A grounded theory study on Swedish 10 to 16-year-olds' perceptions of pain in conjunction with orthodontically indicated tooth extraction

OBJECTIVE

Children frequently experience pain and/or discomfort during dental treatment. Still, pain research in dentistry has mainly been performed on adults using quantitative methods while research on the child's perspective is scarce. This study aims to explore and describe children's experiences and/or thoughts regarding pain in conjunction with tooth extraction.

MATERIAL AND METHODS

Interviews were carried out with twelve Swedish 10-16-year-olds who had recently undergone tooth extractions due to orthodontic reasons. Interviews were transcribed verbatim and analysed according to grounded theory.

RESULTS

A core category was identified and named 'handling the unavoidable unknown'. The informants recalled experiences of pain and discomfort during extractions. However, instead of focussing on pain, they described an urge for more information about the procedure and what to expect in terms of pain and/or discomfort, during and/or after treatment. They stated that the levels of pain/discomfort were manageable, while the lack of information negatively affected their coping abilities, causing feelings of unease.

CONCLUSIONS

To improve patients' ability to deal with pain in conjunction with dental extraction, the dental team should ensure better and individually tailored information about the treatment. Thus, the use of psychological techniques is a cornerstone in pain management and must be reflected in clinical guidelines.

Children's advocacy centre fails to respond to dental, mental and physical ill-health in abused children

Aim

Sweden´s first multidisciplinary children's advocacy centre (CAC) was founded in 2005 as a collaborative practice between child protection services, the legal system and health care in response to police‐reported child abuse. CACs were introduced in the county of Skåne in 2007. The aim of the study was to describe the health of children investigated at the CAC in Lund, and to examine whether the CAC model of collaboration responded to the healthcare needs of these children.

Methods

All children aged 0–17 years investigated at the CAC in 2015 were included in this retrospective study. We reviewed the CAC files and the children's medical and dental records from one year prior to, until one year after their assessment at the CAC.

Results

Our review of the medical and dental records (n = 298) showed a high prevalence of mental, dental and physical ill‐health. After the CAC joint meeting, only 1% of the children were referred for a medical examination and 4% for a focused forensic evaluation.

Conclusion

Our study demonstrates limitations in the CAC process in responding to extensive health issues of the young victims of crime. We suggest mental, dental and physical health assessments to be statutory in CACs.

Effects and cost-effectiveness of postoperative oral analgesics for additional postoperative pain relief in children and adolescents undergoing dental treatment: Health technology assessment including a systematic review

Background

There is an uncertainty regarding how to optimally prevent and/or reduce pain after dental treatment on children and adolescents.

Aim

To conduct a systematic review (SR) and health technology assessment (HTA) of oral analgesics administered after dental treatment to prevent postoperative pain in children and adolescents aged 3–19 years.

Design

A PICO-protocol was constructed and registered in PROSPERO (CRD42017075589). Searches were conducted in PubMed, Cochrane, Scopus, Cinahl, and EMBASE, November 2018. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria, following the PRISMA-statement.

Results

3,963 scientific papers were identified, whereof 216 read in full text. None met the inclusion criteria, leading to an empty SR. Ethical issues were identified related to the recognized knowledge gap in terms of challenges to conduct studies that are well-designed from methodological as well as ethical perspectives.

Conclusions

There is no scientific support for the use or rejection of oral analgesics administered after dental treatment in order to prevent or reduce postoperative pain in children and adolescents. Thus, no guidelines can be formulated on this issue based solely on scientific evidence. Well-designed studies on how to prevent pain from developing after dental treatment in children and adolescents is urgently needed.

Postoperative pain profile in 10-15-year-olds after bilateral extraction of maxillary premolars

PURPOSE

To study pain perception in 10-15-year-olds, during and after uncomplicated extractions of bilateral maxillary premolars. The study investigated pain's natural course and made comparisons between the first and second extractions.

