It is with great regret that we report the sudden and tragic death of the Editor of the EAPD Newsletter, Maxine Pollard.

She was recently promoted to Senior Lecturer (equivalent to Associate Professor) in the Department of Paediatric Dentistry at the University of Leeds and her career in our speciality was developing rapidly. Her bright and outgoing personality meant that she was loved by all who knew her and she was able to encourage and teach many in the skills of Paediatric Dentistry.

Maxine entered an academic career rather later than most as she had raised a family and carried on a general dental practice with her husband John for a number of years. However, she then decided to take up a career in Paediatric Dentistry with a long term view of specialist practice. However, once started on her Master's degree, the academic `bug' took hold and she decided to stay on as a teacher. In this she proved to be most effective as well as in her selected area of research of the cariogenicity of foods and nursing caries. Within only seven years she made many contributions to the paediatric dental literature, organised conferences, gained research grants in several areas and then two years ago was appointed Director of the Leeds Postgraduate training programme.

Her child patients loved Maxine and she was very popular both with them and their parents. She was an excellent role model for the young undergraduate dentist in the management of children.

Her great sense of humour and joie de vivre endeared her to her colleagues at home and abroad. She was great to be with at meetings both scientifically and socially. She loved the mental stimulation and social interaction of the EAPD and ORCA Congresses as well as other scientific meetings.

Maxine will be very sadly missed by us all.

The present situation and indicators for the future.

Active discussions and planning for specialisation are being carried out by members of The Academy in various countries of Europe. It has always been one of the main aims of The Academy to ensure recognition and growth in the number of specialists in Paediatric Dentistry throughout Europe. This is a slow process which, in some countries, is already in place, in others will come about shortly and in others seems not to have even started. In these last countries it is not for want of trying by those committed to our speciality but rather opposition by other dental interests. This may be from general dental practitioners, who fear loss of business, but also from existing specialists of other disciplines in dentistry.

At the present time our speciality is recognised in Sweden and Norway. It is a hospital based speciality in Ireland and the United Kingdom. Within the European Union countries, therefore, it is only recognised in one (Sweden) and there is an EU requirement for two countries to recognise a speciality for the EU to authorise a speciality. We are now near to that happening. 

In the United Kingdom agreement to recognise dental specialities for private practice, by the governing body for dentistry, the General Dental Council, is under consideration and a committee (Task Force) is meeting to draw up the guidelines for Paediatric Dentistry. Recognition for specialists to practice their speciality outside of the hospitals is close to agreement. Within a short time, perhaps within the next year, we hope to see Paediatric Dentistry included as a recognised speciality. The EAPD will need to be ready to use the UK recognition to then make representations to the EU for Paediatric Dentistry to be a speciality within the EU. By the time of our Congress in 1998 we might well be able to attain our first objective.

Recognition of the speciality is however only a first step. Training programmes will be needed and marketing of the need for specialists nationally and locally throughout Europe and within individual countries. It is interesting that our sister organisation, the American Academy of Paediatric Dentistry (AAPD) has just announced a drive to recruit another 2,500 specialists to maintain a target ratio of 5.2 specialists of Paediatric Dentistry per 100,000 children. A ratio of approximately 1:20,000 is a target we can also use. To put this into perspective, we can use the example of the United Kingdom to show how many will be needed. The UK has a population of about 58 million and each year there are about 695,000 children born. Taking the age range of 0 to 16 years this means 11. 12 million children and the target ratio would indicate a need for 556 specialists. Today there are approximately 50 made up of hospital consultants, specialist practitioners and community dental service specialists. The numbers are difficult to determine accurately because some dentists do not confine their practice entirely to children. Nevertheless these UK data indicate the size of the task before us - a tenfold increase in numbers. With children comprising about 20% of a population and Europe having well over 250 million people, we have to think of a target of at least 2,500 specialists. This is what we should be aiming for.

We do not know how many specialists in Paediatric Dentistry we have at present. The Active members of our Academy number about 250, but not all existing specialists in Europe belong. Taking an optimistic view and doubling our members, we could estimate that at present there may be 500.

