The most frequent role reported in verbal school bullying epi-
sodes was ‘bully’ (17.5%). The second-most common role re-
ported was ‘victim’ (16.5%).
Possible SB and involvement in bullying were shown to have a
statistically significant relationship, with most of the adolescents
with SB already having been involved in bullying episodes. SB and
economic class also were related, with bruxism more frequent
among those in the lower economic class. In multivariate analysis,
adolescents with SB were 6 times more likely to have been
involved in bullying episodes than those without SB regardless
of economic class.
DENTIST’S ROLE
Dentists can play an important role in identifying adolescents
at risk for SB and enduring bullying at school. This may
also help in managing depression and suicidal ideation,
which may go unnoticed by teachers or parents. To effec-
tively identify adolescents involved in verbal school bullying,
the dentist should perform a thorough clinical assessment
and take a complete history, noting any warning signs for
behavioral health issues. Dentists can also help to formulate
and conduct an educational campaign to prevent verbal
school bullying. They can also be involved in creating guide-
lines for parents and teachers to use in recognizing bullying
adolescents.
DENTAL CARIES
Treatment of deep caries
BACKGROUND
Pulp-invasive treatments such as root canals are most often done
to manage deep carious lesions in adults. However, sufficient ev-
idence to support the current treatment recommendations for
deep caries and inflamed pulp is lacking. The depth of the carious
lesion is often not indicated in pulp-capping studies, so prognosis
for this aspect is also in question. The terminology and proced-
ures relating to carious removal have been updated to use
more clinically focused terms. Thus what was partial or incom-
plete removal is now selective removal to soft or firm dentin and
what was complete removal is now nonselective removal to hard
dentin. Deep caries can now be addressed by a 1-stage selective
removal process or a 2-stage stepwise removal process. With
these updates, an extension of a previous couple of randomized
clinical trials was conducted, taking the original studies beyond
the 1.5-year follow-up to a 5-year follow-up. In addition, the anal-
ysis covered an assessment of pulp vitality, pain, age, and apical
radiolucency for both unexposed and exposed pulps.
Clinical Significance
Future studies should look at all of the possible peer-
related bullying in school, including how frequently it
occurs and the specific roles played by the various
individuals. Until that information is available, dentists
can include questions regarding SB and bullying dur-
ing history taking and physical examination perfor-
mance. They can also take a public role in
prevention campaigns that educate parents and
other adults, as well as adolescents, about the rela-
tionship between verbal school bullying and psycho-
logical, overall physical, and specific oral health
issues. Early identification can avoid the development
of potentially more severe problems in the future.
Serra-Negra JM, Pordeus IA, Corr^ea-Faria P, et al: Is there an as-
sociation between verbal school bullying and possible sleep
bruxism in adolescents? J Oral Rehabil 44:347-353, 2017
Reprints available from JM Serra-Negra, Dept of Pediatric
Dentistry and Orthodontics, Universidade Federal de Minas Ger-
ais, Av Ant^
onio Carlos 6627, zip code: 31270-901 Belo Hori-
zonte, MG, Brazil; e-mail juniaserranegra@hotmail.com
METHODS
The original studies covered 314 individuals and tested the ef-
fects of stepwise carious tissue removal compared to nonselec-
tive carious removal to hard dentin. All of the teeth in question
had carious lesions that involved at least three-fourths of the
dentin. Stepwise removal of the carious tissue was found to
result in fewer pulp exposures than nonselective carious
removal to hard dentin. The success rate was higher for the
stepwise removal. Success was defined as having an unexposed
pulp with sustained pulp vitality and no apical radiolucency.
Fifty-eight of the 68 patients with exposed pulps after excava-
tion were randomized to direct pulp capping and the rest had
partial pulpotomy. No difference was found between the direct
and partial pulpotomy groups, but the overall pulp survival was
low at 32.8%. For the extension to 5 years, 239 of the original
patients (76.2%) were evaluated, with 118 from the stepwise
excavation group and 121 from the direct complete excavation
group.
