Management of molar-incisor hypomineralisation by general dental practitioners - part two: treatment

Introduction Molar-incisor hypomineralisation (MIH) is a common occurrence in primary and secondary care settings. While severe cases may need specialist care, mild cases should be managed in primary care.Aims To assess how UK-based general dental practitioners (GDPs) plan treatment for children with MIH using two clinical vignettesDesign An electronic vignette survey was designed using clinical photographs and radiographs. Vignette one presented a child with mild MIH who was unhappy about the appearance of his teeth. Vignette two presented an anxious child with severe MIH, caries and sensitivity. Further questions relating to confidence in management of MIH and referral were included. Participants were UK-based GDPs who regularly treat children. The survey was distributed by email and across social media platforms. Data collection occurred between February and May 2019.Results Fifty-eight GDPs completed the survey. Around half of participants addressed the aesthetic concerns of the child in vignette one. The majority of participants demonstrated sound treatment planning in terms of preventive care and management of molars. More GDPs identified increased caries risk in vignette two.Conclusion These findings demonstrate most GDPs in this study were working as effective tier one and two providers when faced with management of children with MIH.

Common Pitfalls in Parenting an Anxious Child

This chapter describes some common pitfalls in parenting an anxious child and ways to avoid them. Many of these traps and pitfalls can be loosely categorized as either “protective” or “demanding,” which are broad categories of beliefs and behaviors, and each can be expressed in many different ways. The first category is that of protection, which covers thoughts and behaviors that center on the goal of protecting the child from harm or distress. Taking on the role of protector for the child, when a danger is not present, can convey to the child that they are in need of protection, making them feel less safe and more vulnerable. The second category is that of demanding. Demanding is when the parents expect the child not to feel anxious, or to be able to act as though they are not, despite the very real anxiety they are feeling. Demanding has an important limitation that makes it almost entirely unhelpful when dealing with child anxiety. When a demand the parents make is not met, they often respond with frustration or anger because they feel helpless to enforce the demand or undermined by the lack of compliance. This can lead to conflict and hostility.

Troubleshooting—Dealing with Difficulties in Working with Your Partner

This chapter suggests some solutions for when the parents do not agree with each other or have difficulty working cooperatively together. If the parents are having a hard time talking about the child’s anxiety, they can try to set aside a time to talk about the issue when neither of them is under pressure nor feeling frustrated and upset. Talking about the problem may raise some negative feelings, but the parents have a better chance of having a productive conversation if they start out feeling calm. The parents should also try to stay away from unhelpful blaming and shaming; even self-blame can make it harder for parents to work together productively. It is best to keep the conversations about how to help the anxious child focused on the issue of the anxiety. If the parents can put other things aside and just focus on the one issue, it may be easier to come up with a plan for that one specific thing. The chapter also offers some additional tools and strategies for improving cooperation between parents. Ultimately, the parents should respect each other’s opinions and decisions.

Teenager with Generalized Anxiety Disorder

This chapter illustrates the work of reducing family accommodation as part of a larger treatment strategy that also includes working directly with the anxious child. The chapter presents the case of Heather, a 14-year-old girl who suffered from generalized anxiety disorder. The chapter first introduces the case, including a detailed description and history. Next, the chapter describes the course of treatment with a focus on the work with parents and the ways it was integrated into Heather’s treatment. The chapter includes transcripts from treatment sessions with parents and child and exemplifies some of the problems and solutions in working with families of anxious children.

Child with Separation Anxiety Disorder

This chapter illustrates the work of reducing family accommodation as part of a larger treatment strategy that also includes working directly with the anxious child. The chapter presents the case of Yuki, a 7-year-old boy with separation anxiety disorder. The chapter first introduces Yuki’s case including a detailed description and history. Next, the chapter describes the course of treatment with a focus on the work with his mother and the ways it was integrated alongside Yuki’s treatment. The chapter includes excerpts of transcripts from treatment sessions that illustrate how the therapist dealt with challenges that arose during the clinical work.

