OBJECTIVE: To compare permanent tooth surface-specific progression/reversal changes between fluoridation-ended (F-E) and still-fluoridated (S-F) communities in British Columbia, Canada, over a 3-year period. METHODS: D1D2MFS examinations were contrasted for 2,964 schoolchildren in 1993/94 (grades 2, 3, 8 and 9) and 1996/97 (grades 5, 6, 11 and 12). Generalized Estimating Equation (GEE) models explored the relation between progression/reversal changes and fluoridation status, age, gender, socioeconomic status, and dietary/fluoride histories. RESULTS: Within a scenario of low levels of caries overall, few children had multiple surfaces progressing. At least one smooth surface progressed in 31.4% of subjects; at least one pit-and-fissure (PF) surface progressed in 43.1% of subjects. At least one smooth surface reverted in 89% of subjects who had reversible stages; at least one PF surface reverted in 23.8% of subjects who had reversible stages. GEE (smooth) indicated that odds ratios of progression were twice as large in the F-E site compared to the S-F site, and slightly increased in older participants and in participants exposed to more fluoride technologies. GEE (PF) also indicated that progression was slightly more common in the F-E site; more frequent snacking and lower parental educational attainment had modest associations with increased progression in PF surfaces. For the two types of surfaces, GEE models demonstrated that unerupted surfaces were less likely to progress than sound surfaces. No associations were found between reversals and independent variables. CONCLUSION: Progressions were found to be weakly linked to socio-demographic factors; baseline surface statuses were better predictors of progression. Using the current definitions for disease transitions, F-E communities had more frequent progressions than a S-F community.

Adolescent↗

PubMedDate not supplied

The association between asthma and dental caries in children and adolescents: A population-based case-control study.

This study explored the potential association between childhood asthma and caries using oral examination and health interview data from the Third National Health and Nutrition Examination Survey 1988-1994 (NHANES III). We fitted GEE Poisson regression models with adjustment for parents' income, gender, race, exposure to potentially xerostomic drugs, and the presence of pit and fissure sealants. There was no association between the use of drugs commonly used by asthmatics (antihistamines, corticosteroids, and antiasthmatic inhalers) and df/DMF scores. Asthmatic children 4-10 years of age at all severity levels had similar dfs scores to the controls, however, severely asthmatic children 4-10 years of age had significantly lower DMFS (p = 0.010) and DMFT (0.049) scores than controls. Similarly, severely asthmatic children 11-16 years of age had significantly lower DMFT scores than controls (p = 0.024) and DMFS scores approaching statistical significance (p = 0.053). While our analysis adjusted for covariates, potential confounders such as fluoride intake from water, diet, use of topical fluorides, and dose of antiasthmatic medication could not be addressed. Our results indicate that any association between asthma and dental caries may occur primarily in younger children with no evidence of an association between asthma and dental caries as children mature.

Adolescent↗

PubMedDate not supplied

Socio-demographic features and fluoride technologies contributing to higher fluorosis scores in permanent teeth of Canadian children.

OBJECTIVE: To examine levels of fluorosis among children in two Canadian communities exposed to fluoride. BACKGROUND: One community had discontinued fluoride, the other had maintained it. Water supplies, however, were fluoridated for all the children when their esthetically important teeth were mineralized. METHODS: We examined 8,277 children to assess Thystrup-Fejerskov Index (TFI) scores. Multivariate Poisson regression models were used to identify the relationship between TFI and water fluoride status, age, gender, SES, and dietary and fluoride exposure histories (supplements, rinses, toothpaste amount, tooth brushing frequency, and tooth brushing starting age). Parent(s) completed questionnaires. RESULTS: Overall, levels of fluorosis were low to mild, with residents of the fluoridation-ended communities having marginally higher TFI scores than those of the still-fluoridated community. Females had higher TFI scores than males. Children aged 10 years or more had higher TFI scores than younger children. Consuming bottled water between birth and 6 months of age was protective. Exposure to fluoridation technologies was consistently associated with fluorosis experience. Children who began brushing with fluoride toothpaste between their first and second birthdays had higher TFI scores than those who began between their second and third birthdays, regardless of daily brushing frequency. Children who regularly used supplements had higher TFI scores than those who did not. Children with a college-educated father had higher TFI scores than those whose fathers had less education. CONCLUSIONS: Higher fluoride exposure slightly increased the likelihood that a child had a higher TFI score, especially when more fluoridation technologies were used at home.

Age Factors↗

PubMedDate not supplied

Is there an association between low birth weight and caries in the primary dentition?

