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Children frequently experience pain and/or discomfort during dental treatment. Still, pain research in dentistry has mainly been performed on adults using quantitative methods while research on the child's perspective is scarce. This study aims to explore and describe children's experiences and/or thoughts regarding pain in conjunction with tooth extraction.Interviews were carried out with twelve Swedish 10-16-year-olds who had recently undergone tooth extractions due to orthodontic reasons. Interviews were transcribed verbatim and analysed according to grounded theory.A core category was identified and named 'handling the unavoidable unknown'. The informants recalled experiences of pain and discomfort during extractions. However, instead of focussing on pain, they described an urge for more information about the procedure and what to expect in terms of pain and/or discomfort, during and/or after treatment. They stated that the levels of pain/discomfort were manageable, while the lack of information negatively affected their coping abilities, causing feelings of unease.To improve patients' ability to deal with pain in conjunction with dental extraction, the dental team should ensure better and individually tailored information about the treatment. Thus, the use of psychological techniques is a cornerstone in pain management and must be reflected in clinical guidelines.

This review aimed to update the clinical practice guidelines for managing adults with 22q11.2 deletion syndrome (22q11.2DS). The 22q11.2 Society recruited expert clinicians worldwide to revise the original clinical practice guidelines for adults in a stepwise process according to best practices: (1) a systematic literature search (1992-2021), (2) study selection and synthesis by clinical experts from 8 countries, covering 24 subspecialties, and (3) formulation of consensus recommendations based on the literature and further shaped by patient advocate survey results. Of 2441 22q11.2DS-relevant publications initially identified, 2344 received full-text review, with 2318 meeting inclusion criteria (clinical care relevance to 22q11.2DS) including 894 with potential relevance to adults. The evidence base remains limited. Thus multidisciplinary recommendations represent statements of current best practice for this evolving field, informed by the available literature. These recommendations provide guidance for the recognition, evaluation, surveillance, and management of the many emerging and chronic 22q11.2DS-associated multisystem morbidities relevant to adults. The recommendations also address key genetic counseling and psychosocial considerations for the increasing numbers of adults with this complex condition. ispartof: Genet Med vol:25 issue:3 pages:100344- ispartof: location:United States status: published

Allir sem vinna með börn ættu að þekkja til Barnasáttmála Sameinuðu þjóðanna, en samkvæmt honum ættu öll börn að hafa jafnan rétt til bestu mögulegu heilsu. Þrátt fyrir góða munnheilsu á Norðurlöndunum, sýna rannsóknir að börn, sem búa við erfiðar félagslegar aðstæður, séu líklegri til að búa við slæma munnheilsu. Forvarnaraðgerðir ná ekki til þeirra, þau nýta sér sjaldnar tannlæknaþjónustu og njóta skertrar tannverndar, samanborið við önnur börn. Af þeim sökum er, auk almennra forvarnaraðgerða, þörf fyrir sérsniðnar aðgerðir fyrir áhættuhópa til að ná til þeirra barna sem búa við erfiðar félagslegar aðstæður. Einnig er mikilvægt að fræðslu- og forvarnarstarf hefjist á unga aldri. Þekkingu um áhrif mismunandi aðferða við forvarnir og meðferð skortir og hagfræðilegir útreikningar þeim tengdir eru fáir. Það er mikil áskorun að skrá og meta á kerfisbundinn hátt tanntengdar fræðslu-og forvarnaraðgerðir ætlaðar börnum sem búa við erfiðar félagslegar aðstæður, svo nýta megi til rannsókna. Þörf er á þverfaglegum rannsóknum með aðkomu tannlæknastofa. Framtíðarsýnin er að jafnrétti til heilsu sé tryggt og að heilsueflandi fræðsla og forvarnir dragi úr ójöfnuði í munnheilsu á milli ólíkra þjóðfélagshópa.

Aim Sweden´s first multidisciplinary children's advocacy centre (CAC) was founded in 2005 as a collaborative practice between child protection services, the legal system and health care in response to police-reported child abuse. CACs were introduced in the county of Skåne in 2007. The aim of the study was to describe the health of children investigated at the CAC in Lund, and to examine whether the CAC model of collaboration responded to the healthcare needs of these children. Methods All children aged 0–17 years investigated at the CAC in 2015 were included in this retrospective study. We reviewed the CAC files and the children's medical and dental records from one year prior to, until one year after their assessment at the CAC. Results Our review of the medical and dental records (n = 298) showed a high prevalence of mental, dental and physical ill-health. After the CAC joint meeting, only 1% of the children were referred for a medical examination and 4% for a focused forensic evaluation. Conclusion Our study demonstrates limitations in the CAC process in responding to extensive health issues of the young victims of crime. We suggest mental, dental and physical health assessments to be statutory in CACs.

