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PubMed2002

A randomised controlled trial of the effectiveness of providing free fluoride toothpaste from the age of 12 months on reducing caries in 5-6 year old children.

OBJECTIVE: To assess the impact of regularly supplying free fluoride toothpaste regularly to children, initially aged 12 months, and living in deprived areas of the north west of England on the level of caries in the deciduous dentition at 5-6 years of age. A further aim was to compare the effectiveness of a programme using a toothpaste containing 440 ppmF (Colgate 0-6 Gel) with one containing 1,450 ppmF (Colgate Great Regular Flavour) in reducing caries. DESIGN: Randomised controlled parallel group clinical trial. Clinical data were collected from test and control groups when the children were 5-6 years old. SETTING: A programme of posting toothpaste with dental health messages to the homes of children initially aged 12 months. Clinical examinations took place in primary schools. PARTICIPANTS: 7,422 children born in 3-month birth cohorts living in high caries areas in nine health districts in north west England. Within each district children were randomly assigned to test or control groups. INTERVENTIONS: Toothpaste, containing either 440 ppmF or 1450 ppmF, and dental health literature posted at three monthly intervals to children in test groups until they were aged 5-6 years. MAIN OUTCOME MEASURES: The dmft index, missing teeth and the prevalence of caries experience. RESULTS: An analysis of 3,731 children who were examined and remained in the programme showed the mean dmft to be 2.15 for the group who had received 1,450 ppmF toothpaste and 2.49 for the 440 ppmF group. The mean dmft for the control group was 2.57. This 16% reduction between the 1,450 ppmF and control group was statistically significant (P<0.05). The difference between the 440 ppmF group and control was not significant. Further analyses to estimate the population effect of the programme also confirmed this relationship. CONCLUSION: This study demonstrates that a programme distributing free toothpaste containing 1,450 ppmF provides a significant clinical benefit for high caries risk children living in deprived, non-fluoridated districts.

Analysis of Variance↗

PubMed1991

Dental health and dietary habits in Greek immigrant children in southern Sweden compared with Swedish and rural Greek children.

Dental health and dietary habits were surveyed in 40 Greek immigrant (GI) children, 2-8 years old, born and living in Helsingborg, Sweden; comparisons were made with 45 Swedish (S) and 54 rural Greek (G) children of the same age. The caries situation was virtually the same in the GI and the S group, where the primary teeth were caries-free in 31-33%, mainly children 2-3 years old. The G group had a higher incidence of decayed and filled tooth surfaces in both primary and permanent teeth than the other two groups and only 15% were caries-free in the primary teeth. The S group had the lowest gingival bleeding index. The distribution of the mutans streptococci and lactobacilli counts in saliva did not differ significantly between the three groups, except that the proportion of GI children with "not detectable" mutans streptococci was lower in either the S or the G group. The toothbrushing frequency was highest in the S group, followed by the GI group. Approximately 80% of the S children who brushed their teeth used a fluoride toothpaste compared to 50 and 55% respectively in the G and the GI group. The intake frequency for 5 out of 6 preselected snack-food items was highest in the G group. The carbohydrate content of the diet, including sucrose, was approximately the same in the three groups. Thus, the dental health and dietary habits of the Greek immigrant and the Swedish children were generally very similar, while the Greek rural children showed a less favourable cariological status.

Bacteria↗

PubMedDate not supplied

Continuous effect of pit and fissure sealing on S. mutans presence in situ.

PURPOSE: The effect of sealants on S. mutans presence in situ was investigated. METHODS: Four intact, fully erupted first permanent molars in each of 74 children, aged 6-8 years were required for inclusion in the study. Baseline examination included deft and plaque index. S. mutans presence on occlusal surfaces of the molars was evaluated, using a microbial replica method. Immediately after sealing the first permanent molars on one side, S. mutans presence in situ was re-evaluated, as well as three and six months thereafter. Three months after the initiation of the study, S. mutans presence was evaluated on the molars of the unsealed side, which were consequently sealed and re-evaluated immediately, and three months later. RESULTS: Positive correlation was found between deft scores, plaque indices and microbial replica values, at baseline. Sealing caused a significant reduction in S. mutans levels on the treated occlusal surfaces, in vivo (P < 0.001), which lasted, in most cases, up to six months. CONCLUSIONS: The data suggest that sealants enable a prolonged reduction of S. mutans presence in situ, indicating an additional prevention effect, by reducing one source of dissemination.