OBJECTIVES: An association between low birth weight and caries in the primary dentition has been suggested but not demonstrated. This study analyzed this association using data from a probability sample of US children 2-6 years of age. METHODS: Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used. Variables included decayed and filled primary surfaces (dfs), birth weight, gestational age, and Apgar score (a surrogate measure of fetal well-being); maternal age, education, income; number of previous births, marital status, the existence of pregnancy complications, and cigarette smoking during the pregnancy. Data were analyzed using SUDAAN 8.0.2. RESULTS: Bivariate Poisson regression showed that children of mothers who were unmarried (incidence density ratio, IDR = 3.28), with less education (IDR = 1.43), who were 17 years of age or younger at birth (IDR = 1.51), and had 2 or fewer prenatal visits (IDR = 1.65) had a significantly ( p <0.05) greater risk of caries than the reference groups. Children of mothers with pregnancy-related hypertension (IDR = 0.14) had less than 20% the risk of caries than the reference group. Blacks (IDR = 1.37) and Mexican-Americans (IDR = 2.38) had greater risk of caries than whites, and children of low (IDR = 2.57) and middle income (IDR = 2.00) level families had higher caries risks than those of upper income families. Multivariate Poisson regression found only race-ethnicity, age, and income level to be statistically significant. CONCLUSIONS: This study did not support the association between low birth weight and caries of the primary dentition.

Age Factors↗

PubMedDate not supplied

Orofacial injuries in youth soccer.

PURPOSE: The purpose of this study was to estimate the incidence of orofacial injuries in youth soccer in the 1995 fall and 1996 spring seasons for eight Dallas, Texas metropolitan area YMCA youth soccer leagues. METHOD: Surveys requesting orofacial injury as well as game and practice information were sent to all soccer coaches of children 3 to 12 years of age in eight cooperating YMCA leagues in the Dallas metropolitan area. RESULTS: The incidence of orofacial injury was low. In 47,772 hours of games and practice only 17 orofacial injuries were reported by the 122 coaches who responded. All reported injuries were to soft tissue and none required professional attention. CONCLUSION: The reported incidence of orofacial injury was very low suggesting that at the age and skill levels represented by these YMCA teams, soccer appears to be relatively safe to the maxillofacial complex.

Age Factors↗

PubMedDate not supplied

Restoring teeth that are endodontically treated through existing crowns. Part I: Survey of pulpal status on access.

OBJECTIVE: The purpose of this study was to identify the pulpal findings encountered by practitioners when accessing complete-coverage crowns that require nonsurgical root canal treatment and the relevance of coronal leakage to the success of the RTC. METHOD AND MATERIALS: The survey package consisted of a cover letter stating the instructions, rationale, and purpose for the questionnaire, a questionnaire with 8 short-answer questions, and a stamped, self-addressed envelope. A randomized sample of active dentists (300 general practitioners, 300 prosthodontists, and 300 endodontists) was selected. Collected data were analyzed with the chi-square test. RESULTS: A 60% response rate was obtained. Statistically significant differences were found among the practitioner groups, depending on the question. General practitioners and endodontists obtain access through crowns and maintain these crowns as final restoration significantly more often than do prosthodontists. Practitioners responded that teeth with complete crowns require nonsurgical root canal treatment after 5 to 10 years. CONCLUSION: Respondents believe that leakage must be addressed when endodontic access cavities in artificial crowns are restored after nonsurgical root canal treatment. General practitioners perform nonsurgical root canal treatment more frequently than do prosthodontists. Practitioners indicated that when teeth with complete crowns require nonsurgical root canal treatment, treatment is most often performed 5 to 10 years after placement of the crown.

Attitude of Health Personnel↗

PubMedDate not supplied

Restoring teeth that are endodontically treated through existing crowns. Part II: Survey of restorative materials commonly used.

OBJECTIVE: A survey was undertaken to categorize the materials used for the restoration of endodontic access openings through complete-coverage crowns after completion of nonsurgical root canal treatment. METHOD AND MATERIALS: The survey package consisted of a cover letter stating instructions, rationale, and purpose for the questionnaire, a questionnaire of 8 short-answer questions, and a stamped, self-addressed envelope. A randomized sample of active dentists (300 general practitioners, 300 prosthodontists, and 300 endodontists), was selected. Collected data were analyzed with the chi-square analysis. RESULTS: Most general practitioners (93%), endodontists (61%), and prosthodontists (75%) reported that they frequently or always permanently restore teeth after nonsurgical root canal treatment. Empress was the all-ceramic system used most commonly by prosthodontists (42%) and general practitioners (38%). A statistically significant difference in restorative material preference was found (P < 0.0001), depending on the type of crown used. CONCLUSION: Amalgam alone and in combination with bonding agents are materials of choice for restoration of access openings through all-metal complete crowns, while resin composite is the choice for all types of complete crowns involving porcelain. Endodontists preferred "other" materials.

