We retrospectively reviewed the clinical records and radiographs of 100 patients who had had supernumerary teeth removed. Their mean (SD) age was 9 years 3 months (2). The 100 patients had a total of 127 unerupted maxillary incisors associated with supernumerary teeth. The supernumerary tooth was removed without exposure of the permanent tooth more often among the 79 younger children (aged 10 years or less) (SND=3.52, P<0.01), and when the incisors were less mature (Cvek classification 1,2, and 3) (SND=5.27, P<0.01). Of these incisors with immature roots that were treated conservatively, 60 (72%) erupted and 24 (28%) required further operation. Of the mature incisors treated conservatively, 10 (63%) required further operation. In this study, almost three-quarters of immature incisors erupted spontaneously after removal of the associated supernumerary teeth. Over half of the mature teeth required further operation. Mature teeth should be exposed with or without bonding at the time of removal of the supernumerary teeth.

Audit is widely used to improve the quality of care in both medicine and dentistry but has not always been subject to systematic evaluation. The aim of this study was to assess the effect of an audit exercise on the diagnosis of occlusal caries. Using combined visual and radiographic methods. 11 dentists assessed 60 extracted molars for occlusal caries on two occasions. An audit exercise, in the form of a meeting, was carried out in the intervening period. Inter- and intra-examiner reproducibility were estimated for each of the two examinations. Validation was through a gold standard set up by sectioning the teeth. Wide diagnostic disparity was seen at both examinations, all inter- and intra-examiner kappa values were below 0.73. Intra-examiner kappa values increased significantly on the second occasion. Mean sensitivity and specificity were 0.65 and 0.74, respectively, at the first examination and 0.65 and 0.72 at the second. No changes were seen that could be attributed directly to the audit exercise but practising the diagnostic test appeared to be beneficial to intra-examiner reproducibility of diagnosis.

Weaning practice can have a major influence on both immediate and future dental health and good dietary practices from birth have the potential to secure a healthy dentition for life. In a recently published report it is recommended that infants (an infant may be defined as a child who has not yet reached the age of one year) be weaned on foods and drinks free as far as possible of non-milk extrinsic (NME) sugars. At the same time, there has also been an increasing development of low-sugar and sugar-free products for infants. There has also been growing concern that infant drinks with low pH may cause enamel erosion in primary teeth, a phenomenon that is perhaps more widespread than has been recognised in the past. The aim of the weaning diet is to achieve a diet which fulfills nutritional requirements for the growing child and which contains a wide variety of foods and drinks. It is suggested that items high in NME sugars are not a necessary part of the diet, should be regarded as 'occasional', and not given every day. Drinks other than milk or water should constitute a minority of total drinks and be given only at main mealtimes; they should not be given in bottles or at bedtime.

The 4-year results of a fissure sealant trial are reported. Glass polyalkenoate and bis GMA sealant were applied to 590 first permanent molar teeth using a half mouth study design in a group of 228 6-8-year-old children. Similar cariostasis was observed for the two materials at the end of 4 years despite marked differences in retention. Polyalkenoate cements probably should be regarded as 'fluoride depot' materials rather than fissure sealants when used in this context.

Previous surveys carried out in the inner city area of Camden between 1966 and 1986 gave indication of a deterioration in dental health in pre-school children during the 1980s. Four hundred and six children were included in the current survey, which used the same sampling and methodology as previously. The aims of the present survey were to determine the current prevalence of caries and of rampant caries and to relate prevalence to social factors, to infant feeding habits and to the use of sweetened comforters, and to determine the extent of dental care received. Caries affected 11% of 2-year-old children and 29% of 3-year-olds, rampant caries affected 6% and 14% respectively, A higher likelihood of caries occurred in children of Asian origin and those given a sweetened comforter. For rampant caries, likelihood was greater amongst those of Asian origin and those given a sweet drink in a bottle for 2 years or longer. Comparison with results of the last study provides little evidence of improvement in dental health in young children in this low fluoride area, with a small proportion suffering relatively severely from caries.