Background The Swedish Quality Registry for caries and periodontal disease (SKaPa) automatically collects data on caries and periodontitis from patients’ electronic dental records. Provided the data entries are reliable and accurate, the registry has potential value as a data source for registry-based research. The aim of this study was to evaluate the reliability and accuracy of the SKaPa registry information on dental caries in 6- and 12-year-old children. Method This diagnostic accuracy study compared dental caries data registered at an examination with dental health status registered in the patient’s electronic dental records, and with corresponding data retrieved from the SKaPa registry. Clinical examinations of 170 6- and 12-year-old children were undertaken by one of the researchers in conjunction with the children’s regular annual dental examinations where the number of teeth were registered, and dental caries was diagnosed using ICDAS II. Teeth with fillings were defined as filled and were added to the ICDAS II score and subsequently dft/DFT was calculated for each individual. Cohen’s Kappa, the intraclass correlation coefficient (ICC), and sensitivity and specificity were calculated to test the agreement of the ‘decayed and filled teeth’ in deciduous and permanent teeth (dft/DFT) from the three sources. Results Cohen’s Kappa of the dft/DFT-values was calculated to 0.79 between the researcher and the patient record, to 0.95 between patient dental record and SKaPa, and to 0.76 between the researcher and SKaPa. Intraclass correlation coefficient (ICC) was calculated to 0.96 between the researcher and the patient journal, to 0.99 between the patient dental record vs. SKaPa, and to 0.95 between the researcher and SKaPa. Conclusion The SKaPa registry information demonstrated satisfactory reliability and accuracy on dental caries in 6- and 12-year-old children and is a reliable source for registry-based research. Trial registration The study was registered in Clinical Trials (www.ClinicalTrials.gov, NCT03039010)

Background: Children frequently experience pain/discomfort during dental treatment. At the same time there seems to be uncertainty among dentists regarding pain management. Pain research in dentistry has mainly been performed in adults using quantitative methods. Meanwhile, qualitative methods as well as the child’s perspective are scarce. This study aims to explore and describe children’s experiences/thoughts regarding pain in conjunction with tooth extraction and the subsequent postoperative period, using grounded theory (GT). Methods: Qualitative interviews were carried out with twelve 10—16-year-olds. Interviews were transcribed verbatim and analysed in open, as well as focused (selective) coding processes according to GT. Three informants were re-interviewed for verification purpose. Results: A core category was identified and named ‘handling the unavoidable unknown’. Instead of focusing on pain, the informants described an urge for more information about the procedure and what to expect in terms of pain/discomfort, during and/or after treatment. They stated that the levels of pain/discomfort were manageable, while the lack of information negatively affected their coping abilities, causing anxiousness. Conclusions: To improve patients’ ability to deal with pain in conjunction with dental extraction, the dental team should ensure better information about the treatment. Thus, the use of psychological techniques is a cornerstone in pain management and must be reflected in clinical guidelines.Trial registration: This study’s protocol was registered on ClinicalTrials.gov (NCT04064853), August 22, 2019, available at https://clinicaltrials.gov/ct2/show/NCT04064853?term=berlin&cntry=SE&draw=2&rank=1

Hovedbudskap FNs Barnkonvention anger att barn har rätt till bästa möjliga hälsa och att de inte får diskrimineras En stor andel av barn i de nordiska länderna lever i social utsatthet som ofta är kopplat till fattigdom Det finns ett starkt samband mellan dålig munhälsa och social utsatthet och trots kännedom om detta sedan flera år består skillnaderna i munhälsa mellan olika grupper Effekten hos olika metoder för att utjämna skillnader i munhälsa är otillräckligt utvärderade; det saknas vetenskapligt underlag/evidens för metoderna Insatser för att utjämna skillnader i munhälsa mellan olika grupper behöver innefatta såväl hälsoförebyggande (promotiva) arbetssätt som prevention, och ske i samverkan med andra delar av samhället, ex skola, barnhälsovård Det är stort behov av flervetenskaplig forskning för att utjämna hälsoskillnader. Sådan forsknings bör även involvera kliniker.

