Anxiety related to dental general anaesthesia: changes in anxiety in children and their parents

AIM

To examine the anxiety levels of children referred for dental general anaesthesia and their parents at various key points of the referral and anaesthetic procedure.

METHODS

Structured interviews and anxiety measures were conducted with 50 children attending the Department of Paediatric Dentistry, Leeds Dental Institute, and progressing to general anaesthetic (GA) and their parents. Interviews were conducted with parents and children prior to initial assessment, following assessment and prior to a GA. Anxiety was measured at each interview, using the Visual Analogue Scale for parents and the Venham's Picture test for children. A fourth telephone interview was conducted with parents one week after the GA when the degree of upset caused to parents and children by the procedure was evaluated.

RESULTS

Anxiety of children remained constant at each interview. Parent and child anxiety were not related. There was a rise in parent anxiety following initial assessment in those families attending in response to a routine referral and progressing to GA (p<0.05). There was a further rise in parent anxiety in these families immediately prior to the GA itself (p<0.001). Parent upset was strongly related to their anxiety at each of the three interviews prior to the GA (p<0.01, 0.05 and 0.001 respectively) and to the distress of their child (p<0.02). Child distress was strongly related to anxiety at each of the three interviews prior to the GA.

CONCLUSION

The anxiety levels of children did not appear to change throughout the whole GA assessment and treatment process. Parent anxiety rose significantly following assessment and again just prior to the GA. Factors contributing to parent upset post treatment were child upset and pre treatment parent anxiety levels. Children who were most anxious prior to GA found the procedure most distressing.

A prospective clinical trial comparing preformed metal crowns and cast restorations for defective first permanent molars

AIM

This study investigated two methods for the restoration of permanent molars affected by amelogenesis imperfecta (AI) or severe enamel defects.

METHODS

A prospective clinical trial was carried out on 17 subjects affected by AI or severe enamel defects of first permanent molars. A split mouth design was used so that each right or left permanent molar in both jaws was restored using either a preformed metal crown (SSC) or a cast adhesive coping (CAC). Subjects were followed for up to 24 months and assessed for longevity and quality of the restorations. Sequential analysis was used to compare longevity.

RESULTS

Records for 42 restorations (19 SSC; 23 CAC) were kept. The split mouth design was possible on 24 occasions (right versus left=14; maxilla versus mandible=10). Three restorations, one SSC (at 6 months) and two CAC (at 2 and 19 months) failed and required replacement. There was no significant statistical difference between the two types of restorations.

CONCLUSION

While there was no difference between the two restorations for quality and longevity, the SSC was considerably cheaper to use and needed only one visit, but more tooth tissue was lost in preparation and fitting. The CAC was significantly more expensive but left nearly all of the tooth crown intact. The choice of which restoration to use is indicated by the immediate and long-term needs of each individual patient.

Evaluation of enzyme-linked immunosorbent assay for the determination of polycyclic aromatic hydrocarbons in house dust and residential soil

Two commercially available enzyme-linked immunosorbent assays (ELISA) for total polycyclic aromatic hydrocarbon (PAH) and carcinogenic PAH (C-PAH) were evaluated. The testing procedures were refined for application to screening PAH and C-PAH in house dust and soil samples for human exposure studies. The overall method precision expressed as percent relative standard deviation (%RSD) of triplicate real world dust and soil samples was within +/- 29% (12-29%) for PAH ELISA and +/- 21% (5.9-21%) for C-PAH ELISA. Spike recoveries from real world dust/soil samples were 114 +/- 30% for phenanthrene from PAH ELISA and 120 +/- 8.2% for benzo[a]pyrene from C-PAH ELISA. The overall method accuracy for PAH and C-PAH assays cannot be assessed for multiple PAH components in dust/soil samples (which represent real-world samples), because of the assays' cross reactivities with other PAH components. Over 100 dust/soil samples from 13 North Carolina homes and 22 Arizona homes were analyzed by PAH and C-PAH assays, as well as by the conventional gas chromatography/mass spectrometry (GC/MS) method. Statistical analysis showed that dust/soil PAH data from ELISA and GC/MS methods are significantly different. In general PAH ELISA responses were higher than PAH GC/MS responses. The regression analysis showed that the linear relationship between ELISA and GC/MS measurements is not strong in the combined data. The relationship became stronger for the data from the same type of dust/soil samples. The screening performance of ELISA was evaluated based on the frequency distribution of ELISA and GC/MS data. The results indicated that the ELISA PAH and C-PAH assays cannot be used as a quantitative analytical tool for determining PAH in real-world dust/soil samples. However, the ELISA is an effective screening tool for ranking PAH concentrations in similar types of real world dust/soil samples.

