Detection, diagnosis and treatment of dental caries:
do we have to change direction?
The Third Congress of The European Academy of Paediatric Dentistry
Letter to the Editor
BIOMED-2 Projects in Europe
I REALLY NEED A LEAFLET
25th IADH CONGRESS
The Annual Scientific Meeting of the British Society of Paediatric Dentistry
A closer examination of how communication has been conducted among board members and councillors of our Academy so far, and subsequently, all those interested in its work, will reveal the need for some serious updating. Until now the primary methods of contact have been the telephone, facsimile transmissions, meetings and general assemblies. These have all provided direct, but costly communications, mostly at one's personal expense. In addition the News Letters (4 per year) and the biennial General Assemblies have been the exclusive means of conveying announcements and discussing issues with the members. With such problems of geography and cost it seems very likely that the present system of communication will no longer be adequate for our ever growing needs in the very near future. I therefore firmly believe that the new medium - The Internet - will allow effective transmission and exchange of information on all issues and activities concerning the Academy.
It is time to update our modes of communication, especially as such an undertaking is the more feasible since it could be ultimately achieved at no cost to the Academy. Electronic communication via The Internet seems, following investigation, to be the best possible answer to the problem. For clarification,there are two ways of using The Internet: basic e-mail, with which most of us are familiar, and the more sophisticated and versatile World Wide Web. Both require access to a computer and modem. Both have their advantages and limitations; those relevant to our purposes are briefly described below.
Using e-mail councillors and board members may communicate with each other faster and more efficiently since whole documents, pictures, graphs and (for more sophisticated users) even voice can be transmitted at optimum speed for minimum cost.
As well as exclusively using e-mail it would be possible to create a World Wide Web page under the name of EAPD. This would act as a bulletin board where the Academy would announce information accessible to all Internet users.The EAPD Web would consist of the following basic sections:
EAPD profile: Biographical information and addresses of Board Members.
News: Press releases, announcements to all members in the form of an electronic newsletter, bulletin boards and so on.
Events: Calendar of Events, schedule and agenda for all EAPD and related congresses, seminars and events.
Members: Membership procedures, list of members, search for a member with keywords, on-line registration application, personal member web pages.
Information of interest to the general public.
Archive: Past papers, abstracts, in- and out-going messages by date, subject, ID and summary.
Links: Links to other EAPD Internet resources in other countries.
Forum: Interactive blackboard for on-line discussion among members.
Search: Search all EAPD web contents using keywords.
Feedback: Questions or comments related to EAPD web procedures and events.
Guestbook: Open to the public for submitting comments or questions.
It is important to note that users would receive information directly from the source without being able to alter, modify or erase material provided throughout the Web.They may, however, make inquiries, exchange information or ideas or pose questions on issues. In this way EAPD would establish both a reliable source world-wide and an adequately interceptive medium to be used by its members.
On the other hand, communication via e-mail, while it could be used between members, would still need to be individually targeted to members if it is to efficiently distribute information. Another limitation of this procedure is that communication would be restricted to within the Academy since relevant e-mail addresses are not accessible to others who might be potentially interested in the activities of the Academy.
The use of the World Wide Web would enable the Academy to reach the public directly and inform parents of various issues of popular interest. This information would include answers and images in an easily understandable format and some suggested areas to cover are: What is a Paediatric Dentist; First dental visit; Pacifiers; Thumbsucking; Fluoride and Prevention; Trauma and Diet.
A disadvantage of the Web might be that some may find it difficult to use or may be reluctant to switch from traditional ways to new methods. I am not advocating an abrupt change but I would suggest we begin by exploring the possibilities of the new technology and its potential uses for the Academy. In order for this to happen and for members to have the opportunity to react and express their views, there would be an EAPD Web page which initially would be a draft and would remain in provisional form from the beginning of January for two to three months while we collect comments, suggestions and additions from our members. The Board would consider the form of the final draft in February and the Council would hopefully give final approval later in the year.
I am certain that members who already use the Internet, will welcome our Web page and use it frequently and with ease. This should help promote its use among other members and, as more users come to appreciate its service, it would eventually establish itself and our Academy throughout Europe and beyond.
