Yankee Dental Pedo Part 3

7/30/2019 Yankee Dental Pedo Part 3.

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Breast feeding and ECC

Kotlow LA. Breastfeeding: a cause for dental

caries in children. J Dent Child.1977; 44:192

Breastfeeding and the risk of early childhood

caries.

White V.

Evid Based Dent. 2008;9(3):86-8.

Association between infant breastfeeding and

early childhood caries in the United States.

Iida H, Auinger P, Billings RJ, Weitzman M.

Pediatrics. 2007 Oct;120(4):e944-52

Erickson PR, Mazhari E. Investigation of the

role of human breast milk in caries

development. Pediatr Dent. 1999;21:86

Conclusions1. Breast milk has a pH of 7.2

2. Proven health benefits of

breastfeeding

3. Lack of consistent evidence

4. Promote breastfeeding

5. Emphasize OH and reduce CHO

consumption
http://www.ncbi.nlm.nih.gov/pubmed/17908749?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/17908749?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/17908749?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/17908749?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/17908749?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/17908749?ordinalpos=22&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum


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Ankyloglossia

6 week old healthy infant is referred to you for

problems with sucking. Pediatrician is concerned

and noted a short tongue. Your examination

reveals ankyloglossia.

What do you tell the parent and pediatrician?

Is there any evidence to support treatment?

Evidence based decision:

There are no controlled prospective trials forsurgical interventions in infants with ankyloglossia,

therefore there no conclusive suggestions

regarding the method of intervention. Also

controversial is which type of tongue-tie needs to

be surgically repaired and which can be left to

observe

How severe is the condition?

Is the infant having problems latching on to themothers breast?

Is the infant gaining weight?

1. Cochrane Oral Health Group-

nothing

2. ADA EBD: nothing

3. PubMed:

Frenulotomy for

breastfeeding infants withankyloglossia: effect on milk

removal and sucking mechanism

as imaged by ultrasound.

Geddes DT, et al

Pediatrics. 2008

Jul;122(1):e188- 94.

4.NGCH-

1. Guidelines for the

evaluation and management of

neonatal ankyloglossia and its

complications in the

breastfeeding dyad. Academy of

Breastfeeding Medicine -

Professional Association. 2004.
http://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.guideline.gov/summary/summary.aspx?doc_id=11228&nbr=005875&string=Ankyloglossiahttp://www.guideline.gov/summary/summary.aspx?doc_id=11228&nbr=005875&string=Ankyloglossiahttp://www.guideline.gov/summary/summary.aspx?doc_id=11228&nbr=005875&string=Ankyloglossiahttp://www.guideline.gov/summary/summary.aspx?doc_id=11228&nbr=005875&string=Ankyloglossiahttp://www.guideline.gov/summary/summary.aspx?doc_id=11228&nbr=005875&string=Ankyloglossiahttp://www.guideline.gov/summary/summary.aspx?doc_id=11228&nbr=005875&string=Ankyloglossiahttp://www.guideline.gov/summary/summary.aspx?doc_id=11228&nbr=005875&string=Ankyloglossiahttp://www.guideline.gov/summary/summary.aspx?doc_id=11228&nbr=005875&string=Ankyloglossiahttp://www.guideline.gov/summary/summary.aspx?doc_id=11228&nbr=005875&string=Ankyloglossiahttp://www.guideline.gov/summary/summary.aspx?doc_id=11228&nbr=005875&string=Ankyloglossiahttp://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/pubmed/18573859?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum


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Pulp Therapy Mythology


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Evidence for Pulpal Therapy

With rare exception, the studies we rely on are

academic thesis projects

Almost all use the same inclusion criteria which

really dont reflect clinical reality

Few follow their teeth through exfoliation and

eruption of the succedaneous teeth

Results are often clouded by purist views of

radiologic success


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Whats the Evidence for Pulp

Therapy?Nadin G, Goel BR, et al. Pulp treatment for

extensive decay in primary teeth (Cochrane

Review).The Cochrane Lib rary2003;2:1-30. Searched all languages, found 138 references, read

77 in entirety, and

Three studies met criteria for inclusion!

Conclusion: Insufficient randomized trials to providereliable evidence supporting one type of pulp

treatment as superior to others


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Common Clinical Situations


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What Evidence Exists On

Diagnosis of the Primary Pulp

Extent of Carious

Lesions Tooth Coloration

Location of Tooth

Clinical, Radiographicand Bleeding


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The Extent of Caries

The relationship between extent of carious involvement

of the marginal ridge and pulp inflammation in primary

molarsMS Duggal, A Nooh, A High. J Dent Res Abs # 1540, 1999

Classified marginal ridge cariesPulp changes identified in 80% of teeth

with 2/3rd of

ridge involved

Part of UK guidelines for pulp therapy


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The Extent of CariesHistopathology of the pulp in primary incisors withdeep dentinal caries.Eidelman, E et al. Pediatric Den t 1992;14:372 Looked at 53 carious primary incisor pulps without x-ray or clinical

pathosis, but deemed unrestorable

Removed caries after these teeth extracted as one would do if they

were to be saved Had carious exposures on 24

but not on 29 of these

Of 29 unexposed, only 6 were

histologically healthy pulps

None of the 24 exposed pulps were

histologically normal; two-thirds had

coronal inflammation


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Are Dark Teeth Sick Teeth? Son is et al.Longitudinal study ofdiscolored primary

teeth and effect onsuccedaneous teeth. JPedo 1987;11:247

Followed 37 darkenedincisors until lost anderuption of successor

No clinical or x-raypathosis on 72 percent

Only 11 teeth withpathosis

Only one successorhad enamel problems;and successors tended

to erupt early

Soxman JA et al .Pulpal

pathology in relation to

discoloration of primary

anterior teeth. JDC 1984;51:282

Total necrosis in 11/23 and as

early as 10 days S/P trauma No correlation between color

and histopathological status


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12

Who Wins the Technique War?

