Objective: Children frequently experience pain and/or discomfort during dental treatment. Still, pain research in dentistry has mainly been performed on adults using quantitative methods while research on the child's perspective is scarce. This study aims to explore and describe children's experiences and/or thoughts regarding pain in conjunction with tooth extraction.

Material and methods: Interviews were carried out with twelve Swedish 10-16-year-olds who had recently undergone tooth extractions due to orthodontic reasons. Interviews were transcribed verbatim and analysed according to grounded theory.

Results: A core category was identified and named 'handling the unavoidable unknown'. The informants recalled experiences of pain and discomfort during extractions. However, instead of focussing on pain, they described an urge for more information about the procedure and what to expect in terms of pain and/or discomfort, during and/or after treatment. They stated that the levels of pain/discomfort were manageable, while the lack of information negatively affected their coping abilities, causing feelings of unease.

Conclusions: To improve patients' ability to deal with pain in conjunction with dental extraction, the dental team should ensure better and individually tailored information about the treatment. Thus, the use of psychological techniques is a cornerstone in pain management and must be reflected in clinical guidelines.

Aim

Sweden´s first multidisciplinary children's advocacy centre (CAC) was founded in 2005 as a collaborative practice between child protection services, the legal system and health care in response to police-reported child abuse. CACs were introduced in the county of Skåne in 2007. The aim of the study was to describe the health of children investigated at the CAC in Lund, and to examine whether the CAC model of collaboration responded to the healthcare needs of these children.

Methods

All children aged 0–17 years investigated at the CAC in 2015 were included in this retrospective study. We reviewed the CAC files and the children's medical and dental records from one year prior to, until one year after their assessment at the CAC.

Results

Our review of the medical and dental records (n = 298) showed a high prevalence of mental, dental and physical ill-health. After the CAC joint meeting, only 1% of the children were referred for a medical examination and 4% for a focused forensic evaluation.

Conclusion

Our study demonstrates limitations in the CAC process in responding to extensive health issues of the young victims of crime. We suggest mental, dental and physical health assessments to be statutory in CACs.

FNs Barnkonvention anger att barn har rätt till bästa möjliga hälsa och att de inte får diskrimineras

En stor andel av barn i de nordiska länderna lever i social utsatthet som ofta är kopplat till fattigdom

Det finns ett starkt samband mellan dålig munhälsa och social utsatthet och trots kännedom om detta sedan flera år består skillnaderna i munhälsa mellan olika grupper

Effekten hos olika metoder för att utjämna skillnader i munhälsa är otillräckligt utvärderade; det saknas vetenskapligt underlag/evidens för metoderna

Insatser för att utjämna skillnader i munhälsa mellan olika grupper behöver innefatta såväl hälsoförebyggande (promotiva) arbetssätt som prevention, och ske i samverkan med andra delar av samhället, ex skola, barnhälsovård

Det är stort behov av flervetenskaplig forskning för att utjämna hälsoskillnader. Sådan forsknings bör även involvera kliniker.

The United Nations (UN) Convention on the Rightsof the Child, states that all children should havethe same right to the highest attainable standardof health. This should be known by everyone whoworks with children. Despite good oral health in theNordic countries, studies show that children livingin socially deprived environments have a greaterincreased risk of poor oral health. These childrenare not reached by preventive measures, they morefrequently do not show up for dental appointmentsand they receive less dental care than others. Therefore, in addition to a more general preventive andpopulation-based method, a special high-risk approach is also needed to reach children in socially deprived areas. It is also important that promotion and preventive efforts start from an early age.There are large knowledge gaps regarding the effects of different preventative and treatment strategies, and health economic analyzes are rare. It is achallenge to systematically document and evaluate oral health promotion and prevention directed atchildren in socially vulnerable environments to enable research. There is a need for interdisciplinaryresearch that includes clinicians. The vision mustbe health equity and that both health promotionand preventive measures contribute to closing theoral health gap between different social groups. l

Allir sem vinna með börn ættu að þekkja til Barnasáttmála Sameinuðu þjóðanna, en samkvæmt honum ættu öll börn að hafa jafnan rétt til bestu mögulegu heilsu. Þrátt fyrir góða munnheilsu á Norðurlöndunum, sýna rannsóknir að börn, sem búa við erfiðar félagslegar aðstæður, séu líklegri til að búa við slæma munnheilsu. Forvarnaraðgerðir ná ekki til þeirra, þau nýta sér sjaldnar tannlæknaþjónustu og njóta skertrar tannverndar, samanborið við önnur börn. Af þeim sökum er, auk almennra forvarnaraðgerða, þörf fyrir sérsniðnar aðgerðir fyrir áhættuhópa til að ná til þeirra barna sem búa við erfiðar félagslegar aðstæður. Einnig er mikilvægt að fræðslu- og forvarnarstarf hefjist á unga aldri. Þekkingu um áhrif mismunandi aðferða við forvarnir og meðferð skortir og hagfræðilegir útreikningar þeim tengdir eru fáir. Það er mikil áskorun að skrá og meta á kerfisbundinn hátt tanntengdar fræðslu-og forvarnaraðgerðir ætlaðar börnum sem búa við erfiðar félagslegar aðstæður, svo nýta megi til rannsókna. Þörf er á þverfaglegum rannsóknum með aðkomu tannlæknastofa. Framtíðarsýnin er að jafnrétti til heilsu sé tryggt og að heilsueflandi fræðsla og forvarnir dragi úr ójöfnuði í munnheilsu á milli ólíkra þjóðfélagshópa.