METHODS

31 Swedish children in need of orthodontic treatment were identified and consecutively enrolled. Tooth extractions followed a standardised protocol and the two teeth were extracted with at least 10 days between. The participants rated pain intensity using visual analogue scale (VAS) at 14 different time points from treatment and 7 days forward.

RESULTS

The pain intensity profile followed the same pattern for all patients. Pain intensity peaked 2 h after extractions (mean VAS_PI 27.3, SD 20.8; median 23.0) when moderate pain intensity (VAS_PI ≥ 40) was registered for 16 (28%) of 57 cases. After that, there was a rapid decrease in pain intensity notable already at 4 h after extractions. There were no statistically significant differences in any VAS_PI measurements between the first and second extractions, sexes, or different age groups.

CONCLUSIONS

The majority of the participants who undergo uncomplicated bilateral extraction of maxillary premolars experience mild to moderate levels of postoperative pain during a short period of time, with no differences between the first and second extractions. Bilateral tooth extractions is a suitable model for further studies on pain management.

Dentists' attitudes towards acute pharmacological pain management in children and adolescents

AIM

This study aimed to investigate Swedish dentists' attitudes regarding pain management strategies for treating children and adolescents. It assessed recommendations for pre- and postoperative analgesics, and use of local anaesthesia, and whether application of these strategies differs between general dental practitioners (GDPs) and specialists in paediatric dentistry (SPDs).

DESIGN

We invited all GDPs (n = 807) in southern Sweden (Region Skåne), and all registered SPDs (n = 122) working in Sweden (929 actively practising dentists under age 65 years) to participate in a postal survey on pain management in paediatric dental care.

RESULTS

The SPDs reported using all types of pain-reducing strategies more frequently than GDPs except local anaesthesia when extracting a permanent premolar, which SPDs and GDPs used equally often. Preoperative analgesic use was greater among SPDs than GDPs. GDPs used local anaesthesia less frequently for filling therapy in primary teeth than in permanent teeth.

CONCLUSIONS

SPDs recommend preoperative analgesics more often than GDPs do. GDPs seem to underuse local anaesthetics when treating children and adolescents. SPDs also use pain management strategies more frequently than GDPs. Among GDPs, pain management is less frequent when treating primary teeth than permanent teeth.

Five years' follow-up of dental fear and anxiety, experience of dental care and oral health behaviour in Swedish preterm and full-term adolescents

Background

There is rising concern about how preterm birth affects long-term health later in life. The various effects that preterm birth have on developmental outcomes, cognitive profiles and medical health may also affect levels of cooperation in the dental care situation in addition to general oral health and other oral health-related habits. Oral health is an integral part of one’s general health and well-being; however, less is known about how prematurity affects oral health and other related areas such as dental care, and including dental fear and anxiety (DFA) in individuals during adolescence and adulthood. This is considered of special interest to study, as preterm children during the preschool and school period were reported to have behavioural problems during dental treatments and less than favourable oral hygiene.

Methods

A questionnaire was used of self-report design and structured into behavioural aspects relating to dental treatment, oral health-related factors, and medical health. This questionnaire at 17–19 years of age was a follow-up from 12 to 14 years of age and considered a predictor for planning future dental care for this group of patients. The 145 participating adolescents were all preterm, born between 23 and 32 weeks of gestation and 140 full-term controls, born ≥37 weeks of gestation.

Results

Dental fear and anxiety, oral health behaviour, and intake of sweets and sugary drinks of 17–19-year old adolescents born preterm was comparable to that of the full-term control group. Medical health problems as well as the intake of sweets and sugary drinks increased from the time of early adolescence to late adolescence in both groups.

Conclusions

Preterm as well as full-term adolescents between 17 and 19 years of age are satisfied with their dental care and display low prevalence of dental fear and anxiety (DFA). The findings in this study indicate that adolescents born very preterm and extremely preterm are well prepared for transition to dental care in adult life with expectations of being able to take responsibility for their oral health.

Local analgesia in paediatric dentistry: a systematic review of techniques and pharmacologic agents

PURPOSE

To evaluate the evidence supporting effects and adverse effects of local analgesia using different pharmacological agents and injection techniques during dental treatment in children and adolescents aged 3-19 years.

