Evaluation of the cytotoxicity of contemporary glass-ionomer cements on mouse fibroblasts and human dental pulp cells Abstract Purpose This study aimed to evaluate the cytotoxic effects of different types of contemporary GICs on human dental pulp cell (hDPCs) and mouse fibroblast (L929) cultures. Methods Three high-viscosity GICs (HVGIC; GC Equia Forte, Riva Self Cure, IonoStar Plus), three resin-modified GICs (RMGIC; Photac Fil, Riva Light Cure, Ionolux), and a metal-reinforced GIC (MRGIC; Riva Silver) were investigated. Twelve disc-shaped specimens of each material were prepared and stored in Dulbecco’s modified Eagle medium (DMEM). L929 fibroblasts and DPCs were then cultured in 96-well plates. Uncultured DMEM was used as a negative control. Mitochondrial dehydrogenase activity (MTT) assays were performed to detect cell viability after 24, 48, and 72 h. Data were analysed using Mann–Whitney U and Friedman tests followed by a Bonferroni-corrected Wilcoxon signed rank test, with the statistical significance set at P < 0.05. Results Toxicity levels varied between the cell-culture systems. MTT assays of L929 cells showed significant differences in percentages of viable cells, as follows: Riva Self Cure = Riva Silver > GC Equia Forte > IonoStar Plus = Riva Light Cure = Photac Fil > Ionolux. MTT assays of DPCs showed the percentages of viable cells to be significantly lower for the Ionolux group when compared to the other GICs, which did not differ significantly from one another. With the exception of Ionolux, none of the other GICs tested showed any toxicity, and in fact, they all induced cell proliferation (> 100% cell viability). Conclusions Although the degree of toxicity varied between the two cell-culture systems investigated, all the GICs tested, with the exception of Ionolux, performed favorably with regard to cytotoxicity (> 100% cell viability in both cell systems).

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.

Maxillary arch dimensions in the first 6 months of life and their relationship with pacifier use Abstract Purpose This study evaluated the maxillary arch dimensions at birth and 6 months of life, and to verify the influence of pacifier use on palatal development. Methods Maxillary arch impressions were taken from 80 full-term newborns, appropriate for gestational age, from 24 to 72 h of life, and repeated after 6 months. Anatomical references were mapped on dental casts and measurements were taken. Parents were questioned about feeding practices and sucking habits. Data were analysed by Kruskal–Wallis test and hierarchical mixed regression model (p < 0.05). Results Anterior maxillary segment (median [interquartile range]) presented an increase in transverse (Δ% = 81.90 [74.40–89.70]) and in length (Δ% = 76.20 [49.10–102.70]) relative growth. No differences were detected in palatine depth from birth (11.00 mm [10.30–11.70]) to 6 months (12.60 mm [12.0–13.90]). Conclusions Pacifier use was positively related to the increase in anterior segment length. In the first 6 months of life, the greatest relative growth of the maxillary arch occurs in the anterior region, showing this growth does not occur homogeneously. The use of pacifiers came to influence this process, even before the eruption of the upper incisors.

Effectiveness of a tooth-brushing programme using the picture exchange communication system (PECS) on gingival health of children with autism spectrum disorders Abstract Purpose The Picture Exchange Communication System (PECS) is a communication system for children with autism spectrum disorders (ASD). The aim of this study was to assess the effect of a PECS-based tooth-brushing programme on gingival health in children with ASD and assess parents’ perception of PECS. Methods This was a prospective interventional study. Using PECS as a pictures/cards series showing a structured tooth-brushing method, 37 children with ASD (31 males, 6 females) (average age 9.49 ± 4.10, 4–16 years) and their parents/caregivers were trained on tooth-brushing twice, 2 weeks apart. Data collected after examinations (baseline, 3, 6-months) included gingival and plaque indices (GI, PI) and two questionnaires (baseline, 6-months) for demographic data and parents’ perception of PECS including difficulty rating (easy, hard, very hard) and PECS usefulness. Results Most children with ASD had language abilities (64.9%) and prior PECS use (67.6%). Both GI and PI significantly dropped between baseline and both re-evaluations, (P < 0.001). Age, among studied factors, significantly affected PI only at all stages (P < 0.001). Most parents/caregivers (75.7%) rated PECS as hard, but useful (100%). Age and PECS prior use significantly affected PECS difficulty rating (P  = 0.000 and 0.031, respectively), while sex did not (P  > 0.05). Conclusion PECS though rated as hard was useful in improving gingival health in children with ASD.

