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Biomedical subjects

M Raadal

Publications and source records attributed to M Raadal.

At least 19 recordsLinked to original sources

Caries increment and prediction from 12 to 18 years of age: a follow-up study.

AIM: This was to determine the increment of caries from 12 to 18 years of age and to explore the possibility of predicting caries increment in this period based on the caries experience at age 12 years. STUDY DESIGN: Prospective longitudinal survey. METHODS: A sample of 12-year-old children (n =159) were examined in 1993 and 70% of them re-examined at 18 years of age. Bitewing radiographs were taken and a diagnostic system using five caries grades (D(1) to D D(5)) was used at both ages. Children at risk were defined as those who developed manifest caries lesions (D(3-5)FS) on approximal surfaces during the follow-up period. Possible predictors were analysed by calculation of sensitivity, specificity, efficiency of the test, proportion that tested positive and actual proportion of the population at risk. RESULTS: The mean caries increment (D(1-5)MFS) from 12 to 18 years of age was 4.2 (SD +/- 9.1). The percentage of caries-free adolescents at 12 and 18 years of age was 10% and 1% respectively; 25% had either a reversal or no increment in caries experience while the D(1-5)MFS increased in 65% of the adolescents. Of the increment of manifest lesions (D(3-5)FS), 18% were located in incisors/canines, 40% in premolars, 26% in first molars and 16% in second molars. Premolars had the largest proportion of the approximal surfaces with manifest caries increment. The best predictors of children at risk of approximal caries increment (D(3-5)FS) were caries experience (D(1-5)FS) on the approximal surfaces of premolars and second molars at the age of 12 years. The individuals that developed four or more manifest lesions on approximal surfaces between 12 and 18 years were the easiest to predict (sensitivity + specificity = 175%). CONCLUSIONS: There was a considerable increment of manifest caries lesions from 12 to 18 years of age in all tooth groups. The best predictors for increment of manifest caries on approximal surfaces during the age period were approximal caries in premolars and second molars at the age of 12 years.

Adolescent↗

The relationship between caries in the primary dentition at 5 years of age and permanent dentition at 10 years of age - a longitudinal study.

OBJECTIVES: To explore a possible relationship between the caries experience and pattern in the primary dentition at 5 years of age and the permanent dentition at 10 years of age. Further, to examine the possibility of predicting children in a caries-risk group at 5 years verified at 10 years of age. MATERIALS AND METHODS: A sample of 186 children (90 males) were clinically examined as 5-year-olds and re-examined as 10-year-olds by calibrated dentists. A five-graded diagnostic system including enamel caries was used. Bitewing radiographs were taken. A true risk group of children at 10 years were defined as those with at least one dentin or filled lesion on the mesial surface of 6-year molars, and/or on incisors, and/or total DMFS (decayed, missing, and filled surfaces) more than 1 SD above the mean. The prediction was measured in terms of OR (odds ratio), sensitivity/specificity, and receiver operating characteristic curves. RESULTS: Statistically significant correlations (r=0.5) were found between the caries experience in the two dentitions as well as between the primary second molars at baseline and the permanent teeth at 10 years. 'Primary second molars' and 'all primary molars' were the most powerful predictors for allocation into the risk group (24% of the sample). The highest achieved sum of sensitivity and specificity, 148%, was attained at a cut-off point above two carious surfaces in enamel and/or dentin in primary second molars. CONCLUSIONS: Statistically significant relationship in disease between the dentitions was found. More than two surfaces with caries experience in primary second molars are suggested as a clinically useful predictor at 5 years of age for being at high risk at age 10.

Age Factors↗

Caries in primary teeth at 5 and 10 years of age: a longitudinal study.