METHODS

A systematic literature search of databases including PubMed, Cochrane, and Scopus was conducted in November 2016. The PRISMA-statement was followed. Two review authors independently assessed the selected randomised control trials for risk of bias and quality.

RESULTS

725 scientific papers were identified. 89 papers were identified to be read in full text of which 80 were excluded. Finally, 9 papers were evaluated for quality and risk of bias. Many of the included papers had methodological shortcomings affecting the possibility to draw conclusions. Information about ethical clearance and consent were missing in some of the included papers. No alarming adverse effects were identified. One study was assessed as having low risk of bias. This reported inferior alveolar nerve block to be more effective than buccal infiltration for dental treatment of mandibular molars, while no differences were found regarding pharmacological agents.

CONCLUSIONS

At present, there is insufficient evidence in support of any pharmacologic agent or injection technique as being superior compared to others. There is a need for more rigorous studies which also handle the ethical issues of including children in potentially painful studies.

Oral health-related quality-of-life in Swedish children before and after dental treatment under general anesthesia

OBJECTIVE

This study evaluated oral health-related quality-of-life (OHRQoL) in children and families before and after dental treatment under general anesthesia because of severe caries or molar-incisor hypomineralization (MIH).

MATERIALS AND METHODS

A consecutive sample of the parents/caregivers of children (3-14 years) in need of treatment under general anesthesia participated in the study. The children were divided into two groups: 3-6 years and 7-14 years. The 49-item questionnaire that was administered before and after general anesthesia comprised the Child Oral Health Quality of Life-components of the Parental-Caregivers Perception Questionnaire (P-CPQ), the Family Impact Scale (FIS) and two global questions concerning oral health and general well-being. The P-CPQ domains were Oral symptoms, Functional limitations, Emotional well-being and Social well-being. The FIS items assessed impact on family life.

RESULTS

In both age groups, a significant decrease (p < 0.001) occurred in overall P-CPQ and the Oral symptoms, Functional limitations and Emotional limitations domains of the P-CPQ. Mean values for the Social well-being domain decreased significantly in the older (p < 0.05) but not the younger age group. Mean values for FIS decreased significantly in the younger (p < 0.001) and the older (p < 0.05) age groups.

CONCLUSIONS

Dental treatment of severe caries or MIH, performed under general anesthesia, had an immediate effect on the oral health-related quality-of-life in the children in this study and a positive impact on the family situation.

Fluoridated salt for caries prevention and control - a 2-year field study in a disadvantaged community

BACKGROUND

Salt fluoridation is considered a cost-effective community strategy for reducing caries.

AIM

To evaluate the effect of school-based and domestic distribution of F-salt to schoolchildren residing in a disadvantaged community.

DESIGN

Seven hundred and thirty-three schoolchildren (12-14 years), attending two public schools, were enrolled; one was assigned to intervention (IS), whereas the other served as reference (RS). Subjects in IS were given access to F-salt (250 ppm F) in marked jars at school lunch and through free supply for domestic use. The 2-year caries increment and progression rate, assessed from bitewing radiographs, was scored. Information on diet, oral hygiene, and fluoride exposure was collected through a baseline questionnaire.

RESULTS

The dropout rate was high (IS 27%; RS 18%). At baseline, the IS children displayed more unfavourable risk factors and a higher caries experience than RS children. There were no significant differences in total caries increment or proximal progression rate between the two schools. A negative correlation (r = -0.29; P < 0.05) between the amount of delivered salt and the caries progression rate was, however, noted. No side effects were reported.

CONCLUSIONS

F-salt was not effective in this setting. Still, the findings indicate that salt may be a beneficial source of fluoride in schoolchildren provided that compliance can be secured.

