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[An epidemiological profile of dental caries in 12-year-old children residing in cities with and without fluoridated water supply in the central western area of the State of São Paulo, Brazil].

This study aimed to analyze the epidemiological profile of dental caries in the central western region of the State of São Paulo, Brazil, focusing on 12-year-old children by gender, comparing the DMFT index in fluoridated and non-fluoridated cities. The study used data from the Epidemiological Surveys in the State of São Paulo, 1998, pertaining to the 10th Regional Health Directorate, including 8 cities. The sample consisted of 485 schoolchildren, both boys and girls, distributed by city. In Pederneiras (a medium-sized city with a fluoridated water supply), DMFT was 7.06, higher than the Brazilian national mean for 1986. Boys showed a higher prevalence of dental caries than girls, showing a new trend for dental caries in the region. There was no statistically significant difference between DMFT in municipalities of the same size, regardless of the presence or absence of fluoride in the water supply, thus suggesting a "convergence" phenomenon, possibly due to the intake of other sources of fluoride and the presence of a "halo" effect. Prevalence of caries in the region was "high", with a DMFT of 4.82, thus failing to reach the goals set for the year 2000.

Brazil↗

Dental fluorosis decline after changes to supplement and toothpaste regimens.

UNLABELLED: In 1989/90, in 659 12-year-olds in Perth (F 0.8 mg/L) and the Bunbury region of Western Australia (WA) (F approximately 0.25 mg/L), dental fluorosis prevalences were 40.2% and 33.0%. Fluoride supplements (OR 4.63) and extended residence in a fluoridated area (OR 4.06) were significant risk factors; toothpaste ingestion variables had ORs greater than unity; in 1990, DMFT for this age group was 0.84. School Dental Service took steps to discourage supplement and toothpaste ingestion and to promote low fluoride toothpaste for children < 6 years of age. OBJECTIVES: To evaluate the effect of this campaign on fluorosis and caries. METHODS: Between May-July 2000, 582 10-year-olds were examined for dental fluorosis (TF index) and dental caries (DMFT) in school dental clinics. RESULTS: Fluorosis prevalence was 22.2% in Perth and 10.8% in the Bunbury region. Overall prevalence was 18.0% and of this, 80.2% was TF 1, 17.9% was TF 2 and just 1.9% was TF 3. In 1989/90, 79 children had used supplements before the age of 4 year; in 2000 only 40 had done so (P < 0.001). Mean DMFT values in Perth and Bunbury were 0.32 and 0.28 (P > 0.05). Low F toothpaste, unavailable in 1989/90, had been used by 24.5%. The only significant risk factor was residence, OR 2.0. CONCLUSIONS: Fluorosis prevalence seems to have fallen in parallel with a reduction in discretionary intake from supplements and toothpaste. No increase in dental caries experience was recorded. Because the teeth examined in this study were at risk of fluorosis in 1992-95, very soon after policies changed, and because people are slow to change health habits, it seems reasonable to expect a further improvement when teeth mineralised in the late 1990s become visible.

Analysis of Variance↗

A preliminary study of the periodontal status and treatment needs of elderly Nigerian subjects.

One hundred elderly subjects comprising of residents of old peoples homes and patients attending routine outpatients clinic at the Lagos University Teaching Hospital were examined in Lagos. The mean age of subjects was 68.7 years. Using the Community Periodontal Index of Treatment Needs (CPITN) it was found that 23% had tooth deposits (plaque/calculusonly) whilst 70% had shallow or deep pockets. 87% of these elderly subjects were caries-free and none had restored or filled teeth. However, more than half of the subjects had an average missing teeth number of 8.829% of the subjects needed extraction with an average of 3.3 teeth. Among the subjects that needed dental extraction, none had healthy periodontal condition whereas, 79% of them were caries free. It is concluded from this study that the periodontal status of the subjects was poor and the incidence of caries was low. Furthermore, the majority of the missing teeth could have been largely due to periodontal disease. Dental health education which is directed towards improved oral hygiene procedures is suggested for the elderly dental population. It is also suggested that elderly patients be given free or subsidised treatment. Furthermore, the National Health Policy should be directed towards domiciliary dental treatment for the compromised elderly patients.