AIM: Decades of research confirm that children and adolescents in out-of-home care (foster family, residential care) have much greater healthcare needs than their peers. A systematic literature review was conducted to evaluate organizational healthcare models for this vulnerable group. METHODS: A systematic literature search was undertaken of the following databases: Academic Search Elite, CENTRAL, Cochrane Database of Systematic Reviews, Cinahl, DARE, ERIC, HTA, PsycInfo, Psychology and Behavioural Sciences Collection, PubMed, SocIndex. Randomized and non-randomized controlled trials were to be included. Two pairs of reviewers independently assessed abstracts of the identified published papers. Abstracts meeting the inclusion criteria were ordered in full text. Each article was reviewed independently, by pairs of reviewers. A joint assessment was made based on the inclusion criteria and relevance. Cases of disagreement were resolved by consensus discussion. RESULTS: No study with low or medium risk of bias was identified. CONCLUSION: In the absence of studies of acceptable quality, it is not possible to assess the impact of organizational models intended to ensure adequate health and dental care for children and adolescents in out-of-home care. Therefore, well-designed follow-up studies should be conducted following the implementation of such models. This article is protected by copyright. All rights reserved.

We used Swedish national registers to analyse dental health care among young adults with childhood experience of out-of-home care (OHC), in Cox regression analyses. All 1.7 million Swedish resident ...

Objectives To evaluate tooth development and calculate dental maturity score in prematurely born children and to compare the findings with full-term born children. Material and methods Nine-year-old preterm children were selected from the Swedish Medical Birth Register. One group consisted of 36 extremely preterm children (born before week 29), and the other included 38 very preterm children (born during weeks 29 to 32). Panoramic radiography was performed on each child and the preterm children were compared with 42 full-term born children. Five observers independently assessed the tooth development stages for all teeth in the left mandible (31–37) on the panoramic radiographs according to the method described by Demirjian et al. (Hum Biol 45:211–227, 1973). Data from tooth development stages were compiled and converted into a dental maturity score for each group. Kappa values were calculated for intra- and inter-observer agreement. Results When the different development stages for each individual tooth were compared, all observers presented a significant delay in the maturity of tooth 37 for the extremely preterm group (p ≤ 0.002). The extremely preterm group had a significantly lower dental maturity score than the full-term group, as assessed by each observer (p ≤ 0.006). Kappa values for inter-observer agreement varied between 0.31 and 0.71 depending on tooth and intra-observer agreement was between 0.16 and 1.0. Conclusions At age 9, the extremely preterm children had a general delay in tooth development. Clinical relevance The increased survival rate of extremely preterm babies adds a new group of children to society. Dental clinicians should be aware that the delay in tooth development could impact the timing of orthodontic diagnostics and potential treatment.

This study aimed to investigate Swedish dentists' attitudes regarding pain management strategies for treating children and adolescents. It assessed recommendations for pre- and postoperative analgesics, and use of local anaesthesia, and whether application of these strategies differs between general dental practitioners (GDPs) and specialists in paediatric dentistry (SPDs).We invited all GDPs (n = 807) in southern Sweden (Region Skåne), and all registered SPDs (n = 122) working in Sweden (929 actively practising dentists under age 65 years) to participate in a postal survey on pain management in paediatric dental care.The SPDs reported using all types of pain-reducing strategies more frequently than GDPs except local anaesthesia when extracting a permanent premolar, which SPDs and GDPs used equally often. Preoperative analgesic use was greater among SPDs than GDPs. GDPs used local anaesthesia less frequently for filling therapy in primary teeth than in permanent teeth.SPDs recommend preoperative analgesics more often than GDPs do. GDPs seem to underuse local anaesthetics when treating children and adolescents. SPDs also use pain management strategies more frequently than GDPs. Among GDPs, pain management is less frequent when treating primary teeth than permanent teeth.

