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PubMed2006

Can oral health-related quality of life measures substitute for normative needs assessments in 11 to 12-year-old children?

OBJECTIVES: 1) assess the relationship between a measure of condition-specific oral health-related quality of life (OHRQoL) and the related normative need for dental treatments, and 2) test the diagnostic validity of the condition-specific OHRQoL measure for specific dental conditions in a group of primary school children. METHODS: A cross-sectional study of all 11 to 12 year-olds carried out in a municipal area of Suphanburi province, Thailand. 1034 children (91.8%) were dentally examined to assess their normative needs for 6 types of treatment (dental caries, traumatic dental injuries, enamel defects, periodontal, orthodontic and prosthodontic treatment). OHRQoL was assessed using the Child-OIDP index and its Condition-Specific impacts measure for the 6 treatment types. RESULTS: The prevalence of specific types of normative needs ranged from 3.2% (prosthodontic) to 97.0% (periodontal) and for Condition-Specific oral impacts from 0.7% (prosthodontic) to 50.6% (dental caries). Despite their statistically significant relationship for every treatment type except for periodontal treatment when need was indicated by a CPI score of 1, there were large differences between measures of normative need and oral impacts. High proportions of children had normative need without impacts and vice versa. The biggest differences were for appearance-related conditions (e.g. enamel defects and orthodontic treatment). For every type of treatment, oral impacts poorly predicted the normative needs of individuals. CONCLUSIONS: Although normative needs and OHRQoL are associated, when assessed appropriately, there was considerable discrepancy between them. OHRQoL measures cannot replace normative needs. Instead, both should be used in combination in order to cover different dimensions of oral health.

Attitude to Health↗
PubMed2001

Enrichment-toy trauma in a New Zealand White rabbit.

An injury was caused by an enrichment toy (a whiffle ball, which is a perforated hollow ball made of hard plastic) that led to its removal from the rabbit enrichment program. Manipulata and food treats form the basis of the Yale rabbit enrichment program. All singly housed rabbits are given toys such as balls, chains, wood blocks, PVC tubing, Nylabones, and corrugated plastic tunnels. Before they are used, all potential enrichment devices are reviewed for safety and potential veterinary problems. The whiffle ball had been considered safe because it was made of hard non-toxic plastic, had no sharp edges, was too large to be swallowed or inhaled, and was judged too sturdy to be broken by the rabbits. However, the ball became lodged in the incisors of an adult female New Zealand White rabbit, preventing her from eating or drinking for 12 h and causing marked trauma to her gums. Removal of the ball necessitated anesthetizing the rabbit and using bone cutters to cut away the ball. Ideally, environmental enrichment should increase species-specific normal behavior and minimize stereotypies and self- and conspecific-directed abusive behavior. This case illustrates that safety assessments for an enrichment device must include both the inherent properties of the device and the risks if the toy is misused or damaged. Considerations for safety assessment are discussed.

Animal Husbandry↗
PubMed2003

Associations between school environments and childhood traumatic dental injuries.

PURPOSE: To assess the associations between social and physical school environments and the prevalence of traumatic dental injuries (TDI) in 12-year-old children in Thailand. MATERIALS AND METHODS: A cross-sectional study in 52 urban schools in Thailand was carried out from a sample of 2,725 12-year-old children that were clinically examined for TDI and interviewed. Cluster analyses were performed to classify the schools into supportive and non-supportive schools by social and physical environmental characteristics. Analyses of the associations were performed using multilevel analyses, accounting for school variations and controlling for confounding factors at the child level. RESULTS: 35.0% of children had TDI. Prevalence was twice as high amongst boys than girls. The prevalence of TDI was significantly lower in the schools with a supportive social environment (Crude OR = 0.6 (95% CI = 0.4 to 0.8, p = 0.004)). The adjusted OR was 0.7 (95% CI = 0.5 to 0.9, p = 0.02). This statistically significant association existed in boys but there was only an insignificant tendency of association in girls. There was no statistically significant association between TDI and the physical environment of the schools. But there was an insignificant tendency of association with the physical environment in girls. CONCLUSION: TDI were much more common in boys than girls. TDI were significantly less prevalent in male children in schools with supportive, compared to less supportive social environments. In boys, there was a tendency for the more socially supportive environment to be more protective rather than the effect of any type of physical environment. In girls, this protective tendency was only apparent when school environments were both more socially supportive, and physically favourable.

Child↗
PubMed2005

Management of dental trauma in primary care: a postal survey of general dental practitioners.