Aged↗

[Caries prevalence and periodontal treatment needs in the same individuals].

The aim of this study was to determine whether dental caries and periodontal disease occur frequently in the same subjects 1469 young people, aged 7, 12 and 15-19 years, and representing the urban (60%) and rural (40%) population from Spain were evaluated. Dental caries and periodontal treatment needs were registered according to the index D.M.F.T. and C.P.I.T.N., following the criteria of WHO. We have found a highly significant relation between both variables, average D.M.F.T. scores increased as periodontal treatment needs were more advanced. Those subjects with lower codes of C.P.I.T.N. presented also lower D.M.F.T. scores, while these individuals with higher D.M.F.T. scores, based on a great number of open carious lesions, were more affected for periodontal disease. It does not support either a directly synergistic or antagonistic correlation in the prevalence of these two diseases in the same subjects. Dental health status is at a certain time an end result of years of varying dental health behaviour. In industrialized countries a variety of factors seems to determine the prevalence of dental caries and/or periodontal disease: dietary habits, access to fluorides, efficacy of oral hygiene measures, utilization of dental health care services. These data and ideas supported the strategy of preventing the dental caries and periodontal disease simultaneously.

Adolescent↗

Knowledge, attitudes and status of oral health in children at risk for infective endocarditis.

AIM: The purpose of this study was to assess the oral health status of 104 children (2-17 years of age) at risk for infective endocarditis attending the Paediatric Cardiology Service of the Martagão Gesteira Institute of Child Care and Paediatrics, Rio de Janeiro, Brazil, and their guardians' attitudes towards and knowledge about endocarditis risks. METHODS: A structured interview was carried out with guardians and an oral examination was performed on each child to determine scores for the plaque index (PI), gingival index (GI) and dmft/DMFT index. RESULTS: The percentage of guardians who understood the meaning of 'heart infection' was 9.6%, who knew the possibility of heart disease caused by dental procedures was 60.6%, who understood the requirement for antibiotic cover before dental treatment was 72.1%, and who understood the importance of good oral health to prevent infective endocarditis was 41.3%. As regards oral health behaviours, 46.1% of children brushed their teeth three times or more a day, 28.8% had never visited a dentist before, and only 24.3% attended the dentist for prevention. There was visible plaque in 98% and gingival bleeding in 99% of children in this study. The caries experience for primary dentition (dmft) was 2.62%, and 3.97 for permanent dentition (DMFT). CONCLUSIONS: Based on these results, we can conclude that the guardians' knowledge and attitudes about oral health were not good. This group at risk has poor oral health, which may give rise to a frequent bacteraemia under physiological conditions.

Adolescent↗

Caries and dental fluorosis in a 0.25 and a 2.5 ppm fluoride area in the Sudan.

The purpose of this study was to assess the caries prevalence of children living in areas with either 0.25 or 2.5 ppm fluoride in the drinking water, and to relate caries experience to the severity of dental fluorosis. The children, aged 6-16 years (mean 11.3 years), were lifelong residents of their rural villages. The severity of dental fluorosis in the maxillary central incisors, assessed by Deans index, was 1.4 +/- 0.9 (n = 59) and 2.3 +/- 0.9 (n = 65) in the 0.25 and 2.5 ppm areas, respectively. There was no significant difference in DMFT between children from the two areas (2.6 +/- 2.3 n = 59 versus 2.1 +/- 2.3, n = 65). In the low-fluoride area 75% of the children had decayed permanent teeth compared to 66% in the high-fluoride area. In the primary teeth, however, both the caries prevalence and the dmft were significantly lower in the 2.5 ppm area than in the low-fluoride area. Stepwise, multiple, linear regression analyses, including all children, showed a significant effect of age on DMFT (30% of the variance explained), but no explanatory effect of fluoride in drinking water, severity of dental fluorosis, or gender. Regression analyses based on children in the 2.5 ppm area alone, showed significantly higher DMFT by increased severity of dental fluorosis. In children with a mixed dentition (n = 66), there was no association between caries in the primary and permanent teeth.

Adolescent↗

Examiner agreement on caries detection and plaque accumulation during dental surveys of elders.

