PubMed Health⌕ Search

Biomedical subjects

C J Holmgren

Publications and source records attributed to C J Holmgren.

At least 19 recordsLinked to original sources
PubMed2001

Provision of Atraumatic Restorative Treatment (ART) restorations to Chinese pre-school children--a 30-month evaluation.

OBJECTIVES: The objectives of this study were: to provide restorations using the ART approach to pre-school children in Southern China in a kindergarten environment, using a high-strength glass-ionomer restorative material; to assess the acceptability of this approach and to evaluate on a longitudinal basis the restorations placed. SAMPLE AND METHODS: A total of 170 ART restorations were placed in 95 children, aged 5.1 +/- 0.7 years, by seven final-year dental students using standard ART procedures and hand instruments. The restorations were evaluated every six months thereafter by two calibrated independent examiners using explorers and mouth-mirrors. RESULTS: 93% of the children reported that they did not feel pain during treatment and 86% were willing to receive ART restorations again. The cumulative 12- and 30-month survival rates of Class I restorations were 91% and 79%, respectively. The corresponding figures for Class V restorations were 79% and 70%, while those for Class II restorations were 75% and 51%. The failure rates of Class III and IV restorations were high with more than half of them scored as missing within the first year. CONCLUSIONS: The ART approach was shown to be acceptable to Chinese pre-school children for providing restorative dental care outside the traditional clinical setting. The success rates were high for Class I and V restorations in primary teeth, modest for Class II, and low for Class III and IV restorations.

Analysis of Variance↗
PubMed2000

ART restorations and sealants placed in Chinese school children--results after three years.

OBJECTIVES: These were to assess whether ART restorations and sealants could be provided to children in a school environment in China, to assess patient acceptability of the ART approach, and to evaluate on a longitudinal basis the treatments performed. METHODS: This study was conducted in Deyang, Sichuan Province, in western China. A total of 294 ART restorations were placed in 197 children and 191 fissure sealants were placed in 140 children by five middle-level dentists in four secondary schools. Standard instruments and procedures for ART were used. The restorative material used was a high-strength glass-ionomer (Ketac-Molar, ESPE). The treatments were evaluated annually after placement by the same examiner who had not been involved in the placement of the restorations nor sealants using explorers and mouth-mirrors. At the 3-year examination an independent external examiner evaluated the restorations using USPHS criteria. RESULTS: Most of the children did not report discomfort during treatment and 92% were willing to receive ART restorations again. The cumulative 1-year and 3-year survival rates of small Class I restorations were 99% and 92% respectively. The corresponding figures for large Class I restorations were 90% and 77%. After 3 years, 72% of the sealants were either partially or completely retained. Only 2% of the sealed teeth developed fissure caries and these involved teeth where the sealants had been lost. Similar success rates were found using USPHS criteria. CONCLUSIONS: The ART approach for preventing and treating tooth decay in Chinese school children was shown to be appropriate, effective and acceptable. The 3-year survival rates of the restorations were high but were related to the size and type of the restoration.

Adolescent↗
PubMed1999

How effective is ART in the management of dental caries?

The ART approach involves excavating cavitated dentine caries with hand instruments, then restoring the cavity and sealing any associated fissures and pits with an adhesive restorative material, resulting in a sealant restoration. Until recently, ART has mainly been used under field conditions, and thus the adhesive restorative material used has been glass ionomer which does not require mixing machines and curing lights. Since the inception of ART, a growing number of studies world-wide have taken place. A total of four studies have reported 3-year survival percentages for one-surface ART restorations. The highest 3-year survival percentage in permanent teeth was 88%, which is comparable to the 85% survival of one-surface amalgam restorations placed under the same field conditions after 3 years. The outcomes depend to some extent on the material used, operator experience and presence of caries. The presence of caries as a reason for failure was higher in the early than in the most recent studies. Only one study has reported on the use of ART restorations in the deciduous dentition. It is concluded that: a very large proportion of dentine lesions in the permanent teeth can be treated using the ART approach; the 3-year survival rate of the more recently placed one-surface ART restorations in permanent teeth was higher than that of ART restorations placed in the beginning; the survival of one-surface ART restorations in the permanent dentition with newer glass ionomers is comparable to that of one-surface conventional restorations placed using amalgam in a comparable setting after 3 years; more studies of longer duration are needed to confirm these findings; ART should be considered a caries treatment modality that benefits people; and educational courses need to be organised before the approach is applied in the clinic.

