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OBJECTIVE: To determine whether or not drooling in children with cerebral palsy is due to hypersalivation. POPULATION AND METHODS: The study population consisted of 10 children with cerebral palsy who were identified as having severe drooling, and a matched control group composed of 10 unaffected children who had no known physical or mental disabilities. Salivary flow rate was compared between the cerebral palsied children and the control group using the chin-cup collection drool quantification method described by Sochanjwskyj. Components of the system included a cup-like collection device, a vacuum pump, plastic tubing, an airtight collection chamber, and calibrated test tubes held against the subject's chin with elastic straps attached to an orthodontic head bonnet. Statistical analysis was completed using the Student's t-test and Fisher's Exact Probability test. RESULTS: The ages of the population ranged from 5.2 to 15.6 years, mean age (+/- SE) of 10.56 +/- 1.13 years. There was no statistically significant difference in the rate of salivary flow rate between the two groups' mean +/- SE: cerebral palsy group 0.220 +/- 0.018; control group 0.334 +/- 0.052 (P = 0.053). The results were further confirmed by comparing the buffering capacity (P = 1.00) and concentrations of the sodium (P = 0.065) and potassium ions (P = 0.058) in the saliva of the study groups. CONCLUSIONS: Children with cerebral palsy who drool do not appear to produce excess saliva. Their salivation is similar to the control children. [ABSTRACT FROM AUTHOR]

Introduction: Molar-incisor-hypomineralisation (MIH) has been identified in recent years as a condition affecting the first permanent molars and, in some cases, the permanent incisors. Many factors have been suggested as to its aetiology. Examples of MIH have also been reported in skeletal remains in the past. These historical examples have, however, been for unknown individuals., Case Report: A skull that has become available for dental examination that is uncertainly attributed to be that of Lady Eleanor Talbot (c.1436-1468) who ended her life as a Carmelite nun in Norwich (England). The dental findings of the examination showed enamel defects of molar teeth 36 and 46, as well as small areas on other molars, and striations of the enamel of permanent anterior teeth consistent with MIH. There is exposure of the roots of some maxillary teeth with resultant root caries. The presence of areas of enamel decalcification commensurate with 'Turner teeth' on 43 and 44 indicates that there were likely to have been periapical abscesses secondary to dental caries of the primary teeth. In addition, there is occlusal wear of all of teeth with extensive calculus and periodontal exposure of the roots of the mandibular incisors. Failed development or very early ante-mortem loss of premolars 15 and 25 is evident, as well as evidence in the same region of a large abscess cavity with extensive maxillary bone destruction. Healing cribra orbitalia, porosity, which is considered to be an indicator of nutritional stress, is visible on the superior aspect of the left orbit., Conclusion: A case of MIH is reported in a skull dating from the mid-15th century.

Background: Research today requires detailed planning to ensure efficient work, to raise funding and to fit into time constraints., Aim: The aim of this article is to provide a broad guidance on the layout and content of a research protocol., Method: Years of experience in writing research protocols were used to give guidance on writing, timings, content, layout and successful completion.

Background: Research involving human subjects requires approval by a research ethics committee before commencement. What appears to many researchers to be a daunting task can be relatively easy if approached sensibly., Aim: The aim of this paper is to offer advice to potential applicants for ethics approval of their research., Method: The paper provides practical information, based on years of experience, for novice and experienced applicants to a research ethics committee.

Background: The publication of basic science and clinical research findings, as well as new clinical diagnosis and treatment techniques, is widely disseminated. These days there is considerable competition to publish so the selection process is even more competitive., Aim: To present advice as to how to enhance the chances of being published and more importantly how to prepare a paper for submission., Method: Instructions are presented as to the steps to be taken in writing a scientific manuscript. This covers Introduction, Materials and Methods, Results and Discussion. Guidance is given as to what should be included and also what should be left out. The precision of writing is paramount and scientific text needs to be simple, easily read and translated by those whose day-to-day language is not English. Advice is given on journal selection and how to ensure the best chance of manuscript acceptance.

Aim: To provide guidance on writing congress abstracts for submission and how to increase the chance of acceptance., Review: There is increasing competition for submitted abstracts to be accepted by scientific congresses. Because the facilities or size of a congress may be limited a selection process is often used based upon the quality of abstracts submitted. Accordingly, it is crucial for a researcher to prepare an abstract very carefully to ensure the best chance of acceptance. The approaches to preparing an abstract and the techniques for enhancing quality are reviewed. Suggestions and guidance are given to ensure the production of a well structured, informative and scientifically sound abstract.