Indices used to evaluate plaque accumulation and coronal caries have been widely accepted in epidemiological studies, yet their reliability cannot be guaranteed. The aim of this study was to evaluate the reliability of clinical criteria used in coronal and root caries diagnosis and oral hygiene evaluation as applied in elders. Nineteen elderly subjects, 73 years old on average, were examined at a first appointment by two independent examiners. They were re-examined two weeks later. Plaque accumulation was evaluated using the Plaque Index (PI) and coronal and root caries were detected according to the WHO criteria and Fejerskov et al. (1991), respectively. Recurrent caries was recorded as recommended by WHO and by probing at the interface tooth-restoration. Inter- and intra-examiner agreement was evaluated using kappa statistics. The PI score showed good reliability except for examiner b, for whom a simplification of the 4-point scale in 3-point scale improved significantly the reliability. The prevalence of coronal caries was very low and intra- and inter-examiner agreement was poor. Most of the root caries lesions were covered by plaque and the kappa values indicated only poor agreement. Recurrent caries were found with good agreement using WHO criteria but the detection with the probe was not reliable. In conclusion, it seems that examiners should be trained carefully to maximise their reliability and that plaque should be removed to obtain reliable diagnoses of caries. Retraining and calibration may be necessary for surveys continuing over a long period.

Aged↗

Caries reductions between 1995, 1997 and 1999 in preschool children in Diadema, Brazil.

AIMS: This study aimed to assess changes in caries prevalence and severity in preschool children in Diadema, Brazil. METHODS: Three cross-sectional surveys were conducted, using the same protocol, in 1995, 1997 and 1999. The first survey included children aged 5-35 months, and the second and third, children aged 5-59 months. Participants were selected from all children attending a National Day of Children's Vaccination; 548, 992 and 690 in 1995, 1997 and 1999, respectively. This approach was sound as uptake rates for all years studied were above 90% for children aged between 1 and 59 months in all three surveys. Caries experience was measured using the World Health Organization (WHO) def index. Time-lag and quasi-longitudinal analysis were carried out. RESULTS: Time-lag analysis showed a marked and statistically significant decline in the prevalence and severity of coronal and rampant caries between 1995 and 1999. There were reductions of 36.5% in the prevalence of caries in 2-year-olds between 1995 and 1997 (P < 0.002) and 36.0% between 1997 and 1999 (P = 0.041). The mean def-s at the same age decreased from 2.0 in 1995 to 1.1 in 1997 (P < 0.001) and to 1.0 in 1999 (P > 0.05). The quasi-longitudinal analysis showed a statistically significantly increase in the percentage of children with caries between 1995 and 1997 and 1997 and 1999 (P < 0.001), but not for 2-year-old children between 1995 and 1997 (P > 0.05). The same pattern was observed for severity of dental caries. CONCLUSION: Oral health in preschool children in Diadema improved markedly during 1995-99.

Age Factors↗

Caries experience and caries increments at 10 years of age.

The aim of the study was to examine the caries experience of 10-year-olds as measured with dmft/DMFT, to explain how caries increases by the age of 10 years, and which factors would explain caries increments. The setting was a representative population sample of first-born children in southwestern Finland. Dental health at 10 years of age was found to be good in 45%, fairly good in 40% and poor in 15% of the children. The caries index remained stable in 23% of carious children from 7 to 10 years of age. Daily consumption of sweets at the age of 3 years (OR 2.7; 95% CI 1.5-4.8; p < 0.001) was associated with a caries increment between 7 and 10 years of age (both deciduous and permanent teeth). This daily consumption of sweets and a child's late bedtime (OR 1.9; 95% CI 1.1--3.1; p = 0.023) were explanatory factors in the permanent teeth alone. In the deciduous teeth, mother's previous caries and child's earlier tooth brushing habits were explanatory factors of caries. As hypothesized, all five significant factors remaining in the final logistic regression analysis were family-related. Parental ability to care for and educate a child could be seen in dental health still at the age of 10 years. The family-related factors which were associated with caries should be emphasized much more comprehensively in everyday dental health care practice.

Age Factors↗

Dental caries in Quebec adults aged 35 to 44 years.