OBJECTIVES: To determine the self-perceived knowledge and attitudes of general dental practitioners (GDPs) concerning management of dental trauma in primary care. To identify potential barriers to the management of dental trauma in primary care. DESIGN AND SETTING: A self-completion postal questionnaire survey of 417 GDPs in six local health authority districts in northeast England. MAIN OUTCOME MEASURES: Likert scale responses to 20 statements designed to test self-perceived knowledge and attitudes. Following descriptive statistical analysis. Factor analysis with principle components analysis was undertaken to identify areas of correlation in questionnaire responses, followed by Chi squared test, Spearman's Rank Correlation and analysis of variance (ANOVA) to measure association between variables. RESULTS: The response rate was 74%. Enamel and dentine fractures were the most common injury, with 45% of GDPs responding seeing more than 10 cases of dental trauma in the preceding year and 53% of respondents seeing one to three cases of complicated crown fracture. Seventy-eight per cent believed that NHS remuneration was inadequate, but only 8% would refer patients with dental trauma to secondary care for this reason. Half of the GDPs believed that trauma could be treated more effectively in practice if NHS payments were greater. GDPs were significantly more likely to agree with this statement if they had previously undertaken a postgraduate course in the treatment of dental trauma (p=0.002). Single handed GDPs were statistically significantly more likely to agree with the statements 'I would not treat dental trauma cases at my practice because the NHS payment is inadequate' (p=0.008) and 'Treating dental trauma at my practice requires too much of my clinical time to be worthwhile' (p=0.002). Ninety-six per cent of GDPs disagreed that treatment of dental trauma rested solely within secondary care. Ninety-six per cent of GDPs agreed that they had a responsibility to provide initial emergency treatment for trauma patients prior to referral. Eighty-eight per cent of GDPs felt that aids to management would be useful. CONCLUSIONS: Although GDPs believed that financial remuneration was inadequate, this did not prevent them treating trauma cases. They strongly agreed that they had responsibility for the management of dental trauma in primary care and that they believed trauma could be treated more effectively in practice if payment was greater. Time constraints were perceived as a barrier to long-term management of complex trauma cases in primary care. GDPs would welcome the use of management aids.

Analysis of Variance↗
PubMed1982

Dentoalveolar considerations in the management of facial trauma.

Facial trauma may result in damage to the structures of the mouth, both by direct insult and by hindering access for routine oral health and hygiene measures. Successful management must include consideration of the stomatognathic system. The four major areas of consideration are dentoalveolar response to the forces of trauma and repair, evaluation and management of changes in vitality of the dental pulp, control of infectious and inflammatory periodontal disease throughout the period of evaluation and management, and restoration of the dentition and supporting structures. Guidelines are offered for use in the management of patients with facial trauma in each specific area presented for consideration.

Dental Pulp Necrosis↗
PubMedDate not supplied

Radiation therapy of the oral cavity: sequelae and management, part 2.

This is the concluding portion of a two-part series dealing with the effects and manifestations in the oral cavity of radiation therapy of head and neck tumors. Preradiation and postradiation extractions in dentulous patients, as well as dental maintenance of such patients (including fluoride treatments follow-up, and restorative care), are discussed. Guidelines for the dental management of edentulous patients are also presented at length (this section covers risk of bone necrosis, soft liners, timing of denture placement, dentures and preexisting bone necrosis, soft-tissue necrosis and dentures, morbidity, and prosthodontic procedures). The article concludes with a brief discussion of osteoradionecrosis and soft-tissue necrosis.

Dental Care for Persons with Disabilities↗
PubMed1988

Changes in teeth and gingiva of dogs following laser surgery: a block surface light microscope study.

The effect of laser surgery on tissues of the periodontal apparatus was studied histologically in dogs using block surface light microscopy, a novel microscopical method. With this approach, changes in the hard and soft tissue components were concomitantly demonstrated; the method enabled preservation of the in situ relationship between these components. Following laser surgery, healing in the gingiva was delayed as suggested by the presence of epithelial ulcerations and dense inflammatory infiltrate. In the enamel and cementum the application of laser resulted in crater-like defects that could be avoided only partially by insertion of a tinfoil shield into the gingival sulcus. In the vicinity of the cementoenamel junction these defects were filled with epithelium or periodontal ligament fibers; the close proximity of the hard and soft tissues at the defect sites suggested occurrence of new attachment. Enamel defects located coronal to the gingiva contained bacterial plaque. These histologic results do not demonstrate any substantial advantage of laser over conventional knife gingivectomy. Such advantage may be accomplished with the design of a special intraoral handpiece and further experiments.