Aim: To provide guidance on reviewing scientific manuscripts for publication., Review: Scientific peer review is possibly one of the most important tasks a scientist is asked to do. It carries a great responsibility and needs to be conscientiously and thoroughly carried out. It is most important that a reviewer decides very quickly whether to undertake a review and if so to complete the task. It must at all times be objective, as positive as possible and seen as contributing to the advancement of our knowledge. This review provides suggestions as to best practice in reviewing a scientific manuscript in dentistry. The various aspects of importance: accepting or declining a review, objectivity, approaches to reading and taking notes, assessment of methods, validity and reproducibility of results and evaluating a discussion, are covered in detail and the standards that are required considered. Suggestions are made as to how a review should be reported.

Background: Behaviour management is widely agreed to be a key factor in providing dental care for children. Indeed, if a child's behaviour in the dental surgery/office cannot be managed then it is difficult if not impossible to carry out any dental care that is needed. It is imperative that any approach to behavioural management for the dental child patient must be rooted in empathy and a concern for the well being of each child., Review: Based on various presentations given at Congresses of the European Academy of Paediatric Dentistry (EAPD), documents reviewing behaviour management prepared by the Clinical Affairs Committee of the EAPD, and written submissions to the Executive Board of the EAPD, a review of the various approaches to the behaviour management of the child dental patient was completed. All aspects of non-pharmacological behavioural management techniques described in the literature over the past 80 years were reviewed., Findings: There is a very wide diversity of techniques used but not all are universally accepted by specialist paediatric and general dentists. Wide cultural and philosophical differences are apparent among European paediatric dentists that seem difficult to bridge when forming agreed guidelines. Accordingly, this review highlights those behaviour techniques that are universally accepted such as tell, show, do (TSD) or positive reinforcement, but nevertheless describes the most commonly mentioned techniques for which there are descriptions in the literature., Conclusion: A wide variety of behavioural management techniques are available to paediatric dentists which must be used as appropriate for the benefit of each child patient, and which, importantly, must take into account all cultural, philosophical and legal requirements in the country of dental practice of every dentist concerned with dental care of children.

Background: Fluoride has been used to combat dental caries using a number of different clinical approaches. An exciting relatively new development is fluoride slow-releasing devices that consistently elevate intra-oral fluoride levels of plaque and saliva for prolonged periods of up to two years., Methods: The literature on the use of slow-releasing fluoride devices in dentistry were reviewed. A Medline search on key words was carried out. All papers in English were individually reviewed., Results: Slow-releasing fluoride devices have been shown to be effective in elevating salivary fluoride levels in both animals and human studies and to enhance the remineralisation of dental enamel. They have been demonstrated to be safe to use and without the risk of fluoride toxicity. A double blind randomised clinical trial demonstrated 76% fewer new carious surface increment in high caries-risk children after two years., Conclusions: These devices have a number of potential uses in dentistry and in particular have great potential for caries prevention of non-compliant high caries-risk groups.

The aim of this study was to conduct a review of the literature to assess the relationship between quantity and pattern of sucrose use and dental caries. Using hand and electronic methods (MEDLINE, EMBASE) the literature was searched for epidemiological papers concerning any relationship of sugars and dental caries published since 1856. Superficial hand searching was carried out between 1856 and 1940, detailed hand searching 1940-1966 and electronic 1966-2007. Selection criteria were set based on, but not confined to, Cochran style standards. Investigations were categorized as A, fulfilling all criteria; B1, relevant fulfilling 19 of 23 criteria; B2, relevant but fulfilling only between 12 and 18 of the selection criteria; and C, all other papers. There were 95 papers meeting most (more than 12) or all of the selected criteria. Only 1 paper was graded A; 31 as B1. There were in addition some 65 as B2 and all the rest as C, which were discarded. There were a wide variety of study designs and those graded A or B1 comprised 23 ecological cross-sectional, 7 cohort and 2 case control studies. Summary results showed that 6 papers found a positive, significant relationship of sugar quantity to dental caries, 19 of 31 studies reported a significant relationship of sugar frequency of use to dental caries. The balance of studies does not demonstrate a relationship between sugar quantity, but a moderately significant relationship of sugar frequency to dental caries.

