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PubMed1988

Dental caries, fluorosis, and fluoride exposure in Michigan schoolchildren.

This study relates the prevalence of caries and fluorosis among Michigan children, residing in four different areas, to the various concentrations of F in the communities' water supplies. Demographic information, details of F history, and dental attendance data were collected by a questionnaire form filled out by parents. Children ages six to 12 were screened for caries by means of the NIDR criteria and for fluorosis by means of the TSIF index. Results pertain only to continuous residents and the permanent dentition. The prevalence of both caries and fluorosis was significantly associated with the F concentration in the community water supply. Approximately 65% of all children were caries-free, ranging from 55.1% in fluoride-deficient Cadillac to 73.7% in Redford (1.0 ppm F). About 36% of all children had dental fluorosis, ranging from 12.2 in Cadillac to 51.2 in Richmond (1.2 ppm). All of the fluorosis was very mild. From logistic regression, the prevalence of caries was significantly associated with age, dental attendance, and the use of a water supply fluoridated at 1.0 ppm. The odds of experiencing fluorosis increased at every F level above the baseline (Cadillac), with the use of topical F rinses, and with age. Results suggest that children in the four communities may be ingesting a similar level of F from sources such as dentifrices, dietary supplements, and professional applications, but the factor that differentiates them with respect to the prevalence of caries and fluorosis is the F concentration in the community water supply.

Child↗

PubMed1990

Prevalence of dental caries and enamel defects in children living in areas with different water fluoride concentrations.

The prevalences of dental caries and developmental enamel defects were assessed in 643 randomly selected children aged 11 to 13 years who were lifelong residents of three areas of Naples with high (4 ppm), optimal (1 ppm), and low (0.3 ppm) concentrations of fluoride in their drinking water. The children living in the high fluoride area had significantly lower dental caries scores (DMFT 0.59, DMFS 1.01) than those in the optimal fluoride area (DMFT 1.67, DMFS 2.87) and those in the low fluoride area (DMFT 1.97, DMFS 3.48). The FDI index of developmental defects of dental enamel (DDE) was used to record enamel defects. There was a significant increase in the number of children with at least one tooth affected by an enamel defect as the fluoride level in their drinking water increased; the prevalences were 9.8 per cent in the low fluoride area, 23 per cent in the optimal area and 53.1 per cent in the high fluoride area. The prevalences of teeth affected were 2.2 per cent in the low fluoride area, 5.7 per cent in the optimal, and 20.3 per cent in the high. Demarcated opacities were the most common defect seen. Diffuse opacities were found to be the discriminating factor between fluoride and non-fluoride areas. In the high fluoride area 64.3 per cent of children with enamel defects had at least six teeth affected. In the maxilla the central incisors were the most affected teeth followed by the second and first premolars; in the mandible the first premolars and first molars were the most affected teeth.

Adolescent↗

PubMed1994

Salivary lactobacilli explain dental caries better than salivary mutants streptococci in 4-5-year-old children.

The present comparative study was undertaken to determine which of the bacteria, lactobacilli (lbc) and mutans streptococci (ms), in saliva better explains the variation of caries in 2728 South African 4-5-yr-old children. Caries was diagnosed according to WHO criteria. For lbc, the Dentocult system was used. The number of ms in stimulated saliva was counted on MSB agar plates. For correction of confounding factors, data on the frequency of intake of sweets were derived from extensive interviews. Oral hygiene was determined according to the simplified debris index of Greene & Vermillion. Simple correlation analyses between dmfs and bacterial counts were done for the total material and for three caries intervals by calculating Spearman's and Pearson's coefficients of correlation. Multivariate regression analyses were done on all intervals to correct for the confounding effects of regular intake of sweets, presence of salivary ms or lbc, and oral hygiene. Of the children, 68% had detectable lbc in the saliva, and 74% had ms. Except for children with more than 6 dmfs, the explanatory values, i.e., percentage of variation in dmfs explained, were higher for the lbc than for ms. Before correction, the values for the total material were 15 vs 6%; for children with caries, 7 vs 5%; for those with 1-6 dmfs, 5 vs 0.4%; and for those with more than 6 dmfs, 0.3 vs 2%. All r-values were reduced after correction, indicating that the confounders explain some of the correlation between dmfs and bacterial count.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗

PubMed2001

Potential associations between chronic respiratory disease and periodontal disease: analysis of National Health and Nutrition Examination Survey III.