To sum up, I would like to re-emphasise the growing communication needs within and around our Academy and hope that this proposal will be welcomed as a feasible solution. I anticipate that if we proceed with updating our communication medium, professional and scientific contact will be greatly enhanced, thus bringing us closer to each other and the Academy. A further contribution of this tool would be the strengthening of the role of the Committees and Councillors and their interaction with members, who, in turn, would become more active in expressing their views on important issues. I therefore propose to introduce the EAPD World Wide Web page, hoping it will be warmly received by the Academy and looking forward to your comments and suggestions for the Web page or e-mail address.
Research during the last decades gives our profession the opportunity to take a closer look at the developmental stages of caries incidence. Are we able to shift our attention to a more elaborate point of view compared to the classic drilling-and-filling concept? To explain this question, the different steps in the approach of dental caries will be discussed.
The detection of dental caries (the former diagnosis) has always been a very difficult matter in dentistry. The mirror and probe still are the most common tools for this purpose, although we now know that the probe can do more harm then that it contributes to a proper detection( 1 ). For proximal caries and lately also for occlusal caries the bitewing is a good additive to trace as many lesions as possible(2). Better tools are nowadays not available. It is possible that only the electrical resistance measurement will bring us a step forward, especially regarding occlusal caries(3). More study and improvement of the available tools, however, is necessary.
Diagnosis of dental caries is another chapter. After the detection it should be part of the routine to try to get an impression about the caries activity before a decision about the right treatment can be made. The colour of caries, the presence of new lesions,the growth of existing lesions and the oral hygiene are direct parameters which can help in getting an idea about the activity of the disease. But also indirect parameters like the health of the patient, his profession, education and social background, his diet and the dental health of close relatives will contribute to a more to the point diagnosis. More recent are the use of saliva and microflora tests to trace at-risk patients. It is expected that these tools will be part of the standard equipment of a general practice in the near future. But also here more research is necessary to find the right instruments and indications for use.
Paying more attention to the diagnosis of caries as an infectious disease will consequently lead to less invasive procedures and more "preventive" treatments. More caries might be left untreated curatively because the diagnosis was "arrested caries", or it will be treated in a preventive way to arrest the active process. This opinion includes not only caries restricted to the enamel but also deeper lesions. Besides the use of fluorides, chlorhexidine and aluminum preparations, though still in their infancy, have as antimicrobial agents to be considered as an additive in the range of preventive means(4,5). Also the sealant as part of the preventive treatment possibilities still needs attention.
Because the detection and diagnosis of occlusal caries still is not full proof yet, not even with x-ray bitewings, it still is disputable whether sealants have to be applied just in particular circumstances (e.g. demineralized or discoloured fissures,suspected caries activity) or in a more standardized way. In other words: do we choose for undertreatment or for overtreatment. We also need more microbiological information. The discussion of what will happen with the cariogenic microflora if a sealant is applied is still ongoing. Most investigators come to the conclusion that the number of micro-organisms will diminish if the substratesupply is stopped. Findings that all die are rare. No one can tell how many cariogenic micro-organisms still are able to let a cavity grow in size? Handelman et a1 found that, despite a decline in number with a factor 2000 after two years,15 % of dentine lesions under intact sealants increased in size(6). This finding is not yet duplicated. Moreover it may be questioned that, even if these data are correct, this 15% is an acceptable failure.
Similar to the ideas of using less invasive techniques in favour of a more preventive approach are the changes in the philosophy about the invasive technique itself. Since the introduction of adhesives in dentistry the removal of sound tooth tissue becomes more and more redundant. The consequence of these techniques, however, is that the prepared cavity will be smaller in size and the visibility of the whole cavity more restricted. The risk of leaving caries behind will be enlarged. The question arises whether this is an undesirable development or that leaving some caries behind will be a deliberate choice of the future.Mertz-Fairhurst et a1 demonstrated that dentine caries under composite resin restorations after nine years did not increase in size(7). In a study by Kreulen et a1 it appeared that carious dentine became harder within half a year under glass ionomer as well as under amalgam restorations(8).
Although these results are promising, more research is essential before the invasive treatment concept can be changed. Because paediatric dentistry is the cradle for dentistry as a whole, new concepts, in both preventive and restorative approaches, have to be developed especially in our speciality.Although it is too early to answer the question in the introduction, it is time to make a distinction not only between detection and diagnosis, but also between a really preventive approach to disease and curing already existing caries. A curative treatment has to be more than an invasive approach of the carious process as such. The next congress in Sardinia should therefore focus on these new concepts, not only in the presentations of results, but also in the discussion about (new) treatment modalities and their protocols.
