Tove Irene Wigen

Intrusive luxation of permanent incisors in Norwegians aged 6-17 years: a retrospective study of treatment and outcome.

BACKGROUND/AIM External replacement resorption (ankylosis-related) is a severe complication leading eventually to tooth loss. Little information exists regarding the influence of variables such as degree of intrusion or treatment method on the development of replacement resolution in intruded permanent incisors. The aim of this study was to report the most frequently involved age group, the preferred type of treatment, and the type and frequency of healing complications. Special attention was paid to the effect of treatment on the occurrence of replacement resorption. MATERIAL AND METHODS Fifty-one intruded permanent incisors were studied in 20 boys and 19 girls aged 6 to 17 years. Only three patients were over 12 years of age. Complete intrusion had occurred in 21 teeth, and 31 teeth were classified as immature. Re-eruption was awaited for 37 teeth. The remaining teeth were repositioned orthodontically (7 teeth) or surgically (7 teeth). RESULTS Re-eruption occurred in 35 out of 37 teeth over a period of 3-12 months. After a mean observation period of 4 years ranging from 1-12 years, retained pulp vitality was recorded in 22 teeth (43%). Pulp necrosis had developed in 57%, inflammatory resorption in 26% and replacement resorption in 12%. Whereas all inflammatory resorptions were arrested after long-term calcium hydroxide treatment, replacement resorption always led to complete root resorption. In the analysis all orthodontic and surgical repositioned teeth were combined into an active treatment group. The non-active treatment group consisted of teeth allowed to re-erupt. The distribution of replacement resorption was significantly lower in teeth allowed to re-erupt than in teeth repositioned actively. CONCLUSIONS The best treatment of intruded incisors in 6-12 year-old children is to await re-eruption. Should endodontic treatment be required before re-eruption has occurred, a gingivectomy can be performed to gain access to the root canal.

Maternal health and lifestyle, and caries experience in preschool children. A longitudinal study from pregnancy to age 5 yr

In this study, associations were explored between maternal health and lifestyle during pregnancy and in early motherhood, and preschool childrens caries experience. The study was based on the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and on data from the Public Dental Services. A total of 1348 children were followed from pregnancy to age 5 yr. A clinical dental examination was performed at age 5 yr. Questionnaires were completed by the mothers during pregnancy and in the first 18 months of their childs life, and as part of the dental examination. Results from the multivariate logistic regression analysis showed that having an obese mother (OR = 2.3, 95% CI: 1.3-4.1), a mother who consumed a diet containing more fat (OR = 1.6, 95% CI: 1.1-2.5) or sugar (OR = 1.5, 95% CI: 1.1-2.3) than recommended, a mother with low education (OR = 1.5, 95% CI: 1.1-2.3) or one or both parents of non-western origin (OR = 5.4, 95% CI: 2.8-10.6) were statistically significant risk indicators for caries experience at age 5 yr. In conclusion, maternal weight and intake of sugar and fat in pregnancy were associated with caries experience in preschool children. These characteristics may enable early referral to the dental services and preventive care to be delivered.

Does early establishment of favorable oral health behavior influence caries experience at age 5 years

Abstract Objective. The purpose was to study associations between tooth brushing frequency, use of fluoride lozenges and consumption of sugary drinks at 1.5 years of age and having caries experience at 5 years of age. Methods. This study was based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and by the Public Dental Services. A total of 1095 children were followed from pregnancy to the age of 5 years. Questionnaires regarding oral health behavior were completed by the parents at 1.5 and 5 years of age. Clinical and radiographic examination of the children was performed at the age of 5 years. Results. In multiple logistic regression, having caries experience at 5 years of age was associated with; at 1.5 years of age having the teeth brushed less than twice daily (OR = 2.1, CI = 1.3–3.6) and being offered sugary drinks at least once a week (OR = 1.8, CI = 1.1–2.9) when controlled for family characteristics and oral health behavior at 5 years of age. Conclusions. Tooth brushing frequency and consumption of sugary drinks in early childhood were related to caries development during pre-school age, independent of family characteristics and oral health behavior at 5 years of age. The results indicate that early established habits regarding tooth brushing and consumption of sugary drinks have long-term effects on caries development. Parents encountering difficulties in establishing favorable oral health behavior in children’s first years of life should receive special attention from health personnel.

Tooth brushing frequency and use of fluoride lozenges in children from 1.5 to 5 years of age: a longitudinal study.

