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1768 Developmental Disturbances of Permanent

Teeth after Trauma to their Predecessors

W. KAMANN, University of Witten/Herdecke, Munster, Germany, and P.
GAENGLER, University of Witten/Herdecke, Germany
Although traumatic injuries to the primary teeth are common, few studies
have analyzed the prognosis of these injuries with respect to damage to the
permanent tooth germ. Objectives: The objective of this follow-up study was
to evaluate the incidence of posttraumatic developmental disturbances in
permanent teeth after trauma of their predecessors using a specific index.
Furthermore the relationship between type of trauma and eruption
disturbances have been investigated. Materials and Methods: 89 permanent
teeth in 49 children, who had been treated in a private practice between 1990
and 2000 due to a trauma to the primary dentition, have been evaluated
clinically and radiographically as for posttraumatic developmental
disturbances. They have been rated using a specific index that distinguishes
the extent of hypoplasia (0 - no hypoplasia; I - hypoplasia with aplastic defect
of enamel; II - hypoplasia with aplastic defect of enamel and dentin; III -
malformation) and discoloration (a - no discoloration; b - white opacities of
the enamel; c - yellow-brownish discoloration of the enamel). Results: 33 of
the permanent teeth showed developmental disturbances following injuries to
their primary predecessor. All teeth affected were incisors. According to the
classification by the index, two main groups have been identified. One group
predominantly presented discolorations (0b/0c) and a second group was more
affected by a distinct hypoplasia (Ia/IIa). There were only few cases showing
both of these symptoms. Sequelae of trauma were related to age and type of
trauma. In case trauma occured during the initial stages of development
mineralization was disturbed. In later stages, eruption disturbances were
predominant. Conclusion: Age and the specific type of injury to the primary
dentition are the most important parameters in determining the type and
extent of developmental disturbances in the permanent successor after

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ment of the permanent teeth.
and method: we examined 120 young patients, age-bracket 8-14 and we followed: the number of permanent
by traumatic injuries to the primary teeth, the patient's age at the time of traumas and the most frequent type o

: the data confirm, that traumas occurring between 0 and 3 years of age are likely to disturb the formation
ation of the permanent teeth; the most frequent consequence is enamel hypoplasia.

art of the isolated anomalies of permanent teeth is the result of local causes occurring during tooth formation. O
uent causes of this type is traumatic injury to the primary teeth. Epidemiological studies in the field show an in

of the primary teeth cause various anomalies in the permanent teeth, depending on their stage of formation, as
ture and severity of the trauma: structural anomalies (opacities, hypomineralization, and enamel hypoplasia), n
s (anodontia), shape and volume anomalies (microdontia, gemination, coronary and radicular dilaceration), erup
s (delayed eruption, ectopias) 6-9
frequent consequences are opacities and enamel hypoplasia of the succeeding permanent teeth. Specialized s
10% of all enamel hypoplasias in frontal teeth are caused by a trauma to the preceding primary teeth. 1-5,9
of studies have reached the conclusion that intrusion is the most frequent cause of enamel hypoplasia (69%) a
f the patient at the time of the trauma is important (age and the stage of growth of the dental bud are closely r

n, as well as other researchers, considers that most traumas to the primary teeth occur up to the age of three,
s period of time learning how to walk and playing are likely to cause accident.3

and method

examined 120 young patients (age-bracket 8 to 14) in the Pediatric Dentistry Clinic (Timisoara) over a period of

o assess the traumatic injuries in the primary teeth, the four upper incisors of the 120 young patients (a total of
re examined, because these teeth tend to be the most affected, and in 39% of these anomalies were found.
g the patient's age at the time of traumatic injury, 65% of the traumas occured between 9 months and 2 years o
ed, intrusion was the most frecvent type of trauma, especially intrusion associated with lateral dislocation, enc

l anomalies were most frecvently found (69% of teeth) and were represented by: simple opacities (38%) and en
Figure 1.
Enamel hypoplasia caused by a
auma to the preceeding primary
curred at 1 year and a half of

on and conclusions

has followed the example of similar studies, among which the best known are those by Ben-Bassat, who record
e number of permanent teeth (414), out of which 46% were affected through traumas to the primary teeth.
has also been conducted on a large number of teeth (480) but the percentage of affected teeth is smaller (39%
y the Department of Pediatric Dentistry in Copenhagen monitored the long-term consequences of traumas to th
rontal teeth for their permanent successors. The Danish researches aimed to discover the etiology and frequenc
tions in clinical-pathological entities. 7
nt the correlation established by these researches between the patient's age at time of the trauma and the
nces for their permanent teeth:
njury at age 5 month to unerupted primary teeth
vulsion of 3 incisors at age 11 month.
vulsion of both central incisors at age 2 years.
vulsion and intrusion of a lateral and central incisor at age 2 years.
ype of injury to the primary teeth is unknown.
s were regularly followed up for periods ranging from 2 years to 14 years with clinical examinations, intra-oral x
phs obtained annually.

etention of 21 and enamel defects at 12, 11, 21.

ilaceration of 11 and sequestration of germs 21, 22.
redicted disturbances of 11, 21.
ilaceration 12,11 and arrested root formation 11.
ctopic eruption and dilaceration 21.
confirm, yet again, the fact that the traumas occurring between 0 and 3 years of age are likely to disturb the fo
ation and eruption of permanent teeth. The severity of the long-term damage depends on the type of trauma an
development of the permanent teeth.
to all these data, at the 18th IAPD-SFOP Congress in Paris in 2001, Andreasen recommended a closer cooperatio
pediatric dentistry clinics and maxillo-facial surgery clinics with a view to improving procedure and ensuring bet
lts.4 Random access to epidemiological studies conducted by both types of clinics would also improve diagnosi

, awareness of these problems is of paramount importance. It is imperative that both the specialists and the ge
ow what needs to be done when dental traumas occur (irrespective of whether they are traumas to the primary
nt teeth) and act adequately and efficiently. 14,15
this problem, at the Faculty of Dentistry in Nancy (France) a "task force" has been set up in association with WH
e - casting of university professors, dentists and maxillo-facial surgeons - has devised a programme, "Nancy Vil
which aims to inform both specialists and non-specialists about the best methods of prevention and treatment o
hrough the publication of booklets, newsletters, etc., which are being sent to dentists, surgery departments,
es, schools, sports and youth centres.

en JO, Ravn JJ. Epidemiology of traumatic injuries to the primary teeth in a Danish population sample. Int J Oral Su

en JO. Injuries to developing teeth. In: Andreasen JO, Andreasen FM, editors. Textbook and Colour Atlas of Trauma
o the Teeth. Copenhagen: Munksgaard, 1994.
en JO, Andreasen FM. Essential for trauma injuries to the teeth. Copenhagen: Munksgaard, 1990.
en JO, Trope M. Recent advances in treatment of traumatic dental injuries. The 18th Congress of IAPD-SFOP 12-15
1 (Abstracts p 29).
sat Y, Fucks A, Zilberman Y. Effect of trauma to the primary incisors on the permanent successors in different devel
ediatr Dent 1985; 9: 72.
P, Pascon EA, Langeland K. Traumatically injured primary incisors: a clinical and histological study. J Dent Child 1987

rd Jensen J. Long-term consequences of traumatic injuries to the maxillary primary incisors. The 18th Congress of th
s 12-15 sept.2001 (Abstracts p.50).
n AY, Keilas S, Wasersprung D, Dayan D. Developmental anomaly of permanent teeth related to traumatic injury. En
aumatol 1990; 9: 23.
an Y, Ben-Bassat Y, Lystmann J. Effect of trauma to primary incisors on root development of their permanent succes
ent 1986; 8: 71.
E, Schiller E. Practica pedodontica. Timisoara: Editura Helicon, 1998.
E, Grivu O, Dragomirescu D, Schiller E. Ortodontia interceptiva. Timisoara: Editura Helicon, 1999.
on FS, Ripa LW. Prevalence and type of traumatic injuries to the anterior teeth of preschool children. J Pedodont 197

m JR. Pediatric Dentistry: infancy through adolescence. W.B.Saunders Comp, 1998.

, Karmann C, Grosse S, Blique M. Dental traumatology: an example of a public and professional intervention. The 18
of IAPD-SFOP Paris 12-15 Sept. 2001 (Abstracts p.86).
, Mathis R. Multidisciplinary approach of sequelae on permanent maxillary incisors after trauma to primary teeth. A c
e 18th Congress of IAPD-SFOP Paris 12-15 Sept. 2001 (Abstracts p 87).

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2006 Volume 7
Number 3 September
8th Congress of the European Academy of Paediatric Dentistry.
Amsterdam, 8-11, June 2006.
I. Espelid, A. Skaare. University of Oslo, Institute of Clinical Dentistry, Oslo, Norway

Clark and Curzon (2004) stated that any visible sign of caries in children indicates need for bitewing
radiography. Espelid et al (2005) concluded that radiography is probably not needed in 5 yr old children in
a low prevalence group without visible caries due to a posterior probability of 0.04 for presence of
approximal caries. Approximal caries prevalence including both individuals with and without visible caries
was 0.15 (prior probability). Aim: The present study aims to make simulations using selection criteria from
three other studies to test the robustness of the previous conclusion. Methods: The simulations were
based on different possible selection criteria for radiography of 5-year old children. The values were
collected from Nielsen & Madsen (2005) a) gingival bleeding, b), approximal plaque, and from Anderson et
al (2005) c) dentists’ judgement, d) dmfs visible surfaces, e) dmfs occlusal surfaces f) sugar between-meal,
g) visible plaque, h) tooth-brushing habits, and from Espelid et al (2001) i) dmfs visible surfaces. In Nielsen
& Madsen’s study the test result is related to caries on distal surfaces of first molars only. Likelihood ratios
negative (LR-) were calculated based on sensitivity and specificity values from the studies. Results: The LR-
values varied from 0.20 (b) to 0.88 (h) and describe how good the test is to rule out approximal caries
when the test result is negative (no radiography recommended). The lower LR- values the better. The
calculated posterior probabilities values a-i were 0.06, 0.03, 0.10, 0.12, 0.12, 0.11, 0.10, 0.13, and 0.07
respectively. Conclusion: Approximal plaque between molars and no visible caries are the two best
methods for excluding 5-year old children who will not benefit from BW in a low prevalence population.

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A. Garan*, S. Akyuz. School of Dentistry, Dept Paediatric Dentistry, Marmara University, Turkey

Aim: The purpose of the present study was to investigate the PREVALENCE of black stain and dental caries
in Turkish schoolchildren and to compare with the literature findings of the other countries. Methods: The
study group consisted of 325 randomly selected children (boys 167, girls 158), in the age group 5 and 13
years. At first appointment a questionnaire was conducted to obtain background information. This was
followed by an oral examination. Teeth were examined for the presence of black stain and dental caries (df-
t and DMF-T indices ; X? test, Mann-Whitney U and Kruskal-Wallis Test were used for statistical analysis).
Results: Black stains were observed in 58 children ( 20 girls, 38 boys). The overall proportion of Turkish
children affected by black stain was 17%. The mean df-t, DMF-T scores were 3,51 ± 2,96; 1,35±1,64 for
children with black stains whereas 3,84. ±3,30; 1,64± 1,91 for children without black stains. The mean df-t
and DMF-T scores were not statistically different between the groups with stain and without stain. Black
staining and df-t, DMF-T scores were not correlated with each other and a negative correlation was
observed between brushing habbit and the presence of black stains. Conclusion: The prevalence of
staining in Turkish children was found higher than Brazilian and Italian but lower than Swiss children.

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F. Gilchrist*, A. Santini, K. Harley, C. Deery. Edinburgh Postgraduate Dental Institute, Scotland.

Aim: The aim of this study was to investigate by means of micro-Raman spectroscopy the differences in
the phosphate v1 band in eroded and sound primary enamel. Method: Ten extracted anterior deciduous
teeth with areas of sound and eroded enamel were used in the study. Scanning electron microscopy was
used to confirm the presence of sound and eroded primary enamel on each tooth. Three ten second micro-
Raman scans were carried out of three points along a 3 micron linear area in both sound and eroded
enamel using the LabRam 300 (Horiba Jobin Yvon, Middlesex , United Kingdom ). The spectra of the three
points were combined to produce a mean spectrum for each of the eroded and sound areas. The
measurements taken for statistical analysis were the maximum intensity of the phosphate í1 band, the
width of the phosphate v1 band at half maximum height (FWHM) and the area under the phosphate v1
band. Results were analysed using Instat (GraphPadSoftware Inc., California , USA ). Results: The
phosphate v1 band was seen clearly in all specimens between 958.5 cm-1 and 967.0 cm-1. Maximum
intensity and FWHM were analysed by means of a two-tailed t test and area under the band by an unpaired
t test (p= 0.88, p= 0.07 and p= 0.73 respectively). There was no statistically significant difference between
the values for the eroded and sound areas. Conclusion: The use of micro-Raman spectroscopy did not
detect any difference between the phosphate v1 band of deciduous eroded and apparently sound enamel
in vitro.