- Penning CH, van Amerongen JP, Seef RE, ten Cate JM: Validity of probing for fissure caries diagnosis. Car Res 1992; 26: 445-49
- Weerheijm KL, Groe HJ, Bast AJJ, Kieft JA, Eijkman MAJ, van Amerongen WE: Clinically undetected occlusal dentine caries: a radio-graphic comparison. Car Res 1992; 26: 305-309
- Ricketts DNJ, Kidd EAM, Liepins PJ, Wilson RF: Histological validation of electrical resistance measurements in the diagnosis of oc-clusal caries. Car Res 1996; 30:148-155
- Emilson CG: Potential eff'icacy of chloorhexidine against mutans streptococci and human dental caries. J Derct Res 1994; 73: 682-91
- Putts MS, Kleber CJ: Anticariogenic properties of aluminum solutions. Thesis, University of Amsterdam,1995
- Handelman SL, Washburn F, Wopperer P: Two year report of sealant effect on bacteria in dental caries. Am Dent Assoc 1976; 93: 967-70
- Mertz-Fairhurst EJ, Adair SM, Sams DR, ea: Cariostatic and u1-traconservative sealed restorations: nine year results among children and adults. J Derct Child 1995; 62: 97-107
- Kreulen CM, de Soet JJ, Weerheijm KL, van Amerongen WE: In vivo cariostatic effect of resin modified glass ionomer and amalgam on dentine. Car Res, submitted
It was a pleasure and an honour for my department and me to be accepted by Council to organise the 3rd biennial meeting of the EAPD. More than two years ago we had our first contacts with the congress centre in ancient Bruges. Hundreds of letters and at least that many faxes and many nightmares later we were ready to welcome the Academy.
Executive Board Meeting - June
After the mailing of the first announcement we received correspondence from 35 different countries. 136 abstracts were referred to the Scientific Committee. Finally 52 oral presentations were selected and another 72 papers were accepted as posters. A further six presentations were programmed as wall presentation'. Finally 6 abstracts were rejected.
Speakers at the Symposium on Fluoride Releasing Additives
Left to Right
L Martens (Belgium)
C Davidson (The Netherlands)
G Eliades (Greece)
C Oulis (Greece)
R Verbeeck (Belgium)
J Berg (USA)
Speakers at the Symposium on Connective Tissue Disorders
Left to Right
L Martens (Belgium)
A De Paepe (Belgium)
R Hal1 (Australia)
K Storhaug (Norway)
T Wright (USA)
G Koch (Sweden)
Together with 3 pre-congress courses and 17 invited speakers a huge amount of scientific information could be obtained from the 5-day event. According to many comments the standard of the programme was very high. This latter is, of course, one of the main goals of the Academy.
After definite subscription, representatives of 31 countries joined the meeting. Compared with the former meeting in Athens a significantly increasing number of colleagues from Eastern Europe, as well as many from overseas attended the Congress. As well as the European countries we welcomed the United States, Canada, Israel, United Emirates, Tunisia, Malaysia, China, Hong Kong, Japan, South Africa and New Zealand.
Left to Right:
J Aps - Fund Raising and Dental Exhibition
Martens - President of the Congress
Pillen - Local Organiser
Marks - Secretary/Treasurer
Besides the scientific programme and thanks to the creativity of our local organiser, several satellite meetings as well as social activities were organised. Everyone will remember the opening ceremony when we were entertained by children, and the Burgundian Banquet with the medieval scenery. At the last briefing meeting I ended by saying "Working with me is thinking with me; divided we fall united we stand!" I think we `stood' for the entire congress until the last second. For this I would like to express my sincere gratitude to all my staff. They did a wonderful job.
Together with Luc Marks and Johan Aps, I also formed the Organising Committee, the Finance Committee and the Fundraising and Dental Exhibition Committee. It was for me a fantastic experience working with them. I would not hesitate for a second to start again with these two very dedicated colleagues, but please give us some time - we are still recovering from our efforts ....
Left to Right
L Martens - New President-Elect
G Koch - Immediate Past President
C Oulis - New President
M Curzon - Secretary
Finally I would like to express my sincere thanks to the Academy, especially to Martin Curzon past President, Goran Koch immediate past President and Constantine Oulis current President, not only for forming the Scientific Committee but also for their friendship during the last 6 years and for the moral support in preparing this congress. Looking into the future I wish Professor Falcolini and his staff the very best in preparing the 4th EAPD congress at Sassari, Sardinia, Italy in 1998.