Aims: To study the fluoride release and retention of new-shaped glass slow-release F devices (SRFD) in vivo in children., Methods: A group of 15 children had a SRFD with 17.4% or 14.8 mgm F with a relative solubility of 294, attached intra-orally on the buccal surface of one of their maxillary permanent molars. The devices were monitored for six months., Results: The retention rate of the devices was 93% and the mean salivary F levels in the child volunteers was 01.17+/-0.1 ppm F compared with 0.025 ppm F baseline levels. The difference was statistically significant (p<0.01). There were no systemic or local side effects., Conclusions: The devices were well tolerated by children and released fluoride intra-orally for the whole period of six months to a level consistent with inhibition of demineralisation.

Aim: To evaluate the benefit-cost (B/C) and cost-effectiveness (C/E) of a long-term dental health education program to prevention 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.

Aim: This is was 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 to setting up assessment criteria with 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 23 criteria that were felt to be appropriate. The list of 23 criteria were deemed to be appropriate for pulp therapy and 21 for restorative techniques and materials. Conclusion.A set of clinically based criteria is suggested for the systematic review of publications on restorative techniques for primary teeth.

In recent years there has been increased interest in the role of commercial soft drinks in dental diseases namely as dental caries and erosion. The objective of this paper has been to review the past and current literature to determine the present knowledge on this subject. The literature related to dental caries, erosion, drinks, soft drinks and fruit juices was reviewed. The literature shows efforts have been taken to modify soft drinks by either adding or deleting certain components so as to reduce their harmful effects on teeth. A rational protocol to encourage the sensible use of drinks and the modification of drinks to render them less harmful would be advisable.

Aim: This study was designed to find the most reliable method of measurement of mesiodistal tooth diameter., Methods: Measurements were made of all erupted permanent teeth of 14 orthodontic study casts. These measurements were made directly by using A) a digital calliper, B) measuring photocopies of casts with a calliper, C) a Magiscan Image Analysis using a photocopy of the casts. Measurements derived from the two methods were compared by statistical analysis., Results: These showed that the electronic digital calliper was the most reliable method of measuring mesiodistal tooth diameter using dental study casts. The measurement of photocopies was unreliable and the image analysis method had a too high error factor.

The objective was to test a fluoride-containing slow-release device in preventing dental caries in children. Accordingly a population of 174 children aged 8 years living in a high-caries, low socio-economic area of Leeds (UK) was assembled. Two slow-release/dissolving glass (SFG) pellets, one with fluoride (F) and one without, were randomly attached to the maxillary molars of the children. Baseline caries as dmft/s, DMFT/S, periodontal disease, plaque and calculus were recorded using standard indices. Unstimulated saliva samples were collected 2 h postprandial for F analysis. All parameters were measured at 6-month intervals for 2 years. There were 132 children completing the trial of whom 63 (test n = 31, control n = 32) still retained the glass devices at the end. Comparison of mean values for gingival health and calculus showed no differences between groups throughout the trial. Mean caries as dmfs at the end of the trial (2.26) was significantly lower for the test (SFG, 2.26) compared with that for the control children (8.41; p < or = 0.001). DMFS was significantly lower at 0.84 and 2.34, respectively (p < or = 0.05). Mean salivary fluoride concentrations were 0.11 and 0.03 mg/l for test and control groups. It was concluded that placement of a glass slow-releasing fluoride device significantly reduced caries incidence in a group of low socio-economic schoolchildren over 2 years., (Copyright (c) 2005 S. Karger AG, Basel.)

Aim: To compare the findings of a clinical examination with those from bitewing (BW), panoramic (Pan) and panoramic plus bitewing (PanBW) radiographs for dental caries in children., Method: A population of 39 children, aged 3.8 to 11.9 years, who required radiographs as part of their initial assessment for care in the Department of Paediatric Dentistry (Leeds), was selected. Each subject was examined clinically for dental caries. Subsequently, a paediatric dentist and a specialist in dental radiography read the radiographs., Analysis: A database in Microsoft Access was used to compare the examiners readings for each radiographic view; agreements were taken to be a consensus. Disagreements were re-viewed by both examiners to arrive at a consensus. Radiographic results were compared with those of the clinical examination., Results: The clinical examination identified 6.0% (95% CI 4.1 to 7.8, p<0.001) more carious surfaces than Pan. Clinical examinations also identified more carious surfaces than BW 1.2% (95% CI -0.7 to 3.2, p<0.247) and PanBW 0.6% (95% CI -1.1 to 2.3, p<0.533) but these differences were not statistically significant. When occlusal surfaces only were compared, the clinical examination identified significantly more carious occlusal surfaces then BW (15.2%, p<0.001), Pan (17.1%, p<0.001) and PanBW (13.5%, p<0.001). Comparing the approximal surfaces only, the BW and PanBW identified significantly more carious surfaces than the clinical examination, 5.1% (p<0.001) and 4.3% (p<0.001) respectively., Conclusion: The use of a clinical examination with PanBW provided the maximum information on dental caries in the primary and mixed dentitions, particularly for approximal surfaces. This is important in planning comprehensive dental care for children.