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L.C. Martens*, R. Leroy, D. Declerck, M.J. Garcia-Zattera, E. Lesaffre.
Dept Paediatric Dentistry & Special Care – PaeCaMeD Research, Ghent.
University, Dept. Paediatric Dentistry and Dept Biostatistics, Catholic University Leuven ; Belgium

Aims: This was to determine the prevalence and determinants of early childhood caries (ECC) and severe
early childhood caries (sECC)in 3 and 5 year old flemish children. Methods: The baseline data of the Smile
for Life project, were used. Caries experience (at d1 level) was determined according to BASCD criteria and
oral cleanliness according to Alaluusua et al.,1994. A validated questionnaire was used. The ECC and sECC
condition was determined according to Drury et al.,1999. Simple and multiple logistic regression analysis
were performed. Results: The prevalence of ECC and sECC was 17.01% and 4.38% respectively in 3 year
olds while this was 43.73% and 13.71% for 5 year olds. From the simple logistic regression it became clear
that for both ages the presence of plaque was a significant determinant for ECC/sECC Common
determinants in both ages were for ECC having sugar-containing drinks at night and for sECC having in
between sugared drinks. From the multiple regression analysis it became obvious that having sugared
drinks at night is strongly related to ECC in 3 year olds [OR=2.94 (95%CI:1.03-8.44)]. In 5 year olds the
presence of plaque [OR=2.43 (95%CI:1.34-4.39)] and having a nursing bottle [OR=3.01 (95%CI: 1.28-7.11)
became of significant importance for ECC. For sECC, age at start brushing (>2yr) [OR=6.37 (95%CI:1.56-
25.97)] and sugar- containing in between drinks (>1day)[OR=3.38 (95%CI:1.01-11.35)] and sugared drinks
at night [OR=6.64 (95%CI:1.10 - 40.19)] seemed to be strongly related. Conclusions: From the present
results it became clear that for both ages oral cleanliness and having sugared in between drinks or having
drinks at night are the most important determinants of ECC and sECC.
Study is supported by GABAInt. and GABA Benelux.

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A. Momeni*, K. Pieper.Dept of Paediatric Dentistry, Dental School, Philipps University Marburg, Marburg,

Aim: This was to assess the prevalence of dental caries and treatment needs of 6-7-year-old children living
in Germany . Methods: The study was carried out in fourteen federal states in 1994/1995, 1997, 2000 and
2004. 5% samples were selected using a two-stage random sampling procedure. According to WHO-criteria
dmf-t-values were assessed. The samples consisted of 20885 (1994/1995), 24806 (1997), 26560 (2000)
and 24946 (2004) children. All examinations were performed by calibrated dentists. The findings were
coded on special survey sheets and later on transferred to package SPSS. a computer and processed using
a special programme for dental surveys (GPRZ). The statistical evaluation was performed by means of the
software Non parametric tests were performed (Mann-Whitney U-Test). The level of significance was set to
be p < 0.05. Results: Between 20% and 45.9% of the children in the various federal states had sound
deciduous teeth in 1994/1995, while in 2004 this figure was between 34.9% and 59.6%. The mean dmf-t
values decreased from 2.89 in 1994/1995 to 2.39 in 1997, to 2.21 in 2000 and to 2.12 in 2004. A caries
reduction of 26.6 % was achieved between 1994 and 2004. In 1994/1995 between 43.9% and 68.7% of the
decayed deciduous teeth were not treated in the various federal states. In 2004 this amount was between
45.3% and 60%. Conclusions: Although a significant caries decline was observed over the past 10 years,
still a high percentage of deciduous teeth are not treated. Special efforts are necessary to achieve the
National oral health goals for Germany which are: 80% 6-year-olds with caries free primary teeth in the
year 2020. Supported by "Deutsche Arbeitsgemeinschaft für Jugendzahnpflege" (Bonn/Germany).

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M. Al-Malik*, M. Al-Sarheed. Armed Forces Hospital, King Saud University, Saudi Arabia

Aims: Dental general anaesthesia (DGA) used to provide comprehensive treatment for unmanageable
children in safe and effective way. The aims of this retrospective study were to determine the
characteristics of patients attending for treatment under DGA at a hospital in Saudi Arabia , and to describe
indication for and type of dental treatment carried out using DGA during 2 years and in a following 3-year
period. Methods: Data were collected from hospital records for patients who received treatment under
DGA at military hospital in Jeddah between 1999 and 2001. Results: A total of 182 patients received
treatment. The mean age was 5 years. The main indication for DGA was behaviour management (46%).
Complete oral rehabilitation including complex, simple restorations and extractions were provided under
DGA at a single visit. Failure to attend for recall was common, 83% compared to 26% after a 3-year period.
Most of the patients requiring further treatment accepted treatment in the dental chair. Only one patient
received a second DGA during the 3 years following treatment. Conclusion: Complete oral rehabilitation
was provided at a single visit, allowing immediate relief of pain with little or no cooperation from the child.
Attendance for recall was poor; thus parents need education and motivation before subjecting the child to
DGA for the success of treatment

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K.N. Arapostathis*, T. Coolidge, N. Kotsanos, D. Emmanouil, Aristole Un., Dental Public Health Sciences, Un.
Washington, Seattle, USA, 3Un of Athens, Greece

Aim: This was to evaluate the reliability and validity of the Greek version of the Children's Fear Survey
Schedule - Dental Subscale (CFSS-DS). Methods: The CFSS-DS was translated into Greek and back-
translated. All patients seen in one paedia-tric private practice in a Greek city over a 10-mth period were
invited to participate. Of these, 476 (approx 95%) agreed. A receptionist administered the CFSS-DS before
a child received treatment. During treatment, a dentist rated child behaviour using the Frankl scale. The
dentist was not aware of the child's answers to the questionnaire. The lowest (most uncooperative) score
on the Frankl was was used for analysis. A consecutive sample of 46 children who returned to the clinic for
dental treatment after a 1-3 week interval completed CFSS-DS a second time. Results: Some children had
never received a restoration and therefore omitted items related to drilling. A total of 269 children (mean
age 8.42 years, SD± 2.39, range = 3-15, 54% male) com-completed the questionnaire and were included in
the analyses. The mean CFSS-DS score was 24.7 (SD± 9.11, range 15-58). The internal reliability (alpha) of
the scale was .84, and the test-retest reliabil-ity was .98. The number of children receiving very
uncooperative and uncooperative scores (Frankl)were small, and therefore these two groups were
combined into one called 'uncooperative'. The three resulting groups (uncooperative, Frankl 3, Frankl 4)
were then compared for criterion validity using the Kruskal- Wallis test. Groups had significantly different
CFSS-DS scores from each other ( uncooperative group highest scores, Frankl 4 group lowest scores, c? =
10.4, p < .01). Conclusion: The Greek version of the CFSS-DS appears to have high reliability and validity.
Supported by NIDCR/NIH #T32 DE07132.

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V. Buerkle*, E. Schoefe.Austrian Association of Paediatric Dentistry, Salzburg, Austria

Aim: to evaluate the two-year outcome of 2 groups of patients who underwent treatment under general
anaesthesia in two different settings. Methods: the records of 100 children in each group - matched for
age and gender - were examined retro-spectively. All children needed extensive dental care and showed
fearful or disruptive behaviour. Group 1 received treatment in a hospital setting free of charge. Group 2
was treated in private practice, where parents had to pay. All children received either one or all of the
following: fillings, pulpotomies/ pulpectomies, stainless steel crowns, strip crowns, extractions, space
maint-ainers. Afterwards, all patients were asked to come for regular recall appointments. Results: in the
hospital setting it was rarely possible to take radiographs prior to or after treatment, which resulted in a
higher rate of non-treated proximal caries, diagnosed later on at recall, or pain and subsequent loss of
molars with non diagnosed furcal involvement. In private practice pre-treatment radiographs were taken
resulting in statistically significant better treatment outcomes. Also, these patients came for recall and
prophylaxis on a more regular basis, had fixed/removable space maintainers, developed a more
cooperative behaviour and developed less caries over time. Conclusions: taking of pre-treatment
radiographs is essential for good outcomes in paediatric dental care. Despite the fact that early childhood
caries is often a social problem, having to pay for dental treatment seems to result in higher reliability
regarding recall appointments, better oral hygiene, less need for fillings or future orthodontic treatment

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A. Chrysikopoulou*, P. Matheson, M. Milles, Z. Shey. M. Houpt.
*University of Athens, UMDNJ-New Jersey Dental School, USA

Aim: This study compared the effectiveness of two nasal hoods (Porter/Brown and Accutron) in reducing
waste nitrous oxide gas during conscious sedation for routine pediatric dental treatment. Methods: Thirty
children, ages 3 to 8 years (mean 5.4 ±1.2 yrs.) participated in this study which was approved by the
UMDNJ IRB. Fifteen randomly selected children started with the Porter/Brown mask which was then
switched to the Accutron mask, and the remaining children used the reverse order of masks. Four
measurements of ambient nitrous oxide were recorded with a Miran 205B Portable Ambient Air Analyzer,
five minutes after each of the following: administration of nitrous oxide, placement of the rubber dam,
change of the nasal hood, and reduction of the vacuum. Samples were taken 8 inches above the nose of
the patient and in the room 5 feet away from the patient. Results: Nitrous oxide levels were significantly
lower (P<.05) with the Porter/Brown device (31± 40 ppm for the patient and 8 ± 10 ppm for the room)
compared with the Accutron device (375±94 ppm for the patient and 101± 37 ppm for the room). When
the suction was reduced, there was an increase in nitrous oxide levels with the Porter/Brown nasal hood
(169±112 ppm for the patient and 28±18 ppm for the room), whereas the levels with the Accutron nasal
hood remained high (368±107 ppm for the patient and 121±50 ppm for the room). Conclusions: This
study demonstrated that removal of waste nitrous oxide was greater with the Porter/Brown device and that
recommended suction levels must be used for optimum effectiveness.

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K.E. Howard*, R. Freeman. Royal Group of Hospitals, Belfast, Queen's University, Belfast, N. Ireland.
Aim: To assess the effectiveness of a post treatment modelling activity to reduce child dental anxiety.
Methods: A convenience sample of all consecutive 5 to 10-year-old child dental patients attending for a
course of dental treatment were selected. Children were randomly assigned to intervention or control
groups. Self reported child dental trait anxiety was assessed by the faces version of the MCDAS at the start
of each dental visit. All children were managed by conventional behaviour management methods during
dental treatment. At the end of the treatment visit the children in the intervention group were introduced to
a glove puppet, which acted as the PALS model. These children then played out the treatment which they
had received on the puppet. The control children received nothing. The change in dental trait anxiety was
examined by t-tests and ANCOVA. Results: 27 children in the intervention group and 26 children in the
control group were included in the final analysis. For children in the intervention group there where no
statistically significant decreases in dental trait anxiety over course of dental treatment or between the first
and second preventive visits in a course of dental treatment or between the first and second invasive
dental treatment visits. Only children in the control group reported a statistically significant decrease in
dental trait anxiety related to examination items between the first and second invasive dental treatment
visits (t=2.53, p=0.02). Conclusions: The PALS modelling intervention was ineffective in reducing child
dental trait anxiety. Potential exists for the modelling intervention to be used with children who have no
previous dental experience and this should be assessed along with child factors which may affect the
impact of this intervention.

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A.K Humphreys*, S. Mc Avinchey, C. Boyd, T.A. Gregg,
Royal Belfast Hospital for Sick Children, 2School of Dentistry, Belfast

Aim: To assess and compare the quality of panoramic radio-graphs taken for paediatric patients in a
specialist setting in a Dental School and General Children's Hospital. Methods: All panoramic radiographs
taken for children in a 2 mth period were assessed according to the 'gold standard' from the European
Guidelines which involved assessment of film quality and techniques. Films were then scored with the
National Radiological Protection Board (NRPB) image quality rating system. 97 radiographs were assessed
independently by 3 investigators under standard conditions. Both hospitals have an identical panoramic
unit however, the Children's Hospital has digital imagery and the Dental School uses a conventional
system. Results: This audit included 53 radiographs from the Dental School and 44 from the Children's
Hospital. Dental School radiographs fulfilled the NRPB targets. Deficiencies tended to be minor positioning
errors and 100% (53) of the films were considered to be of diagnostic quality. Significant problems were
observed within the Children's Hospital and results fell below the required NRPB standard. Problems
identified included positioning errors, incorrect settings and only 72% (32) of films were of diagnostic
quality. Conclusion: Audit of radiographs is important to assess standards, identify errors, minimise
radiation exposure and instigate changes when necessary. Difficulties were identified in a Children's
Hospital with a lower volume of patients per operator compared to a high volume specialist dental unit.
There is a need for additional specialist education in paediatric panoramic radiography and also for regular
updates as part of continuing professional development.

