Biomedical subjects

M Vehkalahti

Publications and source records attributed to M Vehkalahti.

At least 19 recordsLinked to original sources

PubMed2003

Dental health of dentists' children in Mongolia.

OBJECTIVES: To describe the dental health of dentists' children, to evaluate its association with their dentist-parents' background and work-related characteristics and to compare it with that of children in the general population in Mongolia. DESIGN: Cross-sectional survey, questionnaire-based data. SUBJECTS: Dentists' children, aged 3-13 years. SAMPLE: All dentists (n = 250) actively practising in the capital city of Mongolia. RESULTS: The dentists' children's dmft ranged from 0 to 12, and DMFT from 0 to 8; 50% were caries-free. The younger the children, the higher was their total caries experience expressed as the sum of DMFT + dmft scores (r = -0.22; P = 0.001). Dentist-parents' background and work-related factors were not associated with their children's caries status (P > 0.05). When dentists' children were compared with their counterparts at the population level, mean dmft for 6-year-olds was 2.6 for (urban) dentists' children, 6.5 for children in the urban population and 0.9 for those in rural population of equivalent age. Mean DMFT for 12-year-olds were 1.0, 1.8 and 1.2, respectively, in the same three groups. In general, (urban) dentists' children in all age groups had better dental health than did their urban counterparts at the population level. Among 5-7-year-olds, dentists' children had worse dental health than did their counterparts in the rural population. CONCLUSIONS: Despite the dentists' knowledge and awareness, their children demonstrated higher rates of dental caries than expected. This suggests that Mongolian dentists may have insufficient preventive orientation. In particular, the primary dentition of younger children seems to be poorly valued. In Mongolia, dentists should have better training and education in modern methods of caries prevention and their advantages. Appreciation and care of the primary dentition need to be improved at all levels of oral health promotion in Mongolia.

Adolescent↗

PubMed2002

Dentists' perception of their treatment practices versus documented evidence.

OBJECTIVE: To compare the quality of real-life treatment practices to dentists' perceptions of treatment rendered. SETTING: One administrative unit of the Finnish public oral health service. METHODS: The original oral health records of a randomly selected sample of young adults who received treatment during 1994-1996 provided data on actual clinical examinations (n=208), radiographs (n=312), and root canal treatment courses (n=148) carried out by 50 dentists. Dentists' perceptions of the treatment rendered were obtained through a structured questionnaire completed during their working hours in 1996. OUTCOME MEASURES: Criteria for assessing the quality of treatment practices were based on Finnish health legislation, authoritative instructions, and consensus reports. RESULTS: Based on responses, 77% of the dentists followed the prevailing instructions on oral health record keeping (82%, if partial agreement included). Most dentists (88% fully agreed, 95% at least partly) perceived that their knowledge gained through continuing education was being applied in practice; no one answered no. A gap was found between dentists' perception of the treatment rendered and everyday treatment practices as recorded on patient documents. CONCLUSIONS: Overall, dentists' perception of the quality of their treatment practices exceeded that found in patient documents. This gap deserves consideration while planning research, education, or quality-improvement projects that relate to dentists' opinions.

Adult↗

PubMed2000

Quality evaluation of young adults' radiographs in Finnish public oral health service.

OBJECTIVE: To evaluate the quality of young adults' radiographs exposed and processed under everyday clinical conditions. SETTING: One administrative unit of the Finnish public oral health service. DESIGN: Two reviewers independently evaluated the radiographs by the same written criteria that were designed as a checklist for on-site evaluations, without any further calibration. SAMPLE: In total, 312 radiographs (178 bitewing, 88 periapical and 46 panoramic) from 1990 to 1996, collected from patient documents of a randomly selected sample of young adults born in 1966-1971. OUTCOME MEASURES: Radiographs were assessed by quality indicators pertinent to the clinical utility as acceptable or unacceptable. If erroneous by some indicator(s) but still contributing to the diagnostic information, a radiograph was rated as diagnostically acceptable. A score of quality points was calculated for each radiograph. RESULTS: The overall kappa statistics for intra-examiner reliability was 0.63, the proportional agreement 83%. For inter-examiner reliability, 0.42 and 71%, respectively. Although the evaluation criteria took the clinical utility of the radiographs into consideration, only 15% of bite-wings, 13% of periapicals, and 2% of panoramics received the maximum quality points. Erroneous film positioning was the most common fault on intraoral radiographs. On panoramics, the most frequent faults were in density and contrast and in patient positioning. The radiological evaluation had only been recorded for less than one fifth of the films. CONCLUSIONS: A proportion of radiographs fell short of the ideal. There is room for improvement in the quality of radiography in order to obtain the greatest possible diagnostic yield from the exposed radiographs.

