Paediatric dentistry

  1. Pupal success rates
The treatment of 51 primary molars of children aged 5-9 years was used to compare the clinical and radiographic success rates of three different pulpotomy agents after 18 months.
The teeth were randomly assigned to experimental or control groups and after coronal pulp removal and haemostasis, the remaining pulp tissue was covered with mineral trioxide aggregate (MTA) or Biodentine in the experimental groups. In the control group, formocresol was placed with a cotton pellet over the pulp tissue for 5 min and after removal the pulp tissue was covered with zinc oxide-eugenol (ZOE) paste. All teeth were immediately restored with reinforced ZOE base and resin modified glass-ionomer cement, and later with pre-formed metal crowns. Of the 45 teeth available for follow up at the end of 18 months all of the available teeth for MTA and Biodentine were clinically successful, as were 73.3% of the formocresol control group, while radiographic success rates were 100%, 86.66% and 73.3% respectively.

Juneja P, Kulkarni S.  Clinical and radiographic comparison of biodentine, mineral trioxide aggregate and formocresol as pulpotomy agents in primary molars. Euro Archives Paediatric Dent 2017 Aug 05.

Q Which of these agents would appear to be most successful for primary molar pulpotomies?
A Biodentine
B Mineral trioxide aggregate
C Formocresol
D Zinc oxide-eugenol

  1. Stainless success story
Long term treatment outcomes of primary molar carious lesions in a sample of children in primary care were studied using 180, 5-8-year-old children. Each child had one carious primary molar treated by a dental therapist with a plastic restorative material (PRM) or a pre-formed stainless steel crown placed with the Hall Technique (HT). After 2 years, restorative outcomes were categorised as success, minor failure, or major failure. A total of 147 (82%) children were followed up for a mean period of 25 months. Failure was observed significantly more in the PRM group (32%) than the HT group (6%). When baseline carious lesions were radiographically deep with marginal ridge breakdown (MRB), there was a higher proportion of major failures than when they were shallow without MRB (33% and 1%, respectively). Among the deep lesions, those treated with the HT showed better success than PRM. Overall, there was a much higher success rate in the children treated with HT than PRM and, additionally, deep carious lesions responded better to HT than PRM.

Boyd DH, Page LF, Thomson WM. The Hall Technique and conventional restorative treatment in New Zealand children’s primary oral health care - clinical outcomes at two years. Int J Paediatric Dent 2017 Aug 08.

Q The use of plastic restorative material to manage carious primary molars:
A Was far less satisfactory than the stainless steel crown Hall Technique
B Lead to a success rate of 32%
C Was more effective for deep lesions
D Prevented marginal breakdown more successfully

  1. Oscillating-rotating works for children too
Clinical investigations of plaque removal efficacy of power toothbrushes in children are limited, so this research compared their plaque removal versus manual toothbrushes in a paediatric population. Subjects were randomly assigned to a treatment sequence involving an oscillating-rotating power toothbrush and a manual toothbrush control, brushing under supervision with a sodium fluoride dentifrice. Plaque was assessed pre- (baseline) and post-brushing using the Turesky Modification of the Quigley-Hein Plaque Index by two examiners. Plaque scores were averaged for mixed and permanent dentition on a per-subject basis and analysed. Forty-one subjects (mean 9.0 years) were randomised and completed the trial. Both the power brush and manual brush provided statistically significant mean plaque reductions versus baseline in all analyses but for both examiners, plaque removal was significantly larger for the power brush in permanent and mixed dentitions. The interexaminer correlations for the permanent dentition were strong for pre-brushing plaque across all periods. An oscillating-rotating power toothbrush provided superior plaque reduction versus a manual toothbrush in children.

Davidovich E et al. Randomised clinical study of plaque removal efficacy of a power toothbrush in a paediatric population. Int J Paediatric Dent 2017 May 11.

Q An oscillating-rotating power toothbrush:
A Provided an equal plaque removal reduction in children compared to a manual brush
B Provided worse plaque removal reduction in children compared to a manual brush
C Provided superior plaque removal reduction in children compared to a manual brush
D Is not available for use by children

  1. CH or CHX?
The purpose of this study was to evaluate in vivo the antibacterial effect of calcium hydroxide (CH) dressings, with or without chlorhexidine (CHX), on human primary teeth with apical periodontitis. Forty root canals in 40 children were selected. A first microbiological sample was obtained after coronal opening, and the teeth were randomly assigned to two groups: root canals filled with CH paste; CH paste plus 1% CHX. After 30 days, the dressing was removed and the canals were allowed to remain empty for 72 hours. Subsequently, the second microbiological sample was collected. Both CH dressings provided a significant reduction in the number of microorganisms (anaerobic, aerobic, black-pigmented bacilli, streptococci and Streptococcus mutans). However, in terms of complete elimination of microbiota, CH paste alone exhibited greater efficacy. The addition of chlorhexidine did not provide additional antimicrobial benefits compared with pure calcium hydroxide paste as an intracanal dressing in primary teeth with apical periodontitis.

Silva LA et al. Antibacterial effect of calcium hydroxide with or without chlorhexidine as intracanal dressing in primary teeth with apical periodontitis. Pediatric Dent 2017 39: 28-33.

Q In order to eliminate microbiota completely, which agent or agents would you employ?
A Calcium hydroxide paste and chlorhexidine
B Chlorhexidine alone
C Calcium hydroxide paste alone
D Amalgam