Dietary habits and, in particular, the intake frequency of sucrose are of major importance for the development of dental caries. The perception of sweet taste is believed to have an influence on sucrose intake and therefore affects the predisposition to dental caries. The aim was to study the caries experience and sweet taste perception and to further analyze the possible relationship between the 2 tested variables in 13- to 15-year-old children from 3 different geographical areas. A cross-sectional survey comprising 669 children (220 Italian, 224 Mexican, and 225 Saudi Arabian) was conducted. The children were examined in their school setting. A sweet taste perception level was determined by the sweet taste threshold (TT) and sweet taste preference (TP). The sweet test was performed with sucrose solutions varying in concentration from 1.63 to 821.52 g/L. The International Caries Detection and Assessment System (ICDAS) and DMFS indices were used to diagnose caries. The highest mean value for TT was found for Italian children followed by Saudi and Mexican. Saudi schoolchildren showed the highest mean values for TP and DMFS, followed by Italian and Mexican. A statistically significant difference for TP, TT, DMFS, and initial caries was found between the 3 countries. A weak yet positive correlation was found between taste perception (TT and TP) versus DMFS and manifest caries in all 3 countries (r = 0.137-0.313). The findings of the present study showed a variation in sweet taste perception between the 3 countries, which may influence the caries outcome of the children in the individual countries.

Background There is an uncertainty regarding how to optimally prevent and/or reduce pain after dental treatment on children and adolescents. Aim To conduct a systematic review (SR) and health technology assessment (HTA) of oral analgesics administered after dental treatment to prevent postoperative pain in children and adolescents aged 3-19 years. Design A PICO-protocol was constructed and registered in PROSPERO (CRD42017075589). Searches were conducted in PubMed, Cochrane, Scopus, Cinahl, and EMBASE, November 2018. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria, following the PRISMA-statement. Results 3,963 scientific papers were identified, whereof 216 read in full text. None met the inclusion criteria, leading to an empty SR. Ethical issues were identified related to the recognized knowledge gap in terms of challenges to conduct studies that are well-designed from methodological as well as ethical perspectives. Conclusions There is no scientific support for the use or rejection of oral analgesics administered after dental treatment in order to prevent or reduce postoperative pain in children and adolescents. Thus, no guidelines can be formulated on this issue based solely on scientific evidence. Well-designed studies on how to prevent pain from developing after dental treatment in children and adolescents is urgently needed. Funding Agencies|Oral Health Related Research by Region Skane (Odontologisk Forskning i Region Skane) [OFRS 569491]

BACKGROUND: Obesity is a multifactorial disease that is increasing worldwide and is caused by different environmental and genetic factors, with an increase in the consumption of high-energy-containing food and a decrease in physical activity constituting two of the main reasons. Sweet taste perception may have an effect on the subject's dietary choices and affect his or her predisposition to obesity. OBJECTIVES: The aim was to study the sweet taste perception and dental caries in relation to body mass index (BMI) in 13-15-year-old schoolchildren from three different countries and to compare the BMI among the countries. DESIGN: The sweet taste perception level, determined as the sweet taste threshold and preference, was assessed in a total of 669 schoolchildren from Italy, Mexico and Saudi Arabia, examined in school settings. Height and weight were collected and BMI was calculated, after which the children were grouped as underweight, normal, overweight, and obese. For caries registration, the International Caries Detection and Assessment System and Decayed Missing Filled Surfaces indices were used. RESULTS: A statistically significant difference was found for BMI among the children from the three countries (p < 0.001), with the highest mean found among Saudi children, followed by Mexican and Italian children. A statistically significant difference regarding sweet taste threshold when comparing the BMI groups was only found for Saudi Arabia (p < 0.01). No significant correlation was found between BMI and sweet taste threshold or preference and dental caries variables, respectively. CONCLUSIONS: BMI was found to differ between countries, with a further significant difference among the groups among the Saudi Arabia schoolchildren.

Purpose To study pain perception in 10–15-year-olds, during and after uncomplicated extractions of bilateral maxillary premolars. The study investigated pain’s natural course and made comparisons between the first and second extractions. Methods 31 Swedish children in need of orthodontic treatment were identified and consecutively enrolled. Tooth extractions followed a standardised protocol and the two teeth were extracted with at least 10 days between. The participants rated pain intensity using visual analogue scale (VAS) at 14 different time points from treatment and 7 days forward. Results The pain intensity profile followed the same pattern for all patients. Pain intensity peaked 2 h after extractions (mean VASPI 27.3, SD 20.8; median 23.0) when moderate pain intensity (VASPI ≥ 40) was registered for 16 (28%) of 57 cases. After that, there was a rapid decrease in pain intensity notable already at 4 h after extractions. There were no statistically significant differences in any VASPI measurements between the first and second extractions, sexes, or different age groups. Conclusions The majority of the participants who undergo uncomplicated bilateral extraction of maxillary premolars experience mild to moderate levels of postoperative pain during a short period of time, with no differences between the first and second extractions. Bilateral tooth extractions is a suitable model for further studies on pain management. Funding Agencies|Swedish Dental Society, the Swedish Society of Paediatric Dentistry; Faculty of Odontology, Malmo University; Skane Regional Council, Sweden; American Dental Society of Sweden

