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Dental caries is a largely preventable disease, yet the extraction of carious teeth is the most common reason for the hospital admission of children in England. This raises concern over the perceived failure of current preventive strategies. Despite a number of national and local preventive strategies, childhood caries remains most prevalent among the lower socioeconomic groups and ethnic minorities, especially in northern England. Often overlooked is the social and emotional impact of caries and dental treatment on the children and their families. More long-lasting can be the emotional, psychological and developmental impact on children of dental treatment and extractions under general anaesthesia, especially in unfamiliar hospital settings. Yet, the number of hospital admissions for the 5-9-year-old age group continues to rise and was 26,000 in England in 2018. The aim of this paper is to review the demographic and socioeconomic factors related to hospital admission of children for dental extractions, focusing on the localities with the highest proportions of hospital admissions. It is suggested that a reappraisal of the caries-preventive strategy in those areas of England with the highest proportion of hospital admissions is now urgently needed and the case is forcefully made for targeted water fluoridation.

Objectives: To provide a pain-predictive model for the non-operative management of carious deciduous teeth from the analysis of data from a retrospective analysis of clinical case notes of children regularly attending two general dental practices and receiving preventive care., Design: A clearly defined protocol was used to determine the fate of deciduous teeth diagnosed as carious into dentine but symptomless and left unrestored from the sequential examination of the clinical records of 480 children attending at least annually., Results: The age of the children at the first visit when carious teeth were diagnosed ranged from 008 to 12.3 years, with the majority of children (243/480) presenting by 6 years of age. In all, 250 teeth from 162 children were extracted because of pain or became painful and were treated. The remaining 318 children did not report pain on subsequent visits. The strongest predictor of pain was age on diagnosis, the other factors being tooth type and extent of the cavity when first seen. Data from the present study provides a model that enables a child with deciduous caries to be placed into one of six pain-predictive groups associated with a risk of pain or infection if the teeth are not restored but provided with preventive care only., Conclusions: In these patients, the majority of unrestored carious deciduous teeth remain symptomless until shed. A higher risk of subsequent pain or infection was associated with the development of caries in younger patients, disease extending beyond single surfaces, and disease in lower deciduous molars. The results provide evidence to aid the treatment planning of carious deciduous teeth in children receiving regular preventive dental care.

Objective: To investigate the outcome of non-restoration of carious deciduous teeth by means of a retrospective analysis of clinical case notes of children regularly attending two general dental practices and receiving preventive care., Design: Using a carefully defined protocol the fate of deciduous teeth diagnosed as carious into dentine but symptomless and left unrestored was determined from the sequential examination of the clinical records of 481 children attending at least annually., Results: The age at initial diagnosis of carious teeth ranged from 1-12 years with the majority of cavities (1,005) presenting by 6 years of age. In all, 1,587 teeth were followed until loss from the mouth. Of these, 190 (12%) were extracted because of pain and a further 60 (4%) became painful and were treated, leaving 1,337 (84%) that remained symptomless until being lost. Of the 1,337 symptomless teeth, 178 were extracted under general anaesthesia at the same time as painful ones. The final group of 1,159 (74%) teeth were exfoliated without causing pain after a mean survival time of 1,332 days. Excluding from the analysis the 178 extracted, but symptomless teeth, leaves a total of 1,409 teeth of which 18% gave pain and were extracted or treated and the remaining 82% exfoliated. The strongest determinant of pain was age on diagnosis, the other factors being tooth type and extent of the cavity when first seen. The carious teeth most likely to cause symptoms were found to be molars that developed cavities with pulpal involvement by the age of 3 years, 34% of which caused pain. In contrast, those least likely to cause pain were carious molar teeth presenting without pulpal involvement after 8 years, only 6% of which produced symptoms., Conclusion: In these patients, the majority of unrestored carious deciduous teeth remain symptomless until shed. The results provide evidence to aid the treatment planning of carious deciduous teeth in children regularly receiving regular preventive dental care.

Two identical groups of first-year dental students were instructed in the pathology of dental caries and periodontitis using computer-assisted learning (CAL) or tutorial teaching (TT). A cross-over arrangement, in which the first group was taught about dental caries by CAL and periodontitis by TT and the second group in the reverse order, allowed comparison of the two methods. The comparison included a knowledge test and completion of a questionnaire. CAL and TT were equally effective as far as acquisition of knowledge was concerned. Students felt pressurized with CAL and had problems with note-taking. They liked a teacher to be present. Nevertheless, CAL was an acceptable method of instruction and was more economical, in terms of staff involvement, than TT.

This study assesses the effect on enamel formation of the use of fluoride toothpaste in a fluoridated area. The prevalence of enamel hypoplasia in 251 9-10-year-old children born and raised in a fluoridated city (Birmingham) was compared with that in 319 similar children born and raised in a non-fluoridated city (Leeds). Observer bias was eliminated by the use of a new photographic technique, enabling colour slides of both groups to be assessed together in a random order. Scoring was done using both the Jackson-Al-Alousi (J-A) index, which is designed to record nonspecific hypoplasias and the Tooth Surface Index of Fluorosis (TSIF). Both were compared to the results from conventional clinical recording using the J-A index. The results showed that the photographic method was highly reproducible and more sensitive than conventional recording and showed a higher level of mild fluorosis in the fluoridated area. However, no evidence of an increase in the higher grades of fluorosis was found. It is concluded that the use of fluoride toothpaste by young children in fluoridated areas is unlikely to produce aesthetically unacceptable levels of enamel fluorosis.