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G. Haukali*, R. Skovgaard, R.W. Næraa, S. Poulsen,
School of Dentistry, University of Aarhus and Randers Hospital, Aarhus, Denmark.

Background: The purpose of the present case report is to document the complexity of patients with
severe dental mineralisation disturbances, and the need for a cross-disciplinary approach to secure the
best care for them. Case report: A 7 year old boy was referred for dental treatment due to severe
mineralisation disturbances. Until the age of 2 years he had many hospital admittances due to recurrent
airway infections. Persistent unilateral hydr-onephrosis (not needing surgery) was found. He presented with
slight growth retardation. His first dental problem arose, when he was one year old, when a tooth "broke or
was lost" during toothbrushing. Following this, he had repeated episodes of dental pain and infections
leading to extraction of all primary teeth. Both enamel and dentine in his permanent teeth were severely
affected. Over the 5-years he has been seen in our clinic he has presented with acute dental pain on
several occasions. His childhood has been dominated by illness. The stressors arising from his disease have
had a major impact on his personal and social life; he is a shy and private boy. He is often laughing, and
having fun, but just as often he is quiet. He is a very sensitive boy, but lucky having extremely resourceful
parents. Treatment: Growth hormone treatment with injections every evening were started at age 9?,
with a pronounced effect on his growth. He has an upper partial denture, his 32, 31, 41, and 42 are covered
by a composite bridge; 16, 26, and 36 have stainless steel crowns; 46, 11, 21, and 27 are extracted and the
premolars are partly covered with glasionomer. 12 and 41 are rootfilled. He has been offered psychological

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D. Apostolopoulou1, K. Kavvadia1, P Lagouvardos2, L. Papagiannoulis1,
1 Dept. of Paediatric Dentistry, 2 Dept. of Restorative Dentistry, University of Athens Dental School,
Athens, Greece.

Aim: The purpose of this investigation was a) to test in vitro the accuracy of the DIAGNOdent -DD
appliance on the detection of occlusal caries in primary molars and b) to compare DD measurements to the
results of other currently used methods. Methods: 111 sites (24 teeth) were examined by one operator
using direct visual examination (DV), indirect visual examination (IV-digital photographs 3x), periapical
radiographs (XR) and DIAGNOdent (DD). Sites with no lesion were scored as 0, with lesion into enamel as 1
and with lesion into dentin as 2. Teeth were then grinded perpendicular to the examination sites, viewed
under a microscope (13x) and the extent of caries was determined. Sensitivity, specificity and accuracy for
all methods were evaluated using the histological evaluation as the golden standard. Results: Mean DD
values were 32±26,3 for lesions into enamel and 53.6±30 for lesions into dentin. The accuracy of the
appliance was 71,2% and 72,1% for lesions into enamel and dentin respectively. Sensitivity of the DD
appliance was found to be 82,7 % for enamel lesions and 37% for lesions into dentin while specificity was
found to be 46,2% for enamel lesions and 80,5% for lesions into dentin. For healthy surfaces however, the
DD appliance, compared to all other methods, was found to have the highest sensitivity (66,7%), specificity
(99,1%) and accuracy (99,1%). Intra-examiner reliability was found for all methods to be excellent, k> 83%.
Conclusions: The accuracy of the DD appliance was very good for all types of lesions tested, especially for
healthy surfaces. The appliance exhibited better sensitivity than specificity for enamel lesions and better
specificity than sensitivity for lesions into dentine.

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E. Çaglar*1, S. Ergeneli1, S. Kavaloglu1, N. Sandalli1, S. Twetman2
1Paediatric Dentistry, Dental School, Yeditepe University, Istanbul, Turkey, 2Dept Odontology, Pediatric
Dentistry, Faculty of Medicine, Umeå University, Umeå, Sweden
Aim: The aim of the present study was to examine whether or not a mid-term consumption of water
containing Lactobacillus reuteri ATCC 55730 ( by a straw) would affect the salivary levels of mutans
streptococci and lactobacilli in young adults. Methods: A double blind, randomized study was performed
and 60 healthy subjects were followed over 3 weeks. During the trial, 60 subjects ingested 200 ml water
through a probiotic straw containing Lactobacillus reuteri ATCC 55730 once daily or a control straw without
bacteria. Latter 60 subjects chewed a tablet containing Lactobacillus reuteri ATCC 55730 once daily or a
control tablet without bacteria. Salivary mutans streptococci and lactobacilli were enumerated with chair-
side kits. Results: A statistically significant reduction of salivary mutans streptococci was recorded after
the probiotic straw (p<0.05), which was in contrast to the controls. No similar trend was seen for
lactobacilli. Conclusion: Probiotic straw usage reduce the levels of selected caries-associated
microorganisms in saliva.

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N.R. Chedid*1, D. Bourgeois2, P. Ghanem1, T. Haddad1
*Faculté de Médecine Dentaire, Université Saint Joseph- Beirut, Lebanon, 2Faculté d'Odontologie, Université
Claude Bernard, Lyon I, Lyon, France

Aim: to assess caries risk in a population of preschool children attending a dental school clinic. Methods:
a random sample of 100 children aged 4 years and under attending the dental school clinic at the Faculté
de Médecine Dentaire - USJ between January 1st, 2004 and December 31st, 2005 was selected. A caries
risk score was devised from measuring:inta-oral plaque, number and severity of existing carious lesions,
salivary presence of cariogenic bacteria (Vivadent* CRT bacteria test), salivary buffer capacity (Vivadent*
CRT buffer test) and oral hygiene and dietary habits as reported by parents on a questionnaire. According
to his/her caries risk score, each patient was assigned to one of four caries-risk categories: low, moderate,
high and very high. Results: Patients' ages were between 1 year 6 months and 4 years six months ( mean:
2 years 11 months). 43% showed low salivary buffer capacity, 59% had high streptococcus mutans levels,
52% showed high lactobacillus salivary levels.72% of parents reported that their children's teeth were
brushed less than once a day, and dietary sugar consumption was more than three times a day in 23% of
subjects. Caries (dmft)were 6.5+/-2.5. Caries risk categories were represented as follows: 21% low risk,
22% moderate risk, 38% high risk and 19% very high risk. Conclusion: There is a high prevalence of
children presenting with high or very high caries risk scores in our sample. Dietary sugar consumption as
well as salivary presence of cariogenic bacteria seem to play a role in higher caries risk subjects. Supported
by a grant from Conseil de la Recherche- Université Saint Joseph, Beirut , Lebanon .

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M.E. Elfrink*1, J.S. Veerkamp1, H. Kalsbeek2
1 ACTA, Department of Peadiatric Dentistry, Amsterdam, 2TNO Quality of Life, Leiden, the Netherlands

Aim: The aim of this study is to look for differences in caries prevalence between first and second primary
molars in 5-year-old Dutch children. Methods: 692 children, all insured by the "Health Insurance Funds",
living in one of four selected cities in Holland were asked to participate in the study. 435 (49% girls)
participated. Clinical examinations were performed (dmfs in all teeth were assessed). Systematic
differences between first and second primary molars in the same quadrant were tested with the Wilcoxon
signed rank test. For the test to compare dmfs of both primary molars, a p-value <0,05 was used as an
indication of significancy, for different surfaces we used a pvalue <0,01 to compensate for multiple testing.
Results: Second primary molars have a statistically significant higher total dmfs than the first primary
molars. The differences are mainly found on the occlusal surface. On the proximal surfaces, first primary
molars have significantly more caries than second primary molars. The d-component constitutes the major
part of the caries index. Conclusions: From this study, it is concluded that second primary molars have
more caries than first primary molars and the differences in caries prevalence are the largest on the
occlusal surface. Developmental disturbances in second primary molars may be one of the causes.

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A. Dadhe*, P. Ashley, G. Palmer. Eastman Dental Institute, UCL, London, England.

Aim: The aim of this study was to investigate the release of chlorhexidine acetate (CHA) from commercially
available glass ionomer cements (GIC) and its effects on physical properties. Methods: The materials used
were: Chemfil superior (Dentsply) (CS), Ketac Molar (3M ESPE Germany ) (KM), 3M RelyX luting cement
(3M) and GC Fuji VII Capsule (GC CORPORATION, Japan ). Powder was weighed and replaced with 2.5, 5 and
10% by weight of CHA. Six specimens of each were created. These were incubated in distilled water and
CHA release was measured over 3 months using High Performance Liquid Chromatography (HPLC). The
simultaneous release of fluoride was measured using a fluoride electrode. Flexural strength (FS) and
working (WT) and setting times (ST) at 37 C for CS, KM and 3M RelyX were measured using the Instron and
an oscillating rheometer respectively. Results: In comparison to the percentage of included CHA, all
materials show a very low proportion (0 to 3%) subsequently released into solution. All cements continue to
release fluoride independent of the included CHA at or below 5%. Between 5 to 10% appears to be the
critical concentration of CHA which triggers an increased proportion of release of CHA and begins to affect
release of fluoride. FS, WT and ST are largely independent of the percentages of included CHA, except for
3M RelyX, the WT and ST show an unacceptable increase. Conclusion: CHA can be readily incorporated
within these cements, of which CS, KM and Fuji VII show promising characteristics.Further research is
needed to explore the nature and effect of CHA on these cements.

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D. Glavina*, K. Skrinjaric, D. Negovetic Vranic, I. Skrinjaric,
Dept.of Pediatric Dentistry, School of Dental Medicine, University of Zagreb, Croatia

Aim: It has been suggested that application of heat during setting of glassionomer cements (GIC) can
improve mechanical properties of material and retain the same or even higher level of fluoride release. This
also might improve retention rate of GIC sealant. The aim of this study was to assess retention rate of GIC
fissure sealants heated during setting time. Methods: Hundred and twelve teeth with well-delineated
fissure morphology divided in three groups were sealed with composite resin and GIC. In control group A
that comprised 56 teeth composite resin was used (Helioseal F, Vivadent). GIC ( Fuji 7, GC) was applied
using split mouth design with conditioning (group B: 26 teeth) and without surface conditioning (group C:
30 teeth). GIC was heated with external heat source (Elipar Highlight, Espe) during setting time according
to manufacturers instructions. Fissure sealants were evaluated one year after clinical service. Results:
Retention rate in group A was 80,36% after one year of clinical service. Group B showed retention rate of
30,77%, and group C of 26,67%. After one year two new caries lesions were detected in group B and C (GIC
groups. Significant differences in retention between composite and GIC groups were obtained by Kruskal
Wallis and Mann-Whitney tests. There was no significant difference in retention of sealant between two GIC
groups, neither differences in incidence of new caries lesions. Conclusion: It could be concluded that
retention rate of GIC sealing treated with heat during setting time was significantly lower than retention of
conventional composite resin. The heating procedure during setting of GIC sealants could not be
recommended as routine clinical practice.

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N. Katsaris*, N. Lygidakis. Community Dental Center for Children, Athens, Greece.

Aim: This was to evaluate the 10-year clinical results of preventive resin restorations (PRR). Methods: 256
PRR were placed on 185 children aged 7- 11 years, during 1991- 1992 in a private practice. Selected teeth
had minimal occlusal caries. Under local analgesia caries was removed, the occlusal surface was etched,
dried and isolated with cotton rolls. Cavities were restored with photopolymerized composite (Brilliant
Dentine, Coltene), using a primer, and a photopolymerized sealant (Delton, Johnson & Johnson) was placed
on remaining pits and fissures. Children were regular attendees and had recall appointments every 6 mths.
Recorded evaluation of the restor-ations performed at 4, 8, 10 yrs. Ryge criteria were used for evaluation.
Failure was considered when a restoration was replaced due to secondary caries or total PRR loss. Results:
10 yrs later 174 restorations were still available for evaluation. 148 on first permanent molars, 19 on
second permanent molars, and 7 on second premolars. Overall 140 PRRs (80.4%) were considered
successful after 10 yrs 34 PRRs (19.5%) had failed due to caries in areas with sealant loss and were
replaced with composite restorations. From the successful PRRs, 93 (53.4%) were intact without any
intermediate intervention, whereas in the remaining 47 (27%), sealant re-application was needed in the
intermediate evaluations. Conclusions: A good 10-yr retention rate of PRRswas found. Advanced clinical
techniques and the increasing familiarity with this method would further increase the success rate. Caries
due to sealant loss could be further eliminated with regular follow-up.