Day-stay general anaesthesia facilities may be employed to provide comprehensive dental care for children who are unable to accept treatment using alternative methods of patient management. This approach to delivery of care has been shown to be cost-effective, acceptable and efficaceous. This study was set up to investigate changes in the pattern of care provided in day-care facilities at a London dental teaching hospital over a 20-year period--1972 to 1992. The results show that the use of the facilities at this centre has increased with time, with a greater increase amongst older children in recent years. Although the main use is still for the treatment of caries, oral surgery procedures, especially those related to orthodontic treatment, have increased by 200% between 1982 and 1992. This correlates with the increase in older age groups being treated. Details of mean numbers of teeth restored and extracted for each age group are presented for 1992. They indicate, for the younger age groups, not only the high treatment needs of patients referred to the hospital, but also suggest a trend for more radical treatment planning in order to avoid further general anaesthesia. Readers are reminded that, despite its advantages, general anaesthesia should be avoided if possible

A multi-center study of caries experience and defects of dental enamel was conducted among 12-yr-old children in north London, Edinburgh, Glasgow and Dublin. None of the cities had water fluoridation except Dublin, which was included in the national program introduced in the Republic of Ireland in 1964. A random sample of children was drawn from state schools in each location and identical methods of clinical examination were used throughout under the same standardized conditions. All examiners were trained and calibrated with a reference examiner and achieved high levels of inter- and intra-examiner consistency. Mean DMFT values for the 4 cities were 1.27 (London), 1.39 (Edinburgh), 2.70 (Glasgow) and 1.48 (Dublin) (P < 0.001). Proportions of subjects free from caries in the same order were, 50, 47, 24 and 43% (P < 0.001), and child prevalence of diffuse opacities, 28, 29, 7 and 17% (P < 0.001), respectively. The relatively low caries levels recorded in London and Edinburgh (lower than Dublin) were considered to be related most probably to fluoride effects other than water fluoridation.

An article published last year in the British Medical Journal has illustrated that severe deafness does not preclude a career in medicine. My own experience and that of others prompts me to write that the same is true of dentistry. For patients who are deaf, dentists need to be aware of simple measures that may ease communication and avoid misunderstanding

Diagnosis of early occlusal caries has proved more difficult than that affecting smooth or approximal surfaces. With time, this type of lesion has come to form a greater proportion of caries as a whole and its accurate diagnosis is consequently becoming more important. The most widely used methods of diagnosis are visual inspection and bitewing radiography but the value of both of these for occlusal caries has been questioned. The aim of this study was to investigate the validity of diagnosis using each of these two methods in extracted teeth. A total of 100 first permanent molars and 100 second primary molars were used and teeth and sites with questionable or borderline caries were selected for examination. The condition of the tooth on section was used to validate. In these samples sensitivity of radiographic diagnosis was greater than that of visual diagnosis. Both methods showed good specificity. When radiographs were used together with visual examination the status of 82% of first permanent molars and 91% of second primary molars were correctly classified.

This study provides information about snacks and drinks regularly consumed by a group of 2139 4-year-old children. Data were collected through a simple questionnaire completed at interview. Findings were related to caries levels measured at clinical examination 6 months later. Results confirmed that nearly all children had one or more snacks or drinks on most days. The most popular time for these was mid-afternoon. Sweet biscuits and fruit were the most popular snack foods and diluted fruit squash and milk the most popular drinks. Caries, as expressed in mean dmft, increased significantly with increasing number of intakes.

An in vitro study, using dynamic stress analysis and two dimensional photo-elasticity, carried out to relate the strength of porcelain veneers fabricated to three different designs, demonstrated that the 'window' type of preparation was the strongest compared with 'overlapped' and 'feathered' designs. It also confirmed that the strength of the veneer was not proportional to its thickness. It can be concluded that where strength is an important prerequisite, the most conservative type of veneer, namely the 'window' preparation, is the design of choice

One well recognised cause of enamel opacities is excessive fluoride ingestion during the period of tooth development. In the past, "fluorosis", or opacities arising from this cause, has been reported to occur in children given fluoride supplements. In a large experiment in dental health education, fluoride supplements were given regularly to many of the children in two out of three experimental groups. 126 children were dentally examined 10 yr after the scheme began, of whom 79 had regularly received fluoride drops and/or tablets for at least part of the period between birth and 5 yr of age. Labial surfaces of each child's erupted incisor teeth were examined for enamel opacities. 75% of the 126 children had at least one affected tooth. There was a statistically insignificant, but consistent, trend for the prevalence of opacities to increase with increasing duration of use of fluoride supplements.