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Background: This study aimed to investigate the impact of self-reported dental trauma on oral-heath-related quality of life (OHRQoL) of young adults and determine whether personality characteristics influenced how it was reported.Method: A cross-sectional study was carried out using a sample of 435 university students. A questionnaire sought data on previous dental trauma. OHRQoL was assessed using the short-form of the oral health impact profile (OHIP-14); the outcome being one or more impacts occurring 'fairly often'/'very often'. Personality was assessed using the Positive and Negative Affect Scale (PANAS).Results: The participation rate was 87.2%. Dental trauma experience was reported by 110 participants (25.3%), and 242 (55.6 %) indicated previous dental caries experience. Among those with dental trauma history, one or more OHIP-14 impacts was reported by 29.1% (with 21.2% among those with no history). Impact prevalence was higher among those who had previous dental caries experience (29.8%) than among those who had not (14.7%; P < 0.001). Higher PANAS negative affect scores were observed among those reporting one or more OHIP-14 impacts (P < 0.001).Conclusion: While dental trauma does not appear to have a negative impact on OHRQoL in young adults, past dental caries experience does. Negative emotionality influences self-reported oral health. [ABSTRACT FROM AUTHOR]

Background and Objectives: Prior to the introduction of the Southern District Health Board's reconfigured Community Oral Health Service in Otago, a project was undertaken with parents to investigate their knowledge, understanding and views of the historical School Dental Service and of the Community Oral Health Service that was being introduced.Methods: Focus groups were run during 2011 in ten selected schools (parents with children in years 1-8) across two areas in Otago to represent ur ban and rural settings and to represent parents who were already travelling to dental services.Results: Parents valued the traditional School Dental Service in Otago highly, generally agreeing that the service based in schools was accessible and convenient for parents and children. Rural parents who had always taken their children to dental appointments viewed it as a normal process, accepting that there could not be a service located in every school. Parents were aware that facilities were out-of-date. They highlighted the challenges of locating therapists since they started moving from school to school in the later 1990s and felt it was difficult for children seeing different therapists at each recall. There were diverse views on the proposed new system. Some parents felt that school-aged children should go to dental clinics on their own or with peers, while other parents welcomed the opportunity to attend when their child was having health care.Conclusion: It appears that the Community Oral Health Services should have an ongoing process to seek the views of parents and children about the service. [ABSTRACT FROM AUTHOR]

Radiography can serve as a useful aid in the diagnosis of numerous oral conditions, with a place in nearly all of the disciplines of dentistry. As such it can have a beneficial role in caring for the oral health of children and adolescents. The following review discusses the use of radiography in the diagnosis of oral conditions in children and adolescents, with particular reference to the diagnosis of dental caries, dental trauma, growth and development and in other dental scenarios, along with the importance of incidental findings. The risks associated with radiation exposure from the use of radiography are discussed, how these need to be balanced with the possible benefits associated with such use, as well as how risks could be minimised. Summary recommendations are also presented, providing an overview of the use of radiography for oral diagnosis in various clinical scenarios for children and adolescents. [ABSTRACT FROM AUTHOR]

Management of the pulpal tissue in primary teeth is a clinical challenge facing dental practitioners on a regular basis. This article reviews the most common treatments used at the present time in the management of the pulp in deciduous teeth. It gives an overview of treatment options and the indications and contra-indications for the different treatment modalities. The evidence behind the medicaments used, their actions and success rates are discussed. Practical guidelines for choosing to retain or extract deciduous teeth and management of the primary tooth pulp with different clinical presentations are discussed. Areas of future research are highlighted. [ABSTRACT FROM AUTHOR]