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R.C. Van der Knaap*1, W.E. Van Amerongen1, A.J. da Silva Nogueira2, N. Hoshino2,
1ACTA, Amsterdam, the Netherlands, 2Universidade Federal do Pará, Brasil

Aim: This was to compare the quality of class II ART restorations in primary molars made with KetacTM
Molar Easymix and with Ketac Molar. The second objective was the comparison of the survival rate of under
contoured and normally contoured class II glass ionomer restorations. Methods: In a clinical study 343
children aged 7. years (SD 0.73) were randomly divided over four treatment groups. Each child received
one class II ART restoration in a primary molar. Evaluations took place at baseline and after six and twelve
months using WHO criteria. Results: At baseline the survival rate was 85.3%, after six months 58.3% and
after twelve months 24.7%. A restoration was considered to have failed when caries near the restoration
was observed or when it was broken or (partly) disappeared. Throughout the study no significant
differences were found in quality between class II restorations made with KetacTM Molar Easymix
compared to Ketac Molar (p> 0.05). At baseline a significant difference was calculated, caused by less
failures in the under contoured group compared to the normally contoured group (c?= 4.201; p= .040).
However,was not significant anymore. Conclusion: The survival rate of class II ART restorations showed a
dramatic decline in a period of 12 months. KetacTM Molar Easymix glass ionomer cement is not superior to
the classic Ketac Molar. Under contouring has initially a positive effect on the survival rate.

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L.A. Marks*1, C.WVercruysse2, .M.Verbeeck2 .
Dept. Paed. Dent. and Sprecial Care, PaeCaMeD Research, 2Ghent University, Dept. Biomatriales, IBITECH,
Gent, Belgium

Aim: Are the fluoride release profiles (FR) of a glassionomer cement (GIC) and polyacid-modified composite
(PAM-C) affected by soft drinks? Methods: Ketac Fil (3M/Espe) and Dyract (Dentsply / De Trey) were
selected as GIC and PAM-C, respectively. Coca Cola® (CC) and Minute Maid orange juice ® (MM) were
selected as soft drinks. For both materials four groups of 5 samples were made. The different groups were
brought into 100 ml solution of CC for 60 min. / 120 min., MM for 60 min. or H2O ( control) 60 min.
respectively. After the contact time with the soft drink, samples were stored at 37 in flasks, containing 25
ml H2O and shaken for good homogenisation. The amount of fluoride released was determined using a
fluoride selective electrode (Orion Research Inc.) daily for 13 days and then weekly up to 28 days; Results:
The amount of fluoride increased after contact with CC and MM for GIC as well as for PAM-C. The FR of GIC
was influenced during the first day(s) for both softdrinks. Moreover, for the PAM-C the effect could be seen
for a longer period of time. Conclusion: Contact with soft drinks influences enhances the FR of GIC and
PAM-C. These findings support the clinical use these materials as an increased release of fluoride can be
beneficial for preventing recurrent caries.
Study supported by scientific grant of the Flemish society of dent. (VVT) 2003

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H.M. Liversidge*, S. Ahli, M.P. Hector. Barts and The Royal London School of
Medicine and Dentistry, London, England.

Aim: The aim of this study was to explore the association of root formation and eruption levels of
permanent teeth excluding third molars. Methods: Panoramic radiographs of 794 healthy children
excluding those with early loss of primary molars (age 3.00 to 16.98) were examined. Developing teeth
were scored as root quarters and root length complete; eruption was scored as cusp tips at alveolar bone
level, partial eruption (midway between alveolar and occlusal levels) and full eruption. Data for boys and
girls were combined. The modal root stage at each eruption level was noted and compared between jaws.
Mean age of attainment of eruption levels was calculated using logistic regression. Results: Show that
considerable variation in root stage was observed at each eruption level. The modal root stage at alveolar
eruption was R1/2 for incisors and first premolars, R3/4 for canines and second premolars and R1/4 for
molars. The modal stage for partially erupted teeth was R3/4 for most maxillary and all mandibular teeth.
Exceptions were early erupting maxillary teeth (first molar and central incisor, modal root stage R1/2) and
maxillary canine (modal root stage root length complete). In the mandible,average time between alveolar
and full eruption increased from incisors to molars. Conclusion: This study shows important differences
between the pattern of eruption between tooth types as well as between maxillary and mandibular teeth.
Molars reached the alveolar bone level with the least amount of root formed followed by incisors and first
premolars. The canines and second premolars reached alveolar bone level with the most root formed.

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Spyridonos*, R.C. Balmer. Leeds Dental Institute, Leeds, England.

Aim: To assess the quality of life, height, weight and body mass index of children admitted for full mouth
rehabilitation under general anaesthesia. Methods: Children attending the Leeds Dental Institute for
comprehensive treatment under GA were included in this prospective study during July 2005 to October
2005. All ASA categories (ASAI: N=45, ASAII: N=13, ASAIII: N=3) were included apart from the ASA V. On
admission height (cm) and weight (kg) measurements were taken and the parents/guardians were asked to
answer an oral health related quality of life questionnaire concerning pain, sleepless nights, infections,
eating habits, social behaviour for the 3 month period prior to their admission. Results: 61 children were
examined (N=61, age 0-10, mean age: 5.91). SPSS and ImsGrowth (British 1990) were used for the
analysis. On admission the mean height percentile was 38.61, significantly below the 50th in height
(P=0.01, z=-2.6) according to the British 1990 ( Institute of Child Health ) growth data. The mean weight
(51.26) and body mass index (66.77) percentiles were above the 50th percentile. 40 (65.5%) children
complained of pain, 33 (54.1%) had pain whilst eating, 21 (34.4%) had sleepless nights, 15 (24.6%) had
loss of appetite, 27 (44.3%) had pain whilst toothbrushing, 10 (16.4%) parents had to take days off work
due to their children's toothache. Conclusion: The mean percentile weight and body mass index in the
study group was not below the 50th percentile. However their mean percentile height was significantly
below the 50th percentile. Dental caries had a negative effect on quality of life of the children and their
care givers related mainly to the pain experienced and subsequent impact on eating and sleeping.

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C. Sahlberg*1, E. Peltonen2, P-L Lukinmaa3, S. Alaluusua*1 ; 1Pediatric & 2Preventive Dentistry, Oral
Pathology, Institute of Dentistry, University of Helsinki, 3Oral and Maxillofacial Diseases, Helsinki, Finland.

Aim: This was to study changes in gene expression by TCDD on mouse molar tooth development.Previous
experimental studies we have shown that exposure of E14 mouse tooth germs to 1 µ M TCDD leads to
smaller tooth size and defor-ation of cuspal morphology. Methods: Mouse embryonic E14 molar tooth
explants were cultured for 24 h in organ culture with/without 1 µ M TCDD added to the medium. Total RNA
was extracted from pooled samples and analysed by the Affymetrix U74Av2 murine genome array. Results
were run against a list composed of genes expressed at cap stage in E14 molars ("tooth genes"). Genes
with the greatest fold changes were picked for analysis by quantitative PCR. Amplification and analysis of
the cDNA was performed with SYBR Green using the ABI PRISM 7000 sequence detection system. Results:
The overall expression profile of tooth genes in exposed and non-exposed molars was very similar in the
microarray analysis, differences were all but one within the range of 2-fold up- or down regulated.
Quantitative PCR analysis confirmed that of the genes involved in molar tooth development the most highly
upregulated by TCDD was Follistatin (Fst). The most down regulated tooth genes were Cyclin-dependent
kinase inhibitor 1a (p21) and Transforming growth factor beta 1 (Tgfb1). The expression of Runx related
transcription factor 2 (Runx2) changed only slightly between exposed and unexposed explants.
Conclusion: Microarray is a powerful method for identification of candidate genes involved in changes
caused by TCDD during tooth development. After TCDD exposure at cap stage, Fst was upregulated and
Tgfb1 and p21 were down regulated in mouse molar tooth explants within 24 h.
Supported by the Academy of Finland .

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F.I Al-dobiyan*1, R.C. Shore2, M.S. Duggal1, K.J. Toumba 1
1Paediatric Dentistry, 2Oral Biology, Leeds Dental Institute, Leeds, England

Aim: To compare the elemental contents of enamel of MIH molars with those of normal enamel. Methods:
22 extracted first permanent molar teeth were collected from children diagnosed as having MIH. One
extracted sound first permanent molar was used as control. Teeth crowns were sectioned longitudinal,
bucco-lingual direction, using a microtome into 500 µ m sections, labelled and ground to a thickness of 120
µ m. Sections were mounted on aluminium stubs, sputter coated with gold and viewed by SEM. In each
section, five areas were located as follows: one near the outer surface of enamel, one near the DEJ and
three areas between the first two, one of them at the cervical enamel area. EDX spectra were obtained
using SEM and a detector fitted with an ultra-thin window. All analyses were performed under the same
operating conditions. Results: Elemental analyses showed theCa:P ratio of hypomin-eralised enamel of
MIH molars (1.41±0.18) was lower than that of normal enamel (1.65 ± 0.05)(P<0.001). Enamel of MIH
molars had a higher percentage of carbon (9.57%) compared to normal enamel (6.88%)(P<0.05). Although,
the mean Nitrogen percentage of enamel of MIH molars was higher (5.20%) than normal enamel (4.92%), it
was not statistically significant. Conclusions: The results suggest that the high carbon content (not
explained by elevated carbonate) may possibly be an indication of the presence of elevated lipid content.

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L. Jasulaitytë*1, J.S.J. Veerkamp1, J. Narbutaitë2
1ACTA, Amsterdam, the Netherlands, 2Kaunas University of Medicine, Lithuania

Aims: These were to determine the prevalence of MIH in a group of primary school children in Kaunas ,
Lithuania and to compare the prevalence of MIH in Lithuania with the prevalence in other countries.
Methods: First permanent molars and all permanent incisors were examined in 1277 children, aged 6.5-
9.49 and having at least one erupted permanent molar, for demarcated opacities, post-eruptive enamel
breakdown, atypical restorations and extractions due to MIH according to the criteria provided by EAPD
experts. Exams were performed by 2 calibrated investigators (kapa=0.83). Results: Of all the children 190
(14.9%) had hypomineralization defects, 124 (9.7%) had at least one affected molar. Of the affected
children 93 (48.9%) had only one tooth with a hypomineralization defect. Only demarcated opacities were
present in 134 (70.5%) of the affected children; 35 (18.4 %) had at least one tooth with breakdown, 21
(11.1%) had atypical restorations. No teeth had been extracted due to MIH. Girls had significantly more
disintegration defects (post-eruptive breakdown and atypical restorations) than the boys (Chi-
square=4.900; df=1; p=0.027). Molar-only lesions were present in 50.5% of the affected children, 34.7%
had only affected incisors, but no molars and 14.7% had both - molars and incisors - affected. The affected
children had on average 1.92 (+- 1.2) teeth with lesions, out of them 1.27 (+-0.7) first permanent molars.
Girls had significantly more affected teeth than the boys (Mann Whitney; p=0.024), and in particular teeth
with disintegrated enamel (Mann Whitney; p=0.026). Of all the teeth 2.7% and of the first permanent
molars 4.8% had hypomineralization lesions. Conclusion: Demarcated hypomineralization defects are
common among 7-9 year old Lithuanian children; most of the affected children had demarcated opacities in
one or two teeth.

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P.C. Lansen*, A.E. Kraaijenhagen-Oostinga.
Dept Special Dental Care, Haga Teaching Hospital, The Hague, the Netherlands

Background: Regional odontodysplasie (RO) is an uncommon non-hereditary developmental anomaly

involving components of both the dental mesoderm and ectoderm. It affects the primary as well as the
permanent dentition, maxilla, mandible or both jaws. The condition can be differentiated from other
odontogenic disturbances as all the histological elements of the dental organ are abnormal in affected
teeth, while other teeth, in the same individual, are normal. Case reports: A.- a 2?-year old girl who was
referred to the Dept ofSpecial Dental Care because of a disturbance in the eruption of the primary teeth in
the maxilla. Extra-oral examination revealed no significant abnormalities. Intra-oral clinical examination
revealed a caries-free dentition, with normal occlusion and soft tissues except for the upper right quadrant
and the upper left central primary incisor. In this region all the primary teeth are affected. Radiographs
show the typical "ghost teeth". Case B - a 3-year old boy, also referred to the same hospital because of
"caries" in the primary dentition. Extra-oral examination showed no abnormalities. Intra-oral clinical
examination showed an abnormal discoloured first and second primary molar in the first quadrant,
hypoplastic and hypocalcified. Intra-oral x-rays confirm the diagnosis of RO. Treatment: Because of young
age and lack of cooperation of both children, dental treatment was carried out under GA. Cast models were
made for evaluation and the affected primary teeth extracted. The options for a definite overall treatment
plan may include prosthetic restoration, implants or autotransplantation to provide mastication and
phonation, normal vertical dimension and improved aesthetics. Both cases show the need for access to
paediatric dentistry in a multidisciplinary setting.