Adult↗

PubMed2000

Quality evaluation of process of root canal treatments performed on young adults in Finnish public oral health service.

OBJECTIVES: To evaluate the quality of root canal treatments performed in every-day practice on young adults. METHODS: A quality index related to the treatment process was developed based on the guidelines of the European Society of Endodontology. A random computerised selection of 134 young adults (born 1966-1971) produced 125 (93%) eligible oral health documents, including information on 148 teeth that were root canal treated by 47 dentists. The process of root canal treatment was evaluated according to the original oral health documents. The technical quality of root canal fillings was assessed on postoperative periapical radiographs. RESULTS: The overall Kappa statistics for the inter-examiner reliability of assessments was 0.63; the proportional agreement being 87%. The mean quality index was 6.2, s.d. 2.0, with none of the treatments scoring the maximum 13. On the 56 available postoperative radiographs, 52% of the fillings were optimal, showing a length within 0-3mm from the radiological apex, no voids in the apical part nor lumen apical to the filling. Of the completed 144 root canal treatments, only 11 included some recorded follow-up information within 15months from the termination of the treatment. CONCLUSIONS: The technical quality of the root fillings was similar to that found in previous studies. However, the quality index, paucity of pre- and post-operative radiographs, and the lack of follow-up all indicated a discrepancy between consensus guidelines and every-day practice.

Adult↗

PubMed1999

Dentists' selection of measures for assessment of oral health risk factors for Finnish young adults.

Dentists' selection of measures for assessing oral health risk factors for young adults, in relation to their oral health status and to those dentists' characteristics, was studied in one administrative unit of the Finnish public oral health service. A random selection (n = 239) was made of all young adults born in the period 1966-71 and clinically examined during 1994. On the original oral health records of those selected, all notes were scrutinized concerning the most recent clinical examination and treatment course; in total 208 (87%) records. We found that assessment of risk factors to oral health was rare. The patient's diet had been recorded as assessed in 7% of all cases, use of fluoride in 8%, and oral hygiene habits in 14%. No salivary tests were performed; nor was patients' use of tobacco assessed. No correlation was detected between measures used by these dentists and their patients' oral health status (DMFT and DT scores, number of approximal incipient lesions, and number of healthy sextants by CPITN). The oral health status impelled only slightly assessments by bite-wing radiographs. Fewer than half (44%) of the dentists performed and recorded any kind of assessment measure; 4% assessed diet, hygiene, and use of fluoride for all their patients in our sample. A dentist's gender showed no correlation with number of measures used; younger dentists tended to perform and record assessments slightly more often than did older dentists, but in all age groups there were those who had not done this. The practice of risk-factor assessment should be more widespread and standardized, contributing to needs-based treatment and allocation of resources.

Adult↗

PubMed1999

Treatment practices in caries prevention for 6-year-olds in Finland.

OBJECTIVES: To evaluate caries-preventive treatment practices in relation to caries state and eruption of first permanent molars (FPMs) among 6-year-olds (n = 3489) examined and treated in public dental clinics in Helsinki during 1992. METHODS: The study subjects were selected on the basis of their caries state using a two-point study design: the high-caries group (n = 99) had the greatest number of DT + dt, the cavity-free group (n = 32) had neither past nor present caries. Evaluation of dentists' caries-preventive treatment decisions was based on data from detailed personal oral health records. RESULTS: In total, 22% of the high-caries patients (mean DT + dt 8.7; range 4-18) had been judged by their dentists as high-risk patients. Eruption of FPMs had no influence on dentists' judgement on caries risk. A subject's number of DT + dt had no influence on the intensity of preventive treatment given, but those with a high-risk judgement from a dentist received more preventive measures per visit than did other high-caries patients. For high-caries patients with erupting FPMs, three visits in 10 included preventive intervention other than sealants, compared to nine in the cavity-free group. Intensity of oral hygiene instruction correlated with presence of erupting FPMs, yet 86% of the patients with erupting FPMs had received no oral hygiene instruction. CONCLUSIONS: Dentists should be encouraged to use standardized criteria, including data on caries state and eruption stage, in judging each patient's risk of caries to provide intensified caries-preventive treatment to those most in need.

