Message from the President.
The recognition of our speciality has been considered as one of the main priorities set forth since the foundation of our Academy Every President, since then has included the topic in the agenda of all the Council meetings and several discussions have been carried out mainly about the necessity of our speciality to be recognized. Furthermore, we have discussed how much we want to see this happen, and how nice it would be to have Paediatric Dentists amongst the recognized specialities in Europe and so on. It is time though, dear Colleagues, to see what we have gained and how much we have succeeded so far towards the fulfilment of our goal.
How far away from the starting point have we really gone? Have our efforts really been directed in the right direction? Have we convinced anybody else besides our members? Is this the right target of our efforts? Or, are we constantly trying to convince those that have already been convinced?
We do need, of course, our members to support the idea and we need to carry our discussions on the matter within our Academy in order to strengthen our views and move towards the same direction. But this is not enough. This cannot make our speciality be recognised nor can it give our members the power or authority to do so. The recognition of a speciality is more or less a political issue and a decision which is taken by the appropriate authorised bodies of people within each European country or by the analogous group of people in Brussels for Europe (see: Dental Advisory Committee). The critical question asked at this stage of our development is whether we follow the same course that we have followed up to now, or do we change philosophy and line of action.
It is time, I think to be more realistic. To move from the discussions to the actions and take some steps forward. It is time to look beyond our membership. We have to have a strategic plan with identified targets and concrete steps of action.
We have to find and influence the people who make such decisions in every country and those representing their country to the various committees such as the Dental Advisory Committee of the EU and where the decisions are taken. We have to convince these people on why paediatric Dentistry should be recognised as a speciality, why it is needed and what its contribution to the improvement of Children's oral health would be? The general feeling in Europe concerning recognition of more specialities is not very promising nor encouraging. Most people believe that there is no need for more specialities whilst general dental practitioners fear that specialists will take away some of their work. We have to change both of these beliefs because they are both wrong. The general dental practitioner has nothing to fear from the recognition of our speciality, but has much to gain from the children returning to his care after a certain period of time. This brings us to the point where we realise two things that we have not done so far. Firstly, how to find and approach these people, and secondly, all the arguments and convincing points in favour of our speciality have never been written in a document and to date are missing. Such a document in which we would include our mission statement would be a useful tool for communicating with people and authorities.
Based on the above, I see three very important steps that should be taken immediately:
1) Appointment of a Task Force of three people charged to
These are my thoughts and the way I see our action towards the fulfilment of our goal. Let's see what other suggestions we might have towards the direction to do something right now. Time is running out and instead of trailing after problems encountered by not having our speciality recognised, we ought to be ahead of them by preventing their development. And that applies for every European country.
Constantine J Oulis
In Sweden Paediatric Dentistry was first recognized as a speciality in 1958. The speciality has since developed rapidly. In Sweden today there are about 130 members in the Swedish Association for Paediatric Dentistry.
Sweden has 25 counties, all except four of these counties have at least one specialist clinic in Paediatric Dentistry, and some have more.
A survey carried out in Sweden in 1985 by Claes-Goran Crossner, Ingegerd Mejare and Goran Koch showed that the following reasons for referral to the Paediatric Dentistry Clinics were the most common (listed in decreasing order of occurrence):
1) Need for dental treatment in combination with behaviour management problems.
2) Dental trauma.
3) Tooth development disturbances.
4) Tooth eruption disturbances.
5) General disease of the child.
6) Periodontal and gingival disease.
7) Pathology of the pulp and peri-radicular jaw bone.
8) Pathology of oral soft tissues.
9) Severe dental caries, high caries activity.
10) Anomalies of the head and neck skeleton.
11) Stomatognathic Physiology Dysfunctions.
12) Other reasons.
For many years in Sweden it has been concluded that one Paediatric Dentistry Specialist per 15,000 or 20,000 children is appropriate. This ratio has been achieved from the experiences of those Swedish counties where treatment at the Paediatric Dentistry clinics function well. Approximately one percent of all children and adolescents 0-19 years of age will require dental treatment each year by a Specialist in Paediatric Dentistry. This means that during a 20 year period about every fifth will be referred to and seer at a Paediatric Dentistry clinic. Different geographical situations and social structure influence the need for treatment by a specialist in Paediatric Dentistry and so does the ambition of the dental personnel of the differing counties.
