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Progress in paediatric dentistry over the last half a century has been evident across all areas of the speciality. This article highlights significant changes in the diagnosis, prevention and management of dental caries, traumatic dental injuries, developmental enamel defects, tooth erosion, dental fear and anxiety and safeguarding children. The dedication of clinicians and researchers along with advances in material science and technology have supported this progress. We discuss the importance of working with those both within and outside of the specialty in order to collaborate to improve children’s oral health. There have been significant strides in the provision of child-centred holistic care and research. Reviewing the advancements made over this period has set a high precedent for making further progress within paediatric dentistry over the next 50 years. CPD/Clinical Relevance: Knowledge of key advances in the field of paediatric dentistry will facilitate good diagnosis and treatment of younger patients.

Cone beam computed tomography (CBCT) is becoming increasingly available since its introduction in the late 1990s. The technique provides low-dose high-resolution images of the teeth and jaws. This article discusses the clinical applications of CBCT in children. CBCT is most commonly used in children for localization of teeth and the assessment of root resorption. CBCT can offer an advantage over conventional imaging in selected cases. The decision to image using CBCT should be judged for each individual, and should impact on management and outcome. CPD/Clinical Relevance: CBCT affords low-dose, high-resolution imaging that can be used in appropriately selected paediatric cases.

Silver diamine fluoride (SDF) is applied topically to arrest caries and has an increasing evidence base to support its efficacy, both in the primary dentition and to arrest root caries in older patients. It can be used as a non-aerosol generating procedure and is a simple technique. It has a side-effect of discolouring caries black, a factor which requires discussion with patients and their carers prior to application. Due to its efficacy and simplicity, it is a useful intervention for the management of caries. CPD/Clinical Relevance: Caries is a common condition in the UK, and silver diamine fluoride offers a simple alternative management technique when case selection is appropriate.

Untreated dental caries affects children in the UK, with significant burden to the child, family and health service. High quality bitewing radiography is more effective than clinical observation alone at detecting proximal caries in children. Accurate diagnosis before cavitation allows preventive rather than operative management. Research has demonstrated that most children find bitewing radiography acceptable. It is therefore vital that bitewing radiographs of children are taken as per national guidance in general practice. CPD/Clinical Relevance: Timely and high quality bitewing radiography is required for accurate diagnosis and treatment planning in children.

Aim The aim of this study was to establish the diagnostic efficacy of panoramic radiographs in six clinical situations for paediatric patients: caries, acute dental infections, dental trauma, dental anomalies, developmental disorders and pathological conditions. Data sources The authors searched the following databases: Medline, Embase, the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects and the Cochrane Health Technology Assessment database. Forward citation searches of included studies were carried out. There were no language restrictions. The dates were restricted to include studies published between 1990-2018. Study selection Inclusion criteria: children under the age of 18 for whom the diagnostic accuracy of panoramic radiography was compared to either clinical or an alternative radiographic examination for the six included indications. Exclusion criteria: panoramic radiographs taken for orthodontic indications outwith those stated in the aim. Studies of all designs were included. Screening of titles, abstracts and full texts were completed independently and in duplicate by two authors. Disagreement was resolved by discussion including a third author. A total of 3,420 abstracts were screened, from which 175 full texts were reviewed. Sixteen studies across the six indications were included in the review. Data extraction and synthesis Data extraction was performed independently and in duplicate by two authors, with a third resolving disagreement. A standardised form was used which was initially piloted on ten papers. A narrative synthesis was carried out due to heterogeneity of the included studies precluding data synthesis. Results Assessment of bias was completed using the QUADAS 2 tool. Of 16 included studies, the majority were of high or unclear risk of bias for domains including: patient selection, conduct or interpretation of the index test, reference standard, and patient timing and flow. Regarding detection of caries, one study was included which demonstrated clinical examination detected more carious surfaces than panoramic radiographs (6.0%, 95% CI 4.1-7.8%), but that bitewing radiography combined with panoramic radiography led to a higher diagnosis of approximal lesions than clinical examination alone by 4.3% (p

Background\ud \ud Molar incisor hypomineralisation (MIH) is a common developmental dental condition that presents in childhood. Areas of poorly formed enamel affect one or more first permanent molars and can cause opacities on the anterior teeth. MIH presents a variety of challenges for the dental team as well as functional and social impacts for affected children.\ud \ud \ud \ud Objectives\ud \ud Here, we provide an up‐to‐date review of the epidemiology, aetiology, diagnosis and clinical management of MIH.\ud \ud \ud \ud Materials and methods\ud \ud A review of the contemporary basic science and clinical literature, relating to MIH, was undertaken using information obtained (up to 10 April 2020) from the electronic databases PubMed, Scopus, Web of Science and the Cochrane Library.\ud \ud \ud \ud Results\ud \ud There is a growing body of evidence relating to the aetiology, presentation and clinical management of MIH. Current knowledge appears to be focused on potential genetic aspects, as well as the development and validation of indices for the diagnosis and management of MIH. There has also been increasing recognition of the global and individual burden of this common condition.\ud \ud \ud \ud Conclusions\ud \ud Dental health professionals should regularly appraise the basic science and clinical MIH literature to ensure that they provide the best possible short‐ and long‐term care for their young patients.