Carers’ and paediatric dentists’ perceptions of children’s pain during restorative treatment Abstract Purpose Parents/carers’ and dentists’ evaluations are important when assessing young children’s pain. However, there is little evidence on agreement regarding children’s pain according to proxy reports. The aims of this cross-sectional study were to investigate the agreement among paediatric dentists and parents/carers about children’s pain during treatment and the association between the reporting of pain and child behaviour. Methods Participants were 81 parents/carers of uncooperative children undergoing restorative treatment, and five paediatric dentists. Pain during dental treatment was assessed after dental procedures using the Visual Analogue Scale (0–4 mm: no pain; 5–44 mm: mild pain; 45–74 mm: moderate pain; 75–100 mm: severe pain). Child behaviour was assessed by calibrated researchers using the Ohio State University Behavioural Scale. The agreement between respondents about a child’s pain was evaluated using the weighted kappa test. The association between the pain report and child behaviour was verified using the Kruskal–Wallis and Mann–Whitney tests. Results Parents/carers (36, 44.4%) and paediatric dentists (40, 49.4%) reported that children felt mild pain in all sessions. The parents/carers reported that the children experienced higher pain intensities compared to paediatric dentists. The agreement between respondents was slight (weighted Kappa < 0.20). Higher pain intensities were more frequent when the children’s behaviour was uncooperative. Conclusion Parents/carers and paediatric dentists showed slight agreement regarding the pain felt by children in dental treatment. Pain proxy reporting in children is influenced by the children’s behaviour.

Craniofacial and occlusal features of children with sickle cell disease compared to normal standards: a clinical and radiographic study of 50 paediatric patients Abstract Purpose To evaluate craniofacial and occlusal features of children with sickle cell disease and compare them with the normal healthy children. Methods A total of 50 children diagnosed with sickle cell disease (Group I) and 50 normal healthy children (Group II) between age 10 and 18 years were included in the study. Dental casts were obtained, occlusal traits were recorded and DAI and DHC-IOTN were calculated. Cephalometric parameters were measured. Obtained data were compared between the two groups. Results In children with sickle cell disease, 24% had definite malocclusion according to DAI and only 4% of them had normal occlusion as per the DHC-IOTN index. Also, children with sickle cell had significant retruded mandible and vertical growth pattern when compared with normal children. Conclusions Children with sickle cell disease showed delayed eruption of teeth, a tendency towards Class II molar relationship, with increased crowding in the lower anterior region, increased overjet and open bite when compared to the normal children. Children with sickle cell disease had severe and handicapping malocclusion as per DAI and DHC-IOTN indices and a tendency towards skeletal Class II with a vertical growth pattern.

A systematic review of relative indications and contra-indications for prescribing panoramic radiographs in dental paediatric patients Abstract Purpose To systematically review the evidence of the diagnostic efficacy of panoramic radiographs (PRs) in the following six clinical situations: caries, acute dental infections, dental trauma, dental anomalies, Developmental disorders and pathological conditions in children. The research question posed by the EAPD was: “In which clinical situations and age groups is it indicated/contra-indicated to prescribe PRs in relation to these six clinical situations, in children”. Methods An electronic search of the following databases was conducted: MEDLINE via OVID, EMBASE via OVID, The Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE) and the Cochrane Health Technology Assessment (HTA), to identify relevant studies published from 1990 to 2018. The systematic review was performed according to the PRISMA guidelines. Study screening, data extraction and risk of bias assessment of included studies was carried out independently and in duplicate using the QUADAS 2 tool. Results The search resulted in 3420 potentially relevant studies, and following screening 175 full texts were obtained, of which 16 were finally included in the review. Meta-analysis was not possible for any of the aforementioned clinical situations, therefore the included studies were tabulated in terms of qualitative descriptive hierarchy of evidence for diagnostic. Conclusion Based on currently available evidence there is a need for high quality diagnostic accuracy efficacy studies to address important diagnostic tasks in these six clinical situations in children, as there is a lack of scientific evidence concerning PRs in children, as there would support the production of guidelines for prescribing PRs in children along with their relative indications and contra-indications.