It has been suggested that asthmatic children may have a higher caries risk, both as a result of their medical condition and the physical and physiological effects of their pharmacotherapy. By examining the association over time between asthma and caries increment, this study tested the hypothesis that childhood asthma is associated with an increased caries increment. In a long-standing New Zealand cohort study, participants' long-term asthma histories and the 3-year net caries increment between the ages of 15 and 18 years were examined. Of the 781 who were examined at 15 and 18 years, 39 participants were consistently taking anti-asthma medication at the ages of 9, 11, 13 and 15 years (and were labelled in this study as 'medication-determined asthmatics'), 56 were identified as consistent wheezers at the ages of 9, 11, 13 and 15 years ('wheeze-determined asthmatics') and 36 were members of both groups. A smaller group (n = 9) was identified as being very-long-term asthmatics (asthma at 5 years of age and at the ages of 9, 11, 13 and 15 years). Some 206 study members were identified as having no history of asthma, asthma medication or significant wheeze at any time up to and including 18 years. The overall mean net caries increment between the ages of 15 and 18 years was 2.06 surfaces (SD, 3.76). There were no significant differences in caries increment between the 206 asthma-free participants and any of the asthma groups. This study provides little evidence for an asthma-caries causative relationship. [ABSTRACT FROM AUTHOR]

Several previous studies using food consumption tables or diet records have estimated that children aged 1 to 12 years resident in fluoridated (1 ppm) areas receive, on average, between 0.05 and 0.07 mg fluoride/kg body weight from foods and drinks alone. In this study, the duplicate-diet approach, which is a more accurate method of determining nutrient intake, was used to determine if levels of fluoride intake from foods and drinks are similar to those estimated from food consumption tables or diet records. Duplicate portions of all foods and drinks consumed over 24 hours by 66 children aged 3 to 4 years resident in fluoridated and low-fluoride areas of New Zealand were collected on three separate days over a period of 12 months and analyzed for fluoride. Fluoride intake from the use and ingestion of toothpastes and fluoride supplements was also determined for each child. It was hypothesized that the total amount of fluoride received by children in low-fluoride areas from diet, toothpastes, and fluoride supplements was similar to that received by children in fluoridated areas from diet and toothpastes. The mean fluoride intake from foods and drinks alone in the low-fluoride areas was 0.008 ± 0.003 mg/kg body weight (0.15 ± 0.06 mg/day; n = 34) and in the fluoridated areas was 0.019 ± 0.009 mg/kg body weight (0.36 ± 0.17 mg/day; n = 32). The mean fluoride intake from foods and drinks and toothpastes in the low-fluoride areas was 0.027 ± 0.012 mg/kg body weight (0.49 ± 0.25 mg/day) and in the fluoridated areas was 0.036 ± 0.015 mg/kg body weight (0.68 ± 0.27 mg/day). Fluoride intake from diet alone did not exceed 0.04 mg/kg body weight (0.74 mg/day), and fluoride intake from diet and toothpaste did not exceed 0.07 mg/kg body weight (1.31 mg/day). The results suggest that levels of fluoride intake from foods and drinks alone as estimated by the duplicate-diet approach are much lower than previously estimated from food consumption tables or diet records. It was calculated that if all children in the low- fluoride areas were to take currently recommended dosages of fluoride tablets, which have been based on dietary surveys and diet records, then the total fluoride intake of some children in the low-fluoride areas would exceed that of their counterparts in the fluoridated areas. The results suggest that currently recommended dosages of fluoride tablets need to be further reduced if dental fluorosis in children is to be avoided. [ABSTRACT FROM AUTHOR]

The absorption and excretion of fluoride in a group of 25 infants (<6 years of age) were followed for up to seven hours after the ingestion of a known quantity of either sodium monofluorophosphate alone in solution, or toothpastes with sodium monofluorophosphate and an abrasive of either hydrated silica or dicalcium phosphate dihydrate. Fluoride appeared to be well-absorbed based on the excretion patterns found. From the results, it was concluded that parents of pre-school-aged children should now be given appropriate advice regarding their children's use of fluoride toothpaste. Such use of fluoride toothpaste should be closely supervised by the parents, and only a smear of paste, about the size of a pea, should be used, particularly where fluoride supplements are used. Because of the likelihood of toothpastes with even higher amounts of fluoride being marketed, it would also appear that toothpaste manufacturers and researchers in caries prevention should look further at the problem of fluoride absorption from tooth-pastes in infants. [ABSTRACT FROM AUTHOR]