OBJECTIVES The purpose of the analyses was to study development, stability and changes in oral health behaviour - tooth brushing frequency, use of fluoride lozenges and fluoridated toothpaste in children from 1.5 to 5 years of age - and to study associations between oral health behaviour and family characteristics. METHODS This study was based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and data from the Public Dental Services. A total of 771 children were followed from 1.5 to 5 years of age. Questionnaires regarding oral health behaviour in children were completed by the parents three times during preschool age. RESULTS More than half of the children (52%) had their teeth brushed twice daily at 1.5 years of age, increasing to 61% at 3 years and 76% at 5 years of age. At 1.5 years of age, 37% of the children used fluoride lozenges daily, increasing to 74% at 3 years and 75% at 5 years of age. The majority of the children who had started brushing twice daily and used fluoride lozenges daily at 1.5 years of age continued these behaviours until the age of 5 years. At 1.5 years of age, children who brushed twice daily were more likely to use fluoride lozenges daily than children who brushed less frequently (P = 0.03). Multiple logistic regression showed that the probability of a child having its teeth brushed twice daily continuously during preschool age was higher when both parents were of western origin [odds ratios (OR) 4.0, confidence intervals (CI) 1.3-11.9] than when one or both parents were of non-western origin. Children with one older sibling brushed more frequently (OR 1.4, CI 1.0-1.9) and used fluoride lozenges more often (OR 1.6, CI 1.1-2.2) during preschool age than children without older siblings. CONCLUSIONS Oral health behaviour established in early life was stable during preschool age. The results indicate that tooth brushing frequency and use of fluoride lozenges were not in accordance with the present recommendations based on the scientific literature. The teeth of Norwegian preschoolers were brushed less frequently than recommended, and more children than recommended were using fluoride lozenges.

Referral of young children to dental personnel by primary care nurses

Oral health promotion to young children is delivered by primary care nurses as part of general health promotion given to all children in Norway. OBJECTIVE The objective was to evaluate established routines for referral of children by primary care nurses to the dental services and to study whether referred children younger than 3 years required contact with dental personnel. METHODS All children referred by primary care nurses to the dental services in one county during one year were included. Primary care nurses referred children using criteria developed by dental personnel. At the dental clinic, anamnestic information, dental health and oral health behaviour of the referred children were registered. RESULTS Altogether, 181 children were referred; 53% were younger than 3 years. The most frequent reasons for referral of children younger than 3 years were caries or dental plaque, and 34% had visible plaque accumulation and/or visible signs of caries. All referred children had at least one risk factor for caries. The referral reasons given by primary care nurses corresponded partly with findings at dental examination. The results indicated that 2% of the children younger than 3 years were referred to the dental services. CONCLUSION The results indicated that by using established referral routines, all children referred from well-baby clinics to the dental services were caries risk children who required early contact with dental personnel. However, the low proportion of children in the studied population referred by primary care personnel may indicate under-referral of children to the dental services.

Scandinavian multicenter study on the treatment of 168 patients with 230 intruded permanent teeth – a retrospective cohort study

BACKGROUND/AIM The aim of the study was to evaluate the survival of intruded permanent teeth related to treatment in a large number of patients, with special focus on development of pulp necrosis and replacement resorption (ankylosis-related resorption). MATERIALS AND METHODS The material consisted of 168 patients (mean age 9.6 years) with 230 intruded permanent teeth from dental trauma clinics in Copenhagen, Denmark, Stockholm, Sweden, and Oslo, Norway. The degree of intrusion was classified as mild (1-<3 mm), moderate (3-7 mm), and severe (>7 mm). Root development was categorized with respect to root formation and development of the apex into three groups of increasing tooth maturity: very immature, immature, and mature. RESULTS Awaiting re-eruption was the treatment of choice in 107 teeth (47%), orthodontic repositioning in 28 (12%) and surgical repositioning in 95 (41%) teeth. Pulp necrosis was diagnosed in 173 teeth (75%), infection-related root resorption in 57 (25%) and replacement resorption in 50 teeth (22%). Very immature teeth, teeth diagnosed with mild intrusion, and teeth awaiting re-eruption had significantly (P < 0.05) fewer complications. In a stepwise discriminant function analysis, choice of treatment, root development, and degree of intrusion were significantly (P < 0.05) associated with the development of replacement resorption. Root development and degree of intrusion were significantly (P < 0.05) associated with the development of pulp necrosis. CONCLUSION This study indicates that root development and degree of intrusion may be important for the development of pulp necrosis as well as replacement resorption, whereas choice of treatment only seems to influence the development of replacement resorption in intruded permanent teeth. Awaiting re-eruption resulted in the lowest risk for developing replacement resorption.

Response to letter to editor ‘Caries preventive self-care for children. Consistent oral health messages to the public?’

We appreciate that the topic of our study ‘Caries preventive self-care for children. Consistent oral health messages to the public?’ is relevant to readers of International Journal of Dental Hygiene from other parts of the world. In this paper, we compare the recommendations of the different health professions that give oral health education and the sources of information they report to use as basis for their advice. Anissian and co-workers emphasis some of our results based on experiences and research from other countries. Their statement that evidence-based information should be the basis for the basic education of all health professions that are involved in oral health promotion is consistent with the conclusion in our paper. Similar massages from different health personnel are desirable to enhance compliance with advice given to the public.