The dental status of asthmatic British school children

PURPOSE

This study was performed to determine the prevalence of dental disease in British school children with asthma.

METHODS

A convenience sample of 100 asthmatic children (aged 4-16 years) was examined for dental caries, periodontal condition, and tooth surface loss. School children, equated for age, sex, race, and socioeconomic status were chosen for comparison. Children were divided into two age ranges; 4-10 and 11-16 years. A significant difference was found in DMFT (0.96 vs. 0.31) and DMFS (1.37 vs. 0.37) between the 4-10-year-old asthmatic children compared with healthy control children.

RESULTS

In the 11-16-year age range, the asthmatic children had a DMFT and DMFS of 2.48 and 3.39 compared with the control children who had a DMFT and DMFS of 1.11 and 1.97 respectively. Asthmatic children had significantly more plaque, gingivitis, and calculus compared with the control group. There was a significant difference in the severity and number of teeth affected by tooth surface loss affecting labial surfaces of the anterior teeth and occlusal surfaces of the posterior teeth of asthmatic children.

CONCLUSIONS

It was concluded that asthmatic children have more decay affecting their permanent teeth, poorer periodontal status, and more tooth surface loss than healthy controls.

Do we still care about children's teeth?

The level of care for children over the past 5 years has become bimodal, with most children with low levels of dental caries having good maintenance care, but those with moderate to high caries receiving significantly poorer care. Capitation has led to supervised neglect for many children who develop dental decay. This is not at all unexpected considering the general lack of concern by the government and public dental services and the fact that the level of payment of GDPs is such that they cannot afford to treat children. The problems of the dental care of children in the UK are compounded by the lack of specialist paediatric dentists for the more difficult patient.

The effect of different concentrations of sugars in two foods (yoghurts and baked beans) on plaque pH

The effect of different concentrations of sugars in two foods (strawberry yoghurt and baked beans) on plaque acidogenicity was investigated using plaque sampling with a 'Beetrode' electrode. Six varieties of yoghurt, four varieties of baked beans and positive and negative control solutions of 10 per cent sucrose and sorbitol, respectively, were tested on six volunteers, selected according to the guidelines agreed at the San Antonio Conference of 1985. Plaque was harvested immediately before a one minute challenge with the test condition and at 5, 10, 15, 20 and 30 minutes thereafter. Parameters investigated were minimum plaque pH reached after a one minute consumption/rinse of the test food or control solution, maximum drop in plaque pH and 'area of the Stephan curve below pH 6.5'. An Acidogenic Potential Index was calculated for each test food and the results did not suggest a linear relationship between sucrose concentration in a food and acidogenic potential.

The plaque acidogenic response to carbohydrates of children from three ethnic groups in South Africa

The plaque acidogenic response of children from three ethnic groups in South Africa to four different carbohydrates was investigated using the plaque sampling method. A total of 30, 12-year-old children, ten black, ten 'coloured' and ten white, completed this study. The foods tested were 10 per cent sucrose solution, maize porridge, strawberry flavoured yoghurt and banana. The blacks produced an intermediate plaque pH response to sucrose compared with the 'coloureds' and whites but the smallest response for the other carbohydrate challenges. It was concluded that a difference exists in the plaque acidogenic response to carbohydrate between the three ethnic groups and that this may in part account for differences in caries prevalences.