Animals↗
PubMed1980

Altered vascular permeability in the dental pulp of traumatised rat teeth.

A study was made of the vascular permeability changes occurring in the dental pulp of rat teeth subjected to trauma of the occlusal surface with a special steel burr. The vascular response was measured by leakage of 131I-labelled human serum albumin and of colloidal carbon. The effect of a variety of inhibitors of increased vascular permeability was observed. The results obtained support the hypothesis that in the model studied the vascular response of the dental pulp is mediated by the sequential release of histamine and 5-HT, kinins and prostaglandins.

Animals↗
PubMed1983

Ultrastructural study of transganglionic degeneration following dental lesions.

Transganglionic degeneration in the trigeminal main sensory nucleus (MSN) and pars interpolaris (PI) was studied in cats following dental lesions. At early survival times, three types of terminal alteration were seen in both MSN and PI: (1) flocculent degeneration, (2) neurofilamentous hyperplasia and, (3) glycogen accumulation. With longer survival times, the magnitude of these terminal alterations increases. Electron dense degeneration was only seen in the ventral half of PI. Phagocytosis of the altered terminals was also observed. The study suggests a plausible explanation for the variations observed in the CNS projection of primary afferents with degeneration and with HRP transport studies.

Animals↗
PubMed1989

[Anterior tooth injury/anterior tooth loss--the epidemiological and orthodontic aspects].

Trauma to incisors, especially loss of permanent anterior teeth, often effects aesthetics, function, psychology and phonetics. The following article describes the frequency, cause and effect of incisors lost as a result of the trauma. The treatment possibilities are discussed with respect to the specific orthodontic considerations. In addition, the indications for space closure by orthodontic or prosthetic procedures are discussed.

Adolescent↗
PubMed1997

Management of dental trauma: development of a 2D data acquisition system to evaluate passivity of dental splints.

Management of dental trauma in children sometimes requires the use of dental splints, which can be constructed from orthodontic materials. Past studies of the mechanical properties of dental splints have only been interested in their flexibility and not passivity. The purpose of this study is to determine the passivity of splints constructed from orthodontic materials. A specific data acquisition system, with a 2D transducer, is developed for evaluation of its neutrality. The transducer detects the displacements of the splinted tooth generated by the splint. The splints are constructed with 0.406 mm round, straight or Arch Blank preformed stainless-steel wires, with 0.559 mm standard edgewise brackets and with 0.254 mm stainless-steel or 3.05 mm elastomeric ligatures. Results show that mean output voltages generated by the splints range from 1.13 V to 2.48 V. The best control of passivity is obtained with the splints constructed with a preformed archwire and with elastomeric ligatures (p < 0.05), and the worst control is obtained with those constructed with a straight wire and with stainless-steel ligatures (p < 0.05).

Humans↗
PubMed2004

The Callander laryngoscope blade modification is associated with a decreased risk of dental contact.

PURPOSE: Dental damage may occur with laryngoscopy. The purpose of this study was twofold: to determine whether preoperative examination could predict the risk of contacting the teeth with the laryngoscope and to evaluate the effectiveness of a modified Macintosh blade on reducing dental contact. METHODS: Four hundred and eighty-three patients scheduled for elective surgery requiring general anesthesia with endotracheal tube placement were studied prospectively. Features that might predict difficult intubation were assessed preoperatively. Laryngoscopy was performed twice on each patient, once with a regular Macintosh 3 blade and once with a blade in which the flange was partially removed (Callander modification). The distance between the flange of the blade and the upper incisors at glottic exposure was measured. We calculated correlations between individual airway characteristics and the chance of hitting the upper teeth with the regular Macintosh 3 blade and compared the frequencies of contacting the teeth between the two blades. RESULTS: The chance of hitting the upper teeth when using the regular Macintosh 3 blade increased significantly with non-parametric scores for Mallampati classification, mandibular subluxation, head and neck movement, interincisor gap, and condition of the upper teeth. (P < 0.01) The frequency of direct contact varied significantly between the two blades: 20.3% vs 4.1% for Macintosh 3 and modified blades, respectively (P < 0.05). Laryngeal views were improved with the modified blade. CONCLUSION: Airway characteristics correlate with the risk of hitting the upper teeth during laryngoscopy. The modified Macintosh blade reduces the risk of contacting the teeth.

Adult↗