BACKGROUND: Associations between poor oral health and chronic lung disease have recently been reported. The present study evaluated these potential associations by analyzing data from the National Health and Nutrition Examination Survey III (NHANES III), which documents the general health and nutritional status of randomly selected United States subjects from 1988 to 1994. METHODS: This cross-sectional, retrospective study of the NHANES III database included a study population of 13,792 subjects > or = 20 years of age with at least 6 natural teeth. A history of bronchitis and/or emphysema was recorded from the medical questionnaire, and a dichotomized variable combined those with either chronic bronchitis and/or emphysema, together considered as chronic obstructive pulmonary disease (COPD). Subject lung function was estimated by calculating the ratio of forced expiratory volume (FEV) after 1 second (FEV1)/forced vital capacity (FVC). Oral health status was assessed from the DMFS/T index (summary of cumulative caries experience), gingival bleeding, gingival recession, gingival probing depth, and periodontal attachment level. Unweighted analyses were used for initial examination of the data, and a weighted analysis was performed in a final logistic regression model adjusting for age, gender, race and ethnicity, education, income, frequency of dental visits, diabetes mellitus, smoking, and alcohol use. RESULTS: The mean age of all subjects was 44.4 +/- 17.8 years (mean +/- SD): COPD = 51.2 +/- 17.9 years and subjects without COPD = 43.9 +/- 17.7 years. Subjects with a history of COPD had more periodontal attachment loss than subjects without COPD (1.48 +/- 1.35 mm versus 1.17 +/- 1.09 mm, P = 0.0001). Subjects with mean attachment loss (MAL) > or = 3.0 mm had a higher risk of COPD than those having MAL < 3.0 mm (odds ratio, 1.45; 95% CI, 1.02 to 2.05). A trend was noted in that lung function appeared to diminish with increasing periodontal attachment loss. CONCLUSIONS: The findings of the present analysis support recently published reports that suggest an association between periodontal disease and COPD.

Adult↗

PubMed2001

Prevalence and severity of dental caries and treatment needs among population in the Eastern states of India.

The present epidemiological investigation was conducted on a total sample of 2067 individuals in the age groups of 5-6, 15-16 and 30-35 years belonging to urban (U) and rural (R) areas of three states of eastern region of India viz. West Bengal (U & Rn = 361 & 359), Orissa (U & Rn = 351 & 351) and Sikkim (U & Rn = 323 & 321). Dental caries recording was done according to WHO index 1983. The point prevalence of dental caries, deft/DMFT and defs among all the three age groups in the urban and rural areas of three states revealed common pattern i.e. (i) Dental caries was higher in 5-6 year old children (U & R - W.B. = 52.4% & 48.3%, Orissa = 56.0% & 48.7% and Sikkim = 61.8% and 22.0% exception) as compared to 15-16 years (U & R.- WB. = 21.0% & 15.2%, Orissa = 18.3% & 19.8%, and Sikkim = 30.1% & 17.9%) and 30-35 year old individuals (U & R WB = 19.4% & 18.1% Orissa = 24.3% & 20.1% and Sikkim 29.9% & 24.5%) in West Bengal, Orissa and Sikkim respectively, (ii) dental caries was higher in urban as compared to rural areas. The decayed (d/D) component contributed maximum to total deft/DMFT and defs/DMFS score, followed by e/M (missing due to caries) and f/F component (filling) which was negligible or absent. Teeth requiring various type of treatment found that one or two surface fillings were maximum followed by others. Fluoride content of drinking water was negligible (0.004 - 0.011 ppm).