Aims: The aims were to evaluate a) whether a slow release fluoride-glass pellet (SFG) would be retained in the mouth and release fluoride (F) over a long period of time, b) what concentrations of F in the glass would provide ideal intra-oral saliva F concentrations and c) whether an SFG would affect blood plasma concentrations of F after swallowing compared with ingestion of a commercial NaF tablet., Methods: a) A prototype SFG was attached to a maxillary molar of a volunteer. Baseline saliva F concentrations were measured prior to glass placement, daily in week one; one day a week for weeks two to three and then one day a month up to 18 months. Four subjects had the SFG for six months with saliva F concentration assessments at periodic intervals. b) SFGs containing F at 13.3%, 18.3% and 21.9%, and an improved solubility, were tested using three volunteers and saliva F concentrations measured. c) Five volunteers each swallowed either a SFG or a NaF tablet. Blood plasma samples were taken at baseline and F measured at time intervals of 2.5, 5, 10, 20, 30, 45, 60, 90 and 120 mins post-ingestion., Results: a) The prototype SFG were successfully retained and released F into saliva; mean concentrations of 0.035 mg L(-1) were achieved lasting for over 18 months. Overall saliva F concentrations were approximately doubled. Analysis of the pellet at the end of use showed it still contained some F possibly indicating a recharging effect. b) The 13.3% F concentration SFG produced significantly higher saliva F levels than the two other concentrations tested. The two higher concentration F glasses contained aluminium as part of the formulation of the glass structure, which is known to bind F whereas the 13.3% glass contained F alone. c) While blood plasma F levels increased after ingestion of the NaF tablet there was no increase in F when the SFG was swallowed., Conclusion: A slow release F containing glass device showed promise as a means to enhance intra-oral F saliva concentration.

Aim: To examine the anxiety levels of children referred for dental general anaesthesia and their parents at various key points of the referral and anaesthetic procedure., Methods: Structured interviews and anxiety measures were conducted with 50 children attending the Department of Paediatric Dentistry, Leeds Dental Institute, and progressing to general anaesthetic (GA) and their parents. Interviews were conducted with parents and children prior to initial assessment, following assessment and prior to a GA. Anxiety was measured at each interview, using the Visual Analogue Scale for parents and the Venham's Picture test for children. A fourth telephone interview was conducted with parents one week after the GA when the degree of upset caused to parents and children by the procedure was evaluated., Results: Anxiety of children remained constant at each interview. Parent and child anxiety were not related. There was a rise in parent anxiety following initial assessment in those families attending in response to a routine referral and progressing to GA (p<0.05). There was a further rise in parent anxiety in these families immediately prior to the GA itself (p<0.001). Parent upset was strongly related to their anxiety at each of the three interviews prior to the GA (p<0.01, 0.05 and 0.001 respectively) and to the distress of their child (p<0.02). Child distress was strongly related to anxiety at each of the three interviews prior to the GA., Conclusion: The anxiety levels of children did not appear to change throughout the whole GA assessment and treatment process. Parent anxiety rose significantly following assessment and again just prior to the GA. Factors contributing to parent upset post treatment were child upset and pre treatment parent anxiety levels. Children who were most anxious prior to GA found the procedure most distressing.

