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Biomedical subjects

M C Downer

Publications and source records attributed to M C Downer.

At least 19 recordsLinked to original sources
PubMed1992

The status of bite-wing radiographs in enhancing discriminatory ability in caries prophylactic clinical trials.

Data were taken from six randomised controlled trials of caries prophylactic agents in order to investigate the capacity of bite-wing radiographs of posterior approximal tooth surfaces to enhance discrimination between test and control group measurements. The findings showed that, where an active control agent was employed, the addition of radiographic to clinical examination data failed to improve discriminatory power in comparisons between 3-year caries increments.

Adolescent↗
PubMed1992

Time trends in caries experience of children in England and Wales.

Regular national surveys of child and adult dental health and regionally coordinated surveys of caries experience in children provide a comprehensive picture of secular changes in disease levels in England and Wales. The substantial decrease in mean dmft in 5-year-olds between 1973 and 1983, amounting to 7.7% per annum, slowed to 0.9% per annum between 1983 and 1989/90. Conversely the decline in DMFT in older children and adolescents has accelerated more than twofold since 1983. In some parts of the country, caries experience at 5 years has shown a small increase and possible reasons for this are discussed. The validity of the survey data is examined and ways of consolidating and maintaining the downward trend in disease are considered.

Adolescent↗
PubMed1991

The improving dental health of United Kingdom adults and prospects for the future.

The 1988 UK survey shows steady and substantial improvements in adult dental health compared with the previous national surveys. The proportion of adults with some natural teeth rose from 70% in 1978 to 79% in 1988 and is expected to reach 90% by the year 2008. Also, by that time more than 90% of the working age population should be substantially dentate with 21 or more standing teeth on average. Between 1968 and 1988 the pool of sound untreated teeth in England and Wales increased by 65%. At the same time, the number decayed fell by 36% despite an 11% population growth which resulted from increasing numbers of older people. The most dramatic improvements were recorded in young adults. The position for older adults reflected the patterns of disease and treatment experienced in earlier times. Northern Ireland, Scotland and the north of England remained the parts of the country with the poorest dental health. The survey has important implications for the practice of dentistry.

Adolescent↗
PubMed1989

Validation of methods used in dental caries diagnosis.

Accurate diagnosis of caries is critical both in clinical practice and epidemiology. Current knowledge of the validity of conventional caries diagnostic methods is reviewed and some theoretical aspects of the design and conduct of validation studies discussed. Four studies of the validity of clinical diagnostic methods are described and their findings summarized and compared. The results indicate that a trained and experienced examiner using a visual diagnostic technique can detect dentine caries, when it is shown to be present experimentally in borderline lesions, with a sensitivity exceeding 0.6, and can return a negative finding where disease is absent with a specificity exceeding 0.8. It is suggested that a visual technique of diagnosis which emphasizes specificity at the expense of some loss of sensitivity is the clinical method of choice, given a climate of low prevalence and slow progression of disease, the perceptual inability of imperfectly standardized examiners, and the adverse consequences of false-positive diagnoses. Selecting teeth with borderline lesions and balanced numbers of diseased and non-diseased sites is recommended for validation studies to allow standardized comparisons to be made and benchmarks for diagnostic performance to be established. However, an uncritical extrapolation of experimental findings to the general population of teeth is likely to lead to spurious assumptions about the consequences--in particular, of false-positive treatment decisions.

Dental Caries↗
PubMed1987

Craniofacial anomalies--are they a public health problem?

Craniofacial anomalies represent a diverse range of developmental defects. Some of the more uncommon conditions are severely disabling and place a heavy demand upon health care resources. Of primary interest in dental public health are the group of conditions referred to as dentofacial anomalies. A minority of dentofacial anomalies may be damaging to the integrity of the dentition or may interfere with function, some may also constitute a genuine cosmetic problem for the individual. Two important questions to be addressed are first, how can those conditions where treatment at public expense is justified on health grounds be defined and secondly, how can criteria be applied to the individual case in a way that is fair and acceptable. While it may be feasible to develop an index of priority for orthodontic treatment need, the more difficult challenge is having it accepted by the public and profession and adopted as an effective management instrument. Use of a valid and reliable index could lead to finite resources for orthodontic treatment being distributed in a more beneficial way.