So what next? As it is the New Year and it is usual to make New Year's Resolutions the Academy's Resolution for 1997 should be to recruit all the specialists already in Europe to join the EAPD, to drive forward recognition of Paediatric Dentistry in the EU with a target date of May 1998 and set an objective of 2,500 European Specialists within 5 years.

by Stephen Fayle

The relationship between digit sucking and behaviour problems: a longitudinal study over 10 years.

Mahalski PA, Stanton WR.
Child Psychology and Psychiatry 1992: 33; 913-923.

This study was carried out as part of a larger longitudinal investigation of child health in New Zealand.
The main aim was to examine the long-term relationship between digit sucking and behaviour problems in children. The total sample comprised a cohort of 1037 children born in 1973. These children were followed up and their mothers were asked about digit sucking habits at 3, 5, 7, 9, 11, and 15 years. Mothers were also asked to complete Rutter's Behaviour Questionnaire for Parents. Of these, there were 760 whose mothers answered questions on digit sucking at least 4 ages and questions about behaviour problems at 5 ages.
Cross-sectional analysis showed a relationship between digit sucking and behaviour problems. Multiple regression analysis showed that digit sucking at 5 and 7 years predicted behaviour problems at 7, 9, and 11 years. In keeping with previous studies, children who still sucked a digit at 11 years were more likely to have an increased overjet.

A study of the development of the permanent dentition in very low birth weight children.

Kim Seow W.
Pediatric Dentistry 1996: 18; 379-384.

This study investigated dental development and the prevalence of enamel defects in very low birth weight (<1500g, VLBW) children. 55 caucasian children with a history of low birth weight (mean birth weight 1203g) aged between ages 5.5 years and 9.9 years were dentally examined and panoramic dental radiographs taken. A group of normal birth weight children matched for race, sex and age was used as a control.
VLBW children demonstrated a significant delay in their dental maturation of 0.29 ±0.54 years when compared with the controls. This delay was most apparent in children of six years or less at examination, with no delay being apparent in those of nine years and older, suggesting that these children may have the capacity to "catch up".
VLBW children had a significantly higher prevalence of enamel defects in first permanent molars and permanent lateral incisors, but, although the prevalence of permanent central incisor defects was higher in VLBW children, this did not reach statistical significance.

Success of electrofulguration pulpotomies covered by zinc oxide and eugenol or calcium hydroxide: a clinical study.

Fishman SA, Udin RD, Good DL, Rodef F.
Pediatric Dentistry 1996: 18; 385-390.

This study investigates the efficacy of primary molar pulpotomies where electrofulguration was used to produce haemostasis. In this technique, following mechanical amputation of the pulp, an electric current is applied to each pulp stump for 1-2 seconds via an electrode positioned about 1mm above the tissue, producing an electrical arc. The teeth were then randomly assigned into one of two groups, the stumps then being dressed with either zinc oxide and eugenol (ZOE) or calcium hydroxide (COH).

All teeth were coronally restored with stainless steel crowns. Teeth were evaluated clinically and radiographically after 1, 3, and 6 months by two independent examiners. After six months the clinical success of the ZOE and COH groups was 77.4% and 81.0% respectively. The corresponding radiographic success was 54.6% and 57.3% respectively. These differences were not statistically significant.

Bacteraemia in conjunction with endodontic therapy

Debalian GJ, Olsen I, Tronstadt L.
Endodontics and Dental Traumatology 1995; 11: 142-149.