Investigation of Stress Level Among Dentistry Students, General Dentists, and Pediatric Dental Specialists During Performing Pediatric Dentistry in Kerman, Iran, in 2017

Background & Aim:Dentists are exposed to stress and tension as they have a close contact with the patients. The increase in stress may affect the dentists’ performance and can be a major threat to the physical and mental health of the patients. Pediatric dentistry requires experience, without which the amateur dentists and students feel lack of self-confidence, and consequently be unable to deal with problematic patients. There is no study investigating stress during pediatric dentistry among the dentistry students as well as general and pediatric dentists in Iran. Regarding the importance ofthis subject, we aimed to evaluate the stress level among the aforementioned three dental service providers during pediatric dentistry.Materials & Methods:This study was conducted on 300 dentistry students, general dentists, and pediatric dental specialists in Kerman, Iran. The data were collected using a questionnaire entailing demographic information and therapeutic practices of pediatric dentistry. After checking the participant’s comments, the data were analyzed usingSPSSversion 16 (IBM, Texas, USA).Results:According to the results, the mean age of the participants was 28±5 years. Out of the 300 participants, 113 (37.7%) and 178 (59.3%) cases were male and female, respectively, and 9 (3%) participants did not fill out this part. Furthermore, 108 (36%), 173 (57.7%), 6 (2%), and 10 (3.3%) subjects were general students, general dentists, residents, and pediatric residents, respectively. Anesthesia injection in the mandible for an anxious child and amalgam restoration in the mandible led to the highest and lowest stress levels in the participants, respectively. Furthermore, the mean stress levels were significantly different between the practices performed in the maxilla and mandible (P<0.001). In addition, the females showed a significantly higher level of stress, compared to the males (P<0.001). The specialists had significantly lower stress than the dentistry students and general dentists (P<0.001).Conclusion:As the findings indicated, anesthetic injection to a nervous infant was the most stressful practice in pediatric dentistry. The results also showed that the pediatric dental specialists had lower stress level, compared to the students and general dentists.

Local anaesthesia for children

A child’s future perceptions and expectations are likely to be conditioned by early experiences of dental treatment. Just under half of all children report low to moderate general dental anxiety, and 10–20% report high levels of dental anxiety. Montiero et al. (2014) indicate that the prevalence of needle phobia may be as high as 19% in 4- to 6-year-olds. Davidovich et al. (2015) reflected that, for general practitioners and specialists alike, Local anaesthetic (LA) injection for an anxious child was the most stressful procedure regardless of the operator’s age, gender, or years of professional experience. Despite impressive reductions in caries in children in recent years, there still exists a social gradient with inequalities in experience of dental disease, and there remains a significant cohort of children for whom extractions and restoration of teeth are necessary. Aside from emerging restorative strategies that do not require LA (e.g. atraumatic restorative technique or placement of preformed metal crowns using the Hall technique), effective and acceptable delivery of LA remains an important tool to enable successful operative dental treatment to be carried out comfortably for child patients. Effective surface anaesthesia prior to injection is very important as a child’s initial experience of LA techniques may influence their future perceptions and help in establishing trust. Cooling tissues prior to injection has been described but is rarely used, and surface anaesthesia is generally achieved with intra-oral topical agents. Although the main use of topical agents is as a pre-injection treatment, they have been used as the sole means of anaesthesia for some procedures including the extraction of mobile primary teeth. It is possible to achieve a depth of 2–3mm of anaesthesia if topical agents are used correctly: • the area of application should be dried • topical anaesthetic agent should be applied over a limited area • the anaesthetic agent should be applied for sufficient time. In the UK 5% lidocaine (lignocaine) and 18–20% (17.9%) benzocaine gels are the most commonly used agents. Benzocaine topical anaesthetic gel is not recommended for use on children under 2 years old because of an increased risk of methaemoglobinaemia.