Dental characteristics and according treatments of children under GA in Germany Abstract Purpose Due to rising numbers of dental referral to general anesthesia, more specialized dental treatments under GA were needed in the last decades in Germany. However, there are few studies about it. Therefore, the present study aimed to assess dental treatment and characteristics of the children underwent GA at Greifswald University Clinic in comparison with specialized pediatric private practices in Germany. Materials and methods This analytical comparative research reviewed the records of all children younger than 18 years old, whose underwent GA at the university dental clinic and three private practices in 2011. All cases were analyzed anonymously, including age, gender, caries levels, diagnostics and dental treatments. Results About 54% and 50%, respectively, of children who underwent GA at both the university clinic and private practices were under 5 years old. Dental caries were mostly diagnosed among referred children (47.4% and 33.8% at university and private practices, resp.) followed by irreversible pulpitis (19.2% and 22.4%, resp.) and ECC (14.1% and 20.1%, resp.). Dental extractions were often performed at university clinic (40.2%) followed by fillings (33.9%), while more restorations and less extractions were supplied at private practices (47.8% and 16.3%, resp.). Conclusions Dental caries and its complications like pulpal problems were the most important reason for children who underwent GA combined with young age (< 5 years). Therefore, a primary preventive approach would be preferable to decrease the number of children in need of comprehensive dental treatment under GA.

Perceived impact of dental pain on the quality of life of children aged 1–3 years and their families Abstract Purpose To evaluate the perceived impact of dental pain on oral health-related quality of life (OHRQoL) among children aged 1–3 years and their families. Methods A cross-sectional study was conducted with 306 randomly selected preschool and day care children in the city of Diamantina, Brazil. Parents/caregivers answered a questionnaire on socio-demographic information, the Brazilian version of the Early Childhood Oral Health Impact Scale, their child’s general/oral health and the Brazilian version of the Dental Discomfort Questionnaire. The children underwent an oral examination. Descriptive statistics, Spearman’s correlations, the Kruskal–Wallis test, Mann–Whitney test and Poisson regression were used to determine associations between the variables (prevalence ratio [PR], α = 5%). Results The prevalence of dental caries and dental pain was 43.1% and 40.2%, respectively. Dental pain (PR: 1.96, 95% CI 1.52–2.54; p < 0.001), monthly household income (PR: 1.38, 95% CI 1.04–1.83; p = 0.026) and dental caries (PR: 1.06, 95% CI 1.03–1.10; p < 0.001) were significantly associated with the perceived impact on OHRQoL. Conclusions Dental pain, household income and dental caries were associated with a negative impact on the OHRQoL of children aged 1–3 years and their families.

Do expectant mothers know how early childhood caries can be prevented? A cross-sectional study Abstract Aim To evaluate the awareness, knowledge, and beliefs about early childhood caries (ECC) among a sample of expectant mothers and to determine their preferences to help design appropriate interventions. Methods Expectant mothers attending for antenatal care at a large public hospital were interviewed and asked to complete a questionnaire about ECC. The questionnaire was pre-tested and validated and contained questions about risk factors, presentations, management, and complications of ECC. Participants were also asked about their preferred method for oral health education about ECC. Data were analysed using SPSS for Windows release and descriptive statistics were generated. Results Four-hundred expectant mothers were approached and 380 (95%) agreed to participate. 59% reported brushing twice or more daily, but only 10% attended the dentist regularly. Only 16% thought that tooth brushing should start as soon as primary teeth erupt. Most (68%) thought that bottle feeding does not need to stop before the age of two. The majority believed that sugar is better consumed between meals (81%) and in portions throughout the day (85%). Only 12% thought that a child should have their first dental visit by the age of one. Educational level influenced knowledge on several aspects of ECC prevention. The participants suggested leaflets (38%) and social media (24%) as methods for oral-health-education delivery. Conclusion Expectant mothers lack adequate knowledge about ECC prevention. There is a need for interventions that deliver advice on child toothbrushing, dietary practices, and dental attendance as part of wider general-health promotion.

Do preschoolers with adverse birth outcomes have more distress during dental examination? Abstract Purpose Studies assessing the influence of neonatal complications on children’s dental behaviour are lacking. We aimed to investigate whether prematurity, birth weight, and history of neonatal intensive care unit (NICU) hospitalisation are associated with distress during dental examination in children. Methods This preliminary longitudinal, retrospective study included 42 5- and 6-year-old children. Distress during dental examination was assessed using the observational FLACC Pain Assessment Tool through video files. Children self-reported their pain (Faces Pain Scale-Revised) at the end of the session. Information about neonatal complications was obtained through medical records. Bivariate analysis was performed (P < 0.05). Results Children with low birth weight (P = 0.047) and toothache history (P = 0.005) had higher frequency of distress during dental examination. There was no association between distress, prematurity and history of NICU hospitalisation (P > 0.05). Conclusions Health professionals can help to disseminate the knowledge that children with history of low birth weight are more prone to perceive distress with apparently painless procedures.