Aim This systematic review aimed to assess the effectiveness of fluoride varnish in preschool children for reducing the incidence of caries into dentine.Data sources Data came from published and grey literature. Databases searched were: CDSR, Medline, EMBASE, Web of Science, SCOPUS, LILACS and BBO. Hand-searching was done of nine dental journals and two medical journals. Backward citation searches were carried out on the reference lists of identified trials and relevant systematic reviews. Trials registers (Current Controlled Trials, ClinicalTrials.gov, EU Clinical Trials Register, Australia New Zealand Clinical Trials Registry, and Registro Brasileiro de Ensaios Clínicos) were searched for ongoing trials. Grey literature was searched via a number of resources including International Association for Dental Research (2001-2018) and European Organisation for Caries Research (1998-2018) conference abstracts and Open Grey, EThOS, the New York Academy of Medicine (GreyLit Report) and Banco de Teses CAPES.Study selection Inclusion criteria were; the use of fluoride varnish (different regimes and doses were included), randomised controlled trials, preschool age (under 71 months) and over 12 months follow up. Outcomes were caries into dentine and hospitalisations due to caries. A combination of free text and controlled terms were used based on the study question. A total of 2441 studies were identified at initial search, 20 were included for narrative and quantitative analysis after full text reviews of 79 studies.Data extraction and synthesis Data was extracted independently by two reviewers with a third resolving any disagreement. Data was combined by subgroup to compare different interventions and controls, with a global random effects meta-analysis performed on 16 studies to provide a relative risk (RR) of dentinal caries at the individual level. At the individual level meta-analysis was by RR, at the tooth and surface level this was prevented fraction (PF) and weighted mean difference (WMD).Results Only one study was determined at low risk of bias, with four unclear and 14 at high risk based on the Cochrane risk of bias tool. Studies were from 13 different countries. Children at baseline were from 0-100% caries free, with a dmft of 0-6.57 and aged 6 months - 5 years. There were no studies reporting hospitalisation due to caries. The combined RR for the outcome of dentine caries for an individual was 0.88 (95% CI 0.81-0.95) based on 16 studies with considerable heterogeneity (I2 = 75.7%). Tooth level results gave a PF of 31.13% (95% CI 21.08, 41.18) and a WMD of -0.30 (95% CI-0.69, 0.09) for fluoride varnish. At surface level the PF was 24.15% (95% CI 12.91-35.38) and WMD of -0.77 (95%CI; -1.23, -0.31).Conclusions The conclusions of the paper were that there is modest and uncertain evidence for fluoride varnish reducing the risk of developing dentine caries in pre-school children.

Dental anxiety affects children worldwide and can have negative consequences on oral health. This study aimed to evaluate a novel communication aid &lsquo, message to dentist&rsquo, (MTD), as part of a wider cognitive behavioural therapy approach to reduce dental anxiety in young patients. Dentally anxious children, aged 9&ndash, 16 years, were invited to complete the MTD proforma, before and following their course of treatment. They scored how worried they were and their anticipated pain levels on a scale of 1&ndash, 10 (10 being the worst outcome). They also wrote down their coping plans and post-treatment reflections. One hundred and five children, from a UK general dental practice and a hospital clinic, were included. They had a mean age of 11.6 years, and 65% were female. There was a significant reduction in self-report worry (from 4.9 to 2.1) and anticipated pain (from 5.1 to 2.0) scores (p &lt, 0.05, paired t-test). Many children (30%) used listening to music/audiobook as a coping strategy. Thematic analysis revealed concerns around pain, uncertainty, errors and specific procedures. The MTD proforma proved an effective means of facilitating communication between anxious children and the dental team, allowing them to identify their worries and make personalised coping plans.

Data sources PubMed, Medline, CINAHL, Cochrane Library, and Web of Science databases. Study selection Studies involving patients aged between 0-16 years of age having dental general anaesthetic (DGA), where Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) pre- and post-operative assessments were made, were considered. Data extraction and synthesis The quality of studies was assessed by two reviewers using the Newcastle-Ottawa Scale for cohort studies. Information on study design and instruments used to record family impact scale (FIS) were extracted. The main outcome was changes in the FIS section presented as mean difference (MD). Results After an initial search of 105 studies in the database, 21 articles were included in the analysis. A positive outcome in the FIS changes was identified in all studies. The combined MD for FIS using ECOHIS and COHRQoL was 1.52 (95% CI 1.15-1.89; P