BACKGROUND: The purpose of this study was to assess the prevalence of dental caries in Quebec adults aged 35 to 44. METHODS: A stratified sample was used. The participation rate was 77% for the questionnaire and 44.5% for the oral examination. A total of 2,110 people were examined. The World Health Organization's caries criteria were used. Examiner agreement with gold standard dentist was excellent at the end of the nine-day training session (Kappa index > 0.8). RESULTS: The level of caries experience is very high in Quebec adults aged 35 to 44. Almost half of dental surfaces (65 of 148) have been affected. These surfaces are mostly missing (39.3) or filled (23.9). However, there were 1.8 decayed surfaces in need of treatment per adult, and more than half the people (55.5%) had no untreated decayed surfaces. Almost three-quarters of decayed surfaces were present in only 14% of the people; lower family income and lower education are risk factors. CONCLUSION: Comparison between Quebec and industrialized countries (United States, England and the Netherlands) shows that in adults 35 to 44, the mean number of decayed teeth is low (between 1.0 and 2.2) and the mean number of filled teeth is relatively similar (between 9.6 and 11.1); however, Quebec has a higher percentage than the United States of edentulous people. As well, in dentate adults, there are 1.6 times more missing teeth among Quebecers than among Americans.

Adult↗

Prevalence of caries in 6-year-old Austrian children.

PURPOSE: The 2001 Austrian oral health survey investigated a representative sample of 6-year-old Austrian children. MATERIALS AND METHODS: 516 6-year-old Austrian children were investigated with respect to d1-3mft and d1-3mfs and visible plaque index (VPI). RESULTS: Forty-nine per cent of the children were caries free (d3ft = 0). The children had 2.1 d3ft (3.5 d1-3mft) and 3.9 d3fs (6.1 d1-3fs). 2.6 d3s unrestored carious lesions (d3s) predominated over 1.3 filled surfaces (fs). There was no statistical difference between girls and boys. The prevalence of caries showed a very skewed distribution: 50% of all d3s were concentrated in 8% of the children with 86% of all carious lesions in 25% of the children. The prevalence of caries was inversely related to the educational level of the parents (Spearman rank test p < 0.001; r = -0.219) and family income (p <0.001; r = -0.173): Children of parents with low educational levels (9 years of schooling) had 3.3 d3ft whereas children of parents with university degrees had only 1.0 d3ft. CONCLUSION: Six-year-old Austrian children showed a very skewed distribution of the prevalence of caries and high need for dental treatment. There is a great need for pediatric dentistry in Austria.

Analysis of Variance↗

Compliance as a prognostic indicator: retrospective study of 505 patients treated and maintained for 15 years.

BACKGROUND: The relationship of patient compliance to overall tooth prognosis remains controversial. There are little data, often conflicting, that pertain to tooth loss as a function of patient compliance. METHODS: This retrospective study evaluates the impact of compliance (complete versus erratic) on common periodontal clinical variables, such as probing depth, bleeding index, plaque index, and tooth loss for 505 patients in a long-term period of observation (15 to 23 years) and maintenance therapy (at least 10 years). Compliance was defined in two ways for all analyses. Under the definition for compliance 1, patients who missed <30% of all prescribed maintenance visits were classified as complete compliers. Under the definition for compliance 2, patients who never went 2 years without a maintenance visit were classified as complete compliers. Change in clinical variables was dichotomized into reduction in plaque index versus no reduction, reduction in bleeding on probing versus no reduction, reduction in the percentage of periodontal pockets>3 mm versus no reduction, no increase in decayed, missing, or filled teeth (DMFT) versus increase, and no tooth loss versus tooth loss. The effects of both definitions of compliance were then evaluated in a series of multiple logistic regression models with adjustment for potential confounders. RESULTS: The analysis of the dichotomous change in clinical parameters over time revealed that complete compliers tended to show reduction in bleeding on probing and reduction in plaque index compared to erratic compliers for both definitions of compliance. In contrast, complete compliers under compliance 2 were less likely to have a reduction in the percentage of periodontal pockets >3 mm compared to erratic compliers, whereas complete compliers under compliance 1 had about the same likelihood of demonstrating a reduction in periodontal pockets compared to erratic compliers under this classification scheme. Under both definitions for compliance, complete compliers were more likely to exhibit tooth loss than erratic compliers, with the greatest tooth loss exhibited by complete compliers under the definition for compliance 1. CONCLUSIONS: Based on these results, complete compliers under both definitions tended to show a reduction in plaque and bleeding on probing over time. However, change in periodontal pockets and DMFT over time varied according to the definition of compliance that was used. In addition, the results seem to indicate that the decision for tooth extraction made by dental health professionals at maintenance visits may result in greater tooth loss.