Oral Health challenges in children from socially deprived areas

Everyone who works with children should know about the UN Convention on the Rights of the Child, which states that all children should have the same right to highest attainable standard of health. Despite good oral health in the Nordic countries, studies show that children living in socially deprived environments have a greatly increased risk of poor oral health. These children are not reached by preventive measures, they more frequently do not show up for dental appointments and they receive less dental care than others. Therefore, in addition to a more general population based prevention approach, a special high-risk approach is needed to reach children in socially deprived areas. It is also important that the promotion and prevention efforts start from an early age. There are large knowledge gaps regarding the effects of different prevention and treatment strategies, and health economic analyzes are rare. It is a particular challenge to systematically document and evaluate oral health promotion and prevention directed at children in socially vulnerable environments to enable research. There is a need for interdisciplinary research also including clinicians. The vision must be health equity and that both health promotion and preventive measures contribute to closing the oral health gap between different social groups.

Background There is an uncertainty regarding how to optimally prevent and/or reduce pain after dental treatment on children and adolescents. Aim To conduct a systematic review (SR) and health technology assessment (HTA) of oral analgesics administered after dental treatment to prevent postoperative pain in children and adolescents aged 3-19 years. Design A PICO-protocol was constructed and registered in PROSPERO (CRD42017075589). Searches were conducted in PubMed, Cochrane, Scopus, Cinahl, and EMBASE, November 2018. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria, following the PRISMA-statement. Results 3,963 scientific papers were identified, whereof 216 read in full text. None met the inclusion criteria, leading to an empty SR. Ethical issues were identified related to the recognized knowledge gap in terms of challenges to conduct studies that are well-designed from methodological as well as ethical perspectives. Conclusions There is no scientific support for the use or rejection of oral analgesics administered after dental treatment in order to prevent or reduce postoperative pain in children and adolescents. Thus, no guidelines can be formulated on this issue based solely on scientific evidence. Well-designed studies on how to prevent pain from developing after dental treatment in children and adolescents is urgently needed.

PURPOSE: To study pain perception in 10-15-year-olds, during and after uncomplicated extractions of bilateral maxillary premolars. The study investigated pain's natural course and made comparisons between the first and second extractions. METHODS: 31 Swedish children in need of orthodontic treatment were identified and consecutively enrolled. Tooth extractions followed a standardised protocol and the two teeth were extracted with at least 10 days between. The participants rated pain intensity using visual analogue scale (VAS) at 14 different time points from treatment and 7 days forward. RESULTS: The pain intensity profile followed the same pattern for all patients. Pain intensity peaked 2 h after extractions (mean VASPI 27.3, SD 20.8; median 23.0) when moderate pain intensity (VASPI >/= 40) was registered for 16 (28%) of 57 cases. After that, there was a rapid decrease in pain intensity notable already at 4 h after extractions. There were no statistically significant differences in any VASPI measurements between the first and second extractions, sexes, or different age groups. CONCLUSIONS: The majority of the participants who undergo uncomplicated bilateral extraction of maxillary premolars experience mild to moderate levels of postoperative pain during a short period of time, with no differences between the first and second extractions. Bilateral tooth extractions is a suitable model for further studies on pain management.

AIM: This study aimed to investigate Swedish dentists' attitudes regarding pain management strategies for treating children and adolescents. It assessed recommendations for pre- and postoperative analgesics, and use of local anaesthesia, and whether application of these strategies differs between general dental practitioners (GDPs) and specialists in paediatric dentistry (SPDs). DESIGN: We invited all GDPs (n = 807) in southern Sweden (Region Skåne), and all registered SPDs (n = 122) working in Sweden (929 actively practising dentists under age 65 years) to participate in a postal survey on pain management in paediatric dental care. RESULTS: The SPDs reported using all types of pain-reducing strategies more frequently than GDPs except local anaesthesia when extracting a permanent premolar, which SPDs and GDPs used equally often. Preoperative analgesic use was greater among SPDs than GDPs. GDPs used local anaesthesia less frequently for filling therapy in primary teeth than in permanent teeth. CONCLUSIONS: SPDs recommend preoperative analgesics more often than GDPs do. GDPs seem to underuse local anaesthetics when treating children and adolescents. SPDs also use pain management strategies more frequently than GDPs. Among GDPs, pain management is less frequent when treating primary teeth than permanent teeth.

Background: Vitamin D is crucial for mineralized tissue formation and immunological functions. The purpose of this study was to evaluate the association between vitamin D status and dental status in healthy children with vitamin D supplementation in infancy and at 6 years of age. Method: Eight-year-old children who had participated, in a vitamin D intervention project when they were 6 years old were invited to participate in a dental follow-up study. They had fair or darker skin complexion and represented two geographically distant parts of Sweden. 25-hydroxy vitamin D in serum had been measured at 6 years of age and after a 3-month intervention with 25, 10 or 2 (placebo) mu g of vitamin D-3 per day. Two years later, caries and enamel defects were scored, self-reported information on e.g., oral behavior, dietary habits and intake of vitamin D supplements was collected, and innate immunity peptide LL37 levels in saliva and cariogenic mutant streptococci in tooth biofilm were analyzed. The outcome variables were caries and tooth enamel defects. Results: Dental status was evaluated in 85 of the 206 children in the basic intervention study. Low vitamin D levels were found in 28% at baseline compared to 11% after the intervention, and 34% reported continued intake of vitamin D supplements. Logistic regression supported a weak inverse association between vitamin D status at 6 years of age and caries 2 years later (odds ratio 0.96; p = 0.024) with minor attenuation after an adjustment for potential confounders. Multivariate projection regression confirmed that insufficient vitamin D levels correlated with caries and higher vitamin D levels correlated with being caries-free. Vitamin D status at 6 years of age was unrelated to enamel defects but was positively associated with saliva LL37 levels. Conclusion: An association between vitamin D status and caries was supported, but it was not completely consistent. Vitamin D status at 6 years of age was unrelated to enamel defects but was positively associated with LL37 expression.