Decontamination of dental unit water systems: a review of current recommendations

It is now recognised that water delivered to dental handpieces and air/water syringes via dental unit water systems may become significantly contaminated with micro-organisms which originate from the incoming water supply and, to a lesser extent, with oral micro-organisms. The purpose of this article is to review the literature relating to the risks associated with contamination of dental unit water systems and methods which may be used to minimise these risks.

Postgraduate training for specialisation

With the prospect of changes brought about through the Mouatt Report and the European Union, calls for a more flexible approach to teaching dentistry are being made. This article describes a postgraduate dental education system that involves modules and credits set up at the University of Leeds. The new system moves away from the more traditional methods of educating post-graduate students.

Acid anion profiles in dental plaque following consumption of cereal-based foods and fruits

The aim of this study was to investigate the acid anions produced in plaque after chewing various cereal-based foods and fruits for one minute. Test foods were oranges, apples, bananas, Cornflakes, Branflakes, Weetabix, Alpen, white bread, wholemeal bread, rice and spaghetti, plus positive and negative controls of 10% sucrose and 10% sorbitol. 4 males and 3 females, aged 22-37 years, participated in the study .7 min from the start of chewing, 48-h plaque was collected from all accessible smooth surfaces, with no attempt to collect interproximal plaque, and centrifuged. Plaque fluid was withdrawn and analyzed by isotachophoresis for formate, succinate, lactate, acetate and propionate. At rest, acetate was the major anion present in plaque fluid, whereas following carbohydrate consumption, highest levels of lactate were detected followed by acetate. The amount of lactate only, detected in plaque fluid, was significantly correlated to the carbohydrate present in the food. It was concluded that important information regarding the acidogenicity of test foods is gained by studying the acid anion profile of plaque fluid.

A comparison of the effects of some extrinsic and intrinsic sugars on dental plaque pH

The aim of this study was to investigate the effects of some intrinsic and non-milk extrinsic sugars on plaque pH. Three fruits (apple, orange and banana) in three different physical forms (whole, homogenized and juice) were tested. Ten adult volunteers refrained from brushing their teeth for 48 hours and did not eat or drink for at least 2 1/2 hours before each test. Measurements of plaque pH were made at baseline to determine the resting plaque pH and at time intervals of 3, 7, 11, 15, 19, 23 and 27 minutes following a 1-minute rinse/chew of each test fruit. A pooled sample of plaque was removed from the buccal surfaces of six teeth representing all four quadrants of the mouth and thoroughly mixed with 20 microliters of distilled water. Plaque pH was determined using a micro-glass combination electrode. Data were compared with plaque pH changes resulting from rinsing with 10% sucrose solution. Analysis of pH minima and 'area under baseline pH', using ANOVA and multiple Turkey tests, indicated that there was no significant difference in any of the parameters between the different forms of preparation within one fruit, except for the minimum pH of whole orange and orange juice (P < 0.05). The results showed that homogenization of the fruits had little effect on acidogenicity even though the intrinsic sugars had been converted to extrinsic sugars. Both whole and mashed banana were of similar acidogenicity to 10% sucrose. Therefore it was concluded that there was no significant difference in the acidogenic potential between intrinsic sugars and extrinsic sugars derived from fruits.

The acidogenic potential of herbal baby drinks

The acidogenic potential of a range of commonly available herbal baby drinks was assessed on the basis of their ability to depress plaque pH in vivo in 10 adult volunteers using the plaque harvesting technique. In addition the pH and inherent acidity of each drink was also analysed in vitro. Solutions of 10% sucrose was used as a positive control and full fat milk served as a negative control as it has traditionally been recommended as a safe drink. Three of the six test drinks had a low pH though most had a low titratable acidity. All drinks, except herbal tea, on rising led to a significant drop in the plaque pH to near critical pH value of 5.5. Most drinks were also more acidogenic than milk and some behaved essentially similar to a 10% sucrose solution. The area under the curve below the resting pH was highest for apple and raspberry herbal drink (20.51 +/- 3.66) and was the least for herbal tea (0.00) compared with the 10% sucrose control (22.01 +/- 2.87) and milk (0.07 +/- 0.14). It was concluded that most herbal drinks tested, especially those with added fruit, can lead to a significant acid production in the plaque and therefore have a potential to cause demineralisation of the enamel.