Adolescent↗

PubMed1989

Influence of increased toothbrushing frequency on dental health in low, optimal, and high fluoride areas in Finland.

In our previous report we found that the dental health of Finnish 13-15-yr-old children had significantly improved from 1973 to 1982. The aim of this study was to assess whether the improved dental health was associated with frequency of toothbrushing and associated use of fluoride dentifrice. In both 1973 and 1982 some 360 children were scored for the DFS index. In each of three towns with 0.2 ppm, 1.0 ppm, and 2.5 ppm fluoride in the drinking water, samples of about 40 children were randomly picked from each age cohort of 13, 14, and 15 yr. The children were grouped into "infrequent", "daily", or "frequent" brushers. Overall, from 1973 to 1982 the proportion of "daily" and "frequent" brushers had increased from 56% to 75% (P less than 0.001). The overall DFST (T = total) and DFSA (A = approximal) scores had declined significantly in all brushing frequency groups. Looking at separate fluoride areas, the actual decline was found to have occurred in the low fluoride area where in 1982 the DFS scores were 50% or less of the 1973 scores (P less than 0.05). In the low fluoride area in 1973, no association was found between brushing frequency and DFS scores whereas in 1982, high brushing frequency was found to be associated with low DFS scores (P less than 0.05). The decrease in DFS scores was suggested at least partly to be associated with the increased frequency of brushing the teeth with fluoride dentifrice.

Adolescent↗

PubMed1997

Water fluoridation, tooth decay in 5 year olds, and social deprivation measured by the Jarman score: analysis of data from British dental surveys.

OBJECTIVE: To examine the effect of water fluoridation, both artificial and natural, on dental decay, after socioeconomic deprivation was controlled for. DESIGN: Ecological study based on results from the NHS dental surveys in 5 year olds in 1991-2 and 1993-4 and Jarman underprivileged area scores from the 1991 census. SETTING: Electoral wards in three areas: Hartlepool (naturally fluoridated), Newcastle and North Tyneside (fluoridated), and Salford and Trafford (non-fluoridated). SUBJECTS: 5 year old children (n = 10,004). INTERVENTION: Water fluoridation (artificial and occurring naturally). MAIN OUTCOME MEASURE: Ward tooth decay score (score on the "decayed, missing, and filled tooth index" for each electoral ward). RESULTS: Multiple linear regression showed a significant interaction between Jarman score for ward, mean number of teeth affected by decay, and both types of water fluoridation. This confirms that the more deprived an area, the greater benefit derived from fluoridation, whether natural or artificial (R2 = 0.84, P < 0.001). At a Jarman score of zero (national mean score) there was a predicted 44% reduction in decay in fluoridated areas, increasing to a 54% reduction in wards with a Jarman score of 40 (very deprived). The area with natural fluoridation (at a level of 1.2 parts per million-higher than levels in artificially fluoridated areas) had a 66% reduction in decay, with a 74% reduction in wards with a Jarman score of 40. CONCLUSION: Tooth decay is confirmed as a disease associated with social deprivation, and the more socially deprived areas benefit more from fluoridation. Widespread water fluoridation is urgently needed to reduce the "dental health divide" by improving the dental health of the poorer people in Britain.

Child, Preschool↗

PubMedDate not supplied

Relationship among dental plaque composition, daily sugar exposure and caries in the primary dentition.

The relationship among daily sugar exposure, dental plaque composition and caries patterns in the primary dentition is not known. Three groups of 20 children (18-48 months old) were studied: (1) caries-free (CF), (2) presenting pit and fissure caries (PFC), and (3) with nursing caries (NC). Dental caries index (dmfs) was assessed and the frequency of daily sugar exposure (TS) and its forms were estimated by questionnaires. Fluoride (F), calcium (Ca), inorganic phosphorus (P(i)), insoluble polysaccharide (IP) and mutans streptococci were quantified in dental plaque. The three groups of children were statistically different regarding daily sugar exposure. Concentrations of F, Ca and P(i) were lower and the IP and mutans streptococci statistically higher in dental plaque from NC children than those from CF children. PFC children also showed statistically lower F and P levels in their plaque than CF children. Statistically significant correlations were found between IP, TS and dmfs from NC and PFC children. A statistically significant correlation between mutans streptococci in plaque from anterior teeth and dmfs for NC children was also observed. These results suggest that the dietary sugar experience changes the biochemical and microbiological composition of dental plaque, which could partly explain the different caries patterns observed in primary dentition.

