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The use of fluorides and bonded resins in caries prevention for the handicapped child
Journal of Dentistry, 5, No. 4, 1977, pp. 339-354.
Printed in Great Britain
QuarterlyDentuT Review Abstracts
from current
international
CHILD DENTAL HEALTH/ ORTHODOMTICS/PAEDODOMTlCS PRUHS R. J.. OLEN G. A. and SHARMA P. S. Relationship between formocresol PU@tomies on primary teeth and enamel defects on their permament successors, J. Am. Dent Assoc. 94 (1977) 698-700. Twenty-five patients were involved in the study. All had had formocresol pulpotomies in primary teeth. Their permanent successors were compared with the corresponding teeth on the untreated side. The surfaces of the teeth were evaluated for enamel defects and caries. There was a highly significant difference between teeth on the treated and the control sides, there being more enamel defects on the treated side in 24 of the 25 pairs. The results of this study indicate a definite relationship between formocresol for pulpotomies in priman/ teeth and enamel defects on their permanent successors. This information should be considered before formocresol pulpotomy is attempted in the primary dentition. E. Ft. Smart
KUHLKE K. L. and DRENNON D. G. An alternative to the anterior single tooth removable partial denture, J. Int ASOC. Dent Child. 8 (1977) 11-14. The replacement of a missing anterior tooth in a young patient presents problems. Several techniques have been advocated prior to bridge construction when the patient is
literature
older. If the occlusion is such that there is no possible interference in either centric or functional occlusion then a porcelain fused to metal fixed denture is a possibility. This is fixed to the abutment teeth using the acid-etch technique. The clinical procedure and laboratory steps in the fabrication of such a fixed denture are presented. R. S. Brandt
WEI S. H. Y., NOVAK A. J. and SILVERSTONE L. M. The use of fluorides and bonded resins in caries prevention for the handicapped child, J. Int Assoc. Dent Child, 8 11977) 3-9. The oral health of handicapped people leaves much to be desired. This can be due to lack of professional care, but is more commonly the result of high plaque scores, gingival indices and periodontal disease levels due to inadequate home care. There are more carious teeth left untreated and more extracted teeth in the handicapped patient. Undoubtedly water fluoridated at an optimum level is the single most effective means of preventing dental caries for communities with a central water supply. Unfortunately not all communities fluoridate their water supplies and in rural communities the procedure may not be possible. Howowitz (1973) suggested the use of fluoridators in schools at a higher level of fluoride than is suggested for waterworks. Subsequently, some schools used this pre ventive technique and have achieved impressive falls in the caries and extraction rates. Institutions for handicapped patients should
340
Journal of Dentistry, Vol. ~/NO. 4
consider the installation of such a system seriously. The fluoride levels used have ranged between 5 and 6.3 parts/lO’, but it must be remembered that the children only go to school 266 days out of each year and only consume school water for a possible 7 hours out of the 24 hours. In the absence of water fluoridation, fluoride supplementation can be given by drops orvitamin/fluoride tablets or lozenges. Some authorities have suggested slowly dissolving tablets to prolong the topical effect. The professional administration of topical fluorides after a prophylaxis is also effective. APF gels are recommended and especially the thixotropic type of fluoride gel. Various flavocrs are commercially available. Fluoridated dentifrices are to be preferred and plaque removal on a regular basis should be performed by the parent of the patient if the handicap is too great to allow effective plaque removal by the patient. Ball syringes or plastic irrigating devices may supplement the removal of expectorant from the mouth of the very handicapped patient. It is also suggested that APF gel or stannous fluoride gel be brushed on the teeth daily during an initial attack on the caries problem. When the caries activity has been arrested or is low a less intensive fluoride regime can be used, e.g. a daily fluoride tablet. Fluoride rinsing is effective for subjects who can swish and expectorate properly. Pit and fissure sealants are significantly effective in reducing occlusal caries. The technique must be performed properly, preferably under rubber dam. Primary teeth need a longer etching time prior to sealing. Ft. S. Brandt