AIM: This was to explore the caries development in the primary dentition in children aged 5 and later when they were 10, with an emphasis on the caries increment according to type of teeth and surfaces. METHODS: The study was a prospective, longitudinal survey where the children were examined in 1993 when they were 5 years of age (n=217) and re-examined in 1998 when they were 10 (n=186). Caries was examined clinically and with radiographs by calibrated dentists based on a caries diagnostic grading system from 0 to 5. Primary incisors were excluded from the registrations at 10 years of age, while teeth exfoliating during the period were included, based on notes from the dental records. RESULTS: Intra- and inter-examiner reliability ranged from kappa 0.62 to 0.90. Dmfs at 5 years was 5.4 (incisors included) and 7.4 at 10 years (incisors excluded, other exfoliated teeth included). The mean caries increment during the age period showed no significant difference between children with and without caries at 5 years of age. Molar-approximal lesions dominated the increment, and when such lesions were diagnosed at 5 years of age, there was an increased risk for more severe caries (dentine lesions) during the period. CONCLUSION: The caries increment in the primary dentition is considerable for the majority of children during the age period 5-10 years. Even if a risk assessment based on the prevalence of approximal caries at 5 years of age may be useful for deciding individual recall intervals, the results of this study seem to suggest frequent check-ups are needed for the whole population.

Child↗

A videotaped intervention to enhance child control and reduce anxiety of the pain of dental injections.

AIM: While the psychological literature shows that perceptions of uncontrollability contribute to anxiety and other pathologies, interventions that enhance perceived control have been shown to reduce anxiety. This study attempted to assess a brief videotape to enhance child perceived control in a dental setting. METHODS: 101 children aged 7-9 years completed warm-up procedures and viewed either: a) the experimental intervention, a 2 minutes video of a dentist explaining what an injection will feel like and proposing hand raising as a signal mechanism; or b) the control condition, a 2 minutes video of Disneyland. Fear of dental injections was assessed on a 10 cm visual analogue scale before and after the intervention. RESULTS: In the experimental group there was a significant fear reduction from pre- to post-intervention, while this was not the case in the control group. Children with higher pre-existing levels of fear benefited more from the intervention than children with lower levels of fear. CONCLUSION: The results of this pilot study suggest that intervention packages that impact child control have promise in lowering anxiety.

Analysis of Variance↗

An intervention program to reduce dental avoidance behaviour among adolescents: a pilot study.

AIM: To develop and test the methodology of an intervention to reduce avoidance of dental care among adolescents, and to measure the respondents' beliefs regarding the intervention (credibility and cognitions). METHODS: Based on a group comparison design a sample of 18 year olds (n=50) with dental non-attendance behaviour was randomly selected to three experimental and one control group. Subjects were surveyed with one baseline questionnaire and one post-intervention questionnaire, to evaluate their beliefs regarding the program. Two different instruments were tested: 1) cards representing different statements related to previous dental experiences, possible reasons for attending (pros) and not attending (cons) dental appointments, and preferences for future treatment. Cards were selected based on individual priority; 2) a brief, structured telephone interview based on Motivational Interviewing. The instruments were tested separately (groups I and II) and in combination (group III). Subjects in the control group (group IV) were given conventional health education. RESULTS: Subjects in the experimental groups had significantly higher credibility scores to the statement "How much easier do you perceive dental treatment to be for you, based on this program", compared with the control group (p<0.05). They had also more positive beliefs to the statement "I think the interviewer liked to talk to me" (p<0.05) than controls. CONCLUSION: A questionnaire sent to non-attending adolescents followed by a brief telephone call based on Motivational Interviewing appears to be a credible intervention for adolescents avoiding dental care.

Adolescent↗

Relationship between caries prevalence at 5 years of age and dental anxiety at 10.

AIM: The aim of this study was to explore a possible relationship between the individual prevalence of caries in 5-year-old children and dental anxiety in the same children when they became 10 years of age. MATERIALS AND METHODS: A group of 217 children was examined clinically and radiographically for caries at 5 years of age when initial, as well as manifest caries lesions, were recorded. A total of 180 children were available for follow-up at 10 years of age, and dental anxiety was measured by the use of the psychometric questionnaire CFSS-DS. RESULTS: The mean dmfs at 5 years of age was 5.4 (SD+/-7.3) and the mean CFSS-DS at 10 years of age 22.5 (SD+/-6.8). The correlation coefficient between dmfs and CFSS-DS was 0.255 (p < 0.001). Children with high dental anxiety (CFSS-DS sum score higher than one SD above the mean) (N = 22) had a mean dmfs of 10.7, while those with lower dental anxiety had dmfs of 4.7 (p < 0.001). The majority (68%) of the children with high dental anxiety had more than five carious lesions at 5 years of age. CONCLUSION: Children with many carious lesions at the age of 5 years are at high risk for being dentally anxious at 10 years of age. Classical conditioning, including procedural pain and other negative experiences during dental treatment as the unconditioned stimuli, is the most likely reason for this.