Volume 63  Issue 1  43
RESULTS
The stepwise group was assessed a median of 5.0 years after their
first observation period, and the nonselective removal group was
evaluated a median of 4.5 years after their first observation
period. The proportion of success of the stepwise removal group
was 60.2%, which was significantly higher than the 46.3% of the
nonselective carious removal to hard dentin group.
When Cox regression analyses were done of the nonexposed
pulp treatments, age was the only variable that had no effect on
outcome when adjusted for center, intervention, and pain. In
both nonexposed and exposed treatments, choice of treatment
had some effect, but it was not significant when adjusted for other
variables. Age and pain significantly influenced whether a treat-
ment would succeed, regardless of what treatment was
undertaken.
Pulp-capping comparisons indicated no statistically significant dif-
ferences between the options.
DISCUSSION
After 5 years, adult patients with well-defined deep carious le-
sions were shown to have better results when stepwise removal
was undertaken compared to the 1-stage selective approach.
DENTIN HYPERSENSITIVITY
Mouthwash to reduce pain
BACKGROUND
Dentin hypersensitivity (DH) is characterized by pain when
exposed dentin is stimulated by chemical, thermal, tactile, or
osmotic agents. It is not related to any other dental disease
or condition. Many therapies have been developed, but the
best management option remains unclear because the actual
cause of DH and the mode of action of the various interven-
tions remain in doubt. Scientific evidence is lacking in support
of any specific therapeutic option. A systematic review was
done to determine how the home use of desensitizing mouth-
washes compares to placebo agents for reducing pain related
to DH.
METHODS
Searches were done of MEDLINE, PubMed and the Cochrane
Plus Library up to February 2015. The duration of follow-up
was required to be at least 6 weeks and the report had to detail
changes in response to tactile stimuli, thermal/evaporative stim-
uli, or patients' subjective report of the pain experienced after us-
ing the desensitizing agent. Seven articles met the criteria and
were considered for meta-analysis. Follow-up was 6 weeks in 4
44 Dental Abstracts
Clinical Significance
Use of a stepwise carious removal procedure results in
a significantly higher proportion of pulps that have pre-
served vitality without apical radiolucency after 5 years
than use of a nonselective carious removal of deep
caries lesions. Avoidance of pulp exposure is impor-
tant for older patients and those with mild pain before
treatment. More RCTs are needed to determine if se-
lective carious removal is better than 2-stage stepwise
removal of deep carious tissue.
Factors that contributed to a lesser likelihood of success included
age and the presence of mild pretreatment pain.
Bjørndal L, Fransson H, Bruun G, et al: Randomized clinical trials
on deep carious lesions: 5-year follow-up. J Dent Res 96:747-753,
2017
Reprints available from L Bjørndal, Dept of Odontology, Section of
Cariology and Endodontics, Univ of Copenhagen, Nørre Alle 20,
DK-2200 Copenhagen N, Denmark; e-mail: labj@sund.ku.dk
studies and 8 weeks in 3. The study population consisted of orally
healthy patients who had DH in 5 trials and periodontal patients
scheduled for pocket reduction surgery or complaining of root
sensitivity in 2 trials.
Most patients (not reported in 1 study) were instructed to rinse
twice a day with 10 or 15 ml of the mouthwash for 30 or 60 sec-
onds. They could brush their teeth before or after using the
mouthwash. Compliance was checked in 5 studies. Potassium ni-
trate was a component of the test mouthwash in 5 trials; 1 of the
others contained 2.18% aluminum lactate and 1 used sodium
fluoride.
RESULTS
When the results of the 7 studies were pooled, no significant dif-
ference was shown between the placebo and treatment groups
for reducing DH pain. There was a trend toward reducing the ef-
ficacy of the mouthwashes over time. However, no statistically
significant differences were observed between the test and con-
trol groups at any time based on tactile or thermal/evaporative
stimuli.