SI LVESTRO J. R. Second dentition and school readiness, NY StareDent J. 43 (1977) 155-158. To take advantage of the strong desire to learn in children early school entrance may be desirable. However, some believe that it is hermful for a child to begin school too early. Ilg and Ames (1965) found a fairly disrelationship between the second tinct
dentition and early school performance. When the majority of the second teeth erupt, optional growth of the head is completed, with a corresponding increase in the control of voluntary thinking processes. It is hypothesized that children with a greater number of second teeth would show higher levels of performance than children with fewer second teeth. A total of 84 first and second grade children, from predominantly middle class families, was included in this study. Follow ing a dental examination in October the total second dentition score for each child was assessed. The teachers were then asked to complete the Devereux elementary school behaviour rating scale for each child. This is a measure of the overt social and emotional behaviour which either interfere or enhance learning. Following this metropolitan readiness tests were administeredthese measure the degree of intellectual skills which are needed for school learning. Finally, each child was assessed using the concept assessment kit--conservation. This is a series of tests to determine cognitive development. In June each child repeated these tests. In addition, his reading vocabulary and comprehension were assessedusing the Gates-MacGinitie reading tests. The results were partially supportive of the Ilg and Ames findings. For first grade boys the number of second teeth appears to be a valuable index of school readiness. Boys tend to experience more difficulties than girls in the primary grades end edditional information provided by the second dentition should be welcomed. The results were not significant for girls, although similar to those obtained by Rosen. It is suggested that the variation in the dentition scores of the girls was less than that of the boys, resulting in a restriction of the magnitude of the correlations computed. The lack of significant correlations for second grade children is attributed to the fact that they tended to reach the test ceiling, that is the majority scored high on the readiness measurements, and thus reduced the chances of obtaining high correlations with the dentition. The results of this study suggest that a dental examination may become a necessary the psycho-educational component of assessmentof primary grade children. E. R. Smart
Printed in Great Britain
QuarterlyDentuT Review Abstracts
from current
international
CHILD DENTAL HEALTH/ ORTHODOMTICS/PAEDODOMTlCS PRUHS R. J.. OLEN G. A. and SHARMA P. S. Relationship between formocresol PU@tomies on primary teeth and enamel defects on their permament successors, J. Am. Dent Assoc. 94 (1977) 698-700. Twenty-five patients were involved in the study. All had had formocresol pulpotomies in primary teeth. Their permanent successors were compared with the corresponding teeth on the untreated side. The surfaces of the teeth were evaluated for enamel defects and caries. There was a highly significant difference between teeth on the treated and the control sides, there being more enamel defects on the treated side in 24 of the 25 pairs. The results of this study indicate a definite relationship between formocresol for pulpotomies in priman/ teeth and enamel defects on their permanent successors. This information should be considered before formocresol pulpotomy is attempted in the primary dentition. E. Ft. Smart
KUHLKE K. L. and DRENNON D. G. An alternative to the anterior single tooth removable partial denture, J. Int ASOC. Dent Child. 8 (1977) 11-14. The replacement of a missing anterior tooth in a young patient presents problems. Several techniques have been advocated prior to bridge construction when the patient is
literature
older. If the occlusion is such that there is no possible interference in either centric or functional occlusion then a porcelain fused to metal fixed denture is a possibility. This is fixed to the abutment teeth using the acid-etch technique. The clinical procedure and laboratory steps in the fabrication of such a fixed denture are presented. R. S. Brandt
WEI S. H. Y., NOVAK A. J. and SILVERSTONE L. M. The use of fluorides and bonded resins in caries prevention for the handicapped child, J. Int Assoc. Dent Child, 8 11977) 3-9. The oral health of handicapped people leaves much to be desired. This can be due to lack of professional care, but is more commonly the result of high plaque scores, gingival indices and periodontal disease levels due to inadequate home care. There are more carious teeth left untreated and more extracted teeth in the handicapped patient. Undoubtedly water fluoridated at an optimum level is the single most effective means of preventing dental caries for communities with a central water supply. Unfortunately not all communities fluoridate their water supplies and in rural communities the procedure may not be possible. Howowitz (1973) suggested the use of fluoridators in schools at a higher level of fluoride than is suggested for waterworks. Subsequently, some schools used this pre ventive technique and have achieved impressive falls in the caries and extraction rates. Institutions for handicapped patients should