Child↗

PubMed1991

A study of developmental defects in enamel in 10-year-old high social class children residing in a non-fluoridated area.

This study investigated the relationship between reported exposure to fluoride in the form of toothpaste and fluoride supplements, the level of observed developmental defects in enamel and the caries experience in a sample of 10-year-old children. Using a modified and simplified version of the developmental defects of enamel index, 300 10-year-old children who had been continually resident in non-fluoridated high social class areas were examined. The examination was followed by a questionnaire to parents on their child's fluoride supplement and toothpaste usage, and toothbrushing habits in early childhood. The prevalence of developmental defects in enamel was lower than that reported elsewhere. A large number of children had diffuse developmental defects but had no history of exposure to fluoride supplements. The only differentiating factor between this group and a similar group with no diffuse defects was in the amount of toothpaste dispensed during toothbrushing prior to the age of six. There was no association between caries experience and the presence or absence of developmental defects. It was concluded that parents of children from a high social class background should supervise the brushing of their children's teeth and use only a pea-sized amount of toothpaste.

Age Factors↗

PubMed2004

Dental and facial characteristics of patients with juvenile idiopathic arthritis.

OBJECTIVE: It has been shown that the temporomandibular joint is frequently affected by juvenile idiopathic arthritis, and this degenerative disease, which may occur during facial growth, results in severe mandibular dysfunction. However, there are no studies that correlate oral health (tooth decay and gingival diseases) and temporomandibular joint dysfunction in patients with juvenile idiopathic arthritis. The aim of this study is to evaluate the oral and facial characteristics of the patients with juvenile idiopathic arthritis treated in a large teaching hospital. METHOD: Thirty-six patients with juvenile idiopathic arthritis (26 female and 10 male) underwent a systematic clinical evaluation of their dental, oral, and facial structures (DMFT index, plaque and gingival bleeding index, dental relationship, facial profile, and Helkimo's index). The control group was composed of 13 healthy children. RESULTS: The mean age of the patients with juvenile idiopathic arthritis was 10.8 years; convex facial profile was present in 12 juvenile idiopathic arthritis patients, and class II molar relation was present in 12 (P =.032). The indexes of plaque and gingival bleeding were significant in juvenile idiopathic arthritis patients with a higher number of superior limbs joints involved (P =.055). Anterior open bite (5) and temporomandibular joint noise (8) were present in the juvenile idiopathic arthritis group. Of the group in this sample, 94% (P =.017) had temporomandibular joint dysfunction, 80% had decreased mandibular opening (P = 0.0002), and mandibular mobility was severely impaired in 33% (P =.015). CONCLUSION: This study confirms that patients with juvenile idiopathic arthritis a) have a high incidence of mandibular dysfunction that can be attributed to the direct effect of the disease in the temporomandibular joint and b) have a higher incidence of gingival disease that can be considered a secondary effect of juvenile idiopathic arthritis on oral health.

Adolescent↗

PubMed2006

Periapical status and technical quality of root-filled teeth in Swedish adolescents and young adults. A retrospective study.

OBJECTIVE: The aim was to study periapical status and the technical quality of root-filled teeth in Swedish adolescents and young adults in Malmö, Sweden. MATERIAL AND METHODS: The sample, collected from dental records in the Public Dental Service, consisted of notes and radiographs of all root-filled permanent teeth in all 19-year-olds born in 1979 (mean age at root filling=16.2 years). The sample for assessing periapical status and technical quality consisted of 124-153 teeth. The criterion for inclusion for assessing periapical status was a follow-up time of at least one year. Periapical status was assessed with the Periapical Index (PAI). Technical quality was analyzed from radiographs in two respects: sealing quality of the root canal and distance from the root filling to the radiographic apex. The radiographs were analyzed independently by two observers with inter-examiner kappa values of 0.82-0.85. RESULTS: Apical periodontitis was found in 52% of the teeth and occurred significantly more often among molars than among anterior teeth. As judged radiographically, 51% of the teeth were inadequately sealed. In 38%, the distance to the apex was >2 mm and overfilling was registered in 14% of the teeth. Compared with anterior teeth, significantly more root fillings of molars had a distance to the apex of >2 mm. Technical quality was statistically significantly correlated with periapical status at follow-up. CONCLUSIONS: The technical quality and periapical status of root-filled teeth in adolescents and young adults were unsatisfactory in about half of the teeth.