Adult↗

Dental caries prevalence and treatment need among racial/ethnic minority schoolchildren.

A study was undertaken to estimate dental caries prevalence and treatment need among racial/ethnic minority schoolchildren in the Bronx. Oral examinations were conducted on 148 second graders, 193 fourth graders and 299 sixth graders in three different schools. A single examiner trained to use the DMFS index according to National Institute of Dental and Craniofacial Research (NIDCR) diagnostic criteria and procedures examined all the children between November 1999 and July 2000. The study revealed that 39% of the children exhibited dental caries experience in their permanent dentition (mean DMFS = 1.45), treatment need (D/DMFS = 28%); 26.4% of children in their primary dentition (mean dfs = 1.01) and treatment need (d/dfs = 18%). Hispanic children (mean DMFS = 1.71) had higher dental caries experience compared to African-Americans (mean DMFS = 1.14). This was found to be statistically significant (p = 0.004). Treatment need in Hispanics was (30%, 17%) and in African-Americans (30%, 18%) in permanent and primary dentition respectively. Treatment need was highest among sixth grade African-Americans in their permanent dentition and in second grade Hispanics in the primary dentition. The study showed a difference in dental caries prevalence, but the treatment need percentages did not differ between Hispanics and African-Americans in both dentition.

Black or African American↗

The relationship between caries, fluoridation and material deprivation in five-year-old children in Country Durham.

An investigation to assess the impact of fluoridation on the caries experience of young children at high and low levels of material deprivation measured by the Townsend Index was undertaken in County Durham. Electoral wards were ranked for deprivation from 1991 Census data. Dental caries data for 2,751 five-year-old children resident in electoral wards in the upper and lower quartiles of material deprivation in the County were obtained from a dental survey conducted in 1991-92. Wards were stratified for fluoridated and non-fluoridated water supply and the dental data for the resultant four populations, defined by high and low material deprivation and the presence or absence of fluoridation, were analysed. The mean dmft values in the four groups were 0.8 in the fluoridated low deprivation group, 1.2 in the non-fluoridated low deprivation group, 1.2 in the fluoridated high deprivation wards and 2.1 in the non-fluoridated high deprivation wards. Thus, with fluoridation the variation in caries between high and low deprivation groups was significantly reduced but not eliminated, leaving the level significantly lower in the least deprived group, to the continuing disadvantage of that deprived group.

Analysis of Variance↗

Caries experience and distribution in relation to treatment needs among teenagers in Espoo, Finland.

An annual check-up was made in groups of 12- and 16-yr-old children by dentists of the Public Health Center of Espoo. The D index was used instead of DMFT index, because it expresses the need for conservative treatment. This information, again, is essential for planning public dental care. The children were divided into four groups according to the number of decayed teeth developed during a period of approximately 1 yr. Children with D = 0 were classified as healthy, D = 1 as low, D = 2 as moderate, and D = 3 or more as high caries incidence. In 1980 the percentage of the group D = 0 was about 52% in the 12-yr-olds. In 1988 the percentage had increased up to about 73%. The corresponding figures of the 16-yr-olds were 33% and 62%. Simultaneously, the high caries incidence groups had decreased in 12-yr-olds from 13% in 1980 to 5% in 1988 and in 16-yr-olds from 31% to 10%. These observations emphasize the need for retargeting prevention of caries in order to provide additional preventive treatment to the high incidence groups while the routine prophylaxis given to the other groups may be decreased.

Adolescent↗

Should the drinking water of Truro, Nova Scotia, be fluoridated? Water fluoridation in the 1990s.