Adolescent↗
PubMed1999

Painting the future for ART.

The objective of this paper is to review recent research and developments with respect to the atraumatic restorative treatment (ART) approach and to outline future areas of research and development. Areas identified as requiring further investigation include the evaluation of: ART restorations for longer than 3 years duration using recognised evaluation criteria, multi-surface ART restorations, ART restorations in primary teeth and ART sealants. In addition, the possibility and potential dangers of caries remaining after cavity cleaning with hand instruments must be investigated and the findings balanced against the known damage to sound tooth tissue caused by more routine cavity preparation techniques. New bioactive restorative materials which offer the possibility of healing dentinal caries lesions should be developed and evaluated. Finally, behavioural and educational aspects of the ART approach should be investigated.

Cariostatic Agents↗
PubMed1999

Dental caries status and treatment needs of 12-13-year-old children in Sichuan Province, southwestern China.

OBJECTIVE: To update information on the dental caries status of children living in the Southwestern part of China for planning appropriate dental care services and to obtain information on caries level in rural areas. METHOD: All first year students studying in seven secondary schools (two in urban, two in peri-urban and three in rural areas) in Sichuan Province were surveyed. The students were clinically examined in their schools using procedures and diagnostic criteria recommended by the World Health Organization. RESULTS: A total of 1,542 children, 12-13 years of age, were examined of which 660, 519 and 363 were from the urban, peri-urban and rural schools respectively. The prevalence of caries experience was highest in urban children (30%), followed by peri-urban children (21%) and lowest in rural children (13%). The respective DMFT index scores for the urban, peri-urban and rural children were 0.62, 0.38 and 0.18. The differences were statistically significant (P < 0.001). The major component of the DMFT index was untreated decay (DT) in all three areas. CONCLUSION: There was a clear trend of increasing prevalence and severity of dental caries in children as the survey sites moved from rural, through peri-urban to urban areas. Thus, estimates of dental caries in Chinese child populations of this age based on surveys conducted in urban areas will probably lead to gross over-estimation as over 80% of the people live in rural areas.

Adolescent↗
PubMed1996

Clinical performance of preventive resin restorations placed in a hospital environment.

This study was conducted retrospectively to evaluate the clinical performance of preventive resin restorations. Five hundred thirty-two restorations in 351 patients had been in the mouth for a mean of 16.5 %/- 7.6 months. The clinical performance was determined with a modified version of the US Public Health Service rating system. In 79.9% of the restorations, the marginal discoloration was rated as Alfa (no discoloration), while only 0.9% were scored as Charlie (discoloration penetrating in a pulpal direction). The marginal adaptation was rated as Oscar (fully sealed) in 28.4% of restorations; in only 0.4% of restorations, rated as Charlie or Delta, was the dentin or base exposed. In 98.3% of the restorations evaluated, the anatomic form was rated as Alfa (continuous with existing anatomic form). Recurrent caries was associated with 2.3% of the restorations. Chi-squared tests failed to reveal any statistically significant relationships between the clinical performance of the restorations and the length of time in the mouth.

Analysis of Variance↗
PubMed1994

The Hong Kong adult oral health survey--1991: background, study population, and methods.

This second adult oral health survey was conducted with the following main aims: 1) to describe the oral health conditions and to analyse the oral health care needs and demands of 65-74-yr-olds in Hong Kong, and to propose appropriate strategies for meeting their needs in the light of societal obligations; 2) to describe the oral health conditions and to analyse the oral health care needs and demands of 35-44-yr-olds in Hong Kong with special emphasis on assessment of changes in this age group since 1984 (when the first adult oral health survey was conducted); 3) to assess the impact of sociodemographic and dental care system factors on the oral health status of selected adult age groups: and 4) to utilize survey data to refine curriculum development and research strategies in the Faculty of Dentistry, as well as in the proposal of appropriate action to governmental committees on dental health policy. For enhanced comparability with the previous study, the 35-44-yr-olds were selected from the same geographic areas of Hong Kong Island. Multistage cluster sampling was used to recruit the study population, defined geographic units and addresses being used as the starting-point. A sample of 398 subjects was selected, of whom 93% were both interviewed and clinically examined. The 65-74-yr-olds were recruited from housing estates in all principal areas of Hong Kong, yielding a sample of 559 subjects, of whom 96% were both interviewed and clinically examined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Oral mucosal lesions in 65-74-year-old Hong Kong Chinese.