Acceptability of intravenous propofol sedation for adolescent dental care Abstract Purpose Propofol is an intravenous anaesthetic agent commonly utilised in general anaesthesia, however in sub-anaesthetic concentrations can be utilised to provide sedation through automated dosing of target-controlled infusion (TCI). TCI has been shown to provide accurate and stable predicted plasma and effect-site concentrations of propofol. A four-part mixed-method prospective study was undertaken to evaluate the safety and patient acceptability of intravenous propofol sedation in adolescent patients requiring dental care. There is a paucity in the literature on patient-reported outcomes and patient safety in the management of adolescent patients for dental treatment. Methods Demographics were recorded including age, gender, ASA Classification and Children’s Fear Survey Schedule—Dental Subscale (CFSS-DS) completed pre-operatively. Behaviour ratings of the Frankl and Houpt scales were recorded followed by post-operative questionnaire and telephone consultation. Consultation was completed following the procedure to determine patient satisfaction, memory of the procedure and any reported side effects of treatment. Qualitative thematic analysis was utilised. Results 55 patients were recruited for the study, of which 49 (mean age 14.67 years) completed the sedation study and were treated safely with no post-operative complications. The mean lowest oxygen saturation was 98.12% SpO2 (SD 2.6). Thematic analysis demonstrated positive patient-reported outcomes to IV sedation. Conclusion Propofol TCI sedation is an effective treatment modality for the management of dentally anxious adolescents as a safe alternative to general anaesthesia, allowing the opportunity for increased provision of treatment per visit on those patients with a high dental need. Further randomised controlled trials comparing propofol TCI to other pharmacological managements are required.

Prevalence and presentation patterns of enamel hypomineralisation (MIH and HSPM) among paediatric hospital dental patients in Toronto, Canada: a cross-sectional study Abstract Purpose The purpose of the study was to determine the prevalence and presentation patterns of molar incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) in the Division of Paediatric Dentistry at The Hospital for Sick Children (SickKids) in Toronto, Canada. Methods A cross-sectional study of 429 eligible participants was carried out by nine trained and calibrated examiners. The European Academy of Paediatric Dentists (EAPD) criteria for diagnosis and documentation of MIH and HSPM defects were used. Results Molar incisor hypomineralisation and HSPM prevalence was 12.4% and 5.2%, respectively. Regarding MIH, the affected molars and incisors attributed to 5.6% of the total prevalence, the remaining having only molars affected. Demarcated white opacities were most common in MIH (60%) and HSPM (67%), followed by yellow/brown opacities (MIH 22%, HSPM 9%), post-eruptive breakdown (MIH 8%, HSPM 24%), atypical caries (MIH 6%, HSPM 0%), and atypical restorations (MIH 4%, HSPM 0%). In both MIH and HSPM, single surface hypomineralised lesions were significantly more common than multi-surface lesions (p < 0.0001). Most lesions affected buccal enamel (MIH 55%, HSPM 47%). Lesion extension was most frequently less than 1/3 of a tooth surface (MIH 58%, HSPM 67%) and this was significantly more common in teeth affected by HSPM than MIH (p = 0.03). Individuals with HSPM were more likely to present with two affected molars than individuals with MIH (p = 0.03). Hypomineralised second primary molars were not predictive for MIH. Conclusions The prevalence of MIH and HSPM was within the range of published studies. The most common MIH and HSPM lesions affected single surface of a tooth, mostly on the buccal surface and were less than 1/3 of the surface area size.

Prevalence of molar incisor hypomineralisation has a North–South gradient between Europe and North Africa