It is now recommended that there should be two Paediatric Specialists in each location. This is necessary to satisfy the requirements for the teaching and training programmes of junior staff. In addition, two Paediatric Specialists per location would be able to provide cover for each other when absences occur.
Bengt Olof Hansson
Born in Corinth, a town out of Athens, Constantine Oulis grew up and went to school there until the end of High School. Later, he moved to Athens for his undergraduate studies in Dentistry at the University of Athens.
Following his undergraduate studies he had to serve for two and a half years in the military, specifically with the Airforce. Before these obligations were completed, the need for money (due to difficult situations) and his eagerness for action caused him to begin his private practice in General Dentistry - a field that gave him a lot, as it seemed later when he began to work with children. He also started to assist at the University of Athens as a clinical instructor in the Department of Operative Dentistry.
His love for children and the need he realised existed led him to want to pursue Paediatric Dentistry. His dream became a reality and his doors finally opened when American Paediatric Dentists visited children's camps in the territories of Athens every summer. From the first minute, he joined the group and every day that went by, he saw that Paediatric Dentistry would become his great love. This was not, however, adequate training and in order to acquire proper education, he travelled to the United States to receive his speciality certificate.
After a period of three and a half years at the University of Birmingham in Alabama, along with this certificate of the speciality, he obtained a Master's Degree in Oral Biology (Caries Research). The time he spent there was one of the most wonderful and useful periods of his life. Beyond the education he was receiving he had taken opportunities to meet the pleasant people of the South, but most of all he had the chance to work under the supervision of a well acknowledged and respected researcher in the field, Professor Theodore Koulourides.
In 1982, Constantine Oulis returned to Athens and dedicated himself to the University and the Speciality, working full time and hard, in order to accommodate teaching, research and his private practice. Along with two other pioneer Paediatric Dentists (Professor Papagiannoulis and Professor Kouvelas) he fought to achieve the establishment of the speciality of Paediatric Dentistry from square one, simultaneously at the University of Athens and in the Community. Following a great deal of effort, the department was officially established in 1985 and he became a lecturer. After four years he was appointed Assistant Professor, a position he serves until today.
As role models these pioneers in Paediatric Dentistry in Greece stimulated over 50 students to follow their footsteps leading to a dynamic group of well qualified Paediatric Dentists all over Greece. Now a three-year Postgraduate programme in Paediatric Dentistry has finally been established rewarding all their labours. Besides the tireless efforts at the University level, the need for education and training of the profession and the Society was tremendous. For more than ten years hundreds of lectures were given to dentists and parents around the country. From 1984-1986 and 1987-1989 he contributed to the establishment of Dentistry within the National Health System as a member of the Oral Health Care Committee appointed by the Ministry of Health. As part of this contribution, he worked for the implementation of several Preventive Programmes in Dental Health Centres as well as in the Community. Since 1990 he has been continuously voted as elector of the General Assembly of the Hellenic Dental Association and from 1994 he has been elected to the Board of the Dental Association.
For many years, he served in the Council of the Hellenic Society of Paediatric Dentistry and since 1989 has been the Secretary-General of this Society. During these same years, he has also been the editor of the Society's Journal Paedodontia which is published four times a year and has 4000 subscribers. He is an author of many papers, and has published several chapters in Hellenic textbooks. His scientific work beginning with the work for the requirements of his Master's was in Cariology and more specifically with de- and remineralisation of dentine. With passing years, clinical research has attracted him more. He thus carried out several epidemiological and clinical studies in Greece while he also participated in two European collaborative studies one of which was funded by the EU.
by Stephen Fayle
The effect of sleep on conscious sedation: a follow-up study.
J Clin Pediatr Dent 1997, 21:131-134
The purpose of this study was to evaluate the effect of preoperative sleep on the success of conscious sedation for dental treatment in children. Seventy- six children, ranging from 18 to 61 months old and in need of dental treatment were included in the study. All were judged to have been "negative" or "very negative" on the Frankl behaviour scale at an assessment appointment. 62 were sedated using an oral combination of chloral hydrate (50-60 mg/kg) and hydroxyzine palmoate (15-32 mg/kg), and 14 subjects using intramuscular meperidine hydrochloride 2.2mg/kg). On the day of the sedation appointment, prior to treatment, parents were asked to complete a questionnaire about their child's activity, diet and bedtime the previous day. After the sedation the operator was asked to rate the success of the sedation and the patient s behaviour using the Frankl scale. Statistical evaluation revealed no significant difference in the success of sedation between those children reported to have had a normal or greater than normal length of sleep the previous night, and those reported to have had less sleep than normal. The success of the sedation was significantly higher p<0.03) in children older than 3 years. There was a weak relationship between parental perception of their child's tiredness and the success of sedation p<0.08), with a tendency toward poorer sedation in tired children. The authors conclude that although with clear correlation between a child’ s pre-operative sleep and the outcome of conscious sedation was demonstrated, a tired child may increase the likelihood of poor sedation.
