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Srishti Datta: Post-CCST Registrar in Paediatric Dentistry, Newcastle Dental Hospital

A guideline for the extraction
of first permanent molars in children

Children who present with compromised first permanent molars (FPMs) can experience sensitivity, toothache and an increased risk of caries. The prognosis of these teeth is often uncertain and post-eruptive breakdown secondary to molar incisor hypomineralisation at a young age can result in extensive restorations and a high burden of care. In some cases planned loss of a compromised FPM can lead to spontaneous space closure via successful eruption of the second permanent molar (SPM). 

The authors highlight factors that need to be considered during management of compromised FPMs and discuss predictors of successful eruption of the SPM following interceptive extractions. They also describe instances when this guidance should not be used. They recommend that when enforced extraction of a lower FPM is required, compensating extraction of a sound upper FPM should not be routinely carried out unless there is a clear occlusal requirement or likelihood of the upper FPM being unopposed for a significant period of time. They state that routine balancing extraction of a sound FPM to preserve a dental centreline is not recommended unless part of a comprehensive orthodontic treatment plan.

Dentists who treat children should be familiar with this guidance to aid clinical decision-making in the developing dentition and to ensure that timely referrals for specialist-led treatment planning can be completed when appropriate.

 Noar J, Taylor G, Ashley P, Williams A, Harrison M, Cobourne M (2023). Available at www.rcseng.ac.uk/dental-faculties/fds/publications-guidelines/clinical-guidelines

Rights from the start: the place
of children’s rights in clinical dentistry

The United Nations Convention on the Rights of the Child states that adults should know about all the rights that children are entitled to, help children learn about them and ensure children enjoy them. This article encourages dentists to question how to translate children’s rights into practical action in dentistry.

The author explores some examples of key children’s rights that are relevant to clinical dentistry, including Article 24 (the best health care possible), Article 17 (information they can understand) and Article 12 (giving their opinion and adults taking it seriously). A colourful fact sheet is included, co-developed with support from the UK Committee for UNICEF Child Friendly Cities and Communities programme, and endorsed by organisations such as the British Dental Association and the National Society for the Prevention of Cruelty to Children. 

It is important to improve our knowledge and confidence of children’s rights when seeing paediatric dental patients. Displaying this fact sheet as a poster in communal areas such as receptions can be the first step in upholding children’s rights in our daily clinical practice.

Harris J. Br Dent J 2023; 234: 796–799

 Multi-site service evaluation
of silver diamine fluoride use for children

Silver diamine fluoride (SDF) contains silver and fluoride, and can be used off-label to arrest caries. It causes permanent black discolouration of carious lesions, which has resulted in varying degrees of acceptability among parents across the world. Its use in the UK increased during the COVID-19 pandemic. 

This service evaluation of six paediatric dental services aimed to establish how SDF is being used in the UK, and consider patient and parental views of this treatment modality. Data were collected for 54 patients aged two to 13 years over a two-year period using proformas at initial and follow-up appointments in hospital and community-based dental services. Patients and parents rated their satisfaction with aesthetics and treatment experience using a five-point scale.

The authors reported that reasons for choosing SDF included avoidance of general anaesthetic, stabilisation, acclimatisation, avoidance of extractions and insufficient cooperation. They concluded that the majority of children and parents were accepting of the technique and immediate aesthetic outcome. These novel data are the first step prior to further research on how to implement the use of SDF in NHS primary dental care services to reduce caries progression and improve the oral health-related quality of life in children.

 Timms L, Bux S, Maybin L et al. Br Dent J 2023; 235: 269–272

Global overview on current paediatric dentistry teaching: survey of National Member Societies of the IAPD

This cross-sectional survey aimed to investigate the status of current teaching of undergraduate and postgraduate dental students in paediatric dentistry (PD) globally and identify differences by the level of a country’s economic development. The 26-item questionnaire was sent to 80 national member societies of the International Association of Paediatric Dentistry with questions on undergraduate and postgraduate PD curricula, types of postgraduate education offered and recognition of the specialty.

The overall response rate was 63% and results showed that while all countries offered teaching in PD at an undergraduate level, there was variation in postgraduate teaching offered. In addition, high-income countries offered a significantly larger proportion of postgraduate specialisation courses than low-income countries. PD was not an officially recognised specialty in 20% of the participating countries.

The authors identified global differences in teaching, which affect the provision of dental care for children, and mobility of specialists and their career opportunities. They suggest the need for uniform educational curricula to meet the treatment needs of children globally.

 Agouropoulos A, Seymen F, Kupietzky A, Bönecker M. Int J Paediatr Dent 2023; doi: 10.1111/ipd.13097