Background There are diverse opinions among dentists about managing compromised first permanent molars (cFPMs) in children and a perceived lack of guidance to help them evaluate prognosis. Aim To evaluate the current management of cFPM in children referred to a UK hospital centre and to report the severity of the affected teeth. Design A service evaluation was undertaken, based on case records of medically fit children (6‐11 years) referred to for the management of cFPMs. The presence of hypomineralisation, post‐eruptive breakdown and the proposed care plans were recorded. Radiographic signs of severity were scored using the ICDAS index (intra/inter‐rater kappa 0.96/0.82). Results From 349 records screened over a 4‐month period, 249 met the selection criteria. Almost 81% were planned to have extraction of at least one cFPM, whereas 19.3% were managed without extraction. More than half of the extraction cases (n = 105) had radiographic radiolucencies not exceeding the middle third of dentine in the worst‐affected FPM. At the time of extraction, the mean age of the patients was 9.8 years (±0.9). GA was used in 196 (97.5%) cases, and 40.8% had not received previous treatment in any of their cFPMs. Conclusion Potentially restorable cFPMs in children is, most of the time, in a cohort of UK patients referred for tier 3 services, being managed by timed extractions under general anasethesia.
Background: Arrest and regression of enamel caries is generally followed by clinical surface changes in enamel. The aim of this study was to evaluate microscopic surface changes in demineralized enamel submitted to toothbrushing with a fluoridated dentifrice or to a fluoridated gel in situ. Methods: Enamel blocks demineralized by an acidic gel, were built in plates of five volunteers during three periods of 14 days each: exposure to the oral cavity (C+); brushing with a fluoridated dentifrice three times a days (B); application of a 2 per cent sodium fluoride gel and exposure to the oral cavity (F). Eight blocks were kept in 100 per cent humidity under refrigeration as negative controls (C-). Results: Stereomicroscopic examination revealed that 15, 47.4 and 30 per cent of samples from C+, B and F presented enamel cavitation after the experimental period. The demineralized enamel area in these groups decreased considerably compared to C-, both in cavitated and non-cavitated samples, although it was statistically significant only in cavitated samples from B (p=0.003; t test). Scanning electron microscopy revealed that C+ and F retained irregularities caused by the acid challenge, while B presented a more leveled profile of the enamel surface. Conclusions: Exposure of demineralized enamel to intra-oral periods reduced the demineralized enamel area. Tooth brushing enhanced this reduction, because of surface abrasion.Key words: Enamel caries, fluoridated dentifrices, sodium fluoride gel, tooth brushing.(Accepted for publication 6 January 2003.) complete reversal of white spot lesions into sound enamel in 51.4 per cent of the carious surfaces after complete eruption of the teeth and exposure of surface enamel to mechanical and functional intra-oral forces.
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