Prevalence of drooling in children with cerebral palsy (CP) and its severity across dental age (i.e. children with primary, mixed, and permanent dentitions) was investigated. One hundred and sixty children and adolescents (91 males, 69 females; mean age 10 years 10 months, SD 4 years 2 months; range 4 to 18 years) with CP who attended special schools were involved in this study. Sixty eight per cent of participants had spastic CP with the majority (45%) diagnosed as having quadriplegia. Presence or absence of drooling was determined by direct observation of the participants. Other data, such as age, sex, learning disability, and type of CP were collected using questionnaires. Results showed 93 of 160 children (58%) with CP had a drooling condition and of these 53 (33%) had severe drooling. It was found that the degree of drooling decreased as the child's dental age increased. Prevalence of drooling in children with primary dentition was found to be 75% as compared with 43% of those with permanent dentition, although this difference was not statistically significant. It was concluded that any invasive treatment to reduce drooling should, perhaps, be postponed until the child's oromusculature has matured.

Aim: The purpose of the study was to determine if there had been any changes in the clinical practice and attitudes to the care of children by general dental practitioners over a ten year period from 1986 to 1996, following the introduction of a system of capitation payments in the United Kingdom., Methods: A questionnaire was mailed to 1,290 general dental practitioners practicing in Yorkshire (UK) in an identical way to a previous survey ten years before. Practitioners were asked questions concerning their practice of dental caries prevention, behaviour management, restoration of primary teeth and pulp therapy. Responses were compared with the results of the 1986 survey., Results: Of the total of 687 replies (53.2% response) 61% practiced, or said they practiced, diet evaluation and gave dietary advice. Oral hygiene instruction was reported by 87% and 57% used fissure sealants. The routine use of amalgam, previously 80%, had declined to 35% in favour of glass ionomer cements (57%). There had been a significant improvement in the use of pulp therapy for primary teeth at 35% compared with previous 3%. The use of rubber dam also increased, but only from 0% before to 9% in the present study. The usage of stainless steel crowns had changed from 2% over ten years to 8% and strip crowns from 1% to 5%., Conclusion: The use of paediatric dental techniques by general dental practitioners had generally increased, particularly in preventive measures and pulp treatment. Restorative techniques had marginally changed, but a dramatic shift away from amalgam had occurred. There was still a very low usage of stainless steel crowns and rubber dam was also not used to the extent that it should be.

Aim: This study aimed to determine the effect of a long-term dental health education (DHE) for mothers with young children on the level of salivary Streptococci mutans (SM) and their association with caries in young children., Methods: A randomly selected cohort of 228 children born between 1 January and 30 September 1995, in a low socioeconomic high caries suburb of Leeds (UK), was divided into the following groups: A) DHE focused on diet; B) DHE focused on oral hygiene instruction (OHI) using fluoride toothpaste; C) DHE by a combined diet and OHI message. DHE was given using an interview and counselling for at least 15 minutes in each child's home, every three months for the first two years and twice a year in the third year of the study. A fourth group D was given diet and OHI, at home, but once a year only. The children in a fifth group E (control), received no DHE and were never visited, but examined at three years of age only. All children and mothers were examined for caries using the BASCD criteria. The levels of salivary SM were determined by sampling of bacteria from the oral cavity with a 1.8 cm wide wooden spatula, after giving the mother a paraffin pellet to chew for a minute and in children using unstimulated saliva. Bacteria were plated out and counted using image analysis for counting colonies., Results: At three years of age the difference in the level of salivary SM between groups was not statistically significant. However, in group E there was a statistically significant relationship (p<0.05) between salivary SM and caries in children., Conclusion: The difference in the level of salivary SM between groups given various programs of dental health education was not statistically significant. There was a statistically significant (p<0.05) relationship between salivary MS and caries in children.

Aim: An epidemiological study was designed to determine the prevalence of enamel defects in first permanent molars in English children of ethnic backgrounds., Materials and Methods: A population of school children aged seven years, living in the low water fluoride City of Leeds (UK) were examined for the presence of developmental enamel defects in first permanent molars. The examination criteria were based on the DDE index for screening surveys. The ethnic background to the children examined was determined by school records, name and visual assessment., Results: The results for 307 children (154 females) showed an overall prevalence of defective enamel in first permanent molars of 14.5% and tooth prevalence of 7.2%. There were effects of gender or tooth site. There was no significant difference in prevalence between White-Caucasian (17%) or Asian-Caucasian (10%) children. The demarcated opacity was the most frequent type of defect seen, followed by diffuse opacities and hypoplasia. The occlusal and buccal surfaces were the most commonly affected., Conclusion: As there were no significant differences in prevalence between children of different ethnic groups it was concluded that the aetiology of enamel defects in permanent molars was most likely affecting all children.