Previous studies have suggested that endodontic procedures confined to within the root canal do not carry a risk of transient bacteraemia. This well designed study aimed to characterise any oral microorganisms believed to have spread from the root canal into the blood stream during and after endodontic therapy of teeth with asymptomatic apical periodontitis. Microbiological samples were taken under aseptic conditions from the root canals of 26 single rooted teeth in 26 subjects. In half these patients (Group 1 ), following determination of working length, fme reamers were deliberately inserted to 2 mm beyond the apex. In the other 13 subjects (Group 2) instrumentation ended 1 mm short of the apex. Blood samples taken during instrumentation and 10 minutes after treatment. Anaerobic organisms were isolated from all root canals. In 7 patients from Group 1 and 4 patients from group 2, bacteria with identical biochemical and antibiogram profiles to those isolated from root canals were isolated from blood samples. This strongly suggests that the micro-organisms isolated from blood samples had the root canal as their source and that bacteraemia may follow both extra and intra-canal endodontic preparation

Membership of The Academy stands at approximately 305, comprising Active, Associate, Honorary and Student Members. Over the past year the total membership has remained constant at around 300. Some original members have left and new members have been recruited. The number of student members has grown as the various training programmes in Europe nominate their students for membership. This is a good source of recruitment as most of the student members do transfer to Active membership on graduation. The number of overseas members, from outside of Europe, has also grown and we now have members, at the Associate level, in various countries including Israel, Iran, United Arab Emirates, Turkey and the USA

As practising dentists we usually only start paying attention to a child's behaviour when a problem arises in treatment or when progress is blocked. Yet children often send out messages beforehand. There are usually signs when there's likely to be any trouble. So if we have the right tools ready to deal with it we can support the child and continue the treatment smoothly. And the sort of support usually needed is moral support: a few words can make the difference between success or failure.

One way of providing support is to boost the patient's ego. It is often used in hypnotherapy to help a person through a difficult period, or to provide support when faced with a tough decision. To provide this sort of support to children, often all we need to do is keep a careful eye on the child and a close watch on what happens during the treatment. It was five-year-old Donavan's second visit to the dental department. The previous year treatment had been quite a shock and his dentist referred him to the pedodontic department. We let him get used to the treatment site gradually and the next session we successfully restored a tooth. At the follow-up he headed straight for the chair and lay back waiting for his local anesthesia. Everything was quiet and the dentist sat ready to give the shot when the stress became too much of a burden for Donovan, `I'm a little bit scared', he said timidly. His dentist usually answered in a repressive-tolerant way, like `I know, and I think you are right, but together we can do it.', and then continued talking while carrying on. Often, children only need to say what's on their mind and to show that they feel uneasy. With a little support it's soon over. This time the dentist took another trail, inspired by the pink socks Donovan happened to be wearing. Actually, it wasn't just pink, it was the kind of pink that strikes you in your face when you even try to look at it. He stopped, hesitated and stared out of the window a while. `This morning' he began, addressing no-one in particular, least of all his patient, `This morning I was sitting on the side of my bed thinking. I did not feel too happy, and I thought to myself, `If I were to put on my pink socks today I' d feel a lot better and I'd be a lot happier.' And he glanced aside as if looking for support. `I always feel I can do anything when I wear my pink socks, I always feel strong and brave. I can do more, but I didn't have any pink socks this morning so I had to wear a different pair. That's just the way it is'. And then, turning to Donovan, `Shall we carry on?…

Without a word the little mouth opened.

THE APPROPRIATE FILLING THERAPY OF MILK AND CHANGING TEETH

Dr Egbert Korperich FU, Berlin

The annual meeting of the Gesellschaft Fur Kinderzahnheilkunde Und Primarprohlaxe in the Deutsche Gesellschaft fur Zahn- Mund- und Kieferheilkunde was held in the university city of Ulme on 4th and 5th October. The first Chairman of the Society, Professor Klaus Pieper, pointed out the importance of the main topic `Alternatives to Amalgam in the Milk and Changing Teeth' which is today an important topic because of a restrictive position of the federal institute for drugs and medical products.

In everyday practical work the treatment of children still demands lots of skills from the dentist. Because of the fact that as far as filling materials are concerned children's parents are quite unknowledgeable, the dentist must look for good alternatives to filling materials which, according to Professor Pieper, can only be described as `prehistorical'.