Analysis of Variance↗

PubMed1993

Root caries susceptibility in periodontally treated patients. Results after 12 years.

The aim of the investigation was to study the individual susceptibility to root caries in periodontally treated patients in a long-term follow-up of 12 years. Age, plaque score, salivary counts of lactobacilli and mutans streptococci, salivary secretion rate and buffer effect, oral sugar clearance time and dietary habit index were tested as possible predictors for root caries incidence. During the whole observation period of 12 years, new root caries lesions were recorded in 24 of a total of 27 patients. In 8 of these, the root caries incidence was between 1 and 5, in 7 between 6 and 9 and in 9, 12 or more new DFS. However, the annual mean number of new DFS was rather low. 13 patients with > 5 new DFS% during the 3rd 4-year period (years 9-12) differed significantly from 14 patients with < or = 5 new DFS% in salivary mutans streptococcus counts (p < 0.01), plaque scores (p < 0.001) and new DFS% during the 2nd 4-year period (years 5-8) (p < 0.001). Simultaneously, risk values among the variables tested at the 8-year examination were about 3 x more prevalent in patients that developed > 5 new DFS% in years 9-12 than in those with < or = 5 new DFS%. During the whole 12-year observation period, smokers had significantly more root caries than non-smokers (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1993

Dental fluorosis, dental caries and fluoride exposure among 7-year-olds.

Mild dental fluorosis is frequently linked to fluoridated water, but discretionary fluoride sources may also be important. The aim of this study was to record age of weaning and fluoride exposure from water, toothpaste and supplements, and to relate these to the presence of caries and fluorosis in children born in 1983. In Perth (Western Australia) 14 school classes were selected. The 350 children (mean age 7.5 years) ultimately included gave fluoride exposure data for the period birth to 4 years of age. Caries (DMFT, WHO criteria, no radiographs) and dental fluorosis (TF index, dry permanent incisors) were registered clinically. Most (89%) children had lived at least 2.5 years in a fluoridated area. Supplement use was minimal and unrelated to caries or fluorosis. Mean age of weaning of those who had been breast-fed was 7.7 months; by 9 months, 74% had been weaned. Eighty-five percent liked toothpaste, 60.7% had swallowed it, and the mean age of starting to use it was 1.5 (SD 0.96) years. Caries prevalence was 0.1 and mean DMFT was 0.13. The prevalence of fluorosis was 0.48; 63% of fluorosis was TF score 1. Residence in a fluoridated area for > or = 2.5 of the first 4 years of life had an odds ratio (OR) of 4.9 for fluorosis. Weaning before 9 months of age, swallowing toothpaste and liking toothpaste were also statistically significant risk factors. Major risk factors for more severe fluorosis (TF > or = 2) were early weaning and swallowing toothpaste (ORs 2.77 and 2.64, respectively). Residence in a fluoridated area (OR 2.2) was not a statistically significant risk factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Bottle Feeding↗

PubMed1996

Salivary caries risk factors in long-term event-free survivors of pediatric malignant diseases.

In this study we demonstrated that caries prevalence and Plaque Index in long-term event-free pediatric oncology patients are related to Streptococcus mutans, Lactobacillus counts and buffer capacity obtained by chairside saliva tests. The scores showed a significant correlation between the microbiological findings and caries experience in both groups. The results were compared with a control group. A similarity in the results was found between the study and control groups. In a subgroup consisting of children who were diagnosed with cancer maximum two years before oral examinations, no significant differences with a control group was noticed. In this study we did not find any evidence of long-term effects on the studied salivary caries risk factors in children who are long-term event-free after cytotoxic treatment. Chairside tests seem to be useful in this patient group: they provide us information which can contribute to the determination of the individual caries risk, and help to motivate the patient and health care workers to maintain optimal oral hygiene.