Aluminum Silicates↗

PubMedDate not supplied

Louisiana dentists' attitudes toward the dental Medicaid program.

PURPOSE: This study was performed to determine factors associated with Louisiana dentists' participation in the Dental Medicaid Program. METHODS: Surveys were mailed to all pediatric and general dentists as reported by the Louisiana State Board of Licensing. A second mailing was made to non-respondents. RESULTS: Surveys from 956 of 1,926 dentists (50%) were returned. Of 607 general dentists and 40 pediatric dentists who treated dental Medicaid-enrolled children in the past year, 269 (44%) and 18 (45%), respectively, treated all Medicaid-enrolled children. Newly graduated dentists were more likely to be actively enrolled than their more established counterparts (chi 2 = 10.67; p = 0.01). Medicaid reimbursement levels were viewed as "much less" than private fees by 62%, "less" by 33% and "the same" by 4% of the respondents. Broken appointments were the most prevalent reported problem (80%), followed by low fees (61%), patient non-compliance (59%), unreasonable denial of payments (57%), slow payment (44%), and complicated paperwork (42%). With the exception of the perceived importance of Medicaid reimbursement levels, active and inactive general and pediatric dentists' perceptions of the importance of Medicaid issues were not significantly different. These findings indicated that significantly more Medicaid-active general dentists who allocated 10% of their office visits to Medicaid-eligible children felt that slow payment (p = 0.002) and complicated paperwork (p < 0.001) were more important problems than general dentists who allocated less time to Medicaid-eligible children. CONCLUSIONS: Louisiana dentists' sources of dissatisfaction with Medicaid are similar to those of dentists in other states. Some of the issues are programmatic and are within the power of the dental Medicaid director and state legislature to address. Patient-related issues such as frequent broken appointments may be addressed by assigning case managers to Medicaid beneficiaries.

Adolescent↗

PubMedDate not supplied

An application: the cost of clinic care by undergraduate dental students and its relationship to clinic fees.

Explore the source record for details and available documents.

Costs and Cost Analysis↗

PubMedDate not supplied

The average daily dose of fluoride: a model based on fluid consumption.

The quantity of fluoride needed to prevent caries but avoid dental fluorosis is unknown. To estimate the desired daily dose of fluoride, we analyzed fluid consumption data from a stratified random sample of 7,345 children studied during the 1977-78 US Department of Agriculture Nationwide Food Consumption Survey and applied it to Dean's observations of optimally fluoridated communities in the 1940s. The average daily fluoride intake per kilogram body weight from optimally fluoridated tap water was highest (0.080 mg/kg/d) from 7 to 9 months of age, and declined linearly to 0.034 mg/kg/d at 12.5 to 13 years of age. The mean was 0.068 +/- 0.008 mg/kg/d from birth to age 7 years, and 0.042 +/- 0.006 mg/kg/d from age 7 to 13 years. The American Academy of Pediatrics supplementation schedule delivers fluoride dosage rates that are below our findings of the average daily dose of fluoride after the third month of life, although the two curves are within 0.006-0.013 mg/kg/d from 3 months to 16 years of age. While supplementation alone does not exceed the average daily dose of fluoride, the cumulative effects of fluoride from tap water, processed foods, ingested toothpaste, and dental treatments after the third birthday should be evaluated for their role in the increased prevalence of fluorosis.

American Dental Association↗

PubMedDate not supplied

Acute ethanol toxicity from ingesting mouthwash in children younger than 6-years of age.

The purpose of our study was to analyze reports of the American Association of Poison Control Centers (AAPCC) of suspected overingestion of ethanol from mouthrinses by children younger than 6 years of age between 1989 and 1994. Annual incidence rates of reported ethanol exposures attributed to mouthrinses were calculated. Lethal and toxic amounts of several mouthrinses were calculated using peak blood ethanol concentrations of 500 and 50 mg per 100 mL, respectively. In 1994, there were 2937 calls reported by poison control centers related to ethanol-containing mouthrinses, an estimated incidence of 168 reported exposures per 100,000 children younger than 6 years of age. A 15-kg child who ingests 212 mL (7.2 oz.) of Listerine (26.9% ethanol) ingests 57 mL (1.9 oz.) of ethanol, which is potentially lethal. Approximately one-tenth that amount of ethanol can produce a toxic reaction. Physicians, dentists, and other health care providers should inform parents of the dangers associated with accidental ingestion of mouthrinse and encourage them to keep mouthrinse out of the reach of children. The Food and Drug Administration (FDA) should require readily visible warning labels and child-resistant caps for containers with potentially toxic volumes of ethanol. The American Dental Association (ADA) should re-evaluate its acceptance criteria for advertising cosmetic mouthrinses in its publications and consider including child-resistant caps and warning labeling.

Accident Prevention↗