Child↗

PubMed1999

Dental care of six-year-old high-caries patients in relation to their cooperation.

OBJECTIVE: To evaluate caries occurrence in, and dental care given to, 6-year-old high-caries patients in relation to their cooperation as judged by the dentist. DESIGN: Retrospective evaluation study. SETTING: Children selected on the basis of their high number of decayed teeth (dt + DT). Data from personal oral health records. PARTICIPANTS: High-caries children aged 6 years (n = 97) clinically examined and treated in public dental clinics in Helsinki, Finland, with mean dt + DT = 8.7, range 4-18. OUTCOME MEASURES: Data covering ages 3 to 7 years: utilization of dental services, operative and preventive treatment by visit. RESULTS: Treatment strategy for the 6-year-old high-caries patients was not preventive-oriented. High-caries patients had three to four times as many visits as all 6-year-old children on average, but the visits had mostly served for operative treatment. Dentists had judged 34% of the high-caries patients to be non-cooperative. These patients had more past and present caries in their deciduous teeth (P < 0.01), more dental visits (P < 0.01), and received more demanding treatment (P < 0.001) than the cooperative high-caries patients. Caries preventive treatment given to all high-caries patients was rare, number of preventive interventions per patient and per visit (intensity) tended to correlate negatively with patients' cooperation (r = -0.12 and r = -0.23). Treatment courses were completed in 39% among the non-cooperative and in 63 per cent among the cooperative high-caries patients (P < 0.05). CONCLUSION: Dentists should be encouraged to integrate preventive interventions more closely into the treatment of non-cooperative high-caries children.

Chi-Square Distribution↗

PubMed1999

Dentists' decisions as to mode of preventive treatment in adolescents and young adults in Finland.

OBJECTIVE: To evaluate dentists' real-life decisions as to mode of preventive treatment in adolescents and young adults, in relation to these patients' oral-health status, and to the dentists' characteristics. DESIGN: A random sample of 206 adolescents and 239 young adults (mean ages 13 and 27 years) produced 411 (92%) individual oral health records providing data on actual clinical examinations and treatment courses carried out by 56 dentists in one administrative unit of the Finnish public oral health service during 1994-1996. OUTCOME MEASURES: Preventive measures were defined as active and passive, active including any kind of motivation or instructions given to a patient concerning home self-care, and passive prevention being topical application of fluoride. RESULTS: More adolescents had received both active and passive prevention than had young adults (active: 27% vs. 20%; passive: 85% vs. 70%). Of adolescents, 7% and of young adults 25% were given no preventive treatment. The mean number of active preventive measures per adolescent during the treatment course was 0.3 and of passive measures 1.0; for young adults 0.2 and 0.8, respectively. A subject's oral health status made no significant difference in active prevention given. Active measures were more frequently given to all patients by male dentists, 35% vs. 22% (P < 0.02), and passive measures by females, 82% vs. 52% (P < 0.001). The odds of active prevention for adolescents were 7.4 comparing male dentists to female; of passive 13.8 comparing female to male. CONCLUSIONS: Dentists should be motivated to make considered treatment decisions on preventive treatment.

Adolescent↗

PubMed1998

Quality evaluation of oral health record-keeping for Finnish young adults.