Evaluation of remineralisation potential of experimental nano hydroxyapatite pastes using scanning electron microscope with energy dispersive X-ray analysis: an in-vitro trial Abstract Aim To analyse the remineralisation potential of experimental nano hydroxyapatite (nHAP) paste on artificial caries lesions using scanning electron microscope (SEM) with energy dispersive X-ray analysis (EDX). Methods Sixty-five enamel specimens were randomly divided into 4 test groups (n = 15): 1% commercially available nHAP paste (CnHAP) group, 1% experimental nHAP paste (EnHAP) group, 10% EnHAP group, casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) group and control group (n = 5). Artificial carious lesions were induced in all the specimens and treated with respective paste twice daily for 14 days. The specimens were subjected to EDX analysis at baseline, after demineralisation and after remineralisation. The surface characteristics of the remineralised enamel specimens were evaluated by SEM. Results All the test groups showed significant change in calcium and phosphorus weight percentage (wt%) after remineralisation. The 10 % EnHAP showed higher mean value of calcium and phosphorus wt% followed by 1% CnHAP, 1% EnHAP and CPP–ACP. After remineralisation, both 10% EnHAP and CPP–ACP showed favourable enamel surface changes in SEM analysis. Conclusion Commercially available and experimental nHAP have the potential to remineralise artificially induced carious lesions.

Fissure sealants or fluoride varnish? Routines and attitudes among dental health personnel in Norway Abstract Purpose To investigate routines and attitudes among dentists and dental hygienists concerning use of fissure sealants and fluoride varnish for non-operative management of occlusal caries. Methods All dentists and dental hygienists working in child dental care in three counties in Norway were invited to answer a questionnaire on routines for use of fissure sealants and fluoride varnish. Nine statements regarding attitudes towards use of sealants were scored using a five-point Likert scale. Multivariable logistic regression analyses were performed to assess indicators associated with reported routines for use of sealants and varnish. The study was approved by the Norwegian Centre for Research Data. Results In total 142 of 189 (75%) dentists and dental hygienists answered the questionnaire. The majority of the respondents, n = 83 (59%), reported to prefer fissure sealants while fluoride varnish was preferred by 57 (41%) of the respondents. Frequent use of fissure sealants was reported by 58 (41%) and frequent use of varnish by 104 (74%) of the respondents. Most (n = 104, 74%), used sealants on specific indications, and 89 (64%) opened fissures only when suspecting dentine caries. Preferred method and routines for occlusal caries management differed between counties (p < 0.05). Almost all clinicians agreed with the statement that sealants are protective against caries, while statements regarding costs, technique sensitivity and children’s cooperation revealed some concerns regarding fissure sealing. Conclusions Fissure sealants were the preferred method for occlusal caries management despite reported concerns related to technical aspects and patient cooperation. County-level variation in frequency of sealant use was observed.

Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document Abstract Aim To update the exisitng European Academy of Paediatric Dentistry (EAPD) 2009 fluoride guidelines. Methods Experts met in Athens, Greece duirng November 2018 for the following groups: I Fluoride toothpastes, II Fluoride gels, rinses and varnishes, III Fluoridated milk, fluoridated salt, tablets/lozenges and drops, IV Water fluoridation. Systematic reviews and meta-analyses were reviewed and discussed for each of the groups. The GRADE system was used to assess the quality of evidence which was judged as HIGH, MODERATE, LOW or VERY LOW based on the assessment of eight criteria which can influence the confidence of the results. Following the quality assessment, GRADE was then used to indicate the strength of recommendation for each fluoride agent as STRONG or WEAK/CONDITIONAL. Results Parents must be strongly advised to apply an age-related amount of toothpaste and assist/supervise tooth brushing until at least 7 years of age. The EAPD strongly endorses the daily use of fluoride as a major part of any comprehensive programme for the prevention and control of dental caries in children. Regardless of the type of programme, community or individually based, the use of fluoride must be balanced between the estimation of caries-risk and the possible risks of adverse effects of the fluorides. Fluoride use is considered safe when the manufacturer's instructions are followed. Preventive programmes should be re-evaluated at regular intervals and adapted to a patient's or population's needs and risks. Conclusions For the majority of European Countries, the EAPD recommends the appropriate use of fluoride toothpaste in conjunction with good oral hygiene to be the basic fluoride regimen.