Journal Article↗

Reliability and validity of the Dental Indifference Scale in a population of 18-year-olds in Norway.

OBJECTIVES: The aims of this study were to estimate the reliability and validity of the Dental Indifference Scale (DIS) (Nuttall, 1996) in a population of 18-yr-olds in Norway. METHODS: The DIS-scale was mailed to a sample of 1119 18-yr-olds in two Norwegian counties. Nearly 87% completed the questionnaire and consented to the collection of data from their dental records. Ten percent of the sample, drawn at random, was asked to complete the questionnaire a second time, after a time delay of 15 weeks (response rate 83%). The reliability estimation of the sum-scores of DIS was based on Pearson's correlation between test-retest scores and internal consistency (Cronbach's alpha). The frequency of missed appointments from age 12, recorded in the dental treatment records, was used as the validating criterion. The validity was analyzed by Pearson's correlation, and step-wise multiple regression. RESULTS: The correlation coefficient (Pearson) for the test-retest comparison was 0.43. The correlation coefficient between the DIS-scores and the frequencies of missed dental appointments was 0.24. The Cronbach's Alpha coefficient for the eight DIS-questions was 0.35 (n=868). Only two of the eight DIS-questions entered the stepwise regression model and explained 15% of the variance of the frequency of missed appointments. CONCLUSIONS: The Dental Indifference Scale (DIS) was found to have a low reliability and validity in this study population, and it is recommended that it should not be used without further investigation. It may be necessary to design an alternative instrument if further work into the hypothesized trait of dental indifference is to be undertaken.

Adolescent↗

Factors related to missed and cancelled dental appointments among adolescents in Norway.

The aim of this study was to explore possible explanatory factors related to high frequency of missed/cancelled dental appointments during the age group 12-18 yr. A total of 754 20 yr olds completed a questionnaire including variables measuring demographics, occupation (school/job), attendance pattern, attitudes to dentists, opinion about importance of dental treatment, and the psychometric scales Dental Fear Scale (DFS), Dental Beliefs Survey (DBS) and Geer Fear Scale (GFS). Based on written consents, the following data were recorded from their dental records: the total number of scheduled appointments, the number of missed and cancelled appointments and the individual caries experience of those in the age group 12-18 yr. A total of 124 subjects who had missed/cancelled 20% or more of their dental appointments during this age were defined as a target group. A stepwise regression model indicated that the likelihood of being included in the target group increased by a factor of 6.0 if the subject had forgotten dental appointments during the last 5 yr, by a factor of 3.5 for working or without specified occupation (as opposed to attending school), by a factor of 2.7 for negative beliefs of dentists, and by a factor of 2.1 for high caries experience.

Adolescent↗

Dental anxiety and dental avoidance among 12 to 18 year olds in Norway.

The aim of this study was to explore the prevalence and possible explanatory factors of dental avoidance due to dental anxiety among 12 to 18 year olds treated within the Norwegian Public Dental Service. A total of 754 20-yr-olds completed a questionnaire and three psychometric scales, the Dental Fear Scale (DFS), the Dental Beliefs Survey (DBS) and the Geer Fear Scale (GFS), and gave their consent to collect data from their dental records. A total of 169 subjects (22.4%) had high dental anxiety (DFS>59 or DBS>47 at age 20 yr), and 124 subjects (16.4%) had high frequency of missed/cancelled appointments (20% or more) during the period 12-18 yr. Forty-seven subjects (6.2%) fulfilling both of the above criteria constituted the dental avoidance group. An analysis using a stepwise regression model indicated that having had more than one painful or unpleasant treatment experience increased the risk of being included in the avoidance group by a factor of 10.9. Equally, adolescents who were not attending school (working or without specified occupation) increased the risk by a factor of 6.9, having a high caries experience by a factor of 5.0, and not having their dental treatment completed at the age of 18 yr by a factor of 4.4.

Adolescent↗

A randomized clinical trial of triazolam in 3- to 5-year-olds.