The objective of this study was to assess the quality of oral health record-keeping in public oral health care in relation to dentists' characteristics. A random computerized selection of 239 subjects, born in 1966-71 and clinically examined during 1994 in an administrative unit of the public oral health service in southern Finland, included 4-5 cases per dentist, the number of dentists being 50. Data concerning actual clinical examinations and treatment courses carried out in public dental clinics came from original oral health records. Criteria for assessment of oral health record entries were based on Finnish health legislation and detailed instructions of health authorities. The results showed that each patient's identity was available in 90% of documents. Recordings concerning continuity of comprehensive care were infrequent; a questionnaire concerning each patient's up-to-date health history was in only 26% of the oral health records. Notes concerning each patient's bite and function of the temporomandibular joint were in 37% of the records, notes about oral soft tissues were in 11%, and the check-up interval was recorded in 21%. Recording of indices on periodontal and dental status varied greatly; the community periodontal index of treatment need was found in 93% and the index of incipient lesions in 16% of the records. Female dentists and dentists younger than 37 years tended to record more information. Dentists should be encouraged to better utilize the options offered by oral health records for individual treatment schemes.

Adult↗

PubMed1997

Decrease in and polarization of dental caries occurrence among child and youth populations, 1976-1993.

With data on children's dental state from 1976 to 1993, we evaluated how the size of the high-caries group has changed concurrently with simultaneously decreasing mean numbers of teeth with past or current caries. Information related to all dental check-ups done for 5- and 15-year-olds in Helsinki, some 4,000 subjects of each age by year, consisted of numbers of teeth with caries experience (dmft or DMFT) and of all decayed teeth (dt + DT). Polarization of dental caries was described as the proportion of high-caries groups in each year, both in terms of caries experience and current untreated caries, diagnosed at subjects' annual clinical dental check-ups. For 5-year-olds, the high-caries group by caries experience included patients with their dmft > or = 3. For 15-year-olds the limits were set at DMFT > or = 6 and DMFT > or = 15. The high-caries group in terms of untreated caries was similar for both age groups: dt + DT > or = 3. Furthermore, polarization of caries was calculated as the share of numbers of both dmf or DMF teeth and dt + DT in each high-caries group of the total number of such teeth in the entire age cohort. During the 17 years, mean dmft for 5-year-olds decreased from 4.6 to 0.8 and mean dt + DT from 0.9 to 0.6. In 1993, 78% had their dmft = 0, whereas only 8% of the patients accounted for 76% of all decayed teeth. For 15-year-olds the decrease was even greater: their DMFT fell from 12.1 to 3.0 and their dt + DT from 3.1 to 0.8. However, only 26% had their DMFT = 0 in 1993, with 55% of all dt + DT occurring in 10% of the patients. The present results confirmed a strong polarization in caries for both age cohorts, showing the need for renewed strategies in preventive caries treatment.

Adolescent↗

PubMed1997

Occlusal imbalance and temporomandibular disorders in the elderly.

The prevalence of the anamnestic symptoms and clinical signs of temporomandibular disorders (TMD) in 76-, 81-, and 86-year-old subjects was studied, on the basis of Helkimo's anamnestic (Ai) and clinical (Di) dysfunction indexes. Occlusal status was recorded by means of the Eichner index: class A has a maximum of four supporting zones (minimum of one tooth contact between the antagonist jaws in the premolar and molar region on each side), class B has one to three supporting zones or tooth contact in the frontal area only, and class C has no supporting zones. The Eichner index was recorded with two kinds of variations: supporting zones with and without removable prostheses. In the population studied 8% were classified as Eichner class A, 22% as class B, and 70% as class C. Including occlusal supporting zones of the removable dentures, the percentages were 75% in Eichner class A, 21% in class B and 4% in class C. When the groups with and without removable prostheses were compared, no differences were found in the Ai or Di. In conclusion, among the elderly population the severity of TMD does not depend on the supporting zones of the dentition alone, and removable prostheses do not relieve the problem.

Aged↗

PubMed1997

Dentists' decisions on caries risk and preventive treatment by dental state among 15-year-old adolescents.