Background: We aimed to assess the effect of surgical versus non-surgical treatment on health-related quality of life (HRQOL) of patients with oral cancer. Methods: This is a longitudinal study of a cohort of newly diagnosed adult oral cancer patients followed over a period of 3months. HRQOL data were collected for each patient at diagnosis (baseline), 1month after commencing treatment (first follow-up), and after 3months (second follow-up) using a cross-culturally adapted FACT-H& N (v 4.0), a global question, and a Malaysian supplementary set of eight questions (maq; obtained after cross-cultural adaptation of the instrument). The FACT-H& N (v 4.0) is a 39-item head-and-neck-cancer-specific instrument which assesses patients' physical (seven items), social (seven items), emotional (six items), functional (seven items) well-being and head/neck concerns (12 items). FACT-G, FACT-H& N Total Outcome Index (TOI) and FACT-H& N symptom index (FHNSI) scores, which are FACT-H& N derivatives, were also calculated. Paired t-tests were used to test the statistical significance of score changes. Findings: Of the 76 patients recruited at baseline, 42 (55.3%) were followed from baseline to the end of the study. Their HRQOL worsened from baseline (FACT-H& N score 94.1 ±17.6) to first follow-up (score 87 ±20.0; p<0.05) and then improved by the second follow-up (score 91.4 ±20.9) although not all returned to pre-treatment levels. Worsening by first follow-up was reflected in significant deterioration of combined physical and functional well-being and increased head and neck concerns (FACT-H& N-TOI baseline score 58.4 ±13.9; first follow-up score 50.1 ±15.6; p<0.05). Patients' emotional well-being significantly improved from baseline (FACT ewb score 15.6±4.1) to second follow-up (FACT ewb score 18.1; p<0.05). Those undergoing surgical interventions experienced a higher HRQOL improvement by the second follow-up (FACT-H& N 98.5; FACT-G 78.5; FACT-H& N TOI 60.0) than those who received other treatment types (FACT-H& N 83.0; FACT-G 65.5; FACT-H& N TOI 45.0; p<0.05). Interpretation: Oral cancer patients experience substantial worsening in HRQOL once treatment commences, but this improves with time, especially among those treated surgically. [ABSTRACT FROM AUTHOR]

Objective: To compare the severity of dental caries in the primary dentitions of children under 7 years (who received comprehensive restorative treatment under general anaesthesia, GA) from an optimally fluoridated area (0.85 ppmF) and a low-fluoride area (approximately 0.1 ppmF)., Research Design: Consecutive clinical case series: clinical details (diagnoses and the treatments provided) were recorded for children who had received comprehensive dental care under GA between 2000 and 2009. Age, gender, ethnicity, socio-economic status and fluoridation status (determined from the residential address) were also recorded., Results: Of the 1396 treated children, 55.7% came from fluoridated areas and 52.5% were male. On average, children from low-fluoride areas were 2.4 months younger and presented with more decayed deciduous teeth than those from fluoridated areas (4.9 and 3.9 teeth respectively; p<0.0001). For each tooth type, the mean number of carious teeth at presentation was greater among the children from low-fluoride areas. In the multivariate model, the number of deciduous teeth affected by caries was lower among older children, those residing in a fluoridated area and among those seen after 2001. It was higher among those not living in high-SES areas., Conclusions: Children with severe dental caries had statistically significantly lower numbers of lesions if they lived in a fluoridated area. The lower treatment need in such high-risk children has important implications for publicly-funded dental care.