This was, firstly, to study the occurrence of oral pain and discomfort, using the Dental Discomfort Questionnaire (DDQ), in children and adolescents with intellectual or physical disabilities, compared with controls. Secondly, was to analyse the relationship between pain and discomfort, as measured by the DDQ, and dental health, as well as oral hygiene habits and dietary habits. The study included 135 children and adolescents (12–18 years), registered at the Child and Adolescent Habilitation Unit in Goteborg and Sodra Bohuslan, Sweden, and 135 gender- and age-matched controls. The children’s legal guardians completed a questionnaire comprising the DDQ and questions on oral hygiene and dietary habits. Data on dental health were retrieved from dental records. The DDQ total mean score was higher for the study group, compared with the control group, 3.2 (SD 2.9) vs. 1.6 (SD 2.0), respectively (p = 0.001). Furthermore, children and adolescents with a severe intellectual disability had higher total mean DDQ scores than children with a mild intellectual disability, 4.8 (SD 4.2) vs. 2.4 (SD 2.9), respectively (p = 0.034), and also higher than children with a physical disability, 2.2 (SD 2.1) (p = 0.012). There were no differences in DMFT between children with disabilities and age-matched controls. There was no relationship between the DDQ scores and oral hygiene/dietary habits in children with disabilities. Children and adolescents with intellectual or physical disabilities experienced oral discomfort and pain more often than matched controls. Dental health expressed as DMFT could not be related to the DDQ responses.

Background The UN Convention on the Rights of the Child gives all children right to the highest standard of services for treatment and rehabilitation. For children with disabilities, sedation and general anaesthesia (GA) are often indicated for dental treatment; however, accessibility to this varies. The International Classification of Functioning, Disability and Health – Child and Youth version (ICF-CY) enables a biopsychosocial description of children undergoing dental treatment. Aim To investigate conscious sedation and GA in children with complex disabilities and manifest caries and analyse how caries, child functioning, and dental service organisation relate to dental GA (DGA), comparing Argentina, France, and Sweden using the ICF-CY. Design Quantitative, cross-sectional; data collected through structured interviews, observation, and dental records. Results Sedation and DGA were common. Children with limitations in interpersonal interactions and relationships were more likely to have had DGA (OR: 5.3, P = 0.015). Level of caries experience was strongly correlated with experience of DGA. There were significant differences between countries regarding caries prevalence, sedation, DGA, and functional and environmental factors. Conclusions Although caries experience and child functioning are important, dental health service organisation had the most impact on the incidence of DGA, and for the use of conscious sedation, for children with complex disabilities.

Purpose To evaluate the evidence supporting effects and adverse effects of local analgesia using different pharmacological agents and injection techniques during dental treatment in children and adolescents aged 3–19 years. Methods A systematic literature search of databases including PubMed, Cochrane, and Scopus was conducted in November 2016. The PRISMA-statement was followed. Two review authors independently assessed the selected randomised control trials for risk of bias and quality. Results 725 scientific papers were identified. 89 papers were identified to be read in full text of which 80 were excluded. Finally, 9 papers were evaluated for quality and risk of bias. Many of the included papers had methodological shortcomings affecting the possibility to draw conclusions. Information about ethical clearance and consent were missing in some of the included papers. No alarming adverse effects were identified. One study was assessed as having low risk of bias. This reported inferior alveolar nerve block to be more effective than buccal infiltration for dental treatment of mandibular molars, while no differences were found regarding pharmacological agents. Conclusions At present, there is insufficient evidence in support of any pharmacologic agent or injection technique as being superior compared to others. There is a need for more rigorous studies which also handle the ethical issues of including children in potentially painful studies. Electronic supplementary material The online version of this article (doi:10.1007/s40368-017-0302-z) contains supplementary material, which is available to authorised users.

