures for 70 days. Initially and upon dismantling, enamel surface microhardness was measured and the increase in length of indentation in micrometers was recorded at a distance of 0, 0.4, 0.8 and 1.2 mm from the contact point. Respective values were: Pertac II: 16.0±7.5, 27.6±15.4, 38.6±23.3, 47.8±25.2; F–2000: 11.89±9.6, 15.8±14.2, 21.0±15.0, 25.1±15.2; Ketac Molar: 6.6±6.8, 9.4±7.0, 9.5±8.0), 13.4±9.4; Vitremer: 2.7±4.1, 3.5±3.5, 3.6±4.5), 7.4±5.2. Caries protection was Vitremer 82% > Ketac Molar 69% >F–2000 42% in relation to Pertac II (p<0.001). Sections of the slabs examined with polarized light showed typical subsurface lesions only in the Pertac II group, areas of pseudoisotropy in the F–2000 and Ketac Molar groups and no signs of lesion in the Vitremer group.

Reliability and validity of the Greek version of the Children's Fear Survey Schedule–Dental Subscale

BACKGROUND The Childrens Fear Survey Schedule-Dental Subscale (CFSS-DS) is a commonly used questionnaire which measures childrens dental fear. OBJECTIVE The aim of this study was to gather data to evaluate the psychometric properties of a Greek version of the CFSS-DS. METHODS A sample of 260 children aged 4-12 completed the Greek version of the CFSS-DS while in the waiting room of a paediatric dentist. The dentist, who was unaware of the childrens scores, rated the childrens behaviour during the dental appointment using the Frankl scale. Children who returned for a second dental appointment during the study period completed the CFSS-DS a second time. RESULTS The mean CFSS-DS score was 24.80 (standard deviation = 9.17). Age and gender were not related to mean scores. Invasiveness of dental treatment was not related to mean scores. Children who were most uncooperative/fearful on the Frankl had the highest mean scores (Kruskal-Wallis chi2 = 9.48; d.f. = 2; P = 0.009). The internal consistency (Cronbachs alpha) was 0.85, and the test-retest reliability (intraclass correlation) was 0.74. CONCLUSIONS The Greek version of the CFSS-DS appears to be reliable and valid. Further samples should include school samples, to include children who may not go to the dentist.

Evaluation of a resin modified glass ionomer serving both as indirect pulp therapy and as restorative material for primary molars

AIM: The successful performance of resin modified glass ionomer cement (RMGIC) as an indirect pulp therapy (IPT) dressing material and, independently, as a class II restoration material for primary molars has been adequately documented. This study investigates if an RMGIC can be successfully used in a dual capacity. METHODS: A total of 61, 3.5–8.5 year old children with deep proximal carious lesions in one or more primary molars, radiographically suspected of pulp exposure, were included. Exclusion criteria were: continuous unprovoked pain and an exposed or a non-vital pulp. Following adequate caries removal, RMGIC restorations were placed. The teeth were followed-up for signs/symptoms and for restoration survival according to modified United States Public Health Service (USPHS) criteria. Descriptive statistics were applied. RESULTS: The prospective study was completed with 86 restorations in 41 first and 45 second primary molars. Three of the 86 teeth showed pulp necrosis and the remaining 83 (96.5%) were a) asymptomatic for a mean clinical observation time of 31.9 months (SD 10.8) and b) with no radiographic signs of pathology for 25.7 months (SD 10.3). Seventy-six of these 83 (91.6%) class II-‘extended’ restorations were acceptable, exhibiting varying levels of occlusal wear. CONCLUSIONS: A single application of RMGIC was used successfully for over 2 1/2 years as an IPT and restoration material in proximal caries of primary molars.