Aim: The study was carried out to determine whether showing a local analgesia (LA) syringe to a child would influence behaviour during subsequent administration of LA, as opposed to concealing it., Materials and Methods: 25 children were randomly assigned to either a show (13) or no-show (12) group. The children were aged 4 years and 3 months to 8 years and 9 months, mean age 7 years and 9 months. One operator carried out all LA administrations. The procedure and dialogue were strictly standardised. Each child was filmed during LA administration. Three paediatric dentists scored the video recorded behaviours, using the Frankl Behaviour Rating Scale. The raters were blind as to which group the child belonged to., Results: No statistical difference was found between the behaviour ratings of the no-show and the show groups during LA administration (p>0.05)., Conclusion: Overall, the behaviour of the children in the show group did not differ from the behaviour of children in the no-show group. Whether to show or not to show the LA syringe is probably dependent on the behavioural skills of the operator.

AIM: The study was designed to compare the efficacy of the Superbrush three-headed with a conventional brush for oral hygiene in children. MATERIALS AND METHODS: The study population was 78 children attending three primary schools in Leeds (UK). The clinical trial consisted of a single blind, randomized, four visits, crossover and single use toothbrush design. Subjects were randomized to one of two test groups (A and B). The 16-week trial consisted of four visits with a washout period of four weeks between the second and third visits. Both brushes were used with a horizontal mini-scrubbing strokes technique. Plaque scores were recorded at each visit using the Quigley and Hein Plaque Index as modified by Turesky et al. [1970]. RESULTS: Using a paired t-test the results from the outcome measures of the four visits indicated that buccally the conventional brush was superior in plaque removal to the three- headed brush, lingually there was no difference between brushes. Although over-all plaque removal was similar for both brushes, 85% of the children preferred the Superbrush. CONCLUSION: Significant improvements in plaque removal in children can be achieved following good tooth brushing instructions regardless of the design of toothbrush used.

Assessment of the acidogenic and cariogenic erosive potential of foods requires the use of reproducible and standardised methods. The methodology laid down at the San Antonio conference in 1985 remain today the basis for research on and the testing of foods. The 1999 workshop has updated the appropriate methodology and introduced guidelines on the testing of erosive potential of foods. It is to be hoped that researchers wishing to evaluate foods and their effect on the teeth will continue to use these methods.

The results of the UK Child Dental Health Survey of 1993 indicated that dental erosion was a problem in children, with acidic dietary components thought to be the main etiological factor. The aim of this study was to compare, in the form of a case control study, the diets of children with dental erosion with those who were caries-active or caries-free. Structured dietary histories were taken from 309 age and gender matched children to determine the type and frequency of intake of acidic foods and drinks, together with any drinking habits that prolonged exposure of the teeth to dietary acids. Results showed that the children with erosion drank acidic beverages significantly more frequently than children who either had caries or were caries-free. Children with erosion also drank milk or water significantly less often than the control groups, and were more likely to have a swishing or holding habit associated with drinking. Fruit and vinegar consumption was higher in the erosion group, as was the taking of vitamin C supplements. The results of this study suggest that the increased consumption of acidic foods and drinks, particularly when associated with a swishing or holding habit, may contribute to the development of erosion in some children. Dietary advice should emphasize the dangers of a highly acidic as well as that of a cariogenic diet.

Aim: To determine the effect of dental health education (DHE) on caries incidence in infants, through regular home visits by trained DH Educators over a period of 3 years., Method: A randomly selected cohort of 228 children born between 1st January and 30th September 1995, in a low socioeconomic/high caries suburb of Leeds (UK) were divided into the following groups: A) DHE focused on diet; B) DHE focused on oral hygiene instruction (OHI) using fluoride toothpaste; and C) DHE by a combined diet and OHI message. DHE was given using an interview and counselling for at least 15 minutes at home every 3 months for the first 2 years and twice a year in the third year of the study. A fourth group D was given diet and OHI, at home, once a year only. All children and mothers were examined for caries and oral hygiene. A fifth group E (control) received no DHE and were never visited but examined at 3 years of age only., Results: In the groups of children visited regularly only two developed caries and three had gingivitis (all in group A). In group E, however, 33% of children had caries and nine (16%) had gingivitis. The differences in caries levels and caries risk factors between study and control groups were statistically significant (P < 0.001). Mothers of the study groups also showed an improvement in their own levels of gingivitis, debris and calculus scores by the second and third examinations (P < 0.001)., Conclusion: Regular home visits to mothers with infants, commencing at or soon after the time of the eruption of the first deciduous teeth, was shown to be effective in preventing the occurrence of nursing caries.