Damage to the primary dentition resulting from thumb and finger sucking habits.
Fukuta O, Braham RL, Yokoi K, Kurosu K.
J Dent Child 1996; 63: 403-407
In this retrospective study, the dental charts of Japanese children were reviewed to evaluate the effect of digit sucking on the primary occlusion. Records of 671 children with no history of oral habits and 259 children with a confirmed digit sucking habit were identified. Data regarding anterior overjet, overbite and whether the second primary molars exhibited a mesial step, distal step or flush terminal plane were obtained from the clinical records or study models. The results demonstrated a higher frequency of open bite and maxillary protrusion in all ages of children with a thumb or finger sucking habit. In five-year old children, the mesial step terminal plane was less frequent in those with a habit compared to those without. Similarly, a distal step terminal plane relationship was seen more frequently in the habit group. Children who had a distal step terminal plane and continued oral habits after four years of age had an increased tendency to a permanent malocclusion. The authors recommend that efforts should be made to eliminate thumb or finger sucking before four years of age, as persistence of such a habit beyond this age may result in damage to the terminal plane relationship.
Ectopic eruption of maxillary first permanent molars in children with cleft lip.
Silva Filho OG, Albuquerque MVP, Kurol J.
This study aimed to investigate the incidence and outcome of ectopic eruption of maxillary first permanent molars in patients with cleft lip and alveolus. Panoramic radiographs of 70 Brazilian Caucasian children aged 6-8 years of age with complete unilateral cleft lip and alveolus were reviewed. Fourteen patients (20%) exhibited ectopic eruption of one or both maxillary molars and of the 19 teeth involved, 16 (85%) were considered to be reversible. Unlike many previous studies, which have indicated a tendency for higher incidence of molar impaction in females with clefts, no differences were found between sexes. No correlation was found between the unilateral cleft side and the side of the ectopic eruption.
For most children a referral to the Amsterdam dental department means that their dental treatment was obstructed seriously because of fear and anxiety.
Children do not have a large number of subtle coping strategies. Some of them are ready to fight, other children who feel uncomfortable in a certain situation can become extremely withdrawn. If they feel something is going to happen what they consider to be terrible, they shut themselves off completely and this in itself, being an avoidance strategy, increases their fear.
Jesse was six, and rather unlucky. He was scared of the dentist and therefore had been referred to the paediatric department. His dentist could not manage. Every time Jesse was brought into the dentist's office he clammed up and, in the dentist's words "he was out of touch and out of reach". Newcomers like Jesse usually visit us for a short talk. If no other treatment strategy is mandatory, we follow this with a trial session and, having shown the child that there are clear limits to what we do and how the treatment is structured, we are able to continue with something like a small filling.
The renewed contact with another dentist is especially important and very fragile. It is only through good contact between the child and the dentist that the different aspects of treatment can be explained beforehand and that the child can find its own locus of control.
But not with Jesse. The first time he came he already had serious problems: an abscess forced us to take out two teeth. Naturally he didn't like that at all. But we promised him that the next time we would do things gradually. We would polish his teeth and make them smooth and shiny with an electric toothbrush. And if that went well and all his teeth were bright and clean again, he could come back and we would take a look at his other teeth. Sure.
But as you understand, that's not what happened. The next visit another tooth broke down. An acute inflammation and the subsequent pulpotomy made the dentist break his promise. And when the anaesthetic failed little remained of the rather brittle dentist-patient relationship. Polishing and cleaning the teeth came with the third visit.
Jesse came to the fourth lesson without any problem. He went and sat in the chair without any hesitation and opened his mouth quite spontaneously. The anaesthetic was a slightly difficult moment, but he put a brave face on it. He drank a glass of water calmly and looked out of the window. And then, after a while, by which time the dentist was anxious to get started, he asked, Dentist..."
Jesse nodded and examined the dentist's work in the mirror.
Associate Professor Liza Papagiannoulis, University of Athens.