dmfs and BMI in pre-school Greek children. An epidemiological study

AIM: This was to investigate the relationship between dental caries (dmfs) and body mass index (BMI) categories in 3–5.5 year old children in Thessaloniki, Greece. METHODS: The study was conducted in 18 municipal day care centres and involved 361 children. The dmfs was determined on site by one calibrated examiner using disposable dental mirrors and a penlight. The height and weight of the children were measured on site by a nutritionist, who grouped them into four BMI categories. STATISTICS: The estimation of the relationship between the BMI and dmfs values was based on a generalised linear model (Poisson log-linear regression) while the sequential Bonferroni method was used for pair-wise comparisons between BMI categories. RESULTS: Mean dmfs values for each BMI category were: 1.02 (SD±2.41 ) for the underweight (n=44), 0.74 (SD±2.24) for the normal weight (n=281), 1.88 (SD±4.28) for the overweight (n=26) and 0.80 (SD±2.53) for the obese (n=10). Overweight children were found to show statistically significant differences in dmfs values compared with both children of normal weight (p<0.001) and those underweight (p=0.015). CONCLUSION: Overweight Greek pre-school children are at higher risk of dental caries.

A form of 'parental presence/absence' (PPA) technique for the child patient with dental behaviour management problems.

AIM: This paper reports on the use of early introduction of a specific parental presence/absence (PPA) behavioural technique to manage the initially uncooperative child. METHODS: Using a prospective design, 440 healthy children aged 3 to 10 years visited a paediatric dental practice within 33 months. Children exhibiting initially Frankl ‘negative’ and ‘definitely negative’ behaviour were empathically offered parental presence only if they were cooperative. Otherwise, the parent stepped out until behaviour improvement. Statistics: t-tests and Chi-square tests were used to compare characteristics of initially cooperative and uncooperative children, as well as proportions of parents who were asked to leave the surgery. The technique’s success was assessed by a one sample binomial test. RESULTS: 75 of the children presented as Frankl either ‘negative’ (30) or ‘definitely negative’ (45) at theirfirst visit; 70 (93.3%, p< 0.001) responded to the PPA technique by displaying positive behaviour as their first visit progressed. 38 responded without the need to ask the parent to exit the practice room, while the other 32 responded only after their parent exited. 52 children had additional appointments, and 8 required an application of PPA at a second appointment; all children cooperated in all subsequent appointments. CONCLUSION: Early and empathic application of the PPA technique appears very successful in managing initially uncooperative child patients, suggesting that a randomised controlled trial of the technique is warranted

Comparison of Acceptance, Preference, and Efficacy Between Jet Injection INJEX and Local Infiltration Anesthesia in 6 to 11 Year Old Dental Patients

Needleless devices have been developed to provide anesthesia without injections. Little controlled research has examined the acceptability of needleless devices in pediatric patients. The aims of the study were to compare childrens acceptance and preference for one type of needleless jet injection with classical local infiltration as well as to evaluate the efficacy of the needleless anesthesia. Eighty-seven nonfearful children with no previous experience of dental anesthesia were studied using a split-mouth design. The first dental procedure was performed with the classical infiltration anesthesia. The same amount of anesthetic was administered using the INJEX needleless device in a second session 1 week later, during which a second dental procedure was performed. Patients rated their acceptance and preference for the 2 methods, and the dentist recorded data about the need for additional anesthesia. More negative experiences were reported for the INJEX method. Most (73.6%) of the children preferred the traditional method. Among the 87 treatment procedures attempted following the use of INJEX, 80.5% required additional anesthesia, compared with 2.3% of those attempted following traditional infiltration. Traditional infiltration was more effective, acceptable, and preferred, compared with the needleless INJEX.

In Vitro Inhibition of Enamel Demineralisation by Fluoride-releasing Restorative Materials and Dental Adhesives.

