Differences in ethnic beliefs about the perceived need for local anesthesia for tooth drilling and childbirth labor were surveyed among Anglo-Americans, Mandarin Chinese, and Scandinavians (89 dentists and 251 patients) matched for age, gender, and occupation. Subjects matched survey questionnaire items selected from previously reported interview results to estimate (a) their beliefs about the possible use of anesthetic for tooth drilling and labor pain compared with other possible remedies and (b) the choice of pain descriptors associated with the use of nonuse of anesthetic, including descriptions of injection pain. Multidimensional scaling, Gamma, and Chi-square statistics as well as odds ratios and Spearman's correlations were employed in the analysis. Seventy-seven percent of American informants reported the use of anesthetics as possible remedies for drilling and 51% reported the use of anesthetics for labor pain compared with 34% that reported the use of anesthetics among Chinese for drilling and 5% for labor pain and 70% among Scandinavians for drilling and 35% for labor pain. Most Americans and Swedes described tooth-drilling sensations as sharp, most Chinese used descriptors such as sharp and "sourish" (suan), and most Danes used words like shooting (jagende). By rank, Americans described labor pain as cramping, sharp, and excruciating, Chinese used words like sharp, intermittent, and horrible, Danes used words like shooting, tiring, and sharp, and Swedes used words like tiring, "good," yet horrible. Preferred pain descriptors for drilling, birth, and injection pains varied significantly by ethnicity. Results corroborated conclusions of a qualitative study about pain beliefs in relation to perceived needs for anesthetic in tooth drilling. Samples used to obtain the results were estimated to approach qualitative representativity for these urban ethnic groups.
The aim of this article was to report on the attitudes, opinions and confidences of final year dental students in three European schools towards the restoration of posterior teeth and in particular towards the use of amalgam and resin composite. One hundred and twenty-eight pre-piloted questionnaires were distributed to final year dental students in Cardiff, Dublin and Malmö. The questionnaire sought information relating to various opinions and attitudes towards the use of amalgam and resin composite in posterior teeth. Information was returned anonymously. Ninety-one completed questionnaires were returned (response rate=71%; Cardiff: n =40, Dublin: n=24, Malmö: n=27). Ninety-three per cent of Malmö students (n=24), 67% of Dublin students (n=16) and 60% of Cardiff students (n=24) reported that they feel confident when placing posterior resin composites. One hundred per cent of Malmö students (n=27), 75% of Cardiff students (n=30) and 33% of Dublin students (n=8) would prefer to have a resin composite rather than amalgam, placed in one of their own posterior teeth. Eighty-five per cent of Malmö students (n=23), 30% of Cardiff students (n=12) and 25% of Dublin students (n=6) perceive amalgam as being harmful to the environment. For the restoration of a posterior tooth in a pregnant female, 44% of students (n=40) would place a resin composite restoration, and 7% (n=6) would place an amalgam restoration, while 32% (n=29) would place a temporary restoration. Students at Malmö report that they place more posterior resin composites and have greater confidence at placing posterior resin composites than students at Cardiff or Dublin. There was confusion relating to the choice of restorative materials for pregnant females. Large variations in restorative strategies among graduates must be considered as dental professionals can practice in all countries within the European Union.
The aim was to measure variations in threshold for operative treatment of approximal caries in permanent teeth and the use of restorative materials, compared with results from studies conducted in Norway in 1983 and 1995. In 2009, a precoded questionnaire was sent electronically to 3,654 dentists with E-mail addresses in the member register of the Norwegian Dental Association. The questions were related to caries, treatment strategies and choice of dental materials. Replies were obtained from 61% of the dentists after two reminders. Restorative treatment of approximal lesions confined to enamel, based on radiographic appearance, was proposed by 7% of the dentists, compared with 66% in 1983 and 18% in 1995. Younger dentists, significantly more often than older, would defer operative treatment of approximal lesions until the lesion was visible in dentine. While tunnel preparation most often was the preparation of choice in 1995 (47%), saucer-shaped preparation was most favoured in 2009 (69%). Tunnel preparation was only preferred by 4% of the dentists. Resin composite was the restorative material preferred by 95%, compared with 16% in 1995. The corresponding values for conventional glass ionomer cement (GIC) were 1 versus 22%, for resin-modified GIC 1 versus 7%, and for a combination of GIC and resin composite 2 versus 22%. Compomer was preferred by 1% of the respondents. The authors conclude that treatment concepts for approximal caries have changed considerably during the last 26 years. In 2009, only 7% of dentists reported that they would treat approximal caries operatively before the lesion reached dentine.
