J. Foley

Background: Dental decay in children’s primary teeth is a major health problem in the Great Britain with, in some areas, nearly 60% of five-year-olds having some experience of caries and 16% already having had at least one tooth extracted. Whilst currently accepted best practice for the management of carious primary teeth involves complete caries removal and placement of a plastic restoration, such conventional treatment is unpopular with general dental practitioners. Indeed, less than 15% of carious cavities in five-year-olds are currently restored and as such, there has been recent interest in alternative ‘minimal intervention’ treatment techniques for managing dental caries. Review: This review summarises the literature and also recent research efforts directed towards understanding the role of alternative treatment régimens including: (1) alternative techniques for cavity preparation and excavation and (2) the isolation of the carious process (in some cases, using cariostatic materials) from the oral environment or sealing in dental caries.

To determine the acceptability and efficacy of nitrous oxide inhalation sedation for dental treatment to children and to compare these results with the responses of both the accompanying adult and the treating dentist. A prospective, questionnaire-based survey was used. Fifty consecutive patients (ASA I and II) attending the Department of Paediatric Dentistry, Edinburgh Dental Institute, between 2002 and 2003 for dental treatment using nitrous oxide inhalation sedation were recruited for the study. Each patient, the accompanying adult and the dental sedationist completed a short questionnaire which sought details about the acceptability and efficacy of the sedation technique. Overall behaviour and the outcome of treatment were assessed by the dentist providing sedation using the Frankl and Houpt Behaviour Rating Scales respectively. Three sets of questionnaires were completed for fifty patients (M:27; F:23), mean age 10.4 years (range: 5.3-15.8 years). Acceptance of both local analgesia and dental treatment was perceived as greater amongst patients and carers compared with treating dentists (chi2 = 11.31, P = 0.004, 2 df and chi2 = 22.52, P < 0.001, 2 df respectively). Furthermore, dentists observed that inhalation sedation helped fewer male patients with local analgesia and fewer female patients with dental treatment (chi2 = 6.83, P < 0.009, 1 df and chi2 = 3.85, p < 0.050, 1 df respectively). A greater proportion of dentists observed that patients would manage treatment without sedation and would not require sedation for future dental treatment than both patients and their accompanying carer (chi2 = 8.00, P < 0.018, 2 df and chi2 = 18.61, P < 0.001, 2 df respectively). In general, the majority of patients were co-operative and successfully completed dental treatment with inhalation sedation. Dentists' perception of nitrous oxide inhalation sedation was generally less enthusiastic than that of patients and carers.

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