There have been no reported surveys of oral mucosal lesions among the elderly in Asian countries. Therefore, the purpose of this study was to determine the prevalence of oral mucosal lesions among 65-74-yr-old, community-dwelling elderly Chinese in Hong Kong and to determine the prevalence of lesions in denture wearers, tobacco smokers, and alcohol drinkers. A total of 537 noninstitutionalized 65-74-yr-olds were interviewed and clinically examined in an oral health survey conducted in 1991. In the survey, the elderly underwent a systematic examination of their oral mucosa by one of the three examiners with the aid of an overhead light. The examiners were trained and calibrated before and during the survey, and a specially prepared colour atlas of oral mucosal lesions was used for lesion recognition. No mucosal lesions were detected in 64% of the elderly. In the 193 elderly subjects with lesions, 80% exhibited only one lesion. There was no difference in prevalence between men and women. The more common lesions, each being found in 5-7% of the elderly, were lingual varicosities, frictional keratosis on the buccal mucosa, denture stomatitis on the palatal mucosa, and denture-induced hyperplasia in the maxillary and mandibular buccal sulcus. Denture wearers had a higher prevalence of lesions (40%) than nonwearers (32%). There was no difference in the prevalence or number of oral mucosal lesions between those defined as users of tobacco and alcohol and those defined as nonusers in this study. No confirmed oral malignancies were found.

Aged↗
PubMed1994

Periodontal conditions among the middle-aged and the elderly in Hong Kong.

The aim of this study was to describe the periodontal conditions in 372 35-44-yr-old and 537 noninstitutionalized 65-74-yr-old Hong Kong Chinese who were examined clinically for loss of attachment, recession, probing depth, calculus, and bleeding after probing. Community Periodontal Index (CPI) data and treatment need indications were compiled from index teeth or their substitutes. The prevalence of loss of attachment varied considerably in both cohorts according to the definition of the threshold (> or = 6, > or = 9, and > or = 12 mm, respectively). The mean numbers of teeth with loss of attachment at the > or = 6-mm threshold and at higher thresholds were small. In both age cohorts, about one-fifth of subjects had probing depths > or = 6-mm, while at the > or = 9-mm threshold only 2-3% were so affected. Although recession was an important component of loss of attachment in the younger cohort, in the older cohort the prevalence and extent of recession were greater than for probing depths at thresholds > or = 4 mm. All subjects had one or more teeth with calculus, bleeding, or both, most teeth being so affected. Eighty-four of the 537 65-74-yr-old subjects were excluded either because of edentulousness or because extractions indicated for the remaining teeth would have rendered the subjects edentulous. The distribution of subjects according to their highest CPI score was remarkably similar for the two cohorts. No subjects in either age group were assessed as "healthy" (CPI code 0) or had "bleeding only" (code 1) as their highest score. While most subjects scored CPI code 2 or 3 as their highest score, only 17% of the younger and 15% of the older cohort scored Community Periodontal Index of Treatment Needs (CPITN) code 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Oral health care needs among the middle-aged and the elderly in Hong Kong.

A sample of 372 35-44-yr-olds and 537 noninstitutionalized 65-74-yr-olds were clinically examined in an oral health survey of Hong Kong Chinese conducted in 1991. The examination procedures and diagnostic criteria for assessing restorative and extraction treatment need followed those recommended by the World Health Organization. The Community Periodontal Index-based periodontal treatment needs involving index teeth or their replacements were computed from separate clinic scores for maximum probing depth, presence of calculus, and bleeding after probing. A set of criteria for assessing prosthodontic treatment need was specially laid down for this survey. Examiners were calibrated before the survey, and the interexaminer reliability was found to be generally good. Besides reporting the various individual normative treatment need items in the traditional way, the present analysis used some holistic treatment-need categories which may have manpower-requirement implications for the classification of subjects. All dentate subjects surveyed required some treatment. Only 6% of the elderly, all edentulous, required denture work only. Of the 35-44-yr-olds, 42% needed scaling and oral hygiene instruction only, which could be provided by dental hygienists. The treatment needs of the vast majority of the middle-aged and the elderly (mainly scaling; simple fillings; and extractions, dentures, or both) could be easily handled by general dentists. Only about one-fifth of the subjects in both age groups required some complex care such as endodontics, crowns, and advanced periodontal treatment, which could be delivered by senior dentists or dentists with specialist training.

Adult↗
PubMed1994

CPITN--interpretations and limitations.

