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Aim: To examine the reasons for referral to the Paediatric Dental Department, Cork University Dental School and Hospital, Ireland and to study the profile of these reasons in terms of the various sources of referral. STUDY DESIGN: Clinical review. METHODS: Consecutive clinical records for children attending the service were reviewed with regard to a child's age at initial attendance, the reason for referral and the source of referral. Reasons for referral were recorded based on a defined list of acceptance criteria and were categorised by their different sources of referral. RESULTS: Records were available for 612 children with a mean age at time of initial consultation was 9.13 (SD± 3.94) years. Reason for referral; children who had difficulty co-operating for dental treatment made up the largest group (36.1%). Children who only required treatment planning comprised 25.0% of the total. Source of referral: 56.0% of consultations were from the salaried public dental service and 31.2% from private dental practitioners. Forty seven patients (7.7%) were from emergency department, while 31 (5.1%) were from medical practitioners. From the public dental service, 51.0% of referrals were for children who had difficulty co-operating for dental treatment and 22.7% were for treatment planning only. Referrals from private dental practitioners were most commonly for treatment planning only (38.2%). The proportion of referrals from the public dental service for children who had difficulty cooperating for dental treatment was twice as high as from private dentists. The proportion of referrals for trauma and for extensive dental disease from private dental practitioners was twice as high as from the public dental service. Almost all attendances from an emergency hospital department were for dental trauma. The majority of attendances from medical doctors were for medically at risk patients. CONCLUSIONS: Children with difficulty cooperating for dental treatment made up the largest single group of children attending the service. The majority of children attending were referred from the salaried public dental service. [ABSTRACT FROM AUTHOR]

Abstract: Background: The Physiological Profile Assessment (PPA) assesses falls risk in older adults by measuring impairments most associated with multiple falls. To date, no study has investigated the change in PPA impairment profile with age. Objective: To describe impairment profiles, by age and ability to complete the postural sway measure, of older adults fallers. Participants: We note that 885 older adults referred to multidisciplinary falls clinics located within two inner London boroughs (UK). Methods: Anonymised data was extracted from the PPA falls risk database. For comparisons, data was grouped by gender, age, and ability to complete the postural Sway test. Results: There were significant differences between all age groups in PPA falls risk, edge contrast sensitivity, quadriceps strength (Quad), postural sway and reported falls within the previous year (P <0.01). The oldest age group (90+) had the highest PPA falls risk (P <0.01), yet reported significantly less falls than the youngest age group (60 to 69; P <0.05). There was significant variability in test results, with younger age groups displaying greater variability across PPA measures, and older age groups displaying more consistency (P <0.05); 15.1% (n =134) of patients that were able to perform the postural sway measure received a higher risk score for this test than those unable to complete the task. Conclusions: Greater variability in younger age groups indicates that specific impairments may provide the cause of falls, whereas widespread global reduction in function and frailty may provide the cause for falls in the older age groups. The postural sway scoring does not reflect ability to perform the test. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

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). [ABSTRACT FROM AUTHOR]

This study examines the treatment of non-vital immature permanent incisors using the calcium hydroxide apexification technique. There objectives of the present study were to determine the speed and location of barrier formation and those factors discernible at presentation and during treatment which may be related to it. Forty-four non-vital immature incisors undergoing calcium hydroxide apexification were reviewed in detail. All cases were reviewed every 8-12 weeks for up to 18 months, or until apexification occurred. Details of the time and nature of the injuries and treatment were recorded. The degree of apical development prior to treatment was assessed, and barrier formation, location and time were noted. Mean time to barrier formation was 34-2 weeks (range 13-67 weeks). The strongest predictor of rapid barrier formation was the rate of change of calcium hydroxide and a barrier also formed more rapidly in cases with narrower initial apical width. There was evidence of displacement and a higher mean time for barrier formation in half of the cases. The presence of an abscess was the weakest predictor of rapid barrier formation and the effect was not significant (P=0.280). The barrier was located at the apex in 28 cases (63.6%) and the distance from the barrier to the apex for the remaining 16 (63.4%) varied from 1 mm to 4 with a mean of 1.9, and there was a higher mean number of calcium hydroxide placements in the cases where the barrier was located at the apex. [ABSTRACT FROM AUTHOR]

Avulsion is a serious injury which can cause damage to some or all of the dental and surrounding tissues. This study examined the profiles of teeth showing inflammatory resorption, in terms of time prior to reimplantation, contamination, pulp extirpation time and period of splinting and compared them to teeth without resorption. There were a total of 71 children in the present study (mean age 9.8 years, range 6.16 years) with a total of 84 reimplanted teeth. Inflammatory resorption was present in 22 teeth. There was a significant relationship between the presence of inflammatory resorption and the time the teeth were dry prior to reimplantation, with a lesser effect for total delay time. There were slightly later pulp extirption times for teeth with inflammatory resorption, with median delays of 16 and 11 days respectively and increased inflammatory resorption was present in 40 teeth. There was a significantly longer splinting time in teeth with replacement resorption and more resorption in teeth splinted for longer than 10 days. It was concluded that pulp extirption time was not critical unless the delay exceeded 20 days and that splinting time should not exceed 10 days. [ABSTRACT FROM AUTHOR]