President of the 3rd EAPD Congress
Peter Crawford Dental School
University of Bristol, UK.
The Secretary replies:
A well founded society should have sufficieut assets at any one time to support its activities. A general guideline in the United Kingdom is about ό1,000 per member. The EAPD presently has »80 or just over two year's subscription per member. Our subscription level is Iow as our activities are not yet extensive. By contrast subscription levels for other groups are substautially higher (British Association of Paediatric Surgeous (BAPS) is ό125 per annum.
If the EAPD is to advance and fulfil its mission it needs resources to pay for running costs, Newsletters, postage, printing of training guidelines and to have a reserve to pay for future developments. For example there are plans for a European Journal of Paediatric Dentistry at some time in the future which will need initial support.
Although Congresses have been financially successful so far, each Congress requires au initial subsidy of several thousand Pounds Sterling which has to come from reserves. These matters are common to a1I societies aud require sound fircancial solvency and rceed a good bank balance. The sum of 24,000 Pounds Sterling is by no means large and certaiuly not for a membership of 300.
The first call for proposals for the biomedical and health research programme (1994-1998; Biomed 2) closed on 3lst March 1995. 1709 proposals, covering some 6000 organisations, requesting 1.7 billion ECU in total were received. Of these 586 proposals were ranked as between high and outstanding in quality. The available budget of 140 million ECU enabled the best 307 to have a research contract issued. Out of those, four were on the dental projects, all of which were covering paediatric dentistry or orthodontics. EAPD Newsletter will describe in the next few issues the ongoing EU projects in paediatric dentistry. Description of other greater projects in paediatric dentistry are cordially welcomed too.
This project is a study entitled Use of Normal Dental Records Longitudinally as Novel Indicators of Oral Health and General Well-Being of Europeans, in which four European countries are participating: Finland, Germany, Greece and Sweden. The co-ordinator of the project is Professor Markku Larmas, University of Oulu, Finland, while the directors of the participating centres are: Germany, Dr Ulrich Schlagenhauf; Greece, Professor Constantine Oulis; Sweden, Dr Agneta Ekman.
The aim of the study is to analyse the usefulness of a new system for dental health determinations. The system differs from the present ones in two aspects: (1) Instead of the chronological age of subject, dental age is used as a basis for the determinants. This is felt to be important when knowing that the eruption time differs as much as a couple of years between individuals. This causes a great variation in terms of the length of cariogenic challenge during the critical age of the patient. (2) Dental caries is determined as the stage when a dentist makes the filling decision. This means that caries extending to dentine only is counted as caries; most enamel and some superficial lesions are counted as healthy. Fillings due to fractures, hypoplasia etc are also excluded. Modern survival analyses are used in determining survival curves for each tooth and tooth surface from the eruption of the tooth to the point when a filling decision due to dental caries is made.
The study is a retrospective longitudinal study of the age cohorts born in 1970 (when available) or 1980, in subjects who have regular (annual) dental visits up to the 1990's. The shape of the survival curves for each permanent tooth and tooth surfaces will be determined and their shape analysed against certain background factors such as gender, oral health survey systems,nationality, geographical features, degree of pollution etc in order to find out, for example, if the South-North phenomenon which exists in North America is also seen in Europe.
In the initial (opening) meeting in Oulu, Finland (the northernmost dental school in the world) last April, the study group went through the
principles and progress milestones that will regulate the concerted action in organising and functioning of the project. It was unanimously agreed that in addition to purely scientific meetings, the cultural aspects in different European countries are felt as important for fruitful scientific exchange. Therefore the study group decided to combine the business meeting with a cultural weekend which makes them even more economical because Apex airfares can be used.
The second meeting in Athens this September concentrated on the following matters: Progress reports from the targeted computer training sessions that took place in Oulu during the summer; installation and training of the computer programs in participating centres; matters arising during data entries and reports on preliminary results showing, for example, that in the age cohort of 1980, fissure caries on permanent molars is still a major problem, whereas proximal caries has practically disappeared in northern Sweden and Finland.
One of the major parameters in understanding the results of the project is to get familiar with the lifestyle, socio-economic features and cultural background of the people living in each participating country and correlate them to their oral health status. Therefore the meeting in Athens combined the scientific sessions with a number of visits to public health centres, for example in Nea Makri, and a two day tour of Delphi which is named the Omphalus (Navel) of the Earth. According to mythology, when Zeus tried to locate the centre of the world, he left two eagles free to fly, one from the East and one from the West. The two eagles met each other above the town of Delphi, therefore Delphi is considered to be the centre of the Ancient World.
