Paediatric Dentistry

13. Pulpotomy proves successful

The aim of this study was to evaluate and to compare clinical and radiographic outcomes of four materials (formocresol, mineral trioxide aggregate (MTA), Portland cement and enamel matrix derivative) using primary teeth pulpotomies. Sixty-five patients aged 5-9 years (32 female) were included in the study. A total of 140 primary, first and second molars with deep caries were treated with pulpotomy. All teeth were then restored with stainless steel crowns. The treated teeth were evaluated clinically and radiographically at 3, 6, 12, 18 and 24 months. At 24 months, the clinical success rates of formocresol, MTA, Portland cement, and enamel matrix derivative were 96.9%, 100%, 93.9%, and 93.3%, respectively. The corresponding radiographic success rates were 84.4%, 93.9%, 86.7% and 78.1%, respectively. Although there were no statistically significant differences in clinical and radiographic success rates among the four groups, MTA appears to be superior to formocresol, Portland cement, and enamel matrix derivative as a pulpotomy agent in primary teeth.

Yildirim C et al. Clinical and radiographic evaluation of the effectiveness of formocresol, mineral trioxide aggregate, portland cement, and enamel matrix derivative in primary teeth pulpotomies: a two year follow-up. J Clin Pediatric Dent 2016 40:14-20.

Q Which of the following does NOT represent the findings of this study?
A Mineral trioxide aggregate (MTA) was the superior material
B The radiographic success rates of Portland cement was 86.7%
C The teeth were restored with amalgam
D Primary teeth were treated exclusively

14. What do mum and dad think?

In order to re-examine parental attitudes toward advanced behaviour management techniques in paediatric dentistry and determine whether cost, urgency, and amount of treatment influence parental preferences, parents viewed previously validated videotaped clinical vignettes of four advanced behaviour guidance techniques: passive immobilisation; active immobilisation; general anaesthesia; and oral sedation. The study was conducted in a children’s hospital dental clinic and a suburban private paediatric dental practice. Parents rated overall acceptance of the techniques, and acceptance under specified conditions using a visual analogue scale. Oral sedation was rated as the most acceptable technique, followed by general anaesthesia, active immobilisation, and passive immobilisation. As urgency, convenience, and previous experience increased, parental acceptance of the technique increased. As cost of treatment increased, parental acceptance decreased. Ratings differed with the demographic variables of insurance, income, and race. The hierarchy of parental acceptance of advanced behaviour guidance techniques is changing with increasing approval of pharmacological management and decreasing approval of physical management.

Patel M et al. Parental attitudes toward advanced behavior guidance techniques used in pediatric dentistry. Pediatric Dent 2016 38: 30-36.

Q Parental acceptance of behaviour guidance techniques:
A Is not influenced by the cost of the technique
B Differs with the demographic variables
C Is changing away from pharmacological management
D Rated passive immobilisation as the most acceptable

15. Youngsters aware of aesthetics

This study’s purpose was to determine preschool-age children’s social perceptions and self-perceptions regarding altered dental aesthetics. A cross-sectional study was carried out involving 431, 4-5-year-olds who were shown four photographs of children with incisors exhibiting discolouration, crown fracture, a missing tooth, or normal teeth. The children were asked four questions for analysis of social perceptions and two additional questions for analysis of self-perceptions. Children had negative social perceptions, as a significant association was found between their negative feelings and the altered dental aesthetics in children pictured in the photographs. The affected anterior incisor was indicated as the main reason for this feeling. When analysing self-perceptions, a significant association was found between negative feelings and the child’s own altered dental aesthetics with those affected feeling 1.92-fold sadder than those without altered aesthetics. Again, the affected teeth were indicated as the main reason for this feeling (prevalence ratio equals 1.22) in comparison to reasons cited. This age group has negative social perceptions and self-perceptions regarding altered dental aesthetics.

Soares FC, Cardoso M, Bolan M. Altered esthetics in primary central incisors: the child's perception. Pediatric Dent 2016 37: 29-34.

Q What made these young children sad?
A Altered dental aesthetics in children pictured in photographs
B If their own dental aesthetics were altered
C Having to pay a visit to the dentist
D Specifically, crown fracture

16. The art of ART

A pragmatic randomised controlled trial comparing a minimally invasive approach based on atraumatic restorative treatment (ART) procedures (test) was tested against the standard-care approach (control) to treat early childhood caries (ECC). Dental therapists trained in ART provided treatment to the test group and dentists treated the control group. Restoration quality was evaluated at follow-up using the ART criteria. There was no statistically significant difference in age, sex and baseline caries experience between the test and control groups (n=127 each). At follow-up (mean interval 11.4 months), 220 children were examined (test = 115 and control = 105) and 597 teeth (test = 417 and control = 180) were evaluated for restoration quality, of which 16.8% (test) and 6.7% (control) were judged to have failed (required replacement). The ART-based approach enabled more children and teeth to be treated, and multisurface restoration and treatment in a primary-care setting had higher odds of restoration failure.

Arrow P. Restorative outcomes of a minimally invasive restorative approach based on Atraumatic Restorative Treatment to manage early childhood caries: a randomised controlled trial. Caries Res 2016 50: 1-8.

Q The ART technique:
A Meant fewer children could be treated
B Led to fewer failures
C Was utilised by dental therapists
D Was unfairly tested as the groups were not comparable