Integration of methods for determining the acido/cariogenic potential of foods: a comparison of several different methods

Assessment of the acido/cariogenicity of 11 fruits and cereals was carried out using methods recommended at the San Antonio Conference: plaque pH by sampling (PS), indwelling electrode (IDE) and intra-oral cariogenicity test (ICT), together with additional tests of the total carbohydrate content of salivary expectorants, acid anion profiles of plaque, liberated maltose in plaque, total food carbohydrate and fluoride concentration. All foods within each test were compared with sucrose and sorbitol as positive and negative controls. Results for foods were ranked against sucrose for cH area under the curve for PS, for mean ratio [H+] of food versus sucrose (IDE) and mean change in indenter penetration length in enamel after exposure (ICT). Results showed that different rankings of foods were obtained with each method, with a greater degree of commonality for PS and ICT versus IDE. Factor analysis identified liberated maltose in plaque, area below the curve (PS), total food carbohydrate and plaque pH drop (PS) as being important in determining the potential cariogenicity of foods. It was concluded that each of the methods was of value and could be used to assess potential acido/cariogenicity of foods. The recommendation that it was desirable that at least two methods should be used was confirmed.

Acidogenic potential and total salivary carbohydrate content of expectorants following the consumption of some cereal-based foods and fruits

The acidogenic potential of a group of popular cereal-based foods and fruits and total carbohydrate content of salivary expectorants following their consumption were assessed using an indwelling electrode with telemetry and the anthrone method. Paired t tests indicated that sorbitol did not cause the plaque pH to fall as low as any of the test foods (p <0.05) but there was no significant difference between sucrose and the test foods. Only the fruits produced less acid than sucrose. The breakfast cereals tended to yield the highest levels of total carbohydrate in the salivary expectorants although a greater percentage of original carbohydrate was retained after rice and bread. These results suggest the important effect of carbohydrate retention on plaque pH response.

The effect of sucrose in medicines on plaque pH

An investigation into the acidogenic potential of six of the most commonly used sugar-containing and sugar-free paediatric medicines was carried out on 10 adult volunteers. The guidelines of the Food, Nutrition and Dental Health Committee of the American Dental Association were followed. Subjects refrained from brushing their teeth for 48 hours and did not eat or drink for at least 2 1/2 hours prior to each appointment. pH measurements were taken at baseline to determine 'resting' plaque pH and at time intervals of 5, 10, 15, 20, 25 and 30 minutes following a 1-minute rinse with each medication. A pooled sample of plaque was removed from the buccal surfaces of posterior teeth, thoroughly mixed with 20 microliters of distilled water and plaque pH was determined using a glass combination electrode. Data were compared with plaque pH changes after rinsing with control solutions of 10% sucrose and 10% sorbitol. An ANOVA test indicated all sucrose-containing preparations produced a significantly greater drop in plaque pH than their sucrose-free counterparts (P < 0.001). The study provided evidence in support of prescribing sugar-free preparations for children on long-term medication.