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C. Naulin Ifi*1, C. Ichou1 1Hotel Dieu, Garanciere, University of Paris, Paris, France

Aim: The purpose of this study was to identify one or several common aetiologic factors presenting in
MIH's patients. Methods: A customized questionnaire was developed and distributed to the parents of 200
patients (aged 6 to 12 years old) suffering from MIH or not. They came either from private paediatric
practice or from the university's hospital. The questions asked included: sex, birth date, place of residence,
heredity, pregnancy's problems, medications taken during the pregnancy period, birth's weight, drugs
taken during childhood, premature birth baby born, types of delivery, breast- feeding, childhood illness,
gastric regurgitation, D vitamin, fluoride and vaccination history. Input and descriptive analyses of the data
were performed using Microsoft Excel and statistical analysis with the SAS software version 8.2. The
qualitative variables were compared with the chi-2 test or by the Fisher's test. The quantitative variables
were compared with the variance or by the nonparametric test of Kruskal Wallis. Results: No association
was found with sex, birth date, place of residence, heredity, pregnancy's problems, medications taken
during the pregnancy period, birth's weight, drugs taken during childhood (antibiotics.), fluoride. Significant
associations were found with types of delivery (p=0.0195), regurgitation (p= 0.0094), D vitamin
(p=0.0302), hepatitis vaccine (p= 0.0375) and MIH's group. Also, significant associations were found
between premature baby born (p<0.0001), breast- feeding (p=0.0320), otitis media (p= 0.0461) and non
MIH's children. Conclusion: This study was not able to identify any MIH's etiologic factors but has showed
some interesting associations. It has contributed to open research fields for further necessary studies.

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S.E. Preusser*1, V. Ferring1, A. Behrendt1, C. Wleklinski2, W.-E. Wetzel1
1Policlinic Paediatric Dentistry, Medical Center of Odontology, Justus Liebig University of Giessen, 2Public
Health Dept, Dillenburg, Germany

Aim: This was to ascertain the frequency of Molar-Incisor-Hypomineralisation (MIH). Methods: 1,022
schoolchildren aged from six to twelve years were examined during routine dental examinations at schools
which were conducted by the regional Public Health Department of the Lahn-Dill-District. Symptoms of MIH
were recorded referring to teeth and teeth surfaces and they were classified to a scale based on three
degrees of severity. Concerning caries there was a DMF-T/dmf-t evaluation for the mixed dentition.
Statistical analysis of the data was accomplished in association with the Department of Medical Informatics,
using the software package SPSS Win. Results: 5.9% of all examined children showed between one and
four ill-structured first permanent molars; 2.24 on average. In totality, 3.4% of all first permanent molars
were afflicted, nevertheless more often in the upper (4.0%) than in the lower jaw (2.8%). Of all ill-structured
molars which could be classified, 67.2% were assigned to the first, 25.4% to the second and 7.4% to the
third degree of severity. 57.9% of the children with defects of first molars also showed changes in the
enamel structure of the permanent incisors. Moreover, severity and prevalence of MIH decreased from
occlusal/incisal to gingival. Children with MIH showed a significantly higher DMF-T-value for the permanent
teeth with 0.79 than children without MIH with 0.51 (p=0.009). However, there was no significant difference
in the prevalence of MIH neither between the genders nor between children from rural or urban areas.
Conclusion: The results lead to the conclusion that children with MIH require an increasing effort of
therapeutics soon after tooth eruption. The costs which result from this and the straining dental treatment
confirm the necessity of further investigations.

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R. Whatling*1, N. Hay2, J. Fearne1, J. Whatling3
1Royal London Hospital, London, UK, 2Great Ormond Street Hospital, London,UK, 3Accenture, London, UK

Aims: To determine the oral health and prevalence of dental anomalies in children attending a cleft centre
and assess whether there are any differences between cleft types. Methods: North Thames Cleft centre is
one of the 9 centres in England and Wales offering treatment for clefts. It is run from two sites: - Great
Ormond Street Hospital and Broomfield Hospital , Essex . Following the reorganisation of cleft services in
the UK , teams are required to take clinical review records for each patient at 5, 10, 15 and 20 years.
Children attending the review clinic at Broomfield Hospital were examined over a 5 year period by one
examiner (RW) using BASCD criteria for caries experience, modified DDE index for developmental defects
of enamel and differences in tooth number. Results: A total of 383 children were examined: 111 children
aged five, 114 aged ten, 100 aged fifteen and 58 aged twenty. The mean dmft for 5 year olds was 1.46; the
DMFT for 15 year olds was 1.42; and 20 year olds 2.14. Children with bilateral cleft lip and palate had the
highest mean DMFT (2.29). Of those with a cleft involving the dentoalveolus (n=188), 79.8% had dental
anomalies in the region of the cleft and 41% had an anomaly distant to the cleft site. For this group,
anomalies of size and shape were more prevalent in the permanent than the primary dentition. For patients
with a cleft involving the palate only, 47% had a dental anomaly. Conclusions: Caries experience in 5 year
old cleft patients in this study was lower than regional figures published for this part of the UK (dmft =1.54)
but higher in the older groups (14 year olds DMFT=0.96). Dental anomalies are common in patients with
isolated cleft palates.

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F.C. Clauss*1, M. Schmittbuhl1, M-C. Vincent2, M-C. Maniere1
1Faculty of dentistry, Dept pediatric dentistry, 2Dept medical genetics. Purpan hospital, Toulouse, France

Aim: To analyse the dental phenotype variability in a group of Ectodermal Dysplasia (ED) patients whose
molecular diagnosis has been already done. This study will lead to genotype-phenotype correlations, which
will allow a better understanding of the clinical manifestations of ectodermal dysplasia as well as the
molecular and morphogenetic functions of ectodysplasin (EDA). More than 150 mutations of EDA gene have
been described, nevertheless no attempts have been made to correlate the dental phenotype to genotype.
- To analyse the bone phenotype and to identify the structural and metabolic bone perturbations integrated
in the large clinical spectrum of ED, as well as their therapeutic implications. Methods:
Orthopantomograms of 40 ED patients are studied regarding severity of oligodontia and distribution of
agenesis in deciduous and permanent dentition. The molecular diagnosis consists in direct sequencing
following genomic DNA extraction and PCR amplification. The type and localization of etiological mutations
(EDA or EDA Receptor gene in autosomal forms and exons concerned) are analysed regarding to the dental
and bone phenotype. - The bone phenotype analysis of the ED patients group and of a control panel is
based on radiomorphometric parameters like the panoramic mandibular index which is correlated to the
bone mineral density measured by dual energy X-ray absorptiometry. Results: A strong dental phenotype
variability is associated to genetical variability with mutations distributed all along the EDA gene. The
functional important regions, the collagen and TNF extracellular subdomains, as well as the furin-cleavage
site, are associated to different dental phenotypes. The radiomorphometric study of ED patients shows a
pathological bone phenotype.

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I. Tanboga1, N. Gulman Huroglu*2
1Marmara University Department of Pediatric Dentistry, Istanbul, 2Marmara University Department of
Dentistry, Istanbul, Turkey

Aim: The purpose of our study was to investigate the prevelance of dental caries in children with orofacial
clefts and to evaluate their oral health status in relation to the type of cleft. Methods: Oral health was
studied in 55 children aged 2 to 5; 6 to 12 years with clefts of lip and/or palate and 58 healthy controls
matched for sex and age. For each age group ,clefts were devided in three types: cleft lip (CL) and/or cleft
lip and alveolus (CLA), unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP). Children
were examined under standard conditions of seating and lighting and for decayed, missing or filled teeth
the dmf(t) and DMF(T)-indices using WHO criteria; Oral hygiene status was recorded using the simplified
oral hygiene index simplified (OHI-S) recom-mended by green and vermillion. Results: In the primary
dentition, the mean dmft in the 2 to 5 year olds for the cleft group (CG) was 7.42 5.87 compared with 4.26
3.92 for the control group (Cont),(p=0.027) The mean dmft in the 6 to 12 year olds for cleft group 6.50
4.00; control group was 3.65 2.91.(p=0.013). There was no statistically different in the DMFTs of children
with clefts and control group.(p=0.772) nor between cleft types. Conclusion: Children in Istanbul , Turkey
with clefts can be considered as a group having an increased risk of caries and dental disease is prevelent
in these patients.

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R. Balmer*1, V. Tasioula
Paediatric dentistry, Leeds Dental Institute, J.Parsons Paediatuics, Leeds, England

Aims: This was to investigate the dental health and dental care of children with congenital heart disease.
Methods: The study group consisted of a sample of children attending the local cardiac unit between
November 2003- May 2004. Children were between 2 and 16 years old and had congenital heart disease,
diagnosed in their first year of life, that placed them at increased risk of infective endocarditis. Children
with significant co morbidity were excluded. Control group consisted of children referred to the clinic and
who were subsequently found to be healthy following cardiac investig-ations. Children were examined for
dental caries using the criteria produced by BASCoD. Results: There were 86 children in the study group
and 60 children in the control group. Overall there were no significant differences between the dmft of
cardiac (1.57 + 3.01) and healthy (1.81 + 3.64) children. However, cardiac children were found to have a
significantly higher care index (p<0.05) for their primary teeth compared to the controls. In addition
children with cardiac disease had, on average, a greater number of primary decayed teeth treated by
extraction (0.63 + 2.7) than the healthy children (0.29 + 1.07). Conclusions: Although levels of dental
decay in both groups were similar there were differences in the treatment approaches to the two groups.
Children with cardiac disease had more missing primary teeth reflecting a policy of extracting pulpally
involved primary teeth in this high risk group. Earlier intervention is required in children with cardiac
disease in order to save teeth and also to prevent prolonged exposure to dental bacteraemia secondary to
dental infections.

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G. Dahllöf*1, M. Remberger2, O. Ringdén3
1Dept Pediatric Dentistry, Karolinska Institutet, 2Dept Clinical Immunology, 3Center for Stem Cell
Transplantation, Karolinska University Hospital, Huddinge, Sweden

Introduction: Leukemia, severe aplastic anemia, severe combined immunodeficiency and thalassemia
major are some of the established indications for allogeneic stem cell transplantation (SCT). Preparative
regimens include combinations of cytotoxic drugs or total body irradiation. If children are below 12 years of
age this therapy results in disturbances in dental development. Hypothesis. Children conditioned with
busulfan/cyclophosphamide (BU/CY) exhibit fewer disturbances in dental development compared to those
conditioned with total body irradiation/ cyclophosphamide (TBI/CY). Methods: This study included 81
children receiving stem cell transplants between 1980 and 2001. Fifty-seven received 10 Gy single dose TBI
and cyclophosphamide, 24 children were conditioned with busulfan/cyclophosphamide. Panoramic
radiographs were examined for aplasia, microdontia and disturbances in root development of permanent
teeth. Results: When excluding third molars 19% (11/57) in the TBI/CY-group and 22% (5/23) in the BU/CY-
group exhibited aplasia (p=0.8061). In the TBI/CY-group 23% (13/57) compared to 52% (12/23) in the
BU/CY-group exhibited microdontia (p=0.0119). In the TBI/CYgroup 79% (44/56) compared to 96% (22/23)
in the BU/CY-group had disturbances in dental development. The mean number of teeth exhibiting
disturbances in root development was 12.2 ± 9.6 in the TBI/CY-group and 10.3 ± 8.6 in the BU/CY-group.
Conclusion: Contrary to the hypothesis, the results of this study show that developing teeth are
irreversibly and equally in number affected by busulfan and radiation therapy. However, there seem to be a
difference in the severity of disturbances in dental development between children conditioned with BU/CY
and TBI/CY. The results indicate that irradiation caauses more severe effects than chemotherapeutic

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P. Fleming*1, A. Ni Chaollai1, K. Butler2, A. Cant2, 3
1Dental Dept, 2Dept Infectious Diseases, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland,
3Immunology Dept, Newcastle Hospitals, Newcastle-upon-Tyne, England

Background: Chronic granulomatous disease is an inherited disorder of phagocytic cells, which fails to
produce the respiratory burst necessary to kill certain types of bacteria and fungi, leading to recurrent life-
threatening infections. Another manifestation of CGD may be the development of granulomas. Case
Report: A 5 year old boy with X-linked CGD was referred for management of a decayed and abscessed
maxillary primary second molar tooth. He was on continuous oral antibiotic and antifungal prophylaxis
since diagnosis of CGD as an infant. He had recently completed an additional course of oral antibiotics for
the decayed tooth. The tooth was extracted under GA, antibiotics were administerediv and a course of oral
antibiotics prescribed. Six weeks following the extraction he presented with an extensive ulcerated and
granulomatous lesion extending approximately 2 cm from the socket towards the midline. Radio-logical
imaging was consistent with the presence of maxillary osteomyelitis with significant bony erosion and soft
tissue infection. Treatment: He was admitted to hospital for an extend-ed course of high dose intravenous
antibiotic and antifungal therapy and administration of gamma interferon. The oral lesion was curetted and
the developing second premolar tooth was removed. Histopathological examination revealed a marked
granulomatous gingivitis with extensive ulceration but no organ-isms were identified either in histological
staining or fungal and mycobacterial culture of intraoperative specimens. PCR testing for Aspergillus was
positive on blood samples at the time of admission. Subsequent testing was negative. Outcome: The
granulomatous lesion resolved with no spread of infection. A work-up is now being undertaken so a
haematopoietic stem cell transplant may be provided for this child in a specialist centre.