Adolescent↗

PubMed2006

Caries increment in the permanent dentition of Mexican children in relation to prior caries experience on permanent and primary dentitions.

OBJECTIVE: To evaluate the likelihood of caries increment in schoolchildren, based on their prior caries experience. MATERIAL AND METHODS: We undertook a longitudinal study in 452 six-to-nine year olds between 1999 and 2001 in Mexico, with dental exams conducted by two standardized examiners (kappa>0.85). The dependent variable was the DMFT increment, dichotomized as without increment, and at least one unit of increment. Independent variables estimated caries experience at baseline. Data were analyzed using non-parametric tests and generalized linear models (log-binomial) to calculate relative risk (RR) adjusted for age and sex. RESULTS: The percentage of caries-free children diminished by 20.5% from 1999 to 2001. DMFT index increased two-fold, from 0.25+/-0.70 in 1999 to 0.77+/-1.30 in 2001 (p<0.001). The overall risk for this sample was 24%. The DMFT increment was higher (p<0.001) in children with DMFT>0 and dmft>0 in 1999 (RR=1.89, 95% CI=1.37-2.62; RR=2.71, 95% CI=1.94-3.76, respectively). The likelihood for DMFT increment from the 1999 levels was: (1) 2.78 times higher (95% CI=2.06-3.76) if schoolchildren had caries in any of the first permanent molars and (2) 1.62 times higher (95% CI=1.20-2.19) if schoolchildren were affected by high severity caries at baseline. CONCLUSIONS: Both caries prevalence and mean DMFT had significant increments in 18 months. Dental caries in the primary (dmft) and permanent (DMFT) dentitions at baseline are goods indicators of subsequent caries development in this group of children in a medium income country. This relationship became stronger when the occurrence of caries in the first permanent molars was included.

Analysis of Variance↗

PubMed2003

Dental status and oral health of patients with epilepsy: an epidemiologic study.

PURPOSE: We performed a dental survey of epilepsy patients to examine their oral health by statistical means and to provide a guide for the dental treatment of these patients. METHODS: We first set up four "dental" subgroups of epilepsy patients, based on the types of seizures, seizure frequency, and mental state. One hundred one patients underwent a survey concerning their dental, medical, and epilepsy histories, followed by a dental examination. Indexes quantifying oral hygiene, the number and condition of the remaining teeth, periodontium, and the degree of prosthetic treatment were measured. An age-matched control group of general (nonepilepsy) population underwent an identical dental examination. Statistical comparison was performed between the patient and the control groups and between subgroups of epilepsy patients. RESULTS: In almost all aspects of oral health and dental status, patients with epilepsy showed a significantly worse condition compared with the control group. Comparison of the subgroups of epilepsy patients revealed that the most severe findings concern patients who have poorly controlled epilepsy, especially those who have frequent generalized tonic-clonic seizures. CONCLUSIONS: The observed difference probably results from a combination of factors such as the effect of the seizures themselves, socioeconomic conditions, and the negative attitude of dentists. We recommend that the planning of dental treatment of such patients should start with the assessment of their disease and determination of the "dental" subgroup to which they belong. For each subgroup, specific recommendations for interventions are given.

Adolescent↗

PubMed1999

A systematic review of clinical diagnostic criteria of early childhood caries.