A 10-question survey was mailed to the 10 Canadian faculties of dentistry to determine current approaches to teaching undergraduates about silver amalgam and resin composite for posterior restorations in adults and children. Responses were received from all 10 pedodontic programs and from 8 of the 10 operative and restorative programs. The use of silver amalgam and posterior composite for restorations of primary and permanent teeth is covered in the curricula of all dental schools, but the relative emphasis on the 2 materials varies. In the operative and restorative programs, curriculum time devoted to silver amalgam is either greater than or equal to that devoted to posterior composite. Five of the 8 schools reported greater educational emphasis on silver amalgam for the permanent dentition; however, course directors noted that the preference among patients seen in clinics is tending toward composite restorations. Curricula appear designed to educate students about the optimal use of both materials. Requirements for performance of restorations during training generally do not specify the type of material; these requirements range from 60 restorations to 250 surfaces. Five of the 8 schools conduct clinical competency tests with both materials. The responses from the pedodontic programs were more diverse. The proportion of curriculum time devoted to each type of material in these programs ranged from less than 25% to more than 75%. Five schools reported more emphasis on silver amalgam, 3 schools reported equal emphasis, and 2 schools reported more emphasis on posterior composite. No clinical requirements were specified in any of the undergraduate pedodontic programs. Within some of the faculties, there were differences between the operative and restorative program and the pedodontic program with respect to emphasis on different materials for the posterior dentition.
The aim of this randomized study was to compare the longevity and cariostatic effects of 1565 class II restorations in primary teeth placed by 15 clinicians in the Danish Public Dental Health Service in 971 children, aged 3.6-14.9 yr. The restorations were performed using three resin-modified glass ionomer cements and one compomer (polyacid-modified composite resin) with and without their respective cavity conditioners. The restorations were in contact with 1023 unrestored proximal surfaces in 853 primary and 170 permanent teeth. The study was terminated after 7 yr with 1% of the restorations in function, 7% patient dropouts, 18% failed restorations, and operative treatment on 24% of the adjacent surfaces. Multivariate survival analyses showed that the restorative material and cavity conditioning influenced the survival of restorations but not the progression of caries on adjacent surfaces. The 50% survival times were estimated to exceed 5 yr for the restorations and 4.5 yr for the adjacent unfilled surfaces in all treatment groups. It was concluded that resin-modified glass ionomer cement and compomer are both appropriate materials for class II restorations in primary teeth. The differences in longevity and cariostatic effects among the four materials used with and without conditioner were less than the intra-individual differences between clinicians.
The failure rate of restorative treatment in primary teeth was studied in a cohort of children born in 1981 and related to caries diagnosis, prevalence and distribution on different tooth surfaces, and compared with a cohort of children born in 1971. Concurrently, the longevity of composite resin in modified Class 2 cavities in primary molars was followed up and the resistance of deciduous and permanent enamel to acid adjacent to composite resin and glass polyalkeonate cement (GPA) was tested in vitro. From the 70s to the 80s, diagnostic methods changed and the examination intervals were prolonged. The number of bite-wing radiographs was halved and the participation in all six annual examinations decreased from 89% to 32%. Caries prevalence increased from 1.1 ds in 3-year-olds to 6.3 ds in 8-year-olds in Cohort '71 and, in the same ages, from 0.2 ds to 3.0 in Cohort '81. In Cohort '81, an overall decline of occlusal caries was recorded. The distal surface of the first molars was the proximal surface most often affected in both cohorts. In Cohort '81, 30% had caries-free primary teeth at the age of 8, which can be compared with 17% in the cohort 10 years earlier. In Cohort '81, the proportion of replaced proximal restorations was 14% and that of extracted molars 2%. The corresponding figures for Cohort '71 were 17% and 4%, respectively. In Cohort '81, silver amalgam was used in 65% and GPA cements in 35%. On all surfaces, silver amalgam was replaced in 22% and GPA cements in 6%. Composite resin in modified Class 2 cavities showed a cumulative success rate that declined from 86% after one year to 38% after six years. Fractures occurred early and recurrent caries was found from the second year of the follow-up. Histological investigation of these teeth disclosed bacteria subjacent to the fillings in 75% and recurrent caries in 58%. The restorations in teeth with bacterial invasion showed marginal discolouration, visible crevices or colour mismatch. In an acid environment, the enamel showed artificial caries lesions adjacent to composite resin significantly more often in primary teeth than in permanent teeth. No lesions were seen close to GPA fillings in primary teeth. The improved dental health appeared to be of greater benefit to the children and care-providers than advances in restorative treatment. The properties of GPA cements seem useful in the restorative treatment of primary teeth.