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R.E. Gomes*1, A. Cahuana2, C. Fortuny2, J.R. Boj3, E. Espasa3
1Superior Institute of Sciences & Technology, Mozambique, 2Hospital Sant Joan De Déu, Barcelona,
3University of Barcelona, Spain.

Aim: This was to assess the oral health and oral microorganisms of HIVinfected children treated as
outpatients at University Hospital ( Barcelona , Spain ) and at Santo Egídio Community ( Maputo ,
Mozambique ). Methods: Epidemiological examination of HIV-infected children in Barcelona and Maputo
was undertaken by a single examiner to determine oral lesions and dental caries. Orion Diagnostica's
dental diagnostic tests (Dentobuff ® , Dentocult® CA, SM and LB) were used in both groups. Age, sex,
clinical classifications and CD4 counts categories (CDC, 1994), oral medication and oral hygiene were
evaluated. Results: A sample of 77 patients (1 to 18 years old) from Barcelona (group B) and 38 children
(1 to 15 years old) from Maputo (group M) were studied. 38% children were caries free in group B and 42%
in group M. The dmft/DMFT of group B was 0,5/2,6 and group M 2,9/0,3. 43% of Barcelona patients had an
HIV related oral lesion while in Maputo just 11%. The most common oral lesions in group B were candidiasis
(14%), recurrent ulcers (13%), xerostomy (9%), herpes simplex (4%). The most common oral lesions in
group M were candidiasis (5%), recurrent ulcers (5%), leucoplakia (3%) and seborrheic dermatitis (3%).
There were found more positive dental diagnostic tests in Group B. Conclusion: The Maputo group showed
a better oral health and less oral microorganisms. There is dental treatment need for the HIV-infected

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P. Hölttä*0, L. Hovi2, S. Alaluusua1, 3
1Institute of Dentistry , University of Helsinki, Finland, 2Hospital for Children and Adolescents, 3Helsinki
University Central Hospital, Dept Maxillofacial Diseases, Finland

Aim: Effects of total body irradiation (TBI) and age at stem cell transplantation (SCT) on permanent teeth
were studied by assessing developmental dental damage with Individual Defect Index (IDeI). Methods:
SCT patients studied (n=36; mean age at SCT 4.3, range 1-9.4 years; mean follow-up 9.5, range 3.1-20.5
years) were treated with high-dose chemotherapy (HDC) and TBI (TBI group, n=27) or HDC only (non-TBI
group, n=9) prior to SCT. The effect of SCT age on dental aberrations was studied in age groups (¡Ü3.0, 3.1
to 5.0, and ¡?5.1 years). Defect points were assessed for each tooth according to the severity of the
disturbance. Agenesis of a tooth gave 5, microdontia 4, and disturbed dental root development 1 to 4
defect points. Third molars were excluded. To characterize dental adverse effects of therapy with one
figure, defect points were summed up to form IDeI of a patient. Mann-Whitney U test was used in statistical
analyses. Results: TBI-patients had more severe dental disturbances meaning higher mean IDeI (62.9)
than had non-TBI patients (31.9), (p=0.003). IDeI-scores were highly variable among individual patients,
ranging from 3 to 117 in TBI and from 13 to 69 in non-TBI patients. Patients ¡Ü3.0 and those 3.1 to 5.0
years at SCT had the mean IDeIs of 62.3 and 75.8, respectively (p=0.387). Patients ¡?5.1 years or more at
SCT were significantly less affected (mean IDeI 36.1) than the youngest ones (p=0.018) or the 3.1 to 5.0-
year-olds (p=0.001). Conclusions: SCT recipients treated with TBI and HDC together had significantly
more defects in tooth development than those treated with HDC only. Patients less than 5 years at SCT
were more severely affected than the older patients.

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C. Mason*1
1Great Ormond Street Hospital for Children, London, England
Background: Epidermolysis bullosa (EB) describes a group of genetically determined blistering skin
disorders. The main types are simplex, junctional and dystrophic. These vary in course and severity from
minor disability to death in early infancy. Oral problems are dependent on type and include mucosal
blistering, scarring, ankyloglossia, caries, enamel hypoplasia and crowding. In severe cases with extensive
dental treatment needs, general anaesthesia is required and is ideally co-ordinated with other procedures.
Case Reports: 20 cases are reported, illustrating modified techniques to minimise trauma to the skin and
mucosa. Securing of nasal tubes, intravenous access and monitoring equipment was achieved without
adhesive tapes or pads. Peri-oral tissues were protected with vaseline gauze and rubber dam was used for
restorative treatment to protect intra-oral soft tissues. Conventional mouth-props were modified to reduce
the risk of trauma and ease placement where access was limited. Of the 20 cases, 14 had restorations and
extractions, 4 had extractions only and 2 had scaling. 13 patients had their dental treatment co-ordinated
with other procedures under the same anaesthetic. Treatment was completed on all patients with minimal
morbidity such that they were able to resume their normal diet and mouth care on the same day. Follow-
up: All patients are under regular multi-disciplinary care with the emphasis on prevention.
Herod J et al. Epidermolysis bullosa in children: pathophysiology, anaesthesia and pain management.
Paediatric Anaesthesia 2002, 12: 388-397
Wright T J et al. Hereditary epidermolysis bullosa: oral manifestations and dental management. Pediatric
Dentistry 1993, 15: 242-248

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E.A. Alcaino*1, A.C. Cameron2
1University of Sydney, Sydney, 2Westmead Hospital, Sydney, Australia

Background: LSA is a condition characterised by well-demarcated white plaques usually affecting the skin
and genitals in adults, with an increased prevalence in females. Presentation of this condition in children is
uncommon and its occurrence in the oral cavity is extremely rare. Although the aetiology of this condition
remains obscure, an association with autoimmunity has been reported. Case Report: A 12 year-old
Caucasian girl presented complaining of the appearance of her upper incisors and the presence of a white
lesion for approximately 4-6 months. No other symptoms or contributory medical history was found
excepting a scoliosis. Oral examination revealed an area of linear leukoplakia extending from the vermilion
border to the inner aspect of the upper lip. Teeth 12 and 11 appeared infra-occluded with associated
gingival recession and bone loss. No other pathology was noted on radiographs. A percussion test
suggested ankylosis of the central incisor, but both teeth were positive to cold sensibility testing. The
differential diagnosis included: lichen planus, localised scleroderma (LS), a trauma induced lesion, or an
undiagnosed autoimmune condition. Treatment: A biopsy was performed and histopathological exam-
ination suggested a diagnosis of LSA. Systemic lupus erythema-osis was excluded by serological
investigation. A second lab-oratory report confirmed LSA but could not fully exclude LS, as the gingival
recession and bone loss were more characteristic of this condition. This child has been treated
conservatively, with strict oral hygiene, composite reconstructions of the ankylosed teeth, and periodic
reviews. The microvascular changes associated with this condition may explain the unusual clinical
presentation and the options for future treatment including orthodontics and osseointegrated implants will
be discussed.

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A.C. Cameron*1, A.M. Sanares1, C.H. Cheong2, N.M. King2
1Westmead Hospital, University of Sydney, Australia, 2Prince Philip Dental Hospital,
University of Hong Kong, SAR

Background: Ppremature loss of primary teeth is an important diagnostic sign of hypophosphatasia,a rare
inherited disorder of missense mutations at the tissue non-specific alkaline phospha-tase (TNSALP) gene at
1p34-36.1, causing defects in skeletal mineralization. Hypophosphatasia manifesting only as early loss of
primary teeth was originally classified as odontohypophosphatasia, however, this falsely implies that it is
separate from true hypophosphatasia. Case Reports: 11 patients (8 males, 3 females) were referred to
Westmead Hospital , and the Prince Philip Dental Hospital , , where the initial presentation was premature
exfoliation of primary mandibular anterior teeth between 12-42 months of age. The diagnosis of hypophos-
phatasia was confirmed by laboratory findings of decreased TNSALP and increased urinary
phosphoethanolamine (PEA). Only two of these children exhibited skeletal manifestations traditionally
associated with hypophosphatasia. Histological examination revealed a decreased thickness or complete
absence of cementum with areas of apical or lateral focal root resorption. Treatment: Management of all
the patients up to 10 years involved preventive therapy. While these measures are not specifically geared
towards preventing the premature exfoliation, they aimed at minimizing other complic-ations (dental
caries, periodontal disease). Only 1 child has since exhibited exfoliation of a permanent tooth (one upper
pre m o l a r, re q u i red extraction). Hypophosphatasia has highly variable clinical manifestations with
some biochemically- affected individuals exhibiting no other symptoms. Uuse of the term
odontohypophosphatasia to describe a decrease in alkaline phosphatise and premature exfoliation of the
teeth in the absence of other systemic pathology is inappropriate as it is not distinct from true

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A.B. Skaare*1, H.S. Koppang1
1University of Oslo, Institute of Clinical Dentistry, Oslo, Norway

Background: Oro-facial granulomatosis (OFG) is a rare condition characterized histologically by

granulomatous inflammation. It may be the precursor of Crohn's disease. Case reports: Seven children in
the age range 1-12 years were referred to the Dep. of Paediatric Dentistry and Behavioural Science,
University of Oslo , in the period 2000-2005 because of hyperplasia and soreness of the gingiva/oral
mucosa. One case was referred from a medical doctor the others from dentists in the Public Dental Health
Service in the proximity of Oslo . All the patients had a history of allergy/atopi and the extra-oral
examination revealed eczematous facial skin, dry lips and in some cases angular cheilitis. The common
intraoral finding was gingival hyperplasia and inflammation. This was sometimes accompanied by a burning
or stinging pain and in 4 of the patients there were also intermittent abdominal symptoms.
Treatment/follow up: Biopsy from the affected areas revealed granulomatous inflammation. The local
health care system is involved in all the cases and in all but one, further intestinal examination has been
indicated. So far no gastrointestinal manifestation of Crohn's disease is found. All parents/patients were
relieved to obtain a diagnosis. Food allergy testing for the most common food allergens has not given
answer to a possible hypersensitivity reaction, but the avoidance of irritating food seems to alleviate the
pain in some. The patients are at regular follow-up appointments to observe the course of the disease.
Treatment may not be necessary when the symptoms are mild. These cases comprise examples of OFG
and illustrate the importance of paediatric dentists to make an early diagnosis and to collaborate with
paediatricians to watch for food allergy or the development of further bowel symptoms.

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J.S. Heijdra*1, J.S.J. Veerkamp1
1ACTA, Amsterdam, the Netherlands

Aim: The aim of this study was to assess if Dutch dentists have comparable attitudes in maintaining
children's dental health. In several Western European countries studies have been put forward concerning
the increase of caries incidence, or to be more specific, the decline in restorative care. It is however difficult
to assess whether this increase is merely based on a change of focus on the child's dental health or a shift
in treatment attitude of the dental professionals. Prevention, x-ray diagnosis, restorative care were
compared in 4 consecutive age groups 6yrs,<9yrs,<12yrs,<17yrs). Methods: In a cross sectional study
calculations were made using the financial records of AGIS, one of the largest Dutch health care providers.
After medical approval all dental records of 4500 dentists during three consecutive years were used to
calculate correlations and odd ratio's using early treatment, oral diagnosis, preventive approach and use of
local anaesthesia as basic independent variables. Results: Early diagnosis using x-rays in children < 6yrs
increased the likelihood of direct restorative care 2.8 times and the likelihood of restorative care in future
age groups 2.2, 2.0 and 1.6 times respectively. Early x-rays increased the likelihood of making x-rays in
later groups by 3.7, 3.4 and 1.9 times respectively. Dentists using local anaesthesia were more likely to use
p reventive (2.2x) and diagnostic (1.7x) measures and sealants (2.5x). Correlations between prevention
and restoration indicating a more structured approach were stronger for a group of dentists ( 1%, n=50)
treating the largest number of children. Conclusion: the approach of dentists in treating young children
seems to be indicative for their pattern of dealing with older children. This structured approach is limited to
a small number of dentists.

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A.L. Seminario*1, Z. Broukal2, R. Ivancakova1.
1Faculty Medicine, Hradec Kralove, 21st. Faculty of Medecine Charles University, Prague Czech Rep.

Aim: To evaluate S. Mutans in preschool and primary school children after 1year of topical F applications.
Methods: 50 children in good general health, divided in 2 groups, primary (A, mean age: 3.84) and 1st
phase mixed dentition (B, mean age: 7.21), were selected. Evaluation of s. mutans levels (Dentocult SM)
and applications of topicalF each 6months were supplied during 1year. The dmft and DMFT, dental plaque,
carbohydrates ingestion and instruction of dental hygiene were also included since the first step and in
each control. Onset data and those after 1year were compared by paired Student's t-test at P=0.05.
Results: Onset data group A: Dentocult SM 1.88, dmft 1.31, plaque score 0.83. Group B: Dentocult SM 1.84,
DMFT 0.94, plaque score 0.93. Data after 1year: group A: Dentocult SM 1.50, dmft 2.31 (P<0.05), plaque
score 0.41. Group B: Dentocult SM 1.90, DMFT 1.52 (P<0.05), plaque score 1.23. Following statistical
differences were found, with other items examined, at the baseline: group A: Dentocult vs dmft 4.4 (NS),
dmft vs plaque score 53.4(P< 0.05); final data Dentocult SM vs dt 34.3(P<0.05), dt vs plaque score 29.8
(NS). Group B: Dentocult SM vs DT 37.5(P<0.05), DT vs plaque score 9.8 (NS), and final Dentocult SM vs DT
5.0 (NS), DT vs plaque score 1.2(NS). Conclusions: After 1year of topical fluoride applications, parental
instructions and following oral health, we found that Dentocult SM and dental plaque correlation scores
improved from the baseline data. This is the first evaluation data of a 2.5years longitudinal study. We
expect, at the end of our study, an improvement of oral health status for both groups.