340
Journal of Dentistry, Vol. ~/NO. 4
consider the installation of such a system seriously. The fluoride levels used have ranged between 5 and 6.3 parts/lO’, but it must be remembered that the children only go to school 266 days out of each year and only consume school water for a possible 7 hours out of the 24 hours. In the absence of water fluoridation, fluoride supplementation can be given by drops orvitamin/fluoride tablets or lozenges. Some authorities have suggested slowly dissolving tablets to prolong the topical effect. The professional administration of topical fluorides after a prophylaxis is also effective. APF gels are recommended and especially the thixotropic type of fluoride gel. Various flavocrs are commercially available. Fluoridated dentifrices are to be preferred and plaque removal on a regular basis should be performed by the parent of the patient if the handicap is too great to allow effective plaque removal by the patient. Ball syringes or plastic irrigating devices may supplement the removal of expectorant from the mouth of the very handicapped patient. It is also suggested that APF gel or stannous fluoride gel be brushed on the teeth daily during an initial attack on the caries problem. When the caries activity has been arrested or is low a less intensive fluoride regime can be used, e.g. a daily fluoride tablet. Fluoride rinsing is effective for subjects who can swish and expectorate properly. Pit and fissure sealants are significantly effective in reducing occlusal caries. The technique must be performed properly, preferably under rubber dam. Primary teeth need a longer etching time prior to sealing. Ft. S. Brandt
SI LVESTRO J. R. Second dentition and school readiness, NY StareDent J. 43 (1977) 155-158. To take advantage of the strong desire to learn in children early school entrance may be desirable. However, some believe that it is hermful for a child to begin school too early. Ilg and Ames (1965) found a fairly disrelationship between the second tinct
dentition and early school performance. When the majority of the second teeth erupt, optional growth of the head is completed, with a corresponding increase in the control of voluntary thinking processes. It is hypothesized that children with a greater number of second teeth would show higher levels of performance than children with fewer second teeth. A total of 84 first and second grade children, from predominantly middle class families, was included in this study. Follow ing a dental examination in October the total second dentition score for each child was assessed. The teachers were then asked to complete the Devereux elementary school behaviour rating scale for each child. This is a measure of the overt social and emotional behaviour which either interfere or enhance learning. Following this metropolitan readiness tests were administeredthese measure the degree of intellectual skills which are needed for school learning. Finally, each child was assessed using the concept assessment kit--conservation. This is a series of tests to determine cognitive development. In June each child repeated these tests. In addition, his reading vocabulary and comprehension were assessedusing the Gates-MacGinitie reading tests. The results were partially supportive of the Ilg and Ames findings. For first grade boys the number of second teeth appears to be a valuable index of school readiness. Boys tend to experience more difficulties than girls in the primary grades end edditional information provided by the second dentition should be welcomed. The results were not significant for girls, although similar to those obtained by Rosen. It is suggested that the variation in the dentition scores of the girls was less than that of the boys, resulting in a restriction of the magnitude of the correlations computed. The lack of significant correlations for second grade children is attributed to the fact that they tended to reach the test ceiling, that is the majority scored high on the readiness measurements, and thus reduced the chances of obtaining high correlations with the dentition. The results of this study suggest that a dental examination may become a necessary the psycho-educational component of assessmentof primary grade children. E. R. Smart