Dental erosion is becoming a major dental problem in both children and adults. The aim of this study was to measure the salivary flow rates, buffering capacity and mutans streptococci counts in children with erosion, and compare them to age- and sex-matched caries-free and caries-active individuals to establish which factors may be important in erosion. The study was conducted as a case-control study with standard methods of salivary and mutans streptococci measurement. The results showed significant differences for mutans streptococci counts (p = 0.05), unstimulated and stimulated salivary pH and buffering capacity (p = 0.001). These results suggest that although individuals with erosion have caries experience similar to a caries-free individual, their salivary characteristics more closely match those of a caries-active subject. The tests described are simple to carry out and may be useful in explaining individual patient susceptibility.

Purpose: This study was performed to determine the prevalence of dental disease in British school children with asthma., Methods: A convenience sample of 100 asthmatic children (aged 4-16 years) was examined for dental caries, periodontal condition, and tooth surface loss. School children, equated for age, sex, race, and socioeconomic status were chosen for comparison. Children were divided into two age ranges; 4-10 and 11-16 years. A significant difference was found in DMFT (0.96 vs. 0.31) and DMFS (1.37 vs. 0.37) between the 4-10-year-old asthmatic children compared with healthy control children., Results: In the 11-16-year age range, the asthmatic children had a DMFT and DMFS of 2.48 and 3.39 compared with the control children who had a DMFT and DMFS of 1.11 and 1.97 respectively. Asthmatic children had significantly more plaque, gingivitis, and calculus compared with the control group. There was a significant difference in the severity and number of teeth affected by tooth surface loss affecting labial surfaces of the anterior teeth and occlusal surfaces of the posterior teeth of asthmatic children., Conclusions: It was concluded that asthmatic children have more decay affecting their permanent teeth, poorer periodontal status, and more tooth surface loss than healthy controls.

A case of dental erosion caused by excessive consumption of alcoholic soft drinks is described. The low pH of the drinks and associated vomiting can cause substantial damage to the dentition. There are no reported cases in the literature of erosion caused by the use of these drinks, and with their increasing popularity it is important that the dental profession is made aware of the possible dental implications relating to their consumption.

Gastroesophageal reflux (GOR) is often a self-limiting condition but nevertheless is a common cause of morbidity in childhood. Studies of adult patients with hiatus hernias and GOR have suggested that there is an increased incidence of dental erosion in these individuals. The aim of this study was to investigate the relationship between dental erosion and GOR in children. Fifty-three children aged 2 to 16 yr (mean 4.9 yr) with moderate to severe GOR, defined by pH monitoring, were examined for dental erosion. A questionnaire investigating dietary habits, other relevant medical conditions, and erosion risk factors was also completed. Results showed that the prevalence of dental erosion was low, when compared with the UK National Survey, with only 9 (17%) children showing any signs of erosion, and of these only one had erosion involving dentine. These results suggest that dental erosion may not be as great a problem in children with GOR as it is in adults. It may be that refluxing is limited to the oesophagus, and further work is needed to investigate those children that positively reflux into the mouth.

There have been a number of reports on the dental health of long-term survivors (LTS) of childhood malignancy as compared with normal controls. However, it is usually difficult to identify a meaningful control population as most of these patients are from widely differing geographical areas and socio-economic status. The aim of this investigation was, therefore, to study the dental health of LTS compared with siblings. 46 LTS who had siblings of a similar age were identified for the study. Both groups were examined for dental caries, gingivitis and enamel defects. There was no statistically significant difference in the mean DMFS of the test and control groups. However, the LTS had a significantly (P = 0.006) higher number of decayed surfaces (1.50 +/- 0.30) as compared with their siblings (0.50 +/- 0.20). The LTS also had a significantly higher prevalence of severe gingivitis (1.11 +/- 0.33) compared with controls (0.02 +/- 0.02). There was a significantly higher prevalence of all types of enamel defects in the LTS and fewer teeth with no enamel defect as compared with their siblings, with the mean values being 15.7 +/- 0.9 and 25.3 +/- 0.3, respectively. It was concluded that there was a higher prevalence of untreated dental disease and developmental defects in long-term survivors.