The aim of this study was to evaluate, with the aid of a questionnaire handed out to a selected group of dentists, the use of glass ionomer cement (GIC) in different types of proximal preparations. The aim was to evaluate the experience of complications associated with the use of GIC. Very few had often observed secondary caries or gingival inflammation in association with GIC fillings, compared with about 70% of the dentists in association with posterior composites. Tunnel fillings had been made by 60% of the dentists, simple proximal fillings in primary molars by 80%, and sandwich restorations by 80%. Few dentists with at least 2 year's experience with tunnel fillings had observed biologic complications, but ridge fractures had often been observed by 10%. Among the dentists with at least 2 years' experience with proximal fillings in primary molars, 40% mentioned more complications with these than with amalgams. Biologic complications were also not a great problem with GIC/composite sandwich restorations, but wear or dissolution of the proximal GIC surface was often seen by 17% of the dentists.
The aims were to determine whether means of different fear-related items were similar in 1998 and 2001 and to find a common factor structure of the modified CFSS-DS for children at different ages.
Independent random samples of 6-, 9-, 12- and 15-year olds were drawn in two cities in 1998 and 2001 (n = 180 per age group from each city). The study group in 2001 comprised 282, 265, 281 and 234 subjects aged 6, 9, 12 and 15 years, respectively. Each child received a modified CFSS-DS form to be filled out at home. Mean scores of different fear-related items were reported for each age group for both data sets. Confirmatory factor analyses (CFA) were performed to test whether the three factor structures revealed for 6-, 9- and 12-15-year olds in 1998 fitted the 2001 data. Multiple group CFA was used to test for the equivalence of the factorial structure across age groups (configural invariance).
The age-specific patterns of the means for individual fear-related items in 2001 corresponded to the mean values for 1998. When age-specific factor structures were tested separately for each age group, the factor structure for 9-year-olds was, in general, the best-fitting overall structure. The factor structure had a good fit for all age groups, but the loadings differed at different ages.
The modified CFSS-DS provides consistent factor structures for children at different ages and reflects the changes in manifestations of dental fear during growth.
The aim of the present study was to analyze the frequency and the severity of cuspal fracture for posterior teeth endodontically treated by 91 Danish dentists and restored with amalgam either before 1975 or after 1979. A database from a previous study was analyzed (1584 teeth with an MO, a DO, or an MOD amalgam restoration without cuspal overlays). Teeth restored before 1975 had a significantly lower frequency of cusp fracture than teeth restored after 1979. Moreover, when comparing the frequency of subcrestal fractures, that of the second group (after 1979) was more than twice as high as that of the first group (before 1975). Two factors with a bearing on these findings changed in the time period 1975-1979; the high-copper amalgams took over in Denmark, and the use of Gates-Glidden burs to achieve straight-line access to the root canal was introduced. It is suggested that the weakening of the coronal part of the root, caused by the use of Gates-Glidden burs, and the expansion and low creep of high-copper amalgams may be two of the reasons for the increased frequency and severity of cuspal fracture found in the past decade in Denmark.
OBJECTIVE: To identify factors associated with dentists' decisions on choice of restorative material in children and adolescents. MATERIAL AND METHODS: In the period 2001-2004, 27 dentists in the Public Dental Health Service in Norway placed 4030 Class II restorations in 1912 patients. The reason for placement, previous caries experience (DMFT), oral hygiene, and characteristics of the cavity were recorded. RESULTS: The most frequently used material was resin composite (81.5%), followed by compomer (12.7%), amalgam (4.6%), and glass ionomer cement (1.2%). Tooth-colored restorations were more frequently placed than amalgam in younger patients (p=0.017). Female patients received fewer amalgam restorations than male patients (p=0.006). Amalgam was more often used in patients with high DMFT (p