OBJECTIVE: To evaluate dentists' decisions on caries risk and preventive treatment in relation to their clinical findings among 15-year-old children. DESIGN: Two groups of children were selected on the basis of subjects' number of decayed teeth. Data were also used from personal oral health records. PARTICIPANTS: 15-year-old children (n = 132) clinically checked and treated in public dental clinics in Helsinki. The high-risk group (n = 100) had the greatest numbers of decayed teeth (DT + dt), the low-risk group (n = 32) was cavity-free. OUTCOME MEASURES: Dental state, treatment decision, preventive and operative treatment recorded by visit, were used for assessment of caries risk and individual needs for caries prevention, and for evaluation of diversity and intensity of preventive treatment given to each patient. RESULTS: Dentists had judged only 17 per cent of the high-risk patients (mean DT + dt 6.5; range 4-16) as being at high risk of caries. Preventive measures were given only on one out of three visits. One out of two preventive measures was application of fluoride varnish and only one out of ten was dietary counselling. Patients with more decayed surfaces had been given more diversified (P < 0.01) and more intensive (P < 0.005) preventive treatment than had those with none or only a few caries lesions. Despite this, only 4 per cent of the patients with DS = 8-27 had been given four different preventive measures, and one patient out of seven had been left without any caries-preventive intervention. CONCLUSION: To meet individual needs of high caries-risk patients, the variety and intensity of preventive measures directed towards them need to be further improved.

Adolescent↗

PubMed1996

Evaluation of preventive treatment by risk of caries among 13-year-olds.

Implementation of caries preventive treatment in relation to the risk of caries was studied among 13-year-olds (n = 132) in two groups treated in the same public dental clinics in Helsinki: caries patients (n = 100) had the greatest numbers of decayed teeth (DT+dt), 5.5 on average, whereas cavity-free patients (n = 32) had intact teeth. Data taken from patients' personal oral health records served for evaluation of individual need for caries prevention, risk of caries, and preventive treatment given to each patient. Patients with any caries lesions or erupting teeth or poor oral hygiene were considered to be at risk of caries and in need of preventive treatment. The more caries lesions a patient had, the more prevention was expected to have been given. Preventive treatment of caries was weakly or only moderately in accordance with patients' individual needs and risk of developing caries, although patients with more caries lesions tended to have been given more preventive treatment than did those with none or only a few lesions. The majority of preventive measures given were applications of fluoride varnish, whereas motivation of and instruction in oral health care habits remained weak. However, patients whom their dentists had judged to be at high risk of caries received more intensified preventive treatment than did other caries patients. As a conclusion, intensification of caries prevention among high-risk patients is still needed. Dentists should always consider each patient's risk of developing caries to improve quality of preventive treatment.

Adolescent↗

PubMed1996

Factors related to the non-attendance in a clinical oral health study on the home-dwelling old elderly.

OBJECTIVE: To evaluate how elderly home-dwelling subjects' background factors, state of health, functional capacity and edentulousness related to their attendance in a comprehensive clinical dental study. DESIGN: Cross-sectional population study; interview and clinical dental data. SETTING: The City of Helsinki; clinical dental examinations at the Institute of Dentistry, University of Helsinki. SUBJECTS: 600 elderly aged 76, 81 and 86 years, participants in the medical examinations in the Helsinki Ageing Study one year earlier, 81% being home-dwelling. MEASURES: Age, gender, marital status, family structure, educational level, former line of work, self-perceived general health, dentulousness, ability to move, sense of hearing, state of memory, clinical findings of dementia, other medical diagnoses, and intake of drugs. OUTCOME MEASURE: Participation in clinical dental examinations. RESULTS: The overall participation was 63% being reduced by high age and female gender, 75% of the 76-year-olds, but only 53% of those aged 81 or 86 years were clinically examined, figures were for men 72% and for women 60%. As shown by a multifactorial logit model, the strongest factors related to non-participation were the home-dwelling subjects' old age (OR = 3.6), deteriorated ability to move (OR = 5.3), clinically diagnosed symptoms of dementia (OR = 4.1), or edentulousness (OR = 2.5). CONCLUSION: Non-participation selectively by those edentulous will lead to prevalence figures on numbers of teeth being too optimistic for the entire elderly population.

Age Distribution↗

PubMed1996

Evaluation of salivary tests and dental status in the prediction of caries increment in caries-susceptible teenagers.