Specialist paediatric dentistry in Sweden 2008 - a 25-year perspective

International Journal of Paediatric Dentistry 2010; 20: 313-321 Background. Paediatric dentistry in Sweden has been surveyed four times over the past 25 years. During this period postgraduate training, dental health, and the organization of child dental care have changed considerably. Aim. To investigate services provided by specialists in paediatric dentistry in Sweden in 2008, and to compare with data from previous surveys. Design. The same questionnaire was sent to all 30 specialist paediatric dental clinics in Sweden that had been used in previous surveys. Comparisons were made with data from 1983, 1989, 1996 and 2003. Results. Despite an unchanged number of specialists (N = 81 in 2008), the number of referrals had increased by 16% since 2003 and by almost 50% since 1983. There was greater variation in reasons for referrals. The main reason was still dental anxiety/behaviour management problems in combination with dental treatment needs (27%), followed by medical conditions/disability (18%), and high caries activity (15%). The use of different techniques for conscious sedation as well as general anaesthesia had also increased. Conclusions. The referrals to paediatric dentistry continue to increase, leading to a heavy work load for the same number of specialists. Thus, the need for more paediatric dentists remains.

Endodontic treatment in young permanent teeth. Prevalence, quality and potential risk factors

National epidemiologic data on oral health in children and adolescents in Sweden are restricted to caries, such as the number of decayed and filled teeth (DFT) and decayed and filled surfaces (DFS). Information about more complicated and time-consuming procedures such as endodontic treatment is scarce. The aims were to study the prevalence, quality and potential risk factors for endodontic treatment in young permanent teeth. The material consisted of dental records and radiographs. The subjects were all 19-year-olds born in 1979 (paper I-III) and all 15-year-olds born in 1990 (paper IV) belonging to the public dental clinics in Malmo. Paper III also included a control group.

Background factors associated with endodontic treatment due to caries in young permanent teeth

OBJECTIVE

The aim of this retrospective cohort study was to assess the association between background factors and future endodontic treatment due to caries in young permanent teeth.

MATERIAL AND METHODS

The material comprised all 19-year-olds born in 1979 in a city in Sweden who had experienced endodontic treatment due to caries in permanent teeth (n=105) and a control group with no endodontic treatment. From dental records, the following independent variables were derived from age 7 to age 19: immigrant background, caries prevalence (DMFT values) at age 10, occurrence of dental anxiety, and missed or cancelled appointments before endodontic treatment. The outcome variable was presence or absence of endodontic treatment due to caries. Bivariate analysis and a multiple logistic regression model were used to analyse the data.

RESULTS

In the bivariate analyses, all independent variables except cancelled appointments were statistically significantly associated with future endodontic treatment. Of these, immigrant background did not remain as a statistically significant factor in the multiple regression model. The highest odds ratios were 4.3 for >2 DMFT at age 10 and 4.1 for >20% missed appointments.

CONCLUSION

In the present sample, with a relatively high proportion of individuals with an immigrant background, >2 DMFT at age 10, many missed appointments and dental anxiety were all risk indicators for future endodontic treatment due to caries up to age 19.

Periapical status and technical quality of root-filled teeth in Swedish adolescents and young adults. A retrospective study

OBJECTIVE

The aim was to study periapical status and the technical quality of root-filled teeth in Swedish adolescents and young adults in Malmö, Sweden.

MATERIAL AND METHODS

The sample, collected from dental records in the Public Dental Service, consisted of notes and radiographs of all root-filled permanent teeth in all 19-year-olds born in 1979 (mean age at root filling=16.2 years). The sample for assessing periapical status and technical quality consisted of 124-153 teeth. The criterion for inclusion for assessing periapical status was a follow-up time of at least one year. Periapical status was assessed with the Periapical Index (PAI). Technical quality was analyzed from radiographs in two respects: sealing quality of the root canal and distance from the root filling to the radiographic apex. The radiographs were analyzed independently by two observers with inter-examiner kappa values of 0.82-0.85.