As with all indices which impose numerical scales on a biological process, there are limitations with CPITN which must be identified and recognised. The limitations are due to the index being used for purposes for which it was not originally designed and recent advances in understanding which question the underlying assumptions of the index. Whilst questioning whether these limitations are sufficient to abandon the CPITN in favour of a new index, suggestions are made for modifications to the existing system. These include, the recording of each of the clinical indicators separately, as well as including the measurement of total loss of attachment. In addition an extension of the treatment need scale from four to five points is suggested.

Adolescent↗
PubMed1992

Use of shell crowns in Hong Kong dental hospital attenders.

In 1984 an oral health survey of Hong Kong adults aged 35-44 years revealed that 15% of subjects presented with metal shell crown restorations, often as components of fixed-bridge reconstructions. The aim of this study was to describe the patterns and means of use of shell crowns, and to describe the patterns of tooth loss in patients who presented with such restorations, attending for treatment at the dental teaching hospital in Hong Kong over a 2-year period. A total of 1563 such patients attended. The records, which included radiographs, of 165 of these patients aged 35 years and above, obtained by means of a systematic sampling frame, were studied by one trained examiner. On initial presentation each patient was found to have a mean of 4.0 shell crowns, 77% of these being components of bridge restorations. The bridges involved a mean of only 3.9 units (retainers and pontics). The tooth type most commonly replaced by a bridge of this type was the first molar. It was concluded that most shell crowns used in this patient group are abutment retainers for predominantly short-span bridge restorations.

Adult↗
PubMed1991

Cervical enamel projections in Chinese first permanent molars.

Cervical enamel projections in relation to molar furcations may act as predisposing factors in periodontal attachment loss. Limited data are available documenting these features in Chinese teeth. The purpose of this study was to determine the prevalence and distribution in a sample of first permanent molars from Hong Kong Chinese. Three hundred and sixty-two extracted first molars (194 maxillary, 168 mandibular) were selected from the Prince Philip Dental Hospital tooth collection and examined using a dissection microscope for identification and classification. Cervical enamel projections were identified in 59 per cent of maxillary and 79 per cent of mandibular first molars. Buccal aspects were more frequently involved. Forty-nine per cent were Grade III (extending to the furcation area); over one-half were particularly slender while 18 per cent were discontinuous. A modification to the classification system is proposed in order to delineate these features in future studies.

China↗
PubMed1991

Periodontal implications of furcation entrance dimensions in Chinese first permanent molars.

Narrow dimensions of the entrance to furcations of multi-rooted teeth can complicate the periodontal management of furcation involvements. The objectives of this study were to measure the furcation entrance dimensions of first permanent molars from Hong Kong Chinese, and to compare these dimensions with those of the blade widths of periodontal instruments generally advocated for root surface instrumentation. A total of 363 first permanent molars, of which 185 were maxillary, were examined under 1.5 x magnification. Furcation entrance dimensions were measured using calibrated test gauges ranging from 0.3 mm to 1.5 mm. Furcation entrance dimensions equal to or less than 0.75 mm (the blade width of a new Gracey curet being 0.76 mm) in maxillary first molars were found in 79% of buccal entrances, 39% of mesial entrances, and 43% of distal entrances. In mandibular first molars, entrance dimensions equal to or less than 0.75 mm were encountered in 36% and 47% of buccal and lingual furcation entrances respectively. One-half of all furcation entrance dimensions of these first molars were less than the blade width of new Gracey curets. This high prevalence of narrow furcation entrances should be considered in the periodontal management of furcation involvement of first molars in Chinese.

Asian People↗
PubMed1989

Sex differences in the periodontal status of Hong Kong adults aged 35-44 years.

Epidemiological studies on periodontal diseases conducted in many countries employing different indices have generally shown advanced periodontal destruction to be more prevalent in adult males than in adult females. The 1984 Hong Kong survey of adult oral health, using the Community Periodontal Index of Treatment Needs (CPITN) to determine periodontal status, revealed that in males aged 35 to 44 years the prevalence of deep pockets was 23 per cent, compared with 9 per cent in females (P less than 0.01). Males had a mean of 0.4 sextants with deep pockets whereas females had a mean of only 0.1 sextants so affected (P less than 0.01). Females were found to have a significantly larger proportion of healthy sextants (P less than 0.01). The observed sex difference in disease prevalence may have been influenced by the fact that fewer teeth were present in the females, but it could not be explained by differences in reported oral hygiene measures and practices.

Adult↗