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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


1. 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


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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 for surgical 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 the mothers breast? Is the infant gaining weight?

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1. Cochrane Oral Health Groupnothing 2. ADA EBD: nothing 3. PubMed: Frenulotomy for breastfeeding infants with ankyloglossia: effect on milk removal and sucking mechanism as imaged by ultrasound. Geddes DT, et al Pediatrics. 2008 Jul;122(1):e188- 94. 4.NGCH1. Guidelines for the evaluation and management of neonatal ankyloglossia and its complications in the breastfeeding dyad. Academy of Breastfeeding Medicine Professional Association. 2004.

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Pulp Therapy Mythology 4 .

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 don’t 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 5 .

Pulp treatment for extensive decay in primary teeth (Cochrane Review). et al. read 77 in entirety. Goel BR. and… ● Three studies met criteria for inclusion! • Conclusion: Insufficient randomized trials to provide reliable evidence supporting one type of pulp treatment as superior to others ● 6 .What’s the Evidence for Pulp Therapy? Nadin G. found 138 references. The Cochrane Library 2003. Searched all languages.2:1-30.

Common Clinical Situations 7 .

What Evidence Exists On Diagnosis of the Primary Pulp ● ● ● ● Extent of Carious Lesions Tooth Coloration Location of Tooth Clinical. Radiographic and Bleeding 8 .

A Nooh. 1999 Classified marginal ridge caries Pulp changes identified in 80% of teeth with <2/3rd of ridge involved Pulp changes in 100% of teeth with > 2/3rd of ridge involved Part of UK guidelines for pulp therapy 9 .The Extent of Caries The relationship between extent of carious involvement of the marginal ridge and pulp inflammation in primary molars MS Duggal. A High. J Dent Res Abs # 1540.

two-thirds had coronal inflammation 10 . Pediatric Dent 1992. 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.The Extent of Caries Histopathology of the pulp in primary incisors with deep dentinal caries. only 6 were histologically healthy pulps None of the 24 exposed pulps were histologically normal. E et al. Eidelman.14:372 ● ● ● ● ● Looked at 53 carious primary incisor pulps without x-ray or clinical pathosis.

J Pedo 1987.11:247 ● Followed 37 darkened incisors until lost and eruption of successor ● No clinical or x-ray pathosis on 72 percent ● Only 11 teeth with pathosis ● Only one successor had enamel problems. and successors tended to erupt early Are Dark Teeth Sick Teeth? • Soxman JA et al. JDC 1984. Longitudinal study of discolored primary teeth and effect on succedaneous teeth.• Sonis et al. Pulpal pathology in relation to discoloration of primary anterior teeth.51:282 ● Total necrosis in 11/23 and as early as 10 days S/P trauma ● No correlation between color and histopathological status 11 .

7 74.5 Smith et al ‘00 242 4-57 99 n/a 12 .Who Wins the Technique War? Study Yr ‘91 N Time (mos) 12 % Clin 96 % Xray 96 Fei et al Casas et al 83 ‘03 182 24 96 61 Fuks et al ‘97 55 6-35 92.

Casas MJ et al. Coll JA et al. Pediatr Dent 1988. ● Studied 27 incisor pulpectomies and found them 78% effective after 45. Pediatr Dent 2003.5 months 13 .10:178.Pulpectomies Work as Well Two-year outcomes of primary molar ferric sulfate pulpotomy and root canal therapy.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.

Moskovitz et al J Dent (2005): 41-47 • Found 85% success rate with pulpectomy procedure – Filled with IRM Ballesio et al Eur J Pediatr Dent (2002) 133-140.Pulpectomy Research Support Success rate of root canal treatment in primary molars. • Found 92% success rate – Necrotic primary molars with fistulas – First visit: canals filled with powdered antibiotic mixed with anesthetic solution – Second visit: canals were filled with IRM 14 . Chemical and pharmacological shaping of necrotic primary teeth.

Who Has Time For This? Coll J. ● 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.30:230-236. he does not address cost of re-treatment which may be needed 15 . Indirect pulp capping and primary teeth: is the primary tooth pulpotomy out of date? Pediatr Dent 2008.

Al-Zayer MA et al.Bring Back the Indirect Pulp Cap? Indirect pulp treatment of primary posterior teeth: a retrospective study.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 16 . Pediatr Dent 2003.

● Repeated studies suggest that regardless of medicament treatment success depends on initial pulp health [inclusion criterion for all studies] ● First primary molars uniformly have poorer prognosis compared to second molars ● Most studies show either little difference in success between clinical and x-ray findings. so don’t radiograph without clinical signs ● Always follow pulp therapy with a crown 17 .What Else About Pulp Therapy? If we look at what the many studies tell us…. or use clinically irrelevant criteria.

O.33% to be bacteriocidal Comparison of antimicrobial and cytotoxic effects of glutaraldehyde and formocresol . S.23% and cytotoxic concentration (fixation) was 0. O.Why Do a 5-Minute Full Strength Histobiological effectiveness of a reduced FC Pulpotomy? concentration of Buckley’s formocresol. Staph aureus ● Found formocresol concentrations of 0.0075% ● The minimum concentration of formocresol to kill 9 organisms was 0. Hill SD et al. Ped Dent 1985.05 to 0. faecalis.7:130 ● Looked at S.75% for 2 minutes 18 . Verco PJ.O 1991. salivarius.71:89 ● Mean microbicidal concentration of formocresol was 0.

MTA. NaOCl. laser. keep using it! ● 19 . FS.Confused? Me Too! Literature on FC. CH is often conflicting or does not track long enough to show a measurable difference to merit switching materials • If what you use works.

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 20 .

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Restorative Care 22 .

5 yr Dawson 1981 Messer 1988 Roberts 1990 Einwag 1996 102 1177 706 66 72(71) 255(22) 82(12) 38(58) 64 331 673 66 8(13) 40(12) 13(2) 4(6) 2 or more yr 5 yr 10 yr 8 yr 23 .Stainless Steel Crowns: Underused. Abused and Misunderstood Longevity 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.

Stainless Steel Crowns: Not Much Evidence on Technique ● ● ● ● ● ● Pre-crimped. precontoured crowns or do it yourself? Trimming crowns? One brand versus another? Polishing before cementation? Type of cement used? High occlusion? 24 .

SSC Types 3M (Ion) pre-crimped pre-contoured pre-trimmed pre-ferred! Unitek not pre-crimped not pre-contoured not pre-trimmed 2nd molar 1st molar 25 .