RESULTS

Apical periodontitis was found in 52% of the teeth and occurred significantly more often among molars than among anterior teeth. As judged radiographically, 51% of the teeth were inadequately sealed. In 38%, the distance to the apex was >2 mm and overfilling was registered in 14% of the teeth. Compared with anterior teeth, significantly more root fillings of molars had a distance to the apex of >2 mm. Technical quality was statistically significantly correlated with periapical status at follow-up.

CONCLUSIONS

The technical quality and periapical status of root-filled teeth in adolescents and young adults were unsatisfactory in about half of the teeth.

Endodontic treatment during childhood and adolescence. A survey of 19-year-olds living in the city of Malmö, Sweden

The aim of the present study was to determine the prevalence and reasons for endodontic treatment in a sample of 19-year-old adolescents living in the city of Malmö, Sweden. Dental records and available radiographs of all 19-year-olds (1,971) registered at the 20 Public Dental Service (PDS) clinics in Malmö were reviewed and data were collected on the following: endodontic treatment, number and type of teeth involved, and diagnosis leading to treatment. Endodontic treatment had been performed in 180 (9.1%) patients. The percentage of 19-year-olds at a PDS clinic who had undergone such treatment varied between 1.2% and 25.2%. One tooth had been treated endodontically in 138 (76.7%) of these patients. In three patients four teeth and in two patients five teeth had needed treatment. The molars were the teeth most frequently treated (46.5%), followed by the anteriors (39.5%), and the premolars (14.0%). The most commonly treated tooth was the maxillary central incisor and the most common diagnosis was caries (56.4%) followed by trauma (22.2%) and tooth developmental disturbances (1.6%). In conclusion, endodontic treatment seems to be fairly common among 19-year-olds in the city of Malmö. The great variation seen between the different PDS clinics most likely reflected variations in the socio-economic structure of the catchment areas of the clinics.

Dens invaginatus: a retrospective study of prophylactic invagination treatment

AIM

To evaluate the prognosis for pulp survival in teeth with dens invaginatus (DI) subjected to prophylactic invagination treatment.

DESIGN

A retrospective study by examination of dental records and radiographs.

SAMPLE AND METHODS

The dental records of all patients referred to the Eastman Dental Institute, Stockholm, Sweden, with the diagnosis dens invaginatus between the years 1969-1997 were reviewed. Clinical data was collected from the dental records and the diagnosis DI was confirmed on the radiographs from the time of referral. 95 teeth in 66 patients had been subjected to prophylactic invagination treatment. The retrospective evaluation was based on an examination of the radiographs available from the follow-ups.

RESULTS

11.3% of the teeth that were followed for 6 months or longer (n = 80) were judged as failures, All failures were initially classified as Oehlers type 2.

CONCLUSION

The findings stress the importance of a follow-up program for teeth subjected to prophylactic invagination treatment in order to avoid serious periradicular complications that could influence the outcome of the endodontic treatment.

Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth

The aim was to assess the prevalence of pulp exposure after stepwise versus direct complete excavation of permanent posterior teeth with deep carious lesions. The material, representing 116 patients aged 6-16 yrs (mean = 10.2 yrs), consisted of 127 teeth with radiographs revealing carious lesions to such a depth that pulp exposure could be expected if direct complete excavation was performed. Teeth with clinical symptoms, other than transient pain shortly before treatment, were not accepted. The teeth were randomly selected for either treatment procedure. Stepwise excavation implied removal of the bulk of carious tissue and application of calcium hydroxide, followed by sealing of the cavity with zinc-oxide eugenol cement. After a period of 8-24 weeks the rest of the carious dentin was removed and the cavity sealed with calcium hydroxide, zinc-oxide-eugenol (ZOE) and a restorative material. Direct complete excavation entailed removal of all carious dentin followed by sealing as mentioned above. In case of pulp exposure, pulp treatment was performed. The pulp was exposed in 40 of the teeth treated by direct complete excavation. The corresponding figure for those treated by stepwise excavation was 17.5%. The difference was statistically significant. The teeth with no pulp exposure after direct or stepwise excavation showed normal clinical and radiographic conditions at the last check-up (mean = 43 months).