PURPOSE To determine the ability of 5 contemporary fluoride-releasing restoratives and 3 fluoride-releasing adhesives to inhibit enamel demineralisation surrounding restorations, and the associations between inhibition and the levels of fluoride released from these materials. MATERIALS AND METHODS Five fluoride-releasing restoratives (Fuji IX GP, Ketac N100, Dyract Extra, Beautifil II and Wave) and 3 fluoride-releasing adhesives (Stae, Prime & Bond NT and Fluoro Bond II) were investigated. Eight disks of each material were prepared. Fluoride release was measured daily using a fluoride-ion-selective electrode for 15 days. Twenty-four cavities for each group were restored with a restorative and an adhesive. Specimens were subjected to thermal stress and stored for 30 days in saline solution. After a 15-day pH-cycling regimen, two 150-μm-thick sections were derived from each specimen. Enamel lesion depth was measured at 0, 100, and 200 μm from each restorations margin via polarised light microscopy. RESULTS Of the restoratives investigated, Fuji IX GP released the most fluoride. The fluoride-releasing restoratives tested exhibited shallower enamel lesions than did the control group at all distances tested (p < 0.05). Fuji IX GP yielded significantly lower enamel lesion depth than did the other experimental materials. The depths of enamel lesions did not differ significantly when comparing restoratives applied with a fluoride-releasing adhesive with those applied with a non-fluoride-releasing adhesive. CONCLUSION The fluoride-releasing materials tested reduced enamel demineralisation but to different extents, depending on their levels of fluoride release. Fluoride-releasing adhesives did not influence enamel lesion formation.

A model for the production of artificial caries in the mouth in man.

Sixteen blocks of enamel were sliced from the buccal surfaces of caries-free human premolars and mounted in an appliance worn in the mouth by one individual for 6 months. Eight of the blocks were arranged in pairs with buccal surfaces in contact. The other eight were not in contact but were able to accumulate plaque by being recessed in the appliance. Lesions formed in all specimens, the depths of which were measured in ground sections; around contact surfaces, these formed at only half the rate of those not in contact. Histologically, lesions on contact surfaces were similar to natural lesions, but the shape of the artificially-induced lesions was greatly influenced by the curvature of the buccal enamel.

Erosive Tooth Wear and Related Risk Factors in 8- and 14-Year-Old Greek Children

The aim of the present study was to investigate the erosive tooth wear of primary and permanent teeth and its association with related risk factors. Two groups of Greek children aged 8 (n = 329) and 14 years (n = 263) were examined in the classroom using the Basic Erosive Wear Examination (BEWE) index. Data concerning risk factors were collected using questionnaires. Dental caries (DMFS/dmfs) was also recorded. The data were analyzed using the t test, one-way ANOVA, multiple regression analysis, Fishers exact test, and the χ2 test. In the 8-year-olds, the primary teeth showed a predominantly medium level of wear and the permanent teeth no wear. A majority of the 14-year-olds exhibited low risk levels of wear. The most frequently affected dental surface in both age groups was the occlusal surface of the mandibular posterior teeth. In the 8-year-olds, BEWE scores and the prevalence of wear in the primary teeth was influenced by gender (p = 0.020). In their permanent teeth, soft drink consumption (p < 0.0001) and preference for lemon/vinegar (p = 0.041) significantly affected wear prevalence and BEWE scores, while habitually retaining soft drinks in the mouth influenced wear prevalence (p = 0.008), risk (p = 0.004), and BEWE scores (p = 0.022). In the 14-year-olds, wear prevalence was significantly affected by the consumption of lemon-flavored candies (p = 0.016) and soft drinks (p = 0.050). BEWE scores were significantly affected by gender (p = 0.022) and soft drink consumption (p = 0.030). Gender influenced tooth wear risk in both age groups (p = 0.010 and p = 0.021, respectively). The results of this study indicate that erosive tooth wear differed between primary and permanent teeth and was influenced by gender and dietary factors.

Proposed requirements for a European doctorate in dentistry: a discussion document prepared by a special interest group under the auspices of the Association for Dental Education in Europe

In the Bologna process a third cycle is distinguished at the doctoral level. In documents on the Bologna process it is advocated to harmonise the structure and requirements of the doctorate, which in Europe are characterised by a wide variety. Differences exist in all possible requirements between countries, and even between schools within one country differences can be seen. In this paper an inventory is made of these differences in the dental doctorate between European countries. Moreover, the need for necessary harmonisation of requirements for a European dental doctorate is strongly advocated and a proposal is presented.