To describe 0-16-year-old children with disabilities receiving paediatric specialist dental care from a biopsychosocial perspective, with focus on relationship between oral health, medical diagnosis, and functioning.A questionnaire with an International Classification of Functioning, Disability and Health - Children and Youth version (ICF-CY) Checklist for Oral Health was completed using structured interview, direct observation, and information from dental records. Descriptive data analysis was performed together with principle component analysis to calculate factors of functioning used in cluster analysis in order to present functioning profiles.Ninety-nine children with at least one major medical diagnosis were included. Twenty had previous caries experience. Two factors of functioning were calculated, labelled "Physical ability" and "Intellectual ability, communication, and behaviour". Based on functioning profiles three clusters were determined. There were no statistically significant differences in caries experience between medical diagnoses or clusters.It was possible to identify profiles of functioning in children with disabilities receiving specialist dental care. Despite complex disabilities, the children had good oral health. Neither medical diagnosis nor functioning was found to have a clear relationship with oral health. To understand the environmental context leading to high-quality oral health, further studies of dental management in relation to medical and oral diagnoses and child functioning are needed. [Box: see text].

To describe and analyse dental care and treatment modalities for children with complex disabilities from a biopsychosocial perspective, with special focus on dental treatment under general anaesthesia (GA) and its relationship to child's functioning.An ICF-CY Checklist for Oral Health was completed using structured interview, direct observations, and dental records for patients attending a specialist paediatric dentistry clinic. Descriptive and comparative data analysis was performed. Performance qualifiers from the ICF-CY component Activities and participation were used to calculate functional factors.Median referral age was 1.5 years and the majority were referred by their paediatrician. Almost all visited a dental hygienist regularly. Dental treatment under GA was common and was combined in 78% of sessions with medical treatment. Children with limitations in their interpersonal interactions and relationships were most likely to have dental GA.Children without caries experience had been referred for specialist dental care at an earlier age than children with caries experience. GA was a common treatment modality and dental and medical treatments were coordinated under the same GA for a majority of children. By using the ICF-CY, it was possible to identify functional limitations characterising children with disabilities that require dental treatment under GA. Implications for Rehabilitation Early referral to a specialist in paediatric dentistry is valuable for oral disease prevention in children with disabilities. Availability of dental treatment under general anaesthesia (GA) is also important. Combining dental and medical interventions during the same GA session optimises resources both for the individual and for the health organisation. Children with limitations in interpersonal interactions and relationships are more likely to need dental treatment under GA than other children.

Background. In a previous study, 9-year-old children with severe Molar Incisor Hypomineralization (MIH) had undergone dental treatment of their first molars nearly ten times as often as children in ...

Although preterm birth is associated with an increased risk of medical problems and impairments, there is limited knowledge of how this affects oral health. It was hypothesized that when 10-12 yr of age, children who were preterm at birth would present with a higher prevalence of molar-incisor hypomineralization (MIH), more dental plaque, and a higher degree of gingival inflammation than full-term control children. Eighty-two preterm children, born between 24 and 32 wk of gestation, and 82 control children, born between 37 and 43 wk of gestation, were clinically examined for developmental defects in enamel, MIH, dental plaque, and gingival health. In addition, behaviour management problems were evaluated. Information on any aetiological factors with a potential influence on MIH and oral health was collected via questionnaires. Molar-incisor hypomineralization was more common in preterm children than in controls (38% vs. 16%), as were enamel developmental defects (69.5% vs. 51%). Low gestational age and low birth weight increased the risk of MIH. Preterm children had more plaque, a higher degree of gingival inflammation, and more behaviour-management problems than controls. In conclusion, oral health problems were more common in preterm children than in control children.

International Journal of Paediatric Dentistry 2010; 20: 313-321 Background. Paediatric dentistry in Sweden has been surveyed four times over the past 25 years. During this period postgraduate training, dental health, and the organization of child dental care have changed considerably. Aim. To investigate services provided by specialists in paediatric dentistry in Sweden in 2008, and to compare with data from previous surveys. Design. The same questionnaire was sent to all 30 specialist paediatric dental clinics in Sweden that had been used in previous surveys. Comparisons were made with data from 1983, 1989, 1996 and 2003. Results. Despite an unchanged number of specialists (N = 81 in 2008), the number of referrals had increased by 16% since 2003 and by almost 50% since 1983. There was greater variation in reasons for referrals. The main reason was still dental anxiety/behaviour management problems in combination with dental treatment needs (27%), followed by medical conditions/disability (18%), and high caries activity (15%). The use of different techniques for conscious sedation as well as general anaesthesia had also increased. Conclusions. The referrals to paediatric dentistry continue to increase, leading to a heavy work load for the same number of specialists. Thus, the need for more paediatric dentists remains.

