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.

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

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.

BACKGROUND: There is rising concern about how preterm birth affects long-term health later in life. The various effects that preterm birth have on developmental outcomes, cognitive profiles and medical health may also affect levels of cooperation in the dental care situation in addition to general oral health and other oral health-related habits. Oral health is an integral part of one's general health and well-being; however, less is known about how prematurity affects oral health and other related areas such as dental care, and including dental fear and anxiety (DFA) in individuals during adolescence and adulthood. This is considered of special interest to study, as preterm children during the preschool and school period were reported to have behavioural problems during dental treatments and less than favourable oral hygiene. METHODS: A questionnaire was used of self-report design and structured into behavioural aspects relating to dental treatment, oral health-related factors, and medical health. This questionnaire at 17-19 years of age was a follow-up from 12 to 14 years of age and considered a predictor for planning future dental care for this group of patients. The 145 participating adolescents were all preterm, born between 23 and 32 weeks of gestation and 140 full-term controls, born ≥37 weeks of gestation. RESULTS: Dental fear and anxiety, oral health behaviour, and intake of sweets and sugary drinks of 17-19-year old adolescents born preterm was comparable to that of the full-term control group. Medical health problems as well as the intake of sweets and sugary drinks increased from the time of early adolescence to late adolescence in both groups. CONCLUSIONS: Preterm as well as full-term adolescents between 17 and 19 years of age are satisfied with their dental care and display low prevalence of dental fear and anxiety (DFA). The findings in this study indicate that adolescents born very preterm and extremely preterm are well prepared for transition to dental care in adult life with expectations of being able to take responsibility for their oral health. KEYWORDS: Adolescent; Born preterm; Dental care; Oral health behaviour

PURPOSE: To evaluate the evidence supporting effects and adverse effects of local analgesia using different pharmacological agents and injection techniques during dental treatment in children and adolescents aged 3-19 years. METHODS: A systematic literature search of databases including PubMed, Cochrane, and Scopus was conducted in November 2016. The PRISMA-statement was followed. Two review authors independently assessed the selected randomised control trials for risk of bias and quality. RESULTS: 725 scientific papers were identified. 89 papers were identified to be read in full text of which 80 were excluded. Finally, 9 papers were evaluated for quality and risk of bias. Many of the included papers had methodological shortcomings affecting the possibility to draw conclusions. Information about ethical clearance and consent were missing in some of the included papers. No alarming adverse effects were identified. One study was assessed as having low risk of bias. This reported inferior alveolar nerve block to be more effective than buccal infiltration for dental treatment of mandibular molars, while no differences were found regarding pharmacological agents. CONCLUSIONS: At present, there is insufficient evidence in support of any pharmacologic agent or injection technique as being superior compared to others. There is a need for more rigorous studies which also handle the ethical issues of including children in potentially painful studies.