AlternativesThe most commonly used alternatives in the milk teeth are Composites, Compomers and GIC. High viscosity GIC and Compomer are, according to Professors Hickel and Munich and Drs Kramer and Erlangen, the best alternatives for class I and class II cavities. In vitro testing on dentine layers, investigating tensile strength after the surface has been conditioned, the materials Dyract and Tetric showed better results than GIC (Dr Kielabssa et al, Frieburg). Both Dyract and Tetric also showed even better results after 24 hours than after 15 minutes. In literature so far the enamel etching time has been a parameter for optimal order seal in SAT (acid etching technique). Dr Buchalla et al, Frieburg, showed that an etching time of 20 seconds gave the same results as an etching time of 40 seconds using both the compomers Dyract and Compoglass.

Professor Staele, Heildelberg, spoke about minimal invasive care of milk teeth. The decision regarding what to do in preventive orientated restorative therapy is related to different forms of caries; rapidly moving caries, slow moving caries and stable or remineralised caries. A change from fast to slow moving and stable or remineralised caries can be found. Especially the last named kind of caries forces a modern preparation technique. Professor Staehle found that such changes may occur as a result of better oral health, increasing health attitudes and a more wide-spread use of preventive work in all areas of prophylaxis.

Another alternative to amalgam, ceramic inserts, was introduced by Professor Stachniss, Marburg. This filling technique is one of the oldest known. The advantages of using this system is a better border seal compared to the split that is due to polymerised associated shrinking of normal composites.

Another (also antique) filling material is gold foil, as introduced by Dr Kaman, Witten. Especially in small class I cavities this method gives an adequate alternative as proved by clinical studies. In a four year research programme, all fillings were still in situ and showing an optimal border seal.

Professor Hetzer et al, Dresden, have researched the stability of fillings in the milk teeth. They evaluated 6584 fillings in the teeth of 81 patients over a seven-year period. These consisted of 80% amalgam, 16% GIC and only 3% composite (due to the fact that compomer had only been available for the last two years of the study). The amalgam fillings had significantly better results than the GIC. It seems that amalgam is better than GIC while compomers could not be properly evaluated due to the short terms of its use. Stainless Steel Crowns (0.3% of the group tested) were a good alternative and should be used more often.

It often happens that simple filling of milk teeth is not possible when the destruction has been too great and then endodontic treatment becomes necessary. Dr Grassler et al performed clinical and X-ray research on milk teeth with endodontic therapy. The most successful method to use is the formocresol method. This allows vital as well as non-vital extirpations to be used. It has been found that the use of aldehydes has had bad side effects and should not be used.

In a research of Dr Terheyden et al, Kiel, it was shown that in dental abscesses in milk teeth a more yeast-like fungus was found among the bacterial flora compared to permanent teeth.

Epidemiology

Another topic of the congress has been epidemiology. Professor Pieper described caries incidence and paradontal situation among 6 year old children in Western Samoa. He had found that children in rural areas had significantly less lesions than those of urban or peri-urban areas. 

A decrease of caries, which had already been shown among older children, can now be found among the 6-36 month age group (Boemans et al, Giessen). The study was made in 5 paediatric offices among 300 children. An increase in caries containing maltodextrin-containing teas has been demonstrated by in vitro research by Zakipour et al, Giessen.

The Scientific programme was rounded off by a number of other speakers discussing caries diagnostic procedures using electrical resistance test and different alternatives in conservative and endodontic treatment in the milk and changing teeth. Even orthodontic treatment was part of the programme. With the programme seminars and workshops that dealt with practical and relevant topics, there were matters to interest all participants.

The West of Scotland Group

Presents
British Society of Paediatric Dentistry

TOWARDS THE MILLENIUM

 Annual Scientific Meeting 1997

Central Hotel Glasgow
3rd to 6th September 1997

Contact:
Mr Iain Buchanan
Secretary West of Scotland Group BSPD
Orthodontic Department
Glasgow Dental Hospital
Sauchiehall Street
Glasgow G2 3JZ
Tel + 141 211 9669