Triazolam has shown promise as a sedative agent for use in pediatric dentistry. However, the efficacy of triazolam has not been previously examined in a placebo-controlled study. The present clinical trial used a two-group, randomized, double-blind study design to compare the efficacy of oral triazolam with that of a placebo. The primary hypothesis tested was that triazolam would reduce negative behaviors of pediatric dental patients compared with a placebo. A secondary hypothesis was that triazolam would increase the efficiency of dental treatment by reducing the need for time-consuming behavior management by the pediatric dentist. The subjects were 54 3- to 5-year-old children, randomly assigned to the drug and placebo groups. The active drug, 0.03 mg/kg triazolam (Halcion), or lactose placebo was given orally 30 min before dental treatment. Behavior management techniques commonly used in pediatric dentistry were used during dental treatment. A single pediatric dentist provided all of the dental treatment. The procedure included an inferior block anesthesia and careful attention to anesthesia effectiveness. All sessions were video-taped and the tapes coded for child and dentist behaviors by an independent observer. There were no statistically significant differences between the groups with respect to completion of dental treatment. There were no significant differences found in either the total time or the percent of time that the subjects exhibited disruptive movements, verbal or non-verbal distress. The total use of time in the dental chair was slightly higher in the placebo than in the drug group due to more time spent preparing the child. Contrary to preliminary reports in the literature, this investigation found little or no improvement in child behavior when triazolam was used as a sedative compared with a placebo. However, triazolam did shorten the length of dental treatment, primarily by reducing dentist time in preparing the child for the dental procedure (e.g., establishing rapport and shaping behavior).

Administration, Oral↗

Dental anxiety among 18-yr-olds in Norway. Prevalence and related factors.

The aims of this study were to determine the prevalence of dental anxiety at the time when adolescents are leaving the public dental service, and to explore the relationship at this stage between dental anxiety and some possible etiologic factors. The sample consisted of 571 18-yr-olds in high school who completed a questionnaire and three psychometric scales, the Dental Fear Scale (DFS), the Dental Beliefs Survey (DBS) and the Geer Fear Scale (GFS), in the classroom. The relationship between dental anxiety (DFS and DBS) and a total of nine possible etiologic factors was explored by the use of stepwise regression analyses, and risk estimates (odds ratio) were calculated in cross-tables. There were significant sex differences for DFS and for GFS, but not for DBS. Nineteen percent of the total sample were classified as having high dental anxiety (DFS > 59). Previous experiences of pain, phobic anxiety indexed by GFS and pain at the last dental visit entered into the stepwise regression models of both dental anxiety indices explaining 50% of the variance of DFS, but only 18% of DBS. Students who reported more than one previous experience of pain were 9.9 times more likely to report high dental anxiety as recorded by DFS than the rest of the group. The corresponding risk factor for DBS was 3.4.

Adolescent↗

Missed and cancelled appointments among 12-18-year-olds in the Norwegian Public Dental Service.

The aims of this study were to evaluate the prevalence and distribution of missed and cancelled dental appointments in the Norwegian Public Dental Service during the age period from 12 to 18 yr, and to explore possible relationships with demographics and individual caries experience (DMFT). A total of 968 patients (86.5% of the sample) gave their consent to collect data from their dental records. Forty-seven % of the group had missed and 26% had cancelled one or more dental appointments. A total of 13.6% had missed more than 20% of their appointments. Missed and cancelled appointments were to a great extent related to different individuals. The frequency of individuals with missed and cancelled appointments showed an almost linear increase from age 12 to 18 yr, and the mean individual frequency increased from 1.1 to 11.8% for missed appointments and from 0.7 to 4.8% for cancelled appointments. Subjects with missed appointments had a significantly higher mean DMFT at the age of 18 compared with the rest of the group. Individuals with missed and cancelled appointments may represent a risk group for future dropout from dental care which should be further analyzed.

Adolescent↗

The ability of Corah's Dental Anxiety Scale and Spielberger's State Anxiety Inventory to distinguish between fearful and regular Norwegian dental patients.