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G. Vadiakas*1, C.J. Oulis1, E.D. Berdouses1, M. Larmas2
1Dental Schoo, Athens Greecel, 2Dental School, University of Oulu, Finland

Aim: To evaluate the effectiveness of sealants FS in preventing occlusal caries in permanent molars,
longitudinally, in a cohort of children. Methods: Longitudinal data from dental records of children visiting a
private practice and a municipal health center out ( Athens ) were collected. In order for the children to
participate in the study children had to have their initial visit before the eruption of the first permanent
molar, and recall examination visits at least once a year, thereafter. The min-imum number of annual recall
examinations required was 6. 559 children, 292 females and 267 males satisfied the study criteria. The age
of the patient and time of: each exam, eruption of the teeth, placement of first sealant, resealing and
placement of first restoration due to caries, were recorded. A cumulative distribution function (CDF) was
estimated for each molar using the Kaplan-Meier method. Results: Filling placement rates (20-30%) on the
occlusal surface of FS first molars were found significantly lower 9 years after eruption, compared to
unsealed first molars (70- 80%). Similarly, significantly lower rates (10-20%) were found for FS second
molars 3-4 years after eruption, compared to the unsealed molars (60-70%). CDF curves for FS first molars
showed a higher increase in filling placement rates 7 years after eruption, while the curves for unsealed
molars showed a leveling phase corresponding to small increases in filling placement at the same period.
Conclusions: FS seem to have a long-term preventive effect in reducing occlusal caries in molars, in
children. But, caution is needed, as an increase of carious sealed molars was noticed 7 years after their
eruption, regardless of when the first sealant was placed.

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C.V. Witt*1, M.P. Hector1, R.P. Allaker2, J.J. Doel2.
1Dept Oral Growth and Development, 2Dept Microbiology, Royal London,Queen Mary's School of Medicine
& Dentistry, University of London, England.

Aim: To test the hypothesis that a combination of high salivary nitrate (N) and high nitrate reducing
capacity are protective against dental caries. Method: Dietary N intake was measured in the form of a
questionnaire concentrating on vegetables, fruits and drinks for their source of N. Iintake of N (mgm per kg
body weigh/day) was calculated and a diet score was given. Saliva samples were obtained from children
using two sterile cotton wool swabs. Microbiological analysis was done to calculate the number of colony
forming units per ml of S. mutans and Lacto-bacillus species. Biochemical analyses estimated the salivary N
and N concentration, and the ratio between the two. A caries index of DMFT and dmfs was used to establish
a possible relationship. Results: In the caries free group, their dietary nitrate and salivary nitrite/nitrate
concentration is higher compared to the caries active group. The number of colony forming units per
millilitre of Streptococcus mutans and Lactobacillus species is lower in the caries free group. When salivary
nitrite/nitrate concentrations and ratio are high, the number of colony forming units per millilitre of saliva of
cariogenic microorganisms are low, thus fewer caries. Salivary nitrite/nitrate concentrations and ratio could
be a reliable 'marker' to identify 'caries risk' patients. Conclusion: Individuals with high nitrate intake and
oral flora with the ability to reduce nitrate to nitrite in oral cavity may be protected against cariogenic
bacteria, thus dental caries. The aetiology of caries is multi-factorial, high nitrate intake is the first step to
suppress the growth of cariogenic microorganisms. A probiotic therapy with nitrate reductase enzyme may
be a potential therapy against dental caries.

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M. Cannon*1, I. Gerodias1, A.E. Vieira2, C. Percinoto2
1Northwestern University, Chicago, USA, 2UNESP Paulista State University, Aracatuba, Brasil

Aim: The purpose of this study was to compare the effectiveness of resin based (BioCal) or pure Portland
cement and resin based calcium hydroxide or glass ionomer in the formation of hard tissue bridges after
exposure and contamination of primate dental pulps. Methods: The experiment required four primates
who each had 12 teeth prepared with buccal penetrations into the pulpal tissues and hemostasis obtained.
Each quadrant was randomly assigned to one of four treatment groups; BioCal (Bisco) was applied and light
cured for 15 seconds ( Group A), pure Portland cement mixed with a 2% chlorhexidine solution (Group B),
Triage, Fuji VII (GC America) mixed in capsule then placed (Group C), and VLC DYCAL (Dentsply) applied
and light cured (Group D). The pulp capping bases were then covered with a GIC (GC America). The tissue
samples were collected at 4 weeks after animal sacrifice. Hard tissue bridge formation was measured at
three different sites with each specimen. Statistical analysis of the results was performed with the Kruskal-
Wallis test. Results: Both the Portland cement and BioCal groups had significantly more frequent hard
tissue bridge formation than the GIC and VLC Dycal groups (H= 11.989 with 3 degrees of freedom,
P=0.009). The measured thickness of the hard tissue bridges with the pure Portland and BioCal groups
were statistically greater than that of the other two groups (H= 15.849 with 3 degrees of freedom,
P=0.002). Conclusion: Both the light cured Biocal and pure Portland cement are acceptable pulp capping
materials that stimulate hard tissue bridge formation.

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L. Burbridge* Edinburgh Dental Institute , Edinburgh, Scotland.

Aims: To compare retention of fissure sealants (sealants) placed on occlusal surfaces following use of a
self etching priming agent or traditional acid etch; to compare caries incidence of occlusal surfaces sealed
using the two techniques and to compare the ease of placement of sealant following use of the two
techniques as assessed by subjects and operators. Methods: A randomised controlled trial was undertaken
NHS Lothian Community Dental Service and Dental Hospital clinics. Sixty subjects were recruited to this
study by seven dental professionals who placed sealants on lower permanent molar pairs. The technique
used for enamel preparation prior to sealant placement on the right and left side of the lower arch was
randomised. On one side of the lower arch Xeno® III (Dentsply, Germany) was used to prepare the occlusal
enamel and on the other side phosphoric acid etch together with Prime and Bond® (Dentsply, Germany)
was used. Opaque Delton® ( Dentsply , USA ) was used to seal all surfaces. Subjects were blinded to the
techniques used. Subjects and operators recorded on individual questionnaires their impressions of the
techniques used. Results: Forty six (77%) of the sixty subjects were reviewed after six months. The
retention of the acid etch group was significantly superior (P<0.01) as was the caries preventive effect
(P<0.01). Subjects tended to report that placement of sealants was easier following enamel preparation
with Xeno® III (P=0.085) and in the opinion of the operators sealants were significantly easier to place
when using Xeno® III (P=0.016). Conclusions: Best practice for placement of sealants remains enamel
preparation with acid etch and use of an intermediate bonding layer.

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V.H. Khouw-Liu*1, E.C. Bouvy-Berends2, N.C. Iburg1
1Stichting Bijter, Centre for Special Care Dentistry, Rotterdam, 2Radboud University, Department of
Paedodontology, Nijmegen, the Netherlands

Aims: Tto review the provision of dental treatment of special needs children under general anaesthesia
(GA) in the region of Rotterdam and to look at the emerging trends in GA services from 1993-2005.
Methods: Foundation 'Bijter', a referral dental centre, provides dental services under GA for special needs
patients including children in Rotterdam . Clinical data were collected retrospectively in the period 1993-
2005 on the number, age and type of special needs patients under the age 18 who had undergone dental
treatments under GA. These were either carried out at the dental centre under 'office based dental
anaesthesia' (OBDA) or in an academic children's hospital. Results: The centre treated a total of 1874
special needs patients under OBDA from 1993-2005. 810 were patients under the age of 18. The lowest
age group treated under OBDA was 3 years. In the same period, 564 children, mainly the severely disabled
or those with early childhood caries, underwent GA treatments in the hospital. The lowest age group was
1.5 years. Due to restricted hospital GA sessions, the centre saw, over the years, an increase in (i) the
number of children and (ii) younger ASA class I/ II children treated under OBDA. Very young children (under
18 kg ) or ASA class III/ IV children were treated in the hospital. Conclusions: Limited GA capacity in the
children's hospital has caused a shift in our patient selection. Hospital treatments were indicated for
children with higher GA risks. Developments in GA techniques and the accumulated experience of OBDA
meant that young disabled children could be safely treated outside hospital settings.

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O.O. Kuscu*1, S. Akyuz1
1Marmara University, School of Dentistry, Dept Paediatric Dentistry, Istanbul, Turkey

Aim: Determining the effectiveness of Palmar Sweat Index (PSI) and Facial Image Scale (FIS) for measuring
the state anxiety during dental treatment. Methods: The study group consisted of 45 children, aged
between 9-13, registered for treatment at Marmara University , Dept Paediatric Dentistry. Informed
consents from the parents were obtained as well as an approval from University Ethics Committee. Prior to
treatment, children were asked to answer Children's Fear Survey Schedule-Dental Subscale(CFSS-DS) to
determine their levels of dental anxiety and were assigned as non-anxious (CFSSDS< 32) and mod-erate-
highly anxious (CFSS-DS>32) accordingly. Initial/leaving FIS and PSI values were recorded to evaluate the
state anxiety before and after the profilaxy treatment. Results: Mean initial/ leaving FIS and PSI values
were 0.41±0.21/0.11±0.13 and 15.07±12.36/7.76±10.15. Initial anxiety levels according to both measures
were corr-lated with CFSS-DS (FIS: r=0.447 p=0.003; PSI: r=0.327 p= 0.037) but were not correlated with
each other (r =0.293 p =0.063). Initial/ leaving anxiety levels of children exhibited sig-nificant reductions
( p<0.0001) in both measures. To analyze FIS and PSI further, anxious (mean CFSS-DS=43.37 ± 7.48,
n=22) and non-anxious (mean CFSSDS= 23.23 ± 3.93, n=19) groups were compared, and only FIS values
revealed the difference between the groups sig-nificantly (p=0.002). Anxiety levels, according to FIS and
PSI, again exhibited significant reductions (p<0..001) both in anxious and non-anxious groups but again
were not correlated with each other. Conclusion: FIS and PSI were found to be equally effective for
measuring the state anxiety during dental treatment. FIS and CFSS-DS distinguish and measure
approximate components of anxiety within its multidimensional construct.
Supported by Marmara University Scientific Research Committee (Ref. no: SA?- 051/070403)

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N. A. Lygidakis*, M. Kyritsi, G.E. Dimou.
Community Dental Center for Children, Athens, Greece

Aim: The aim of this clinical study was to investigate the relation of children's behaviour during dental
treatment to parental dental attitude and perceptions. Methods: 88 children (53 male and 35 female)
aged 3-11.5 years and their parents, attending the Community Dental Center for Children in Athens ,
participated in this study. A question-naire including demographic information, questions regarding parents'
dental experience and anxiety (M-DAS test), as well as questions regarding expecting behaviour of the child
and his/her dental anxiety (parental version of the Children's Fear Survey Schedule - Dental Subscale) was
completed by the parents during the first examination appointment to the Center. During the two following
operative sessions the child's behaviour was recorded and evaluated by the same clinician using the Frankl
Scale. Collected data were statistically analyzed using a StatMost program for Windows XP. Results: No
significant differences were found among parental dental behaviour and anxiety and their children's
behaviour during treatment. When parental perceptions about their children's fear, were analyzed there
was also no relation to the children's actual behaviour during treatment. Conclusions: According to the
present study, parental dental experience and fear as well as predictions for expected behaviour, appear to
have no influence on the children's actual behaviour.

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M. Majstorovic*1, I. Skrinjaric1, L. Szirovicza3, J.S.J. Veerkamp2
1Dept. Paediatric Dentistry, University of Zagreb, 2ACTA, Amsterdam, the Netherlands, 3Institute for
Anthropology, Zagreb, Croatia

Aim: The purpose of the present study was to evaluate differences in dental anxiety in adolescents by
using the Achenbach CBCL YSR (1991), Children Fear Survey Schedule - Dental Subscale (CFSS-DS), Corah
Dental Anxiety Scale (CDAS) and Child Medical Fear Questionnaire (CMFQ). Methods: A sample of 113
children (50 girls and 63 boys) aged between 15 to 18 years was randomly selected. Children were
interviewed by using the YSR form of the CBCL (1991), CFSS-DS, CDAS and CMFQ questionnaires. Results:
Anxiety/ depression scores were significantly higher for girls (x=6.20) than for boys (x=4.83; p=0.046). The
CBCL internalizing problems were significantly higher for girls (x=13.94) than for boys (x=10.54; p=0.010).
Dental anxiety scores were signif-icantly higher in girls, using CFSS-DS (p=0.001) and CDAS (p=0.002).
CMFQ questionnaire revealed a significantly higher fear of treatment in girls (x=18.06; p<0.001).
Conclusion: Adolescent girls showed more internalizing problems and signif-icantly higher level of anxiety
than boys. Discrim-inant analysis showed higher reliability of CFSS-DS (á=0.89) and CDAS (á=0.88) than
CBCL (á=0.79) in evaluating dental anxiety.