The level of care for children over the past 5 years has become bimodal, with most children with low levels of dental caries having good maintenance care, but those with moderate to high caries receiving significantly poorer care. Capitation has led to supervised neglect for many children who develop dental decay. This is not at all unexpected considering the general lack of concern by the government and public dental services and the fact that the level of payment of GDPs is such that they cannot afford to treat children. The problems of the dental care of children in the UK are compounded by the lack of specialist paediatric dentists for the more difficult patient.

The effect of different concentrations of sugars in two foods (strawberry yoghurt and baked beans) on plaque acidogenicity was investigated using plaque sampling with a 'Beetrode' electrode. Six varieties of yoghurt, four varieties of baked beans and positive and negative control solutions of 10 per cent sucrose and sorbitol, respectively, were tested on six volunteers, selected according to the guidelines agreed at the San Antonio Conference of 1985. Plaque was harvested immediately before a one minute challenge with the test condition and at 5, 10, 15, 20 and 30 minutes thereafter. Parameters investigated were minimum plaque pH reached after a one minute consumption/rinse of the test food or control solution, maximum drop in plaque pH and 'area of the Stephan curve below pH 6.5'. An Acidogenic Potential Index was calculated for each test food and the results did not suggest a linear relationship between sucrose concentration in a food and acidogenic potential.

Three triclosan-containing "multi-benefit" dentifrices were compared for clinical efficacy in reducing supragingival calculus formation following a dental prophylaxis. A total of 544 subjects completed a double-blind parallel-group clinical study using the Volpe-Manhold Index (VMI) to record severity and occurrence of supragingival calculus. The study design included a pre-test period where the calculus formation rate was measured in subjects brushing with a placebo dentifrice. Following a prophylaxis, subjects were stratified for age, gender and VMI scores and assigned to one of four treatments: 1) a dentifrice containing 5.0% soluble pyrophosphate/0.145% fluoride as NaF/silica abrasive/0.28% triclosan (hereafter PPi/TCS-comparable to Crest Complete dentifrice, Procter & Gamble, UK); 2) a commercial dentifrice containing 2.0% Gantrez acid copolymer/ 0.145% fluoride as NaF/silica abrasive/0.30% triclosan (hereafter Gan/TCS-Colgate Total dentifrice, Colgate-Palmolive Company, UK); 3) a commercial dentifrice containing 0.5% zinc citrate trihydrate/0.15% fluoride as sodium monofluorophosphate/silica abrasive/0.20% triclosan (hereafter Zn/TCS-Mentadent P dentifrice, Unilever, UK); and 4) a control dentifrice comprised of 0.145% fluoride as NaF/silica abrasive (hereafter Control). Subjects were instructed to use their assigned dentifrice at least twice per day and to brush as they do normally. Supragingival calculus formation was assesed at two and four months using site-specific and whole-mouth VMI indices for both calculus severity and occurrence. Following four months of use, the PPi/TCS dentifrice provided statistically significant reductions in calculus severity (22-23%) and occurrence (15%) as compared with the Control dentifrice. The Zn/TCS dentifrice also provided significant reductions in calculus severity (17-19%) and occurrence (12-13%) as compared with the Control. The Gan/TCS produced no statistically significant reductions in calculus formation (occurrence or severity) compared with the Control. The PPi/TCS dentifrice provided statistically significant reductions in calculus severity (15-21%) and occurrence (12-16%) as compared with the Gan/TCS dentifrice. These results support the clinical effectiveness of PPi/TCS and Zn/TCS dentifrices for the reduction of supragingival dental calculus formation following a dental prophylaxis.

The prevalence of malocclusion in children with cerebral palsy was studied by comparison with a normal control group. The prevalence of drooling and prematurity was also assessed as well as the degree of mental handicap. Results showed an increased prevalence of malocclusion in children with cerebral palsy. Cerebral palsied children are likely to have a significantly increased overjet (P < 0.001) when compared with normal children. The comparatively small sample sizes precluded firm conclusions being drawn regarding other group comparisons (such as comparing children with cerebral palsy with and without a mental handicap) but there may be a tendency towards the more handicapped group having a Class II malocclusion.

With the prospect of changes brought about through the Mouatt Report and the European Union, calls for a more flexible approach to teaching dentistry are being made. This article describes a postgraduate dental education system that involves modules and credits set up at the University of Leeds. The new system moves away from the more traditional methods of educating post-graduate students.