The purpose of this study was to test the ability of Corah's Dental Anxiety Scale (DAS) and Spielberger's State Anxiety Inventory (STAI-S) to distinguish between fearful (n = 145) and regularly attending (n = 156) Norwegian dental patients. The reliability of both instruments was high (Cronbach's alpha indices > 0.95). With DAS, 90% of the fearful patients and 85% of the reference patients were correctly assigned to their appropriate group. Thus it may be concluded that, when used on a Norwegian population, DAS is a valid instrument for distinguishing fearful patients from those regularly attending dental treatment. The corresponding figures for STAI-S were 80% for the fearful patients and 79% for the reference patients. Although not developed specifically for this purpose, this instrument may therefore still validly be used to distinguish between the groups. The correlation between the instruments was 0.76, indicating that to some extent they measure the same phenomenon.

Adult↗

Impact of diagnostic criteria on the prevalence of dental caries in Norwegian children aged 5, 12 and 18 years.

The study aimed to investigate caries prevalence in children using a severity grading diagnostic system, and to evaluate the influence of different diagnostic thresholds on the caries data. A group of 513 children, aged 5, 12 and 18 years, were examined clinically, and with available bitewing radiographs, by four calibrated examiners. The inter- and intra-examiner reliability, assessed by a weighted kappa, varied between 0.80 and 0.95. The mean dmft/DMFT values were 3.8, 5.8 and 11.0 for the three age groups respectively, and the corresponding dmfs/DMFS values were 5.4, 9.9 and 22.6. The d/D-component constituted the major part of the dmf/DMF index in all age groups, and enamel lesions accounted for 59%, 89% and 86% of the d/D-component in the three age groups respectively. It is concluded that enamel or initial caries lesions contributed substantially to the total caries prevalence, illustrating the importance of using diagnostic criteria that include all stages of clinical caries if a total picture of the caries situation is needed.

Adolescent↗

Validation of the Dental Fear Scale and the Dental Belief Survey in a Norwegian sample.

The aim of this study was to validate the Kleinknecht's Dental Fear Scale and the Getz's Dental Belief Survey in a Norwegian sample by 1) testing their ability to discriminate between fearful (n = 151) and regular (n = 160) patients, and 2) correlating them. Both instruments were highly reliable (Cronbach's alpha > 0.90). Between 81% and 95% of the fearful and regular patients were correctly assigned to their appropriate groups with both instruments. It may thus be concluded that both instruments are valid. Also, the correlation between the instruments was 0.68, indicating that they to a large extent seem to measure the same concept. The most important predictor items for both instruments were related to avoidance of dental treatment.

Adult↗

Fissure sealing with a light-cured resin-reinforced glass-ionomer cement (Vitrebond) compared with a resin sealant.

The aims of the present study were to evaluate the retention and caries-preventive effect of a single application of a light-cured resin-reinforced glass-ionomer cement (Vitrebond) in pits and fissures of newly erupted permanent first and second molars, when compared with a single application of a resin-based sealant (Concise White Sealant) during a 3-year period. The study group comprised 73 pairs of contralateral newly erupted permanent first and second molars (136 fissure sites) in 53 children (29 girls, 24 boys). A split-mouth experimental design was used in which the two sealants were randomly allocated to one of the teeth within each pair. Acid etching was not used before application of the glass-ionomer cement. The sealed teeth were checked for retention and caries after 1, 6, 12, 24 and 36 months. The resin-based sealant was almost totally retained after 3 years (97%) and there was no caries in these teeth. The glass-ionomer cement was increasingly lost and could be observed in only 9% of the sealed sites after 3 years. Carious lesions developed in 10 (7.4%) sites (nine teeth, seven children). It was concluded that the resin-based sealant is superior to the glass-ionomer cement in preventing caries, and that the superior retention of the resin probably is an important factor for this.

Adolescent↗

The prevalence of dental anxiety in children from low-income families and its relationship to personality traits.

The prevalence of dental anxiety and the association between dental anxiety and personality traits were examined in a population-based sample of 895 US urban children, from 5 to 11 years of age, from low-income families. Dental anxiety was reported by the child using the Dental Subscale (DS) of the Children's Fear Survey Schedule, and behavioral problems and personality traits were evaluated by parent report on the Child Behavior Checklist (CBCL). Mean DS scores were 31.1 (SD = 10.3) for boys and 34.3 (SD = 11.0) for girls. CBCL score means were 33.3 (SD = 23.2) for boys and 28.5 (SD = 19.1) for girls. The hypothesized relationship between DS and CBCL scores in this population was not demonstrated.

Child↗