Disease activity and need for dental care in a capitation plan based on risk assessment.
This article describes a capitation model of care which would stimulate both dentists and patients to apply existing preventive knowledge.
Biomedical subjects
Publications and source records attributed to I Zickert.
This article describes a capitation model of care which would stimulate both dentists and patients to apply existing preventive knowledge.
The retention of natural teeth among the elderly is increasing and, in recent studies, dental caries has been identified as the main reason for teeth being extracted. The 5-year incidence of tooth loss and dental caries and the most crucial dental factors for tooth extraction were studied in a random sample of 60-, 70- and 80-year-old inhabitants of Gothenburg. Of the 208 persons examined at baseline, 148 (71%) participated in the follow-up examination: 69, 51 and 28 respectively in the different age groups. In all, 110 teeth had been extracted during the period in 40% of the participants. Only 9 persons had lost three or more teeth. The mean numbers of remaining teeth were 22. 18 and 15 respectively in the 60-, 70- and 80-year age groups and the mean numbers of teeth lost during the 5-year period increased with age from 0.4 in the 60-year-olds to 0.8 and 1.4 in the 70- and 80-year-olds (P < 0.05). The major reason for tooth extraction was dental caries and it was found in 60% of all cases and at a higher rate of 77% in the oldest age group. Fifty-one per cent had developed new coronal carious lesions and 61% had new root carious lesions, while 27% had not developed caries during the period. The mean 5-year increment in decayed and filled coronal surfaces increased with age from 2.3 in the 60-year-olds to 3.7 and 5.3 in the 70- and 80-year-olds (N.S.I. The increment in decayed and filled root surfaces was higher in women than men, 3.4 compared with 1.8 (N.S.), which also increased with age from 1.4 in the 60-year-olds to 2.4 and 5.5 in the 70- and 80-year-olds (P < 0.0001). It was concluded from this study that few teeth had been lost during the 5-year period but that dental caries still appeared to be a serious problem among some very elderly people.
The prevalence and intraoral distribution of decayed and filled root surfaces were evaluated in 55, 65, and 75-yr-old inhabitants of Gothenburg. From randomly selected groups, 88, 72, and 48 dentate persons in the respective age groups participated and as many as 85, 93, and 90% respectively had one or more decayed or filled root surfaces. In the two oldest age groups 32-35% were free from root carious lesions, while 20% had five or more decayed root surfaces. The corresponding figures for the youngest group were 63% and 8%. The prevalence of root surface caries was evaluated using the Root Caries Index (RCI), excluding prosthetic crowns. The mean RCI value increased with age (P less than 0.05, ANOVA on age groups) from 14% to 16% and 22% in the 55, 65, and 75-yr-olds, respectively. The root surfaces of the molars were most frequently affected by caries and fillings, the incisors least frequently. In the maxilla the proximal surfaces were most affected, in the mandible this applied to the buccal surfaces, while the lingual surfaces had the lowest proportion of carious lesions and fillings in both jaws.
Secretion rate, buffer capacity, and cariogenic microorganisms of resting and stimulated whole saliva were examined in 208 55-, 65-, and 75-yr-old Swedes. The secretion rate for both resting and stimulated saliva decreased with age. When the use of drugs was taken into account the difference in terms of age group was significant for resting saliva alone (P less than 0.01). In 22% the resting saliva was less than 0.1 ml/min, and in 5% the stimulated saliva was less than 0.7 ml/min. Persons with subjective dryness in the mouth had a lower salivary flow. Men had higher secretion rates than women irrespective of medication (P less than 0.05). The buffer capacity was strongly correlated to the secretion rate of both resting and stimulated saliva (r = 0.39 and r = 0.44, respectively). The number of mutans streptococci and lactobacilli increased with age, although significant in terms of age group for lactobacilli alone (P less than 0.05). The number of these microorganisms was lower in resting saliva than in stimulated saliva (P less than 0.0001). Individuals harboring both Streptococcus mutans and Streptococcus sobrinus had higher values of mutans streptococci in resting and stimulated saliva than those harboring only S. mutans (P less than 0.001). Actinomyces viscosus and Actinomyces naeslundii comprised greater than or equal to 1% of the total CFU in 89% of the plaque samples. The corresponding figures for lactobacilli and mutans streptococci were 6% and 38%, respectively.
The prevalence of root surfaces caries in 208 randomly selected 55, 65, and 75-yr-old Swedes was related to the frequency of coronal caries, the number of remaining teeth and to bacteriologic, salivary, and dietary variables. At least one decayed or filled root surface was found in 89% of the individuals and all of those had also experienced coronal caries. The frequency of root surface caries was positively correlated to the frequency of coronal decay and negatively correlated to the number of remaining teeth and exposed root surfaces. The study shows that the same factors which are associated with enamel caries seem to be of importance in determining the development of root surface caries. The variation in the frequency of root surface caries was best explained by the salivary levels of mutans streptococci and lactobacilli, the percentage of surfaces harboring plaque and the frequency of carbohydrate intake. Other contributory factors were the saliva secretion rate and the buffer capacity.
The purpose of the present study was to examine the long-term effect of a special caries preventive program in teenagers. Over a 3-yr period directed and controlled antimicrobial treatment using Streptococcus mutans as an indicator organism resulted in a remarkable caries reduction especially in children with greater than 10(6) S. mutans per ml of saliva at the start of the study. Two years after discontinuation of the special preventive program 83 out of 101 subjects, 18-19 yr old, were reexamined. All the children had followed the same basic preventive program in the Dental Health Service. The number of S. mutans and lactobacilli per ml of saliva within and between control and test groups was with few exceptions practically the same as 5 yr earlier. During the posttreatment period the caries activity was similar in the control and test groups and lower than during the experimental years especially in the control group. Subjects with initial S. mutans level of greater than 10(6) CFU per ml of saliva continued to show incremental caries scores higher than those subjects with lower S. mutans levels.