International Journal of Paediatric Dentistry 2010; 20: 391–399 Background. An enhanced frequency of cognitive and behavioural disturbances has been reported in preterm children. It is not known if this affects their perceptions of or behaviour in the dental care situation. Hypothesis. The hypotheses were that preterm (PT) children aged 12–14 years more often exhibit dental fear and anxiety (DFA) than full-term controls (C), while no differences were expected regarding oral health behaviour. Methods. One hundred and nine PT and 108 C children took part in the present questionnaire study. DFA was assessed using the Children’s Fear Survey Schedule – Dental Subscale (CFSS-DS). In addition the questionnaire covered items including satisfaction with received dental care, oral health behaviour and medical health. Results. The children’s CFSS-DS scores revealed no differences between the PT and C groups. Regarding oral health behaviour there were no differences, except that PT children more often used dental floss and extra fluoride supplements. PT children reported more medical health problems than C children. Conclusions. Preterm (PT) children 12- to 14-years-old, as well as C of same age group, seem to be satisfied with their dental care and display low prevalence of DFA. Still, a higher frequency of medical health problems in the PT children suggests that these children should be regarded as potential risk patients for oral health problems.

International Journal of Paediatric Dentistry 2010; 20: 283–292 Background. 22q11 deletion syndrome (22q11DS) is one of the most common multiple anomaly syndromes, and many dentists are likely to meet patients with the syndrome. Odontological research has focused on describing and analysing conditions/concepts based on the current state of knowledge within the dental profession. Yet, these research topics are not necessarily the most important issues for the patients. Aims. To explore and describe, by use of Grounded theory, parents’ experiences of oral health issues and needs for dental care in their children with 22q11DS. Design. Twelve parents from different regions in Sweden were interviewed. Analyses were carried out according to Grounded theory. Results. Parents recognised good oral health as important for the wellbeing of their children. Oral health was a concern and the parents described the fight for this as struggling in vain for good oral health in their child. Conclusions. Parents not only described their children’s oral health as important but also hard to gain. Thus, it is important that all patients with disabilities, regardless of whether there is a defined medical diagnosis or not, are identified and well taken care of in the dental care system.

Background The 22q11 deletion syndrome (22q11DS) is one of the most common multiple anomaly syndromes, with an incidence of approximately one per 4000 newborns. Although a patient may have several not too severe symptoms, the cumulative effect may be substantial disability. The aim of this study was to explore and describe parents' experiences of the diagnostic process and of being parents of a child with 22q11DS. Methods Open, tape-recorded interviews were carried out with 12 parents. The interviews were analysed in accordance with classical grounded theory. Results The analysis show that parents describe the disclosure of their child's medical diagnosis as two-sided, ambivalence between relief and sorrow, and the differences between these two aspects were related to the age of the child at time of diagnosis as well as to the problems and symptoms that had led to the diagnosis. Different strategies for handling this ambivalence are presented in the categories. Conclusions Our conclusions are that information must be individually tailored, and there is no standard format for how to describe the syndrome to the parents. After disclosure, scheduled appointments for follow-up on diagnosis-related information is essential.

The aim of this study was to gain deeper knowledge of how teenagers with the diagnosis of ADHD experience their disorder, treatment and the consequences of diagnosis and treatment in their daily lives. Ten teenagers were interviewed in depth. The interviews were analyzed according to the grounded theory method. In the analysis of the data the core category 'hiding parts of one's self from others' emerged. Four other categories were also identified: 'being different from others; wanting to be like everybody else;' 'keeping the medical treatment a secret;' and 'feeling worried about the future.' The teenagers strove for normalcy and wanted to be like everyone else. They tried their utmost to conceal their diagnosis and medical treatment from others, such as schoolmates, friends and the reference group.

International Journal of Paediatric Dentistry 2010; 20: 31–36 Background. Enamel hypoplasia is a developmental disturbance during enamel formation, defined as a macroscopic defect in the enamel, with a reduction of the enamel thickness with rounded, smooth borders. Information on the microstructural level is still limited, therefore further studies are of importance to better understand the mechanisms behind enamel hypoplasia. Aim. To study enamel hypoplasia in primary teeth by means of polarized light microscopy and scanning electron microscopy. Methods. Nineteen primary teeth with enamel hypoplasia were examined in a polarized light microscope and in a scanning electron microscope. Results. The cervical and incisal borders of the enamel hypoplasia had a rounded appearance, as the prisms in the rounded cervical area of the hypoplasia were bent. The rounded borders had a normal surface structure whereas the base of the defects appeared rough and porous. Conclusions. Morphological findings in this study indicate that the aetiological factor has a short duration and affects only certain ameloblasts. The bottom of the enamel hypoplasia is porous and constitutes possible pathways for bacteria into the dentin.