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J.L. Sixou*, M.E. Barbosa-Rogier Université de Rennes1 and CHU Rennes, Rennes, France

Aim: The intra-osseous injection (IO) allows placement of a local anesthetic solution into the cancellous
bone adjacent to the tooth to be anesthetized. The aim of this study has been to assess its anesthetic
efficacy in children and adolescents using a comp uter-assisted system. Methods: IO injection of 4%
articaine with 1:200 000 epinephrine was performed using the Quick Sleeper 2T system in 82 healthy
children and adolescent (8,1 ± 3,3 yrs) attending the Department of Paediatric Dentistry of the Center for
Dental Treatment of Rennes (France). Statistical evaluation of data was performed with EpiInfo 6.0T using a
khi square and Fisher test analysis. Results: IO could be evaluated in 75 patients (118 teeth). The average
quantity of anesthetic solution injected was 0.80 ± 0.28 ml (0.45 cartridge). The overall success rate was
93.2% (110/118): 94.4% (67/71) in primary teeth and 91.5% (43/47) in permanent teeth. It showed better
efficiency in endodontic treatments (97.7%) than in extraction (83.3%) of primary teeth. Conclusion: IO
injection showed good analgesia efficacy in children/adolescents. It may be considered a complement or an
alternate solution of classical local analgesia.

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R.G. Cauwels*1, I. Pieters2, L.C. Martens1, R.M. Verbeeck2
1Dept. Paediatric Dentistry and Special Care, University Hospital, PaeCaMed Research, 2Dept. Dental
Biomaterials Ghent, Belgium

Aim: This study aims to investigate the strength of simulated root canals after a one-visit apexification with
MTA (ProRoot® MTA Original, Dentsply) compared to gutta-percha techniques. Endodontic treatment after
trauma in immature teeth is often complicated because of the open apex and a flaring root canal resulting
in thinned dentin walls. Long-term prognosis is surprisingly low not because of the treatment itself but
because of cervical root fractures occurring following an impact of weak forces. Efforts should be directed
towards strengthening the immature root. Methods. Bone cylinders (diam.7 mm, H 10.5 mm ) from bovine
femurs were used as standardized samples. The samples received a central canal of 3.5 mm diameter
imitating a root canal in an immature tooth and were divided into 4 groups : unfilled (G1; N=173),
obturated with gutta-percha (G2; N=159), with thermo-plasticized injectable gutta percha (G3; N=142) or
with grey MTA(G4; N=75). Fracture resistance was analysed using indirect tensile strength. Results. 1-way
ANOVA (P<0.001) and Bonferroni's test (á=0.05) demonstrate that the tensile strength (MPa) increases
according to: G1 (3.99% +/-0.07) < G3 (5.91% +/-0.08) < G2 (6.59% +/- 0.09) << G4 (13.47% +/- 0.97).
Conclusion. The present alternative treatment procedure for a root filling in standardized samples resulted
in a dimensional and structural reinforcement. Further investigation needs to define the best biocompatible
materials having the opportunity to perform a one-visit apexification and to increase the mechanical
properties of the traumatized tooth.

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K.A. Ebeleseder*, E. Lang, K. Glockner.University Dental Clinic, Dept. of Conservative Dentistry , Germany.
Aim: An analysis of factors which lead to loss of teeth, of vitality or function after traumatic root fracture.
Methods: Treatment protocols from the local dental trauma ambulance were screened for root fracture
cases in patients younger than 16 years. All teeth were included which had been vital before the trauma
and showed a follow up of at least six months. Results: 36 teeth in 32 patients (m = 27, f = 5) were found
among 1700 dental trauma patients. No tooth was extracted. 12 teeth developed pulp necrosis, 11 of them
healed after endodontic treatment in the coronal fragment. Final healing modalities were: hard tissue
healing (17 = 47%), connect-ive tissue healing (9 = 25%), interposition of alveolar bone (9 = 25%),
chronical inflammation / no healing (1 = 3%). A positive prognostic factor was an initial positive sensibility
test. A negative prognostic factor was antibacterial therapy (systemic antibiotics and chlorhexidine
mouthrinse). Dislocation, intactness of crown and splinting type did not seem to influence prognosis.
Conclusion: Root fractures in children and adolescents have a high potential of self-healing. Most of them
only need initial treatment (repositioning and splinting).

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Y. Pohl*1, A. Filippi2 1Department of Oral Surgery, 2Department of Oral Surgery, Radiology, Oral Medicine.

Aim: To assess the success of transplanting primary canines to replace traumatically lost permanent inc
isors. Methods: Perman-ent incisors of the maxilla that had been lost or that were ankylosed due to
traumatic injuries were replaced by transplant-ation of primary canines. Pulp necrosis being predictable an
immediate, extraoral endodontic treatment was performed by a retrograde insertion of titanium posts.
After the removal of the splint the crowns of the transplants were reconstructed using composites to mimic
form and colour of incisors. Results: 26 primary canines were transplanted in 23 patients. Mean age was
9.2 years (7.6-12.4 years). 17 primary canines were followed for at least 12 mths or considered because of
healing complications. Median observation period was 26.4 months (6.7 - 54.6 months). Initially all
translants exhibited functional healing. 5 transplants were lost due to another trauma, in 2 cases another
transplantation of primary canines was performed. Root of 1 transplant was completely resorbed within 6.7
mths following initial healing. 1 primary canine was resorbed by the developing permanent canine and lost
after 26 mths. The mean expected survival according to Kaplan-Meier-Analysis was 39.2 mths. Survival was
significantly shorter for teeth that were lost due to external reasons ( p<0.05). Conclusion:
Transplantation of primary canines following loss or ankylosis maintains alveolar bone and soft tissues and
enables the continue of alveolar growth. A high incidence of second traumas seems to be problematic and
relevant for the prognosis.

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B. Azrak*, A. Callaway, B. Ebadi, B. Willershausen, C. Gleissne.
Dept Restorative Dentistry, Johannes Gutenberg University, Mainz, Germany.

Aim: The results of the new method for caries-risk diagnosis, lactic-acid production (LAP) ere compared
with the findings of established clinical and subclinical methods, in children. Methods: 119 children (65
girls, 54 boys; 9±1.2 years old) participated in the study. Data collection included clinical [number of
carious lesions (D-T), filled teeth (F-T), fillings placed within the last 12 months (F-T/12), Approximal Plaque
Index (API)] and subclinical informations [buffering capacity of stimulated saliva (BC), counts of mutans
streptococci (MS) and lactobacilli (LB) in saliva, LAP]. According to clinical indicators of caries risk, the
children were divided into low (D-T=0 and F-T/12=0) and high (D-T>0 and /or F-T/12>0) risk groups.
Statistical analysis used Spearman's test for non-parametric correlations, uni- and multivariate regression
analysis. Results: According to clinical findings, 47 children (mean: 8.8±1.2 years old; F-T=0.4±1.4) had a
low and 72 children (mean: 9.0±1.2 years old; DT= 2.5±2.7; F-T/12=1.2±1.8; F-T=1.5±1.9) a high caries
risk. Spearman correlation analysis confirmed the statistical significant correlations of established clinical to
subclinical indicators (SM to LB, SM and LB to D-T, LB to F-T and API, F-T/12 to D-T and F-T). LAP showed
significant correlations to F-T and F-T/12 but not to D-T , MS and LB. The univariate regression analysis in
both caries risk groups showed statistically significant differences for SM, LB, F-T and also LAP. The
multivariate analysis showed that LB and F-T are the significant factors in caries risk; but LAP showed no
correlations to any other caries indicator. Conclusion: LAP might be useful as a supplementary screening
tool for caries-risk assessment, but it shouldn't be used as a sole predictor.

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R. Leroy, K. Hoppenbrouwers, A. Jara Vallejos, D. Declerck*1
Catholic University Leuven, Leuven, Belgium

Aim: The study aimed to assess the effect of parental smoking on children's oral health. Methods. Cross-
sectional data from 1,250 3-year old and 1283 5- year old children from 4 geographical areas in Flanders
( Belgium ) were analysed. Children were examined at school by 8 trained dentist-examiners, using
standard criteria and calibrated examination methodology. Data on oral hygiene and dietary habits, oral
health behaviour, socio-demographic variables and parental smoking habits were obtained through
structured questionnaires, completed by the parents. Results: Roughly, 7% of 3-year-olds and 31% of 5-
year-olds presented with visible caries experience (i.e. d3mft>0). In both age groups, about one third of the
parents reported a smoking habit. With caries prevalence as the dependent variable, simple logistic
regression analysis - with correction for examiner misclassification - revealed that parental smoking was a
significant independent variable. In 3-year old children, the effect of family smoking status was not longer
significant after controlling for age, gender, socio-demographic characteristics, oral hygiene and dietary
habits. In the oldest age group the significant relationship between parental smoking habits and caries
experience persisted after adjusting for the other evaluated variables (OR= 3.36; 95% CI: 1.49-7.58).
Conclusions: This study confirms the important impact of parental smoking habits on children's oral
Supported by GABA International and GABA Benelux.

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A. Giannouli*, K.J. Toumba. Leeds Dental Institute, Leeds, England.

Aims: The aims of this study were to compare the effect of toothbrushing before or after breakfast on
enamel demin-eralisation and on the enamel surface integrity. Methods: Nine healthy adults were
recruited in this in situ, randomised, single-blind, two-phase, crossover study. During each 28-day study
period, each subject wore a lower removable Hawley type appliance with two polished (one covered with
gauze and one exposed to the oral environment) and one natural enamel slab fitted buccally. The
volunteers ate their breakfasts with their appliances in place and they brushed the two uncovered slabs ex
vivo for 30 seconds every morning (before or after breakfast) and night with a 1450ppmF toothpaste.
During the day the slab covered with gauze was immersed in 10% sucrose solution for 10 minutes and
enamel demineralisation was studied by surface microhardness testing. Surface loss on the two brushed
slabs was investigated by optical profilometry and confocal laser scanning microscopy (CLSM). Results:
The confidence intervals (CI) of the mean difference between the baseline and after-treatment
measurements were calculated. The demineralisation in the "before breakfast" group was statistically
significant higher that "the after breakfast"group (CI=2.1,-11). The polished enamel specimens examined
by optical profilometry showed no surface loss except for two slabs. Mean surface losses (±SD) of
2.31±1.02ìm and 3.23±1.68ìm were detected with the CLSM on the natural enamel surfaces. No
statistically significant difference was observed (CI=-3.18,1.34). Conclusions: Toothbrushing after
breakfast seemed more beneficial as far as caries prevention is concerned.

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S. Gizani*1, W. Papaioannou2, L. Papagiannoulis1.
1Dept. Peadiatric Dentistry, 2Dept. Preventive and Community Dentistry, Dental School, University of
Athens, Greece

Aim: The aim of the present study is to describe the oral health condition, the dental attendance and
dental care provided to Greek children from public schools for special education, in Athens with mild mental
impairment. Methods: A number of 171 schoolchildren (114 boys, 57 girls) with a mean age of 11.46 ±
1.92 years participated in the study. The following parameters were evaluated: dental caries (DMFT/S
index), provision of dental treatment [RIT/RIS (Restorative Index: (F/F+D) x 100)] and oral hygiene (Plaque
Index). Information was obtained through questionnaires given to parents and teachers, about the
demographic and medical profile, the oral health behaviour as well as the dental attendance of the
children. Results: Regarding dental attendance, 55.88% of the children occasionally visited the dentist
while 16.91 % had never visited a dentist. The main responsible reasons reported were difficulties in the
cooperation of the children with the dentist and financial aspects. From the children that attended a
dentist, 58.06% visited a private dentist while 38.71% visited a dental clinic in the university/hospital.
Although the restorative index of the children regularly attending was higher (RIS, mean: 15.85, SD: 31.39)
than those who visited less often or even never a dentist (RIS, mean: 4.34, SD: 17.58 and 4.38, 19.11
respectively), it was still low. A mean 53.77% of tooth surfaces were free of plaque in the group of children
attending regularly, while the same was true for 43.89% of tooth surfaces of children attending sporadically
and 47.27% of those never visited the dentist. Conclusions: For the children participating in the study, the
efficiency of the preventive measures and the restorative treatment provided were not related with the
frequency of dental visits.