The effect of oral chlorhexidine gel treatment supplemented with fluoride applications was studied in subjects with high salivary levels of S. mutans. In two experiments short-term treatment with a 1% chlorhexidine gel was followed by applications of either a 1% NaF gel daily for 2 weeks or a 1% NaF gel daily for 6 weeks supplemented twice with topical application of an 8% SnF2 solution. The salivary numbers of S. mutans were lower in the test group than in the placebo group after 6 and 12 weeks in experiments 1 and 2, respectively, and considerably lower than the pretreatment values. The findings show that fluoride applications can be a valuable adjunct to chlorhexidine treatment for combatting S. mutans.
The caries incidence at various levels of Streptococcus mutans infection was analyzed in a control group and a test group. In the control group, the incidence of caries and the duration of S. mutans infection were significantly correlated. In the test group, the S. mutans infection was suppressed by antimicrobial measures when the number of S. mutans exceeded 250 X 10(3) CFU per ml of saliva. The results illustrate that the level and duration of the S. mutans infection are strongly correlated to the incidence of caries. The findings support the concept of S. mutans as a key cariogenic microorganism and illustrate the value of antimicrobial treatment in the prevention of caries.
The number of Strep. mutans in saliva samples was examined in 101 13-14-year-old children, 53 in a control and 48 in the test group. All in the test group with 2.5 X 10(5) Strep. mutans per ml saliva were treated with 1 per cent chlorhexidine gel, once a day, for 14 days when the number of Strep. mutans was greatly reduced. Saliva samples were then examined in the test group every 4th month and all children with Strep. mutans levels above 2.5 X 10(5) were treated. A few selected children had fissure sealants applied to the occlusal surfaces. After 3 years, the mean number of new carious lesions was 9.6 in the control group and 4.2 in the test group. In the children with 10(6) Strep. mutans at the start of the study, the corresponding figures were 20.8 compared with 3.9. Thus a reduction in caries activity can be achieved by controlled antimicrobial treatment.
The dental health and the prevalence of Streptococcus mutans and lactobacilli were examined in 101 13-114-year-old children. The average number of decayed (incipient caries) and filled surfaces (DFS) was 10.1 and 12.8, respectively. S. mutans was not detected in 11% of the children while 21% had 10(6) or more S. mutans per ml saliva. Lactobacilli were not found in 21% of the children whereas 11% had 10(5) or more lactobacilli per ml saliva. Statistically significant correlations were found between S. mutans and lactobacilli, S. mutans and DFS, lactobacilli and DFS and S. mutans plus lactobacilli and DFS. Increasing numbers of S. mutans and lactobacilli, alone and in combination, were associated with an increased caries frequency.
The present investigation was performed to estimate the effect on caries and gingivitis of a plaque control program delivered at different intervals and supplemented with different fluoride compounds. The study ran for 2 years and was completed by 260 children who were 13-14 years old at the beginning. Professional tooth cleaning in combination with detailed oral hygiene instructions repeated once a month or every 3 months significantly improved their oral hygiene status and reduced clinical signs of gingivitis. The addition of fluoride (NaF or MFP) in mouthrinses and toothpastes significantly reduced the number of new carious lesions. No significant differences were observed in gingival health and caries activity between the programs delivered once a month and every 3 months.
The effect of penicillin on the number of oral Streptococcus mutans, Streptococcus sanguis and lactobacilli in hamsters and in man was investigated. This is of interest as S. mutans and lactobacilli are involved in the carious process while S. sanguis is not. Hamsters infected with both S. mutans and S. sanguis or only S. sanguis received penicillin in their drinking water for 14 d. The treatment reduced the proportion of S. mutans and S. sanguis in dental plaque to undetectable levels. After the penicillin treatment the population of S. mutans and S. sanguis gradually increased. In man, the effect of oral penicillin therapy was examined in 21 adults with more than 2 X 10(5) S. mutans per ml saliva. The penicillin treatment had almost no effect on the numbers of S. sanguis and lactobacilli, but a pronounced decrease in the number of S. mutans was observed. The duration of this effect, however, was short. Consequently, such treatment alone is of limited value for the control of the oral infection of these microorganisms.
The effect of topical application of a fluoride-containing varnish, Duraphat, on the level of Streptococcus mutans in saliva and in dental plaque was investigated in schoolchildren. Samples of saliva and pooled buccal plaque were taken before varnish application and 4, 10 and 21 d after treatment. Fluoride varnish treatment with or without a preceding dental prophylaxis had no significant effect on the plaque and salivary levels of S. mutans. The findings suggest that the caries-reducing effect of fluoride varnish cannot be explained by an alteration of the incidence of S. mutans in dental plaque or in saliva.
The effect of intensive treatment with chlorhexidine on the number of S. mutans in saliva was studied in 24 schoolchildren highly infected with this organism. Chlorhexidine gel in individual dental trays was applied under supervision on two consecutive days, four times the first day and three times the second day. The number of S. mutans in saliva was monitored for 6 months. Immediately after treatment, the number was greatly reduced in all of the children. Thirty days after treatment only three children had more than 2 X 10(5) S. mutans/ml saliva, and after 4 months, 11 children still had less than 2 X 10(5) S. mutans/ml saliva. After 6 months the effect of the treatment was obvious in 20% of the children. The results indicate that intensive treatment with chlorhexidine can be used to reduce the S. mutans infection. The antimicrobial treatment, however, should be individually controlled because of variations in the response of the subjects.
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