We evaluated caries increment in connection with salivary caries-related findings and dental status in teenagers by carrying out a retrospective follow-up, lasting on average 28 months. A total of 66 adolescents, mean age 15.2 years, were selected by their susceptibility to caries, as clinically defined at a routine checkup. Their baseline DMFT was 5.7, compared to 4.3 in the root population of 230 patients. Increment of caries on selected surfaces (delta DFSs) included new caries reaching the dentine and new fillings done due to such caries. Delta DFSs > 0 was taken as the validation criterion to define a caries case. Screening criteria for salivary tests were set as follows: flow rate of unstimulated saliva less than 0.2 ml/min, and of stimulated saliva less than 1.0 ml/min; buffering capacity: final pH below 4.5, mutans streptococci (SM) score of 2 or 3 (> or = 10(5) CFU/ml), and lactobacilli (LB) score of 5 or 6 (> or = 10(5) CFU/ml). Mean delta DFSs per subject was 1.1, with 70% of these new DF findings being on occlusal surfaces. Delta DFSs was correlated with LB (0.31) for both genders, for boys only with buffering capacity (-0.34), and for girls only with flow rate of stimulated saliva (-0.28) and DMFT (0.35). The highest sensitivities of salivary tests for caries were shown by LB (0.82) and SM (0.64), their specificities being 0.63 and 0.59, respectively. Positive predictive values of the five tests varied between 0.69 and 0.89. Predictions based on DMFT showed a sensitivity of 0.87 for DMFT > 3, but only of 0.33 for DMFT > 7, the corresponding specificities being 0.44 and 0.81.

Adolescent↗

PubMed1996

Academic dissertations by dentists in Finland, 1891-1991, and in Finland, Norway, and Sweden, 1984-93.

Dental education in the Nordic countries was founded in the late 1800s, but the doctor's degree in dentistry (Ph.D.) was established somewhat later. Since the first dissertation in Finland in 1891, a total of 204 doctoral dentist candidates had defended their Ph.D. theses by 1991, 50% of them during the most recent 12 years. Over the 100-year period, 54% of the dentists' Ph.D. theses in Finland were defended at the University of Helsinki, 27% at Turku, 14% at Kuopio, and 5% at Oulu. Women constituted a minority of the candidates (23%) during the first 90 years but 54% from 1982 to 1991. From 1984 to 1993 a total of 374 dentist candidates in Finland, Norway, and Sweden defended their Ph.D. theses. The mean ages of the candidates ranged from 37.7 to 41.7 years for men and from 40.6 to 43.2 years for women. In the 10-year period on average 53 doctor's degrees were received per institute in Sweden, compared with 28 in Finland and 27 in Norway. In all three countries about 6 of 100 graduates in 1980s received a doctor's degree in dentistry. Almost all of these Ph.D. theses were written in English and based on collections of articles. Female candidates dominated in Finland (56%), compared with 34% in Sweden and 26% in Norway, where, however, women's contribution increased most rapidly, being tripled from early 1980s to 1990s.

Academic Dissertations as Topic↗

PubMed1994

Association between root caries occurrence and periodontal state.

To analyze the occurrence of root caries in relation to the periodontal state, we examined clinically a representative sample (n = 4,777) of Finish adults, aged 30 years and older. Our definition of root caries included primary decay on root surfaces, and a subject's periodontal state was described according to the presence or absence of gingival inflammation or periodontal pockets and subgingival calculus and/or overhangings. Subjects with a healthy periodontium seldom (4%) had any caries on root surfaces, whereas 15% had caries in conjunction with gingival inflammation, and 17% in conjunction with deepened pockets. The deeper the pockets, the greater the frequency of root caries for men, but not for women. Subgingival plaque retention showed a strong association with root caries. As the study population represented Finnish adults, the results can be generalized with reasonable confidence.

Adult↗

PubMed1994

Outcome of public oral health services in relation to treatment mix.

We evaluated the outcome of public oral health services in relation to the treatment mix in the city of Helsinki, in which 7 independent districts provided dental care to 98,000 patients in 1989. Outcome was defined as the increase in numbers of DMF teeth over the 2 years from 1989 to 1991 in 16,000 patients 8, 10, 12, and 13 years of age. The share of each type of treatment in the treatment mix was calculated on the basis of the market price of the items of service. The greater the share of prevention, the more positive the outcome (p < 0.01)- that is, the lower the increase in numbers of DMF teeth. In a regression model the share of prevention alone accounted for 53% of the variation in the outcome by district. Addition of the share of checkups to the model increased its explanatory power markedly (R2 = 0.74). A positive outcome was seen both in districts with poor and in those with good educational structures.

Adolescent↗