To assess the cross-sectional construct validity of the Malay-translated and cross-culturally adapted FACT-H&N (v 4.0) for discriminative use in a sample of Malaysian oral cancer patients. A cross-sectional study of adults newly diagnosed with oral cancer. HRQOL data were collected using the FACT-H&N (v 4.0), a global question and a supplementary set of eight questions ('MAQ') obtained earlier in pilot work. Of the 76 participants (61.8% female; 23.7% younger than 50), most (96.1%) had oral squamous cell carcinoma; two-thirds were in Stages III or IV. At baseline, patients' mean FACT summary (FACT-G, FACT-H&N, FACT-H&N TOI, and FHNSI) and subscale (pwb, swb, ewb, fwb, and hnsc) scores were towards the higher end of the range. Equal proportions (36.8%) rated their overall HRQOL as 'good' or 'average'; fewer than one-quarter rated it as 'poor', and only two as 'very good'. All six FACT summary and most subscales had moderate-to-good internal consistency. For all summary scales, those with 'very poor/poor' self-rated HRQOL differed significantly from the 'good/very good' group. All FACT summary scales correlated strongly (r>0.75). Summary scales showed convergent validity (r>0.90) but little discriminant validity. The discriminant validity of the FHNSI improved with the addition of the MAQ. The FACT-H&N summary scales and most subscales demonstrated acceptable cross-sectional construct validity, reliability and discriminative ability, and thus appear appropriate for further use among Malaysian oral cancer patients., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objectives: To characterize molar-incisor hypomineralisation (MIH) defects of different severities quantitatively and qualitatively using X-ray microtomography (XMT) and to measure the range of reduction in mineral density (MD) of MIH enamel compared with the normal range., Methods: Ten sound teeth and ten MIH teeth were scanned using a commercial XMT system. Four hydroxyapatite phantoms of different densities were used as calibration standards with each scan. A calibration equation derived from the phantoms with each tooth was used for MD calibration. MD was traced from the cementum-enamel junction (CEJ) to the cusp tip and from the dentine-enamel junction (DEJ) to the outer enamel surface., Results: In sound teeth, MD increased from CEJ to cusp/incisal tip, while in MIH teeth MD dropped from the CEJ to the occlusal region, then increased again at the cusp tip. MD was highest midway between DEJ and outer enamel in sound teeth. In MIH, enamel showed normal thickness and MD was highest near the DEJ and then decreased towards the outer enamel. MD of MIH enamel was on average about 19% lower than sound enamel. The MIH defects seemed to follow the incremental lines of enamel formation., Conclusions: MIH defects are hypomineralised defects of different severities that follow the natural incremental lines of enamel formation. Cuspal areas are usually only mildly affected and cervical enamel always appears to be sound.

Objectives: To study the relation between the mechanical properties of hypomineralised enamel, and its laser fluorescence (LF)., Methods: Five extracted teeth with molar-incisor hypomineralisation (MIH) were sectioned longitudinally through the defects and polished to prepare the hypomineralised enamel for testing. Hardness (H) and elastic modulus (E) of enamel were measured using nanoindentation. Measurement recording started from the cervicoenamel junction and proceeded occlusally in increments of 200 microm. Laser fluorescence readings were taken along the same line and at the same sites using a DIAGNOdent pen., Results: H, E, and LF readings from cervical enamel were within the expected range for normal sound enamel. After log transformation of the H and E measurements to allow for linear correlation analysis, there was a significant and moderately strong inverse correlation between LF and H or E samples (r (between specimens)=0.59, r (between specimens)=0.39, respectively; p<0.001)., Conclusions: This study shows that, in the absence of dental caries, increased DIAGNOdent readings can indicate enamel hypomineralisation. While the increased LF readings in carious enamel are thought to be related to the presence of caries bacterial metabolites, the increased readings in hypomineralised enamel may be related to proteins in the hypomineralised enamel and/or light scattering by the inhomogeneous enamel.

Aim: Cheeses have been investigated for their potential cariogenicity in several studies and have been shown to produce little change in the resting pH in dental plaque and little or no demineralisation of enamel in most intra-oral cariogenicity studies. The aim of the present study was to investigate the cariogenicity of four processed cheese formulations., Methods: Enamel demineralisation was measured intra-orally in bovine enamel, and aliquots of 10g of each test cheese were used to assess plaque pH using the plaque harvesting technique after the San Antonio criteria. In a second experiment, the same cheeses were assessed for their effects on enamel using the intra-oral cariogenicity test (ICT) with bovine enamel., Results: None of the four cheeses caused pH drops below the critical pH and two of the cheeses raised the pH slightly. The effects on pH were all significantly different from those of the sucrose saliva control. None of the cheeses produced microhardness changes that were statistically significantly different from the saliva control., Conclusion: None of these cheeses as tested were found to lead to acidogenicity and by inference to be cariogenic. They were therefore deemed to be safe for teeth when used as a food.