Adolescent↗

PubMed1994

Influence of oral hygiene on early enamel caries.

For 548 children aged 4-16 years, mean (+/- SD) age 10.3 +/- 2.7 at visit 1, the dental status was recorded at four consecutive 6-monthly visits. Simultaneously oral hygiene was scored according to a modified patient hygiene performance (PHP) index after application of disclosing solution and before the dental examination. The following cariogenic changes could be observed: initiation (white spot formation), progression (cavitation), stabilisation and regression (disappearance of a white spot). The PHP score was examined in relation to these changes in smooth surfaces, as well as in fissures. For fissures when oral hygiene worsened, stabilisation of a white spot increased significantly. Also, regression of a white spot into sound enamel increased with poor oral hygiene, but the significance was only marginal. White spots turning into cavities, however, did not change with poor oral hygiene. It was speculated that under low oral hygiene conditions the remaining plaque of children receiving intensive fluoride treatment can bind fluoride to the fissure surfaces, thereby promoting enamel maturation concomitant with stabilisation and regression of white spots, which in an earlier study were also found to be dependent on posteruptive age.

Adolescent↗

PubMed1979

Dental caries and restoration. IV. A six-year longitudinal study of the caries increment of proximal surfaces.

In order to study the progression of proximal caries lesions and the quality of restorations, a sample of individuals in Gothenburg, Sweden was radiographically examined at the ages of 16, 19 and 22. By means of an index system every proximal tooth surface was given a diagnosis and differences between examinations were evaluated by a score system. Of all decayed and filled surfaces observed at the age of 22 more than 70% were already established at the age of 16. During the 16--19 year interval more than twice as many new carious lesions were developed than during the 19--22 year interval. The decrease in the number of new lesions during the last interval was accompanied by a slower progression of already existing lesions. Both factors resulted in a lower mean value with regard to scores during the 19--22 year interval compared with the preceding one. However, great individual differences were noted and 22 percent of the individuals exhibited larger score values during the last interval than during the first. Relatively seen the number of restorations with overhanging margins was lower at the final examination than at the previous ones.

Adolescent↗

PubMed2005

The life course approach: explaining the association between height and dental caries in Brazilian adolescents.

AIM: To investigate the relationship between height and dental caries in Brazilian adolescents. METHODS: A cross-sectional survey design was used to collect retrospective data. Of 764 eligible 13-year-old adolescents enrolled in urban private or public schools in a Brazilian town, 652 were clinically examined and interviewed. Data were collected on socioeconomic circumstances, family related variables, oral health behaviour and anthropometric measures (height and weight). Dental caries was measured by decayed, missing and filled teeth (DMFT) index. The DMFT was categorized according to two levels of severity (low DMFT </= 6; high DMFT > 6) using the 75th percentile of the distribution as the cut-off point. Data analysis involved multiple logistic regression. RESULTS: Adolescents who were the second or later child were 1.90 times more likely to have a high DMFT, whilst being a taller adolescent had a protective effect on caries experience (OR = 0.04; 95% CI = 0.00-0.79). In addition, adolescents from rural areas (OR = 2.74; 95% CI = 1.56-4.82), those whose mothers had less than 8 years of education (OR = 2.10; 95% CI = 1.03-4.27) and those who reported high levels of paternal punishment (OR = 1.60; 95% CI = 1.02-2.52) had an increased risk of having a high DMFT. CONCLUSION: There is a relationship between height and dental caries experience in this sample of Brazilian adolescents.

Adolescent↗

PubMed1985

Changes in oral health from 1973 to 1982 of 13-15-year-old schoolchildren residing in three different fluoride areas in Finland.