Attitude to Health↗
PubMed1985

The Edinburgh-Helsinki study: a comparison of dental care for children.

A comparison was undertaken of dental care for children in Edinburgh and Helsinki. The evaluation centred upon an epidemiological investigation of the dental health of children in the 5-, 12- and 15-year age groups. This was performed by examiners using standardized procedures who were drawn from both countries. They employed an established system of data recording and processing (SPEED). Using these data, and background information from official and other sources, an assessment was made of the effectiveness, adequacy, efficiency and appropriateness of the services. Children's dental health, particularly in the youngest age group, was generally better in Helsinki than in Edinburgh as were both the population coverage and extent to which disease was controlled. However, the services in Edinburgh were marginally the more economically efficient. This arose from their being provided mainly by independent contractors working under a fee per item of service rather than by a public salaried system. In neither city was the delivery of dental services supplemented by water fluoridation nor was extensive use made of auxiliary personnel. The decrease in caries prevalence in recent years has profound implications for the dental services in both countries. It calls for continuing re-appraisal of present policies on expenditure, manpower, dental education and ways of delivering dental care.

Adolescent↗
PubMed1983

Changes in the caries prevalence of 11-12-year-old schoolchildren in the North-West of England from 1968 to 1981.

Since 1968, six caries clinical trials have been conducted in the North-West of England by different examiners using the same diagnostic system, and a steady reduction in caries prevalence in 11-12-yr-old schoolchildren has been recorded. In the present study, five of the examiners revisited some of the schools which participated in their original trials and each examined between 196 and 296 children. The time intervals between the original and repeat examinations were 12, 10, 8, 5 and 3 yr. Percent caries reductions (PCRs) ranged from 19 to 33 for DMFT and from 24 to 35 for DMFS but the PCRs did not relate to the time intervals between examinations. The PCRs were greater on free smooth and approximal surfaces than on fissure surfaces and for the anterior teeth than for the mouth as a whole, suggesting that fluoride may have played a role in the reductions.

Child↗
PubMed1983

The Danish oral health care service for children: an evaluation.

An evaluation of the children's oral health care service was performed by an international assessment team who undertook a field programme in Denmark. Three counties were visited, one metropolitan, one urban and one rural. Data on dental health costs were collected and dental services in six municipalities selected at random were examined. Opinions of administrators at all levels and those of clients and providers were obtained and interviews also took place with staff and students at the two dental schools. The service was considered effective insofar as active dental disease was closely controlled by restorative care and a high level of dental awareness was instilled in all sections of the child population. The service was also clearly adequate since participation of schoolchildren was almost universal. However, resource expenditure on both professional personnel and clinical facilities was considered high and the efficiency of the service was possibly rendered less than optimal by a degree of over-provision in 'passive' prevention and orthodontics. The appropriateness of devoting so much resource to children at the expense of the population as a whole was also regarded as questionable as was the lack of a fluoridation programme. Client groups wholeheartedly supported the service as a result of the high quality of care and the attractive, considerate image projected by clinics and staff. The overall excellence of the service was a matter of satisfaction to administrators, of gratification to clients and of pride to the providers whose morale was high.

Adolescent↗
PubMed1983

The Danish oral health care service for children: a comparison with alternative systems.

Aarhus in Denmark, Adelaide in Australia, Saskatchewan in Canada, Bristol in England and Limerick in Ireland were chosen as representing five different systems for improving the dental health of children. Fluoridation apart, the system of dental care delivery seems to have little influence on the level of dental disease, but appears to have remarkable cost implications. The most expensive system employs salaried dentists to carry out all the operative procedures. Employing dental therapists to do the simple operative procedures reduces costs materially, but utilizing private dentists in an insurance scheme that encourages efficient practice may be less expensive still. The results of this study highlight the need for more detailed comparison of delivery systems, in order to advise public dental health authorities on the most effective and efficient systems for children.

Adolescent↗