Aim: To investigate the prevalence and severity of tooth wear in the primary dentition of a representative sample of New Zealand school children and relate these to possible risk factors., Design: A cross-sectional study., Setting: Primary schools in Dunedin, New Zealand., Participants: 104 children of both sexes, aged between 5 and 8 years, randomly selected., Methods: Clinical examinations of the buccal, occlusal/incisal and lingual surfaces of deciduous canines and molars., Main Outcome Measure: Degree of wear and the presence of dentinal cupping of teeth. Information on weaning and consumption of fruit-based drinks at bed time, frequency of consumption of fruits, yoghurt, pickled foods, fizzy and fruit-based drinks., Results: The prevalence of tooth wear was similar in boys and girls and there were no significant differences between sides of the arches. A high percentage (82%) of children had at least one primary tooth with dentine exposed. While maxillary canines showed the greatest prevalence of dentine exposed, maxillary molars displayed the greatest prevalence of cupping. Severe tooth wear was less prevalent among children weaned after 12 months (14.3%) than those weaned earlier (27.9% P < 0.01). There were no statistically significant associations between wear and the consumption of fruit, yoghurt, pickled foods, fizzy drinks or fruit-based drinks., Conclusions: Tooth wear associated with dentine exposure is common in 5-8 year old children. This is not significantly associated with dietary factors, but appears to be related to early weaning from the breast.

Preventive dental care for children and adolescents requires a good understanding of the dental caries process and the particular relationships that exist throughout childhood and young adulthood. Only when these relationships are understood can they be used to diagnose dental caries risk and apply appropriate preventive therapies and restorative care that is effective. The need to diagnose risk when applying preventive care is as important for individual patients as it is for population groups. At the individual level, the aim is to aid the development of a healthy functioning dentition for life. This applies in the population group level but the cost benefits also become important in justifying the funding to carry out preventive practices. Risk can be determined by general factors including the socioeconomic status, access to optimally fluoridated drinking water and age. Specific factors include the microbiology of the dental plaque, dietary practices, oral hygiene practices, individual fluoride use and previous dental caries history. Once the risk has been diagnosed and the related factors identified, the best preventive approach can be selected. This may include oral hygiene, dietary change, fluoride recommendations, restorative care using fluoride releasing materials or antibacterial mouthwashes. The dentist may play several roles in preventive dental care. The first is as the giver of advice and care for the individual child patient; the second is as an advocate to help the child get the care by getting the consent and support of the parents; and the third may be to lobby for the appropriate funding to obtain this care in publicly funded programs.

Undoubtedly, to achieve the goals set for oral health in New Zealand, representative leadership is essential for effective coordination of work force planning, education, and research. It is to be hoped that, from discussion and debate, this Forum will be able to make suggestions or recommendations for a structure that can be developed to allow the appropriate representation and leadership to drive research and work force planning for the provision of oral health care in New Zealand.

Panoramic radiographs of 1,608 children and adolescents aged 10 to 15 years (797 males and 811 females) were reviewed to determine the prevalence of tooth and jaw abnormalities. Abnormalities were detected on 21 percent of the radiographs (23 percent females and 17.3 percent males); 879 teeth were diagnosed with abnormalities on 331 radiographs. The more common abnormalities were malpositioned teeth, missing teeth, misshaped teeth, and teeth with hypoplastic appearance. Bony abnormalities and growth problems were detected in a few radiographs. This study demonstrates the value of panoramic radiography in detecting or confirming dental abnormalities, and supports recommendations on the use of panoramic radiography to aid in the assessment of dental development.

This study investigated the disposal of clinical waste within dental surgeries in Bangkok, Thailand and followed the waste trail to the rubbish tips. A questionnaire was sent to all dental practices in the Bangkok Metropolitan Area. The response rate was 57.7 per cent. At the same time, rubbish collectors and scavengers were interviewed to see if they encountered clinical dental waste. Few dentists complied with all recommendations for the disposal of waste. Most waste was disposed of into the domestic rubbish stream. Rubbish collectors and scavengers knew what dental rubbish looked like and some had had needle-stick injuries. Although recommendations can be made to the dental profession to alter their behaviour, real improvement is unlikely without changes to legislation and social policy.