The aim of the present study was to analyze the change from 1973 to 1982 in the oral health conditions of 13-, 14-, and 15-year-old school-children residing in three different fluoride areas in Finland. Oral hygiene, as measured with the Visible Plaque Index (Ainamo and Bay, 1975), had improved significantly both among 13-year-old girls (P less than 0.01) and among boys of the same age (P less than 0.05). A highly significant improvement (P less than 0.001) of gingival health, as measured with the Gingival Bleeding Index (Ainamo and Bay, 1975), was observed for boys but not for girls. The striking change was for the DFST (T = total) and FSAA (A = approximal) scores for the totals of 180 girls and 180 boys. This improvement in dental health was mainly due to a dramatic decline of caries in the low-fluoride (0.2 ppm F) area, whereas in the high-fluoride area (2.5 ppm F), the improvement in oral hygiene and gingival health was the greatest. The results support earlier assumptions that caries and gingivitis are separate and mutually independent disease entities. The study further suggests that local fluoride treatments can provide caries-preventive benefits similar to those achieved by community water fluoridation, although at greater cost. The comparison in time revealed that most of the differences in oral health, observed in 1973 both between sexes and between the different fluoride areas, had disappeared by the time of the 1982 examination.

Adolescent↗

PubMed1989

The effects of airborne fluorides on oral conditions in Morocco.

The purpose of this study was to determine the prevalence and severity of dental caries and dental fluorosis, as well as various other oral conditions, in 2378 subjects (ages seven to 60) living in the fluoridated area of Khouribga and the non-fluoridated area of Beni Mellal, Morocco. The community index of dental fluorosis (CFI) ranged from 1.99 to 2.80 in the high-fluoride area: Over 90% of the population was affected, and more than one-third of the subjects showed moderate dental fluorosis. However, in Beni Mellal, more than 96% of the dentate subjects examined were free of dental fluorosis, and the CFI of 0.02 was considered not significant. Significant differences were observed between the two areas with respect to caries prevalence. DMFT and DMFS indices were markedly lower in the fluorosis area of Khouribga. The oral conditions of subjects appeared to be better in Khouribga, where the gingival and calculus indices were significantly lower than in Beni Mellal. The analyses of covariance showed no significant differences in plaque accumulation (PI) between the Khouribga and Beni Mellal samples. However, a close statistical correlation was found between PI and GI in Beni Mellal and Khouribga.

Adolescent↗

PubMedDate not supplied

A comparison of oral health status and need for dental care between abused/neglected children and nonabused/non-neglected children.

This paper compares oral health status and presence of untreated, decayed permanent teeth in abused/neglected children with nonabused/non-neglected controls. The sample comprised 903 children between 5 and 13 years old; 30 were confirmed cases of child abuse and 873 served as controls. Their oral health status was assessed by two calibrated dentists using the DMFS index. Presence of untreated, decayed teeth was determined from the decayed and unfilled component of the DMFS score. The data were analyzed using logistic regression so that the influence of other explanatory variables (sociodemographic characteristics) on oral health status and presence of untreated, decayed teeth could be controlled while the influence of abuse status was evaluated. Results show that abuse status is an important explanatory variable for both oral health status and presence of untreated, decayed teeth. While the impact of abuse status on oral health status is obscured by interactions with other explanatory variables, its impact on the presence of untreated, decayed teeth is clear. Abused children are eight times more likely to have untreated, decayed permanent teeth than nonabused children. Accordingly, it is recommended that confirmed cases of child abuse/neglect should be referred routinely for dental screening as part of their overall rehabilitation.

Adolescent↗

PubMed1995

Dental fluorosis and caries prevalence in children residing in communities with different levels of fluoride in the water.

OBJECTIVES: This study investigated the prevalence of dental fluorosis and caries in 7-14-year-old children residing in communities with negligible (NF: 0.2 ppm), optimal (OPF: 1.0 ppm), and four-times optimal (4X OPF: 4.0 ppm) naturally occurring fluoride in their water systems. METHODS: Examinations were performed on 344 children who were lifetime residents of their communities. RESULTS: Whether using the tooth surface index of fluorosis or Dean's index, children examined in the 4X OPF community had the highest prevalence of dental fluorosis. While the severity of fluorosis seen in the OPF and NF communities was mild in appearance, the results indicate that fluorosis does occur in optimally and negligibly fluoridated communities. Compared to the NF community, DMFT and DMFS scores in the OPF community were 9.2 percent and 21.2 percent lower, respectively. CONCLUSIONS: The ingestion of water containing 1 ppm or less fluoride during the time of tooth development may result in dental fluorosis, albeit in its milder forms. However, in these times of numerous products containing fluoride being available, children ingesting water containing 1 ppm fluoride continue to derive caries protection compared to children ingesting water with negligible amounts of fluoride. Thus, the potential for developing a relatively minor unesthetic condition must be weighed against the potential for reducing dental disease.