It was decided that the next scientific meeting should take place in TΟbingen, Germany, in March 1997 when the possibility of the South-North phenomenon will be preliminarily analysed in the centre of Europe.
Markku Larmas (Co-ordinator)
Dental ill health is one of the few medical problems where the preventive message is well researched and if put into practice will deliver a positive health gain. Unfortunately most dental professionals receive a predominantly mechanistic training and the communication skills to help our patients control disease are not well developed. ALL too often the dental profession forgets that giving advice to patients requires a scientific approach and is not a skill that can be `picked up' by a process of experience. Indeed, many dental practitioners find that patients forget the advice they are given and may even adopt the wrong patterns of behaviour. To overcome this problem a leaflet may be produced to try and solve the communication dilemma. However, many leaflets are poorly produced, the educational objectives are not clearly deflned and far too much irrelevant information is offered.
There are some basic rules of leaflet production which can help members of the dental team develop useful teaching aids. The best ones are as follows:
Design: for many people, difficulties with reading are often more to do with the look and layout of something written, than the complexity of the text itself. Design features usually cause fluent readers no problems (although we alI have trouble with the design of some material, for instance tiny dense print on legal agreements and credit card contracts). However, many people find poorly designed documents difficult to read and their understanding of the text is compromised. In addition dental heath is a peripheral interest for the majority of our clients so we need to be encouraging them, not actively turning them away!
It is important that anyone reading something can find their way around a text easily. Too much text on a page can put people off. Columns too close together often cause confusion and pages that have no margins, or little space between paragraphs are more difficult to read. People prefer short, clearly separated `chunks' of text which they can work through at their own pace. This helps them to see how far they have to go, and reduces the chances of them giving up.
Spacing and type size: the spacing between lines is important in making reading easier. Too close and readers will tend to drop lines; too far apart and the reader will not be clear whether the lines relate to each other at all. Don't think that if a large type size is used it will help people to read a leaflet. It often looks childish and puts people off. Any typeface you choose needs to be reasonably clear and distinct.
Upper or lower case: the overuse of upper case, to convey emphasis for example, is counter productive. It is less likely that the text will be read not more likely. It's much better to use bold type, or boxing, to show the important part of the text.
Illustrations: it's helpful to use illustrations and photographs to break up text. It's even better if the illustrations relate directly to the surrounding text so anyone reading can use the illustration as a clue to the text itself. The illustrations should
wherever possible come at the end of paragraphs or sentences, rather than in the middle of them. Sometimes illustrations are used as background, with print running over some areas of the illustration. This makes the text most difficult to read.
Readability: If you want to make the material you produce easier to read you must pay attention to sentence length and avoid the use of bracketed comments. A long sentence (like this one)- 'Dental plaque is an important cause (but not the only orce) of periodontal disease in adults as well as adolescents, but may also affect some children; especially those that have large toothbrushes, as most experts agree (usually those in dental research laboratories) that a small brush (readily available in supermarkets) is an essential part of the package of measures to control plaque accumulation both adults and children' - will defeat all but the most determined of readers! It is far better to break up the text into shorter sentences where the meaning is clear and the main facts are obvious.
These are practical design issues. The other factors to consider are the target group you are aiming for and the scientific validity of the messages you are offering. Try and avoid the all purpose leaflet which advises everyone from babies to grannies on how to have a healthy mouth. Specific age related advice given in a straight forward manner is the best approach. Clearly, if you want to design and print a leaflet that is up to you, but it is sensible to look at the efforts of others to learn from their mistakes ! Until recently it was often quite hard to fmd out who else was producing DHE material. In an effort to help dentists in the UK the Department of Health funded the compilation of a catalogue of Dental Health Resources for England, Wales and Northern Ireland. The catalogue gives details of DHE materials, grouped under target populations to help readers who have specific projects in mind. By sampling material listed in the catalogue the dental team can either decide to use leaflets that have already been printed or assess them and then produce a better end product. The catalogue has received enthusiastic reviews in the United Kingdom and there is potential to produce a European version.
Catalogue of Dental Health Education Resources for England, Wales & Northern Ireland
AS Blinkhorn, P J Holloway and M Ashton.
Published by Eden Bianchi Press ISBN 1898274 061
Cost: 5 Pounds Sterling each.