Study Yr NTime

(mos)

%

Clin

%

Xray

Fei et

al

91 83 12 96 96

Casas

et al

03 182 24 96 61

Fuks

et al

97 55 6-35 92.7 74.5

Smith

et al

00 242 4-57 99 n/a


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Pulpectomies Work as WellTwo-year outcomes of primary molar ferric

sulfate pulpotomy and root canal therapy.Casas

MJ et al. Pediatr Den t 2003;25:97

Studied 109 molar pulpectomies and they

were as good as ferric sulfate pulpotomies(98% after 2 years)

An evaluation of pulpal therapy in primary

incisors. Coll JA et al. Pediatr Den t 1988;10:178.

Studied 27 incisor pulpectomies and found

them 78% effective after 45.5 months


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Pulpectomy Research Support

Success rate of root canal treatment in primarymolars.

Moskovitz et alJ Dent (2005): 41-47

Found 85% success rate with pulpectomyprocedure

Filled with IRM

Ballesio et alEur J Pediatr Dent (2002) 133-140.

Chemical and pharmacological shaping of necroticprimary teeth.

Found 92% success rate Necrotic primary molars with fistulas

First visit: canals filled with powdered antibioticmixed with anesthetic solution

Second visit: canals were filled with IRM


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Who Has Time For This?

Coll J. Indirect pulp capping and primary

teeth: is the primary tooth pulpotomy out of

date?Pediatr Den t 2008;30:230-236. This author recommends placement of GIC for

several months in primary teeth when caries

approaches the red zone

While he maintains this is cheaper than a

pulpotomy, he does not address cost of re-treatment

which may be needed


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Bring Back the Indirect Pulp Cap?Indirect pulp treatment of primary posterior

teeth: a retrospective study.A l-Zayer MA etal. Pediatr Den t 2003;25:29

Looked at 187 primary posterior teeth treated with

indirect pulp therapy Deep dentinal caries, but no symptoms or x-ray

signs of pulpal pathosis

CaOH placed with crown, amalgam or composite

A 95% success with a 96% 1-year success

Crowns had best success


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What Else About Pulp Therapy?

If we look at what the many studies tell us.

Repeated studies suggest that regardless of medicamentt reatment succ ess depends on ini t ia l pu lp health[inclusion

criterion for all studies] First primary molars uniformly have poorer prognosis

compared to second molars

Most studies show either little difference in successbetween clinical and x-ray findings, or use clinically

irrelevant criteria, so dont radiograph without clinical signs Always follow pulp therapy with a crown

Wh D 5 Mi t F ll St th


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Why Do a 5-Minute Full Strength

FC Pulpotomy?Histobiological effectiveness of a reducedconcentration of Buckleys formocresol.Verco PJ.

Ped Den t 1985;7:130

Looked at S. faecal is, S. sal ivarius, Staph aureus

Found formocresol concentrations of 0.05 to 0.33%to be bacteriocidal

Comparison of antimicrobial and cytotoxic effects of

glutaraldehyde and formocresol .Hill SD et al. O,O,O1991;71:89

Mean microbicidal concentration of formocresol was0.23% and cytotoxic concentration (fixation) was0.0075%

The minimum concentration of formocresol to kill 9

organisms was 0.75% for 2 minutes


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Confused? Me Too!

Literature on FC, FS, MTA, laser, NaOCl, CH

is often conflicting or does not track long

enough to show a measurable difference tomerit switching materials

If what you use works, keep using it!


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So What Does the Evidence

Say? Carious primary tooth with deep caries but no

exposure, do an indirect pulp cap

Carious primary tooth with stoppable pulpal

hemorrhage and no other clinical or radiographic

signs, do a pulpotomy

Carious primary tooth with pulpal pathosis but

good root structure (ie, no resorption) do a

pulpectomy


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Restorative Care


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Stainless Steel Crowns: Underused,

Abused and MisunderstoodLongevity of crowns compared to amalgam demonstrated

clearly by numerous studies

Author Amalgams

placed

Failures

#/(%)

SSCs

placed

Failures

#/%

Study

Duration

Braff

1975

150 131(87) 76 19(25) 2.5 yr

Dawson

1981

102 72(71) 64 8(13) 2 or more

yr

Messer1988

1177 255(22) 331 40(12) 5 yr

Roberts

1990

706 82(12) 673 13(2) 10 yr

Einwag

1996

66 38(58) 66 4(6) 8 yr


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Stainless Steel Crowns:

Not Much Evidence on Technique

Pre-crimped, pre-contoured crowns or doit yourself?

Trimming crowns?

One brand versusanother?

Polishing before

cementation? Type of cement used?

High occlusion?


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SSC Types

3M (Ion)pre-crimpedpre-contouredpre-trimmedpre-ferred!

Uniteknot pre-crimpednot pre-contoured

not pre-trimmed

2nd molar 1st molar

Documents

Yankee Dental Pedo Part 3