OBJECTIVE: This paper reviews case definitions and clinical diagnostic criteria of early childhood caries (ECC) and severe ECC (S-ECC) in children aged 1 to 5 years old. The acronym S-ECC as used in this paper refers to nursing caries, baby bottle tooth decay, rampant caries, labial caries, maxillary anterior caries, and other terms used to refer to severe dental caries in preschool children. METHODS: A search was carried out for articles published in peer-reviewed journals and indexed in MEDLINE using the following terms: nursing caries, baby bottle tooth decay, early childhood caries, rampant caries in preschool children, labial caries, maxillary anterior caries, and nursing bottle caries. MEDLINE's MeSH terms "dental caries" and "deciduous teeth" were used to search for other relevant studies. Reports were selected if they included children 1 to 5 years of age and described diagnostic criteria or case definitions of S-ECC. Three previous reviews were searched for other relevant reports. One unpublished report was included in this review and data from NHANES III were analyzed to provide information on caries patterns in preschool children in the United States. The first author read all the abstracts from the MEDLINE search and tagged relevant reports for photocopying. He also abstracted all the information from the reports. The first author calibrated the second author, who independently read all included and excluded reports. Disagreements were resolved by consensus. RESULTS: Out of 126 studies, 32 were excluded and 94 (93 published and 1 unpublished) were included in this review. Eighty-one of the 94 published studies were cross-sectional surveys or clinical studies, 7 were case-control clinical studies, 2 studies were controlled clinical trials, and 4 were cohort or field trials. About two-thirds of the included studies did not report on calibration of examiners. Information on reliability of examiners was reported by 19 of the 94 studies. The included studies varied widely in the name used to identify S-ECC, case definitions, and diagnostic criteria. "Cavitation" was the most common criterion used to define dental caries. Several studies measured early or noncavitated carious lesions. Twenty-seven studies used the presence of 1 dmf maxillary incisor to classify a child with S-ECC. Another 23 and 9 studies defined S-ECC by the presence of 2+ or 3+ dmf maxillary incisors, respectively. Dental caries in preschool children clusters in pits and fissures and on smooth tooth surfaces of primary molars and maxillary incisors. CONCLUSIONS: This review found a wide variation in the case definitions and diagnostic criteria used to diagnose ECC or define S-ECC. Dental caries in the maxillary incisors is one of several patterns of dental caries that may occur in primary teeth of preschool children. A consensus is needed on case definitions and diagnostic criteria that can assist researchers to test preventive interventions and study the etiology and epidemiology of ECC.

Bottle Feeding↗

PubMed1989

Prevalence and distribution of caries in a Jerusalem adolescent population by age, sex, and family income.

Four hundred and fourteen high school students aged 12-17 were examined clinically using the DMFS index and bitewing radiographs. Analyses by age, sex, economic status, and types of teeth and tooth surfaces were performed and results were compared with other international studies. Only 7.5 percent of the study population had a zero DMFS score. Females had a significantly higher DMFS score than males (13.21 vs 9.59). Caries experience increased with age and a general trend of increasing DMFS was observed with increasing levels of income. Socioeconomic status (SES) was related directly to DMFS in Israel, in contrast to an inverse relationship observed in most other western countries. First molars were most susceptible to caries attack and accounted for 41.2 percent of the total DMFS. Almost 50 percent of all affected surfaces were occlusal and 29.4 percent were proximal. Caries prevalence in general and proximal caries in particular were found to be much higher in the study population than corresponding figures in other industrialized countries. A significant decrease in caries prevalence could be expected in Israel in the next decade if primary preventive measures are implemented immediately.

Adolescent↗

PubMed2005

Subjective impacts of dental caries and fluorosis in rural Ugandan children.