Background. Children born preterm (PT) have medical conditions and impairments that may affect their oral health. Hypothesis. Our hypothesis for the study was that PT children display more dental behaviour management problems (BMPs) and less favourable oral health behaviour than controls (C). Methods. Parents of 153 PT children and 153 C children were interviewed regarding the children's oral health behaviour and experience of dental care on two occasions, 2 years apart. The interviews concerned the preschool period and the early school years, respectively. Results. BMPs were more common in PT children of preschool age, but not during the early school years. Regarding oral health behaviour, there were no differences between the groups, except that PT children had more problems with toothbrushing than C children in the preschool period, in spite of the fact that the PT group reported more medical health problems and more anxious behaviour and indications of cognitive problems than the C group. Conclusions. Children born PT exhibit several risk factors for both BMP and impaired oral health. It is essential that this group of patients is identified early and receives special attention from the dental services. (Less)

Objectives. The aims were to compare saliva secretion rate, buffer capacity, cariogenic bacteria, total protein, IgA, and electrolytes between patients with 22q11 deletion syndrome (22q11DS) and control subjects and to study correlations between saliva and serum levels of IgA and electrolytes in 22q11DS patients.Study design. Twenty-nine consecutive 22q11DS patients (mean age 12.6 years) and matched healthy control subjects were clinically examined, and stimulated saliva samples were collected.Results. Patients with 22q11DS had impaired salivary secretion rate (P

BOOK REVIEW: Constructing grounded theory. A practical guide through qualitative analysis Kathy Charmaz, 2006, 208 pp. London: Sage. ISBN 2005928035

Orofacial functions include competences/abilities such as eating, breathing, speech/ language, mimicry, as well as oral health, and disturbances are common in children with rare disorders. To describe parental experiencesof orofacial function and needs in children with rare disorders, in-depth interviews focusing on orofacial function were carried out with 14 parents. Interviews were transcribed verbatim and analysed in open, axial (theoretical) and selective coding processes according to Grounded Theory. Two core categories emerged from data in the analysis: 'the vulnerable family' and 'support perceived from others'. The data indicated the importance of a balance between these two core categories: the strain caused by living in a family with a child with a severe disability/handicap, and the availability of perceived support from caregivers and significant others. This balance was necessary for the parents in developing self-reliance and in reconciling themselves to their life situations. Parents described orofacial dysfunction in terms of feeding and communication problems, needs for orthodontic treatment to reduce risk of trauma or improve chewing, and drooling. Oral health issues such as dental caries and gingivitis were not mentioned. Five aspects of good professional attitude were recognized: respect, involvement, continuity, knowledge, and availability.

Summary. Objectives. The aims of this study were to investigate and describe oral manifestations in 22q11 deletion syndrome, and to relate the findings to medical conditions. Design. Cross-sectional. Sample and Methods. Fifty-three consecutive patients from Sweden referred to the Sahlgrenska University Hospital during a 3-year period were included, median age 8 yrs (range 2–43; mean age 11·09). All but six patients were children 3–19-years-old. The patients were examined concerning oral mucosa, dental anomalies, dental caries, occlusal development, and eruption of the teeth. The clinical findings were compared to medical data and case history. Results. Dental anomalies were registered in high numbers. Enamel hypoplasia was found in 16 patients. In 13 cases this was documented in primary teeth, of which 10 patients had symmetrical and chronological defects. Enamel hypomineralization was found in 23 patients and was equally common in both primary and permanent teeth. The use of computerized inductive analyses revealed that enamel hypoplasia was associated with medical conditions like preterm birth and congenital heart malformation while hypomineralization was associated with more diffuse conditions like frequent infections. Hypodontia was registered in seven patients, while eight had aberrant tooth shape, and nine patients presented delayed tooth eruption. The patients had an average of 4·6 carious or filled teeth and the oral health was assessed as impaired in 15 patients who had severe dental caries (5–18 carious teeth or multiple active incipient caries lesions). Conclusions. In 22q11 deletion syndrome the oral cavity is affected by anomalies in dental enamel, tooth shape, numbers of teeth, and eruption. Dental health problems due to caries are common. This is of special importance as patients with 22q11 deletion syndrome frequently present with congenital heart malformations and immunological problems.