This seminar took place in Athens on 22-23rd February 1997. On the first day there were three invited speakers who gave presentations, and on the second day there was a round table discussion on "Restorative Materials and Techniques used in Paediatric Dentistry Today".
FLUORIDE, PAST AND FUTURE. WHAT IS THE OPTIMAL USE?
Before going into details about mechanisms and methods of using fluoride a presentation was made to illustrate the interaction of the factors involved in caries development and fluoride. After a short historic summing up the systemic and topical methods for fluoride application were discussed as well as the inhibiting mechanisms of fluoride in the caries process. Recent findings on the importance of accumulating calcium fluoride on/in the enamel surface were reviewed. This formed the base for the analyses of practicability and effect of different modes of topical fluoride applications such as through: toothpastes, mouthrinses, sucking tablets, chewing gums, paintings, varnishes, gels etc. Special attention was given to the limitation of prolonged effect of topical applications. One possibility to overcome this problem is to use devices which continuously release fluoride to the oral milieu. Recent research on fluoride releasing restorative materials were presented. At the end of the lecture the determinants for a successful use of fluoride were discussed as well as recommendations to be used in the clinical setting.
SUGAR AND SPICE AND ALL THINGS NICE - DO WE TELL THE TRUTH ABOUT SUGARS?
Sweetness has been an inherent taste in humans for as long as man has been in existence. Originally, sweetness was obtained from the use of honey and in some parts of the world, such as India and Southern China, from sugar cane (khandi). Recent research, however, shows that over the centuries honey was more extensively used than previously thought and, for some periods, at a level equivalent to that of sugar today. Yet the prevalence of dental caries during these periods of high use of honey was not as great as that in the last two hundred years. This paradox will be explored.
The production of sugar (from cane) was originally confined to India and carried over land to Europe via the Spice Route to the Mediterranean and on to the seaports of Venice and Genoa. The importation of sugar, a product cheap to produce, easy to keep for a long time and carry and demanding a high price, made many fortunes. Sugar was felt to be valuable and important in health care.
REFINED DIAGNOSIS AND THE ESTIMATION OF CARIES-RISK.
Caries activity and caries susceptibility both determine the caries-risk of a patient. In this respect special attention has to be paid to tooth morphology and the harmful potential of using a probe. After refined diagnosis, appropriate restorative dentistry - following guidelines for preventive restorations - can eliminate class II restorations. For this, priority has to be given to an adequate fluoride programme.
In order to estimate caries-risk in a proper way the following factors have to be evaluated: medical and social history, dietary habits, fluoride use, plaque control, clinical evidence, composition of oral microflora and saliva. The cariogenicity of food is not principally determined by "the sugar content". Factors such as stickiness, solubility, mineral content, particle size, quantity of fat, intrinsic pH, texture, temperature, saliva stimulation, buffering capacity and clearance are even more important. In order to prevent caries we have to focus on the reduction of feeding moments combined with an adequate fluoride use, rather than eliminating sweets frantically! This holds for 80% of the population.
With respect to dietary habits, we have to take into account several risk groups or factors such as nursing bottle caries, low socio-economic status, fanatic intake of soft drinks and grapefruit, pregnancy, geriatric patients and institutionalized or hospitalized people.
Finally, clinical evidence of microflora and some saliva properties can be obtained using chairside tests that are quite promising with respect to reproducibility and predictibility.
The topic for the second day was "RESTORATIVE MATERIALS AND TECHNIQUES USED IN PAEDIATRIC DENTISTRY TODAY".
A round table discussion was led by Prof L Papagiannoulis, Dr G Hliades and Dr K Kavvadia.
The rapid development of new restorative products and the controversial subject of amalgam biocompatibility had a significant impact in the material selection criteria and the techniques employed in the field of paediatric conservative treatment. In spite of the political decisions taken in several European countries for the potential health hazards associated with amalgam, a rather puzzling goal was set for materials research; not to search for new materials, but to urgently find an alternative to amalgam. This trend has occasionally led to the misuse of some dental materials which have subsequently had implications for the oral health status of patients.
The topics of this seminar were focused on the clinical relevance of materials, their properties and the application techniques which provide a sound background for establishing selection criteria and safe guidelines in clinical practice.
Discussion and conclusions were drawn up for the following dental materials:
"Strategies in Promoting Oral Health in European Countries"
Further information: Dental Public Service
The West of Scotland Group
21st to 23rd October 1998
17th to 21st September 1997