Adolescent↗

PubMed2000

Caries in five-year-old children and associations with family-related factors.

It is generally understood that the teeth of pre-school-aged children are healthy, but the improvement in the dmft index has halted in the industrialized countries. Those few children who have caries have more of it than before. Little is known of the family-related factors which are associated with this polarization of caries. A representative population-based sample consisted of 1443 mothers expecting their first child. The children were followed at well-baby clinics and public dental health clinics for over five years. The objective was to study the prevalence of dental caries and its predictors in five-year-old children and to assess children's own dental health habits and the meaning of family-related factors in dental health. The findings were based on questionnaire data from parents and on clinical dental examinations of the five-year-old children as completed by 101 public health dentists. In firstborn five-year-old children, dental health was found to be good in 72%, fair in 20%, and poor in 8% of the cases. The final multivariate analysis illustrated that the dmft index > 0 was independently associated with the mother's irregular toothbrushing (OR 2.2; 95% CI 1.4-3.5), annual occurrence of several carious teeth in the father (OR 2.6; 95% CI 1.9-3.6), daily sugar consumption at the age of 18 months (OR 2.4; 95% CI 1.4-4.1), occurrence of child's headaches (OR 3.7; 95% CI 1.5-8.8), parents' cohabitation (OR 3.3; 95% CI 1.5-7.6), rural domicile (OR 2.4; 95% CI 1.2-4.5), and mother's young age (OR 5.0; 95% CI 1.3-19.8). The findings indicated that attention should be paid not only to the child's dental health care but also to that of the whole family. Parents should be supported in their upbringing efforts and encouraged to improve their children's dental health habits. In everyday life, parents function as role models for their children, and therefore, parents' own dental hygiene habits are very meaningful.

Chi-Square Distribution↗

PubMed1996

Adjustment of the M-component of the DMFS index for prevalence studies of older adults.

Cross-sectional studies of caries in older adults report a substantial number of missing teeth, making it difficult to estimate caries experience accurately. The goal of this study was to improve the method of estimating caries experience as expressed by the DMFS index in population groups with missing teeth. The adjustment was demonstrated with reference to the Piedmont 65+ Dental Study conducted on a random sample of 363 community-dwelling older adults in North Carolina who were followed for 5 years. These older dentate adults had a mean (+/-SE) of 11.7 +/- 0.5 teeth missing at baseline, 56.1 +/- 2.5 missing surfaces and a DMFS of 86.7 +/- 2.0. A predicted caries prevalence was determined from the DFS at 5 yrs plus the 5-yr DFS incidence and the baseline DFS of teeth lost during the study period. Then a formula was developed that would estimate the predicted caries prevalence as a function of the observed 5-yr DMFS. This formula provided a good estimation of caries prevalence at 5 yrs (DMFSadj) when compared with the predicted prevalence (paired t-test, p > 0.05), while prevalence was underestimated by the DFS and greatly overestimated by the traditional DMFS index. Subgroup analyses by race, sex, and periodontal status also indicated that the DMFSadj resulted in patterns of estimates similar to the predicted prevalence, while the DFS and the DMFS were likely to result in different findings. The DMFS from the time of tooth eruption also was adjusted using this formula. The resulting analyses of subgroup differences in caries were not different from the previous estimates based on the 5-yr historical data, indicating that the adjustment of all M surfaces avoids the biases inherent in the traditional DMFS and DFS indices. This study showed that predicted caries prevalence could be estimated by adjusting the M component of the DMFS. It appears that this adjustment formula can be used without obvious bias, but additional studies are needed to provide adjustment figures for populations with different caries prevalences.

Black or African American↗

PubMed2003

Ethnic disparities in the prevalence of dental caries and restorative dental treatment in Brazilian children.