The effectiveness of electronic dental anesthesia (EDA) for pain control during restorative procedures was compared with local anesthetic injection (LA) in 32 children aged 6 to 12 years. Each child selected had two antimere primary or permanent molars requiring similar-sized Class I or Class II restorations. The pain levels during restorative treatment were assessed using a visual analogue scale. Heart rates and behavior were also recorded. A crossover design was used with each child acting as his/her own control. The results showed that overall, EDA was less effective than LA for cavity preparation. The reported pain scores for EDA were higher in permanent teeth for the deeper cavities, and with one of the operators. The pre- or post-treatment anxiety scores were not found to differ significantly between the two restorative appointments. However, children with the highest pretreatment scores were more likely to report higher pain scores with EDA. Despite this, 63% of the children preferred EDA to LA. Dental anxiety, cavity depth, the tooth being treated, and operator attitude may also be important factors in determining the success of EDA.

Proximal contact loss due to caries may contribute to the appearance of marginal alveolar bone loss (ABL) in the deciduous dentition. Children referred for treatment to the School of Dentistry, University of Otago, usually have special problems related to caries or management, or both, and the aim of the study was to determine the prevalence of marginal ABL in children treated in this clinic, and to compare it with that found in a previous study in a random sample of New Zealand 5-year-olds. Posterior bite-wing radiographs of 187 children, aged 4 to 14 years, were selected for examination. A total of 1,523 sites, from the distal of the deciduous cuspids to the mesial of the deciduous second molar or the first permanent molar if present, were examined. ABL was recorded when there was complete absence of the lamina dura and the distance from the cemento-enamel junction to the crest of the alveolar bone was > 2 mm. ABL was found in 20.8 percent of the children; 31.9 percent of these sites were adjacent to extensive proximal caries; 83.3 percent were in the maxilla, and 95.8 percent were between deciduous teeth. The youngest age at which ABL was found was 5 years. Among the children with ABL, 48.7 percent had ABL in more than one site. Comparison of the prevalence of ABL at age 5 in the present study (19.2 percent) with the one previously reported for a random population (2.1 percent), suggested that, because of the special characteristics of the children attending the University clinic, students are exposed to an exaggerated image of caries and periodontal diseases in children.

For children with extensive caries of primary teeth, or with deformed or traumatised teeth, restoration with composite using a crown form gives excellent results. Strength is gained by full crown coverage. The aesthetics are very acceptable. The technique also allows primary teeth to be modified to resemble permanent teeth when these are missing and the primary teeth are being kept until more definitive treatment is provided. Caries is usually well controlled, and space loss due to further tooth breakdown is avoided.

Fluoride analyses of baby foods were carried out using a microdiffusion technique, which was found to be reproducible and accurate with less than 8% error. Analysis of 113 baby foods and drinks showed a wide range of fluoride concentrations: 0.01-0.31 mg F/kg for baby milk products; 0.04-0.72 mg F/kg for meat products; 0.04-0.70 mg F/kg for cereals; 0.03-0.48 mg F/kg for vegetable products; 0.03-0.07 mg F/kg for fruits; 0.02-0.28 mg F/kg for desserts, and 0.01-0.51 mg F/l for baby drinks. None of the baby foods and drinks contained fluoride of a sufficiently high concentration to be of concern or likely to contribute to enamel mottling, when used in the normal way.

Eight adults ingested five different toothpastes with and without 1,000 ppm (1 microgram/g) fluoride added as NaF or Na2PO3F. The systemic fluoride absorption was estimated by by comparing the areas under salivary fluoride concentration curves produced after the toothpaste ingestion. Of the toothpastes investigated--chalk, dicalcium phosphate dihydrate, silica or alumina with sodium monofluorophosphate, and silica with sodium fluoride--the fluoride absorption was found to be statistically significantly lower only from the dicalcium phosphate dihydrate toothpaste. Measuring changing fluoride levels in saliva appears to be an acceptable non-invasive technique for following systemic fluoride absorption.