Available from Professor A S Blinkhorn Oral Health arcd Development, University Dental Hospital, Higher Cambridge Street, Manchester M15 6FH.
Cheques to be made payable to the Urciversity of Manchester.
The biennial congress o IADH is the singlee most important opportunity for professionals and others from around the world to share their experiences and knowledge on oral health care for people with special needs. The `Special Care' area encompasses people with handicaps disabilities, medical disorders and the effects of ageing that may alter the usual pattern in which they receive and we provide oral care.
Last September, Edinburgh was `the' place to be. The 25th Anniversary Congress was very well organised at a very convenient congress centre, the Herriot Watt University. The scientific programme reflected a high scientific standard. Nine keynote speakers, six different workshops and 141 abstract presentations were the key to the success of this programme. Editing all abstracts of lectures and presentations in the International Dental Journal 1996, 46:4 was really a very good idea and a great success.
Having just recovered from the 3rd EAPD Congress organisation we understood quite well what the organising and scientific committee have been going through. We really congratulate them for all the hard work they did.
Luc Martens, Luc Marks, Johan Aps
Organising Committee, Bruges 1996
This year arranged by the BSPD Merseyside Group imagination in the diagnostic field of lesions, syndromes at the Gladstone Hotel in Liverpool 18 - 21 September 1996. and neoplasms. In the last part of his presentation he took The meeting was opened by Dr Jane Goodman, President the audience on a guided "tour" around the world from h I d 1' h of BSPD. Then followed a symposium held by Dr R Duckworth, Professor J J Murray and Professor MA Lennon. They gave an excellent update on the "Scientific Basis of the Action of Fluoride", "Current View on Fluoride Supplementation" and "Community Fluoride Programmes" followed by a discussion with audience participation.
Two lectures about tooth wear and several interesting presentations on various topics covered two afternoons.
The main speaker of the meeting was Professor R Gorlin from the University of Minnesota. He gave a series of lectures on oral pathology and genetics summarising his experience in this field over the last 40 years. He emphasised the importance of being curious and not taking anything for granted when we meet something unusual in the dental office. The audience was fascinated by his knowledge and ancient tlmes to the present. An art an lterature e demonstrated old knowledge about several syndromes. He also showed us how the ancient belief in the evil eye, as an etiological agent has survived into our days. In many places people still wear protective symbols against this evil eye, however in some cultures without knowing what the signs and symbols stand for.
The social programme was well and creatively organised. We enjoyed the meeting and the discussions with our British colleagues.
Anna Dyster-Aas and Jan Ostlund
Members of the Swedish
Academy of Paediatric Dentistry
EUROPEAN ASSOCIATION OF DENTAL PUBLIC HEALTH
First Announcement - lst Congress - 22th & 27th September 1997
Cittadella - Padua Italy
"Strategies in Promoting Oral Health in European Countries"
Further information: Dental Public Service
Azienda U.L.S.S. N.15 "Alta Padovana", Via Pilastroni 1 35013, Cittadella Padua Italy
Tel: +39 49 9424343 Fax: +39 49 942 4343
Consensus Conference on
ORAL IMPLANTS IN YOUNG PATIENTS
Editors: Goran Koch, Tom Bergandal, Sven Kvint, Ulla-Britt Johansson
This book is a presentation of a consensus conference on oral implants in young patients.
Topics discussed include the need for dental habilitation in young patients based on available epidemiological data, the biocompatibility of implant material, psychological-ethical aspects and issues in growth development. Clinical aspects are reviewed and case presentations made. Finally consensus statements are given concerning timing of the placements of oral implants, advantages and disadvantages of choosing oral implant therapy, general health implications, treatment planning, ethical considerations and the multiprofessional approach.
Price SEK 250 ex VAT & postage
To Order: Fax +46 8 462 03 22, Phone +46 8 462 26 60
Mail: Fόrlagshuset Gothia AB, Box 15169 SE, 104 65 STOCKHOLM, SWEDEN
University of Gent, Belgium
3 year Education Programme in Paediatric Dentistry
A well established three year full time course set up
according to the EAPD guidelines.
A Dutch language course and test is required.
Prof Dr Luc MARTENS
Dept Paediatric Dentistry De Pintelaan,
185. b-9000 GENT, BELGIUM
Fax: (+32) 9 240 3851
IXth WORLD CONGRESS ON DENTAL TRAUMA
2lst to 23rd October 1998
XVl Congress of the
International Association of Peadiatric Dentistry
17th to 21st September 1997