AIM: This study assesses disparities in the oral health status of Brazilian black and white children. PARTICIPANTS: 11- and 12-year-old schoolchildren living in 131 cities of the State of São Paulo, Brazil. METHODS: Spatial data analysis of city-level indexes of oral health, socio-economic status and provision of dental services. MAIN OUTCOME MEASURES: Ethnic ratios of the DMFT and the care index. RESULTS: White children had higher indexes of caries in permanent teeth than their black counterparts, concurrent with a higher utilisation of dental attendance. The gap of caries prevalence between black and white children was reduced in cities with a better profile of socio-economic status. Cities with higher per-capita yearly budget, expenditure in health, and provision of public dental services presented reduced indications of ethnic inequality in dental care. CONCLUSION: The knowledge of conditions associated with a lower ethnic discrepancy in the risk of caries and in the incorporation of dental services can be used to design socially appropriate dental services. An improved community dental service, higher public expenditure in health and per-capita municipal yearly budget contribute effectively to reducing inequities in oral health by allowing an incorporation of restorative dental treatment more equitably distributed between black and white children.

Black People↗

PubMed2000

Comparing the ability of different area measures of socioeconomic status to segment a population according to caries prevalence.

OBJECTIVE: to compare the ability of different area based indicators of socio-economic status to segment a population of 5-year-old children according to caries prevalence. BASIC RESEARCH DESIGN: The study population consisted of all 5-year-old children in seven districts in the North West Region of England who were examined in whole population surveys during the 1995/6 NHS epidemiological survey. This population was segmented according to caries prevalence by market penetration analyses using Super Profiles and the ONS geodemographic classifications, Jarman and Townsend (at ward and ED level) deprivation indices, the single census variables of unemployment and percentage of households without a car, and also the school that the children attended. Lorenz curves were plotted from the outputs of the penetration analyses. MAIN OUTCOME MEASURES: Overall caries prevalence for the population was 55.3%. All the indicators provided a very similar picture. Large differences were detected between the highest and lowest market penetration rankings for each indicator, ranging from 42.5% for the ONS geodemographic classification to 31.4% for the Townsend index at enumeration district level. However, for each indicator, the fall between these two extremes was gradual. This picture was represented by the similar effectiveness scores of around 10% for each indicator which were derived from the Lorenz curves. Each indicator could identify approximately 30% of those with disease in the topmost 25% of the total population in the penetration ranking. When the analysis was restricted to those children with severe disease (dmft> or =5) a similar picture was found, however the effectiveness score increased to 19%. CONCLUSIONS: There was a remarkably consistent inequitable distribution of population disease prevalence found between deprived and affluent area types, irrespective of what measuring instrument was used. Although there was a large difference in prevalence (dmft>0 and dmft>5) found between deprived and affluent areas, there was a gradual fall between the two extremes. This gradual fall has implications for oral health improvement strategies.

Child, Preschool↗

PubMed1999

Prediction of caries development for molar fissures with semiquantitative mutans streptococci test.

Risk-specific caries prevention requires validated and simple parameters for a caries risk assessment. The aim of the study was to evaluate the validity of a site-specific chair-side mutans streptococci (MS) test for the prediction of caries incidence in fissures. In 230 6- to 7-yr-old children, occlusal plaque samples of teeth 16 and 36 were cultured with Dentocult SM tests at 37 degrees C for 24 hr. Caries (DMFS), initial caries, sealants, and a plaque index (QHI) were recorded and oral hygiene habits were assessed. Not erupted, carious, filled and sealed teeth were excluded from the analysis (n = 154). After 2 yr, the status of the fissures was re-examined, and a fluoride history was recorded with a questionnaire filled out by the children's parents. Sealed teeth were excluded again (n = 54). With a classification of MS score 0 or 1 as low and MS score 2 or 3 as high caries risk, 92% agreement was reached by two independently working examiners. The MS scores and caries incidence correlated significantly. Seventy-eight % of the caries progression in fissures was prognosed correctly. Sensitivity was 50%, specificity 82%, positive predictive value 29%, and negative predictive value 92%. Children with caries progression tended to have lower fluoride scores. Low MS scores were most likely to be associated with low caries incidence, while high mutans streptococci scores seem to be partially compensated by other parameters.

Cariostatic Agents↗