Effect of addition of 0.103% citrate to a blackcurrant drink on plaque pH in vivo

The aim of the present study was to investigate whether the addition of a small amount of citrate to infant fruit drinks resulted in a similar beneficial effect to that reported recently with 10% sucrose solution. A popular blackcurrant drink was tested with and without added 0.103% citrate by measuring its ability to depress plaque pH in 20 adult subjects using the plaque-harvesting technique. Solutions of 10% sucrose and 10% sorbitol were used as positive and negative controls, respectively. The results showed that the blackcurrant drink with added citrate had a significantly weaker plaque pH response as compared with the blackcurrant drink without added citrate and 10% sucrose (positive control). The mean areas enclosed by the pH curve below pH 6.0 (+/- SD) were 10% sorbitol (negative control) 0.00, blackcurrant with 0.103% citrate 1.85 +/- 1.07, plain blackcurrant 4.65 +/- 2.11, and 10% sucrose 6.25 +/- 2.35. The acidogenic potential of the blackcurrant drink with added citrate was less than half as compared with the plain blackcurrant drink. It was concluded that the addition of relatively low levels of citrate to a blackcurrant drink reduces the acidogenic response in plaque.

Potential cariogenicity of starches and fruits as assessed by the plaque-sampling method and an intraoral cariogenicity test

The cariogenicity of starches and fruits was investigated by measuring acidogenicity (plaque sampling) and enamel demineralization. Test foods were oranges, apples, bananas, Cornflakes, Branflakes, Weetabix, Alpen (no added sugar), white bread, wholemeal bread, rice, and spaghetti, with positive and negative controls of sucrose and sorbitol. Plaque sampling indicated that all the foods were less acidogenic than sucrose, but only significantly so (p < 0.05), as follows: maximum drop in plaque pH: all foods; minimum plaque pH reached: Cornflakes, Branflakes, and wholemeal bread; cH area: wholemeal bread. All foods produced enamel demineralization. The low pH of oranges and apples caused more demineralization than sucrose. Overall, the foods were less cariogenic than sucrose, but more than sorbitol.

Congenital erythropoietic porphyria--oral manifestations and dental treatment in childhood: a case report

Congenital erythropoietic porphyria is a rare condition resulting from an inborn error in prophyrin metabolism. This deficiency leads to hemolytic anemia, photosensitivity, blistering of the skin, and deposition of red-brown pigments in the bones and teeth. The literature regarding the dental aspects of this disorder is briefly reviewed and the preventive, restorative, and esthetic dental management of a 4-year-old child with congenital erythropoietic porphyria is described.

The effect of different concentrations of citrate in drinks on plaque pH

The effect of 0.1, 0.2 and 0.4% citrate in 10% sucrose solutions on the plaque pH in vivo was tested in 20 volunteers using the plaque harvesting technique. Results showed that the pH response for the three test solutions with citrate was significantly less compared with that for 10% sucrose (positive control) alone (p < 0.05). Mean areas under the pH curve were: sorbitol (negative control) 0.02, citrate 0.2% 5.30, citrate 0.4% 6.24, citrate 0.1% 6.94 and 10% 12.69. The cariogenic potential index of all the citrate test drinks was almost half compared with a 10% sucrose solution (p < 0.05). It was concluded that the addition of relatively low levels of citrate in a sucrose solution reduces the acidogenic response in the plaque.

The effectiveness of the yellow card warning system for paediatric cardiology patients

Questionnaires were completed by the parents of 100 children with cardiac problems attending the regional paediatric cardiology clinic in Yorkshire. The parents' possession and knowledge regarding the use of a yellow card (warning parents and dentists of the need for antibiotic cover before certain dental treatment) was assessed. Only 57 per cent of parents reported that they had received a yellow card.

Dental health and salivary Streptococcus mutans levels in a group of children with heart defects

One-hundred children aged 2-16 years who were attending the Outpatients Department of the Yorkshire Regional Cardiac Centre were examined for dental caries, gingivitis, plaque and calculus. A control group of 100 children was also examined. A saliva sample was taken from each child in the study group to assess the level of Streptococcus mutans colonization. Comparing study and control groups, dental caries experience (dmft) was significantly higher only in the primary teeth of 5-9-year-old children in the study group, and there were no significant differences in gingivitis, plaque or calculus. The S. mutans count was found to be positively correlated to the number of decayed teeth in the study group.