OBJECTIVE: Describe the oral health related quality of life among a group of children in rural Uganda and compare impacts on oral health related quality of life associated with dental caries and fluorosis. BASIC RESEARCH DESIGN: Cross-sectional clinical and questionnaire analytical study. PARTICIPANTS: Proportional sample of 174 12 year olds attending primary schools in a rural sub-county of Uganda. OUTCOME MEASURES: Clinical assessments using WHO basic methods and the Thylstrup and Fejerskov index of Fluorosis (TFI). Child Oral Health Related Quality of Life data collected with self-administered child perception questionnaire (CPQ11-14). RESULTS: Two thirds of children reported a dental impact 'often' or 'everyday'. The mean number of impacts per child at this threshold was 2.6 and the mean total CPQ11-14 score was 25.8 (sd 21.1). Mean DMFT was 0.68. No children had fillings. Forty-one children had dental fluorosis with 10 having scores greater than 2. CPQ11-14 showed acceptable criterion validity and reliability. The number of sites with gingivitis or the presence of calculus or trauma were not associated with summary measures of CPQ11-14 whereas having any dental caries or treatment experience was associated with higher total scores and more impacts. Socially noticeable fluorosis (TFI >2) was associated with more impacts but not with higher total scores. CONCLUSIONS: Despite low levels of oral disease these children experience appreciable impacts on oral health related quality of life. The greatest burden was associated with dental caries and to a lesser extent, fluorosis.

Attitude to Health↗

PubMed1998

Oral health status in Belgian 3- to 5-year-old children.

The aim of this study was to determine the need for oral health care in young Belgian children in the municipality of Leuven, Belgium. The sample consisted of 750 boys and girls (3 years = 200, 4 years = 200 and 5 years = 350). Clinical examination was carried out by one examiner and duplicate recordings were made on 10% of the sample. The clinical examination included recording of: (1) plaque index; (2) gingival index; (3) caries index; and (4) fluorosis index. Plaque and gingival indices were recorded at six sites of smooth surfaces on selected teeth. Occlusal plaque was also registered. Before the clinical examination for caries and fluorosis, the children had their teeth professionally cleaned with toothbrushes and dental floss and dried by means of gauze bandages. In all age groups, the percentage of plaque-free sites was of the order of 60% and sound gingiva was identified at 83% of the recorded sites. The percentages of caries-free children were 69% (3 years), 57% (4 years) and 52% (5 years). The mean deft scores (standard error) were 1.37 (+/- 0.21), 1.76 (+/- 0.21) and 2.03 (+/- 0.17). The corresponding mean defs scores were 2.04 (+/- 0.44), 2.46 (+/- 0.35) and 3.75 (+/- 0.42). Non-cavitated active lesions, included in the defs scores, represented about 50% of all caries lesions. Early signs of dental fluorosis were identified in 19% (3 years), 17% (4 years) and 9% (5 years) of children. The need for oral health care in the population studied is mainly related to non-operative treatment procedures aimed at controlling the progression of disease.

Belgium↗

PubMed2005

Increasing inequalities in the distribution of dental caries in the Brazilian context in Finland.

OBJECTIVE: To document the process of concurrent decline and polarization of dental caries distribution in the Brazilian context. BASIC RESEARCH DESIGN: Ecologic assessment of dental outcomes of surveys performed in 1998 and 2002, and several covariates using data aggregated at city-level. PARTICIPANTS: 9,327 (1998) and 5,722 (2002) 12-year-old schoolchildren surveyed for oral health status in 131 and 34 towns respectively of the state of São Paulo, Brazil. MAIN OUTCOME MEASURES: DMFT index and Gini coefficient for caries distribution. RESULTS: The DMFT index declined from 3.72 in 1998 to 2.52 in 2002, while the Gini coefficient for the distribution of caries increased from 0.479 to 0.565. An improved profile of socio-economic standings, preventive dental treatment, access to fluoridated tap water and initiatives of dental education associated significantly with reduced levels of caries distribution. However, as these conditions were non-homogeneously distributed in the population, they are also associated with increasing levels of inequality in the distribution of caries. These observations indicate that there is room for further reduction of caries levels, by targeting the expansion of dental services and access to fluoridated water to groups and areas with higher levels of needs. CONCLUSIONS: Improved characterisation of the skewed distribution of caries experience demands that monitoring of the inequality in the distribution of caries by statistics such as the Gini coefficient be used. This information will inform programmes aimed at reducing levels of caries without reinforcing inequalities in the experience of the disease, a strategy that may contribute to the development of socially appropriate programmes of oral health promotion.

Brazil↗