An epidemiological assessment of differences in caries and fluorosis prevalences between children in Truro (< 0.1 ppm) and Kentville (fluoridated at 1.1 ppm in 1991), Nova Scotia, Canada, was completed in 1991. Out of a total of 429 children, in grades 5 and 6, in the two towns in 1991, 219 (51%) were examined. Parents answered a self-administered questionnaire investigating the sources of drinking water used by the children since birth, residence history, use of fluoride supplements, dentifrices, and other fluoride products during the first 6 yr of the life. The examination criteria differentiated between non-cavitated and cavitated carious lesions. Dental fluorosis was measured using the TSIF index. Examiner agreement was excellent. Of the children examined, 80 (36.5%) drank water (fluoridated or non-fluoridated) from municipal water systems during the first 6 yr of life. The children were assigned into five groups based upon residence history and exposure to fluoridated water during the first 6 yr of life. The percentage difference in mean DMFS scores between children in the fluoridated and non-fluoridated groups is 17% (delta DMFS1 = 0.7) when non-cavitated carious lesions are included and 39% (delta DMFS2 = 1.1) when they are excluded. The differences are not statistically significant. The significant risk factors associated with the DMFS1 and DMFS2 scores identified by a stepwise multiple regression analysis are: education level of the father, gender, and number of years of reported use of toothpaste during the first 6 yr of life. Dental fluorosis (mainly TSIF score of 1) was present in 41.5% and 69.2% of the children in the non-fluoridated and fluoridated groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

Effect of self-brushing with acidulated phosphate fluoride (pH 5.6) on dental caries in children.

The aim of this work was to study the effect of a preventive program on the dental plaque and on the caries incidence in school children. The program comprised weekly supervised self brushing with acidulated phosphate fluoride (APF) gel (pH 5.6; concentration: 4520 ppm of ion F-). The program involved 240 children of 1st., 3rd and 5th grade of a primary school in the City of Buenos Aires (Argentina). The population was divided in 2 groups: A (experimental) and B (control). Ninety children from both groups (45 experimental and 45 control) were submitted to baseline clinical examination (DMFT and plaque index) and microbiological analysis (total streptococci, St mutans and St. mutans and St. mutans percentage). Group A was then submitted to a preventive program which included self brushing with APF gel (4520 ppm of ion F-). The 90-children sample was monitored after 1 and 2 years of program. Results were statistically processed and they revealed the following: a--DMFT was significantly greater in the control group than in the experimental group after 1 and 2 years of program; b--an 81.43% reduction in caries increment rate at the end of the 2-years program in the experimental group as compared to the control group; c--a rise in the number of colonies of total streptococci and of St. Mutans; d--a reduction in the % of St. mutans in the total streptococci flora in the plaque of children in the experimental group; e--the presence of St. mutans colonies featuring a rough surface; f--the effectiveness of the program in the modifying the profile of the diagnosed dental pathology.

Acidulated Phosphate Fluoride↗

Oral health in adolescents from a small French town.

In France, caries are more prevalent in rural areas than in large cities. This study analyzed the relationship between number of oral health indices and some known risk factors (toothbrushing, sugar consumption, saliva components) and sociodemographic factors in adolescents from a small town. The sample included 112 children aged 12-14 in the north-east of France. School marks was found to be better linked with dental caries indices than the socio-occupational category of parents: gingival index (GI), DMFS, DMFT and caries severity (CS) significantly increased with decreasing school marks; oral plaque was related to socio-occupational of parents. The analysis using the regression method showed that the variance explained by the various factors studied was modest (between 23 and 30%) for GI, initial caries sites (IS), DS, DMFS, DMFT and CS, and was small for plaque (5%) and calculus (3%). This would be due in part to the wide dispersion of these indices. The sex had a non-significant regression coefficient for all oral health indices investigated. For GI, only mutans streptococci (MS) and plaque had a significant regression coefficient. Calculus was explained by any factor considered. Only MS had a significant part in plaque. IS was explained by MS, toothbrushing and age. For DS, only toothbrushing, MS and sweet drinks during meals had a significant part. DMFS and DMFT were explained only by MS and age. CS was explained by MS, age, salivary buffer pH, salivary flow rate, and toothbrushing.

Adolescent↗