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How useful are cross-sectional data from surveys of dental caries?

Surveys are projects involving systematic data collection without a specific hypothesis to be tested and hence without a specific research design. This paper reviews their uses, and some of the issues involved with measuring dental caries in surveys. The principal benefits of surveys are in (a) monitoring trends in oral disease when the surveys are repeated periodically: and (b) giving dental health a visibility it might otherwise not get among policy-makers. On the other hand, they are of limited use in determining treatment needs for a population, evaluating treatment outcomes, and evaluating prevention programs. Some major issues in caries surveys today include difficulties with the DMF index; the use of exclusively visual versus visual-tactile criteria; "hidden" caries; and the appropriate role for early, non-cavitated carious lesions. The DMF index suffers from its mixing of disease and treatment, and more research is needed to determine the most appropriate role for exclusively visual criteria in surveys. Trade-offs, such as weighing the benefits of exclusively visual criteria against the probable greater difficulty in finding "hidden" caries, have not been determined. Inclusion of non-cavitated lesions in a survey will increase its cost. Organizers should therefore be clear before the survey on how this additional information will be used to justify the additional expense.

Costs and Cost Analysis↗

Dental health differences by social class in home-dwelling seniors of Barcelona, Spain.

BACKGROUND: The aim of this study was to assess dental health differences by social class in home-dwelling seniors in Spain. METHODS: A cross-sectional household survey of a cohort of senior residents in Barcelona (Spain) was undertaken. Of 891 survivors (72 years or older), 561 (62.9%) oral examinations were completed according to the DMF Index (Decayed, Missing and Filled teeth). RESULTS: 42% of participants were edentate. The individuals of social class IV-V were more likely to be edentate, and to have fewer than 15 teeth compared to those in social class I-II. The DMF Index in dentate individuals (Adjusted mean=16.4) also showed significantly worse dental health for lower social classes (p = 0.001). CONCLUSIONS: The results of this study indicate a different level of utilization of dental health services and dental health by social class in home-dwelling seniors. Further research is needed to understand the barriers of access and social inequality.

Age Factors↗

[Gingival hypertrophy due to cyclosporine. A clinico-statistical study in 82 patients].

Eighty-two patients were observed at the Dental Department at Parma University. Seventy-six of them had renal transplant and 6 liver transplant. They were in immunosuppressive therapy with cyclosporina, 42 of them were also in calcium antagonist therapy. Gingival hypertrophy was observed in 52 subjects (63.4%) 25 (30%) patients underwent surgical operation, 6 of them (24%) showed a relapse about 3 months after the first operation. Clinical data were measured in accordance with 5 indicators: the level of oral hygiene, cyclosporinemia, contemporaneous use of calcium antagonist, the duration of therapy and the DMF index. By the results obtained, it's possible to suppose that the gravity of the disease is related to the contemporaneous use of calcioantagonist, but it wasn't highly significant (p < 0.05). The degree of oral hygiene was decidedly in relation to the most severe forms of gingival hyperplasia (grade 2-3), (p < 0.001). No relation was found for the duration of therapy, distribution of the DMF index and the level of drugs in the blood.

Adolescent↗

[Social disparities in dental health: measuring risks and health needs].

Our aim was to compare the dental health level of the general population to that of beneficiaries of universal health coverage (CMUC) in order to define their needs and to measure the dental health risk associated with precariousness. The study sample was composed of requests for prior approval in eight administrative regions. Accordingly, 3118 patients covered by the CMUC and 3310 beneficiaries of the general fund stricto sensu were examined by the fund's salaried dental advisors (chirurgiens-dentistes-conseils) and enrolled in the study. With a similar average DMF index, CMUC recipients had more missing teeth than was found in the general population. In the DMF index, this greater number of missing teeth was compensated by fewer filled teeth than in the general population. The F/DMF index allows a better functional evaluation of dental health. The risk of not receiving conservative care is increased by one and half to three in destitute individuals. The overall results suggest that CMUC recipients fail to obtain sufficient early dental care.

Adult↗

Clinical evaluation of glass ionomers used as fissure sealants: twenty-four-month results.

This study evaluated the twenty-four-month retention and effectiveness in dental caries prevention, of Vitremer and Ketac-Bond glass ionomers used as occlusal sealants. The initial sample consisted of 200 school children ages six to eight years whose permanent first molars were sound. The children were divided into two experimental groups (group 1 Vitremer; group 2 Ketac-Bond) and a control group (group 3 unsealed molars). Statistical analysis (Mann-Whitney test) revealed that there were statistically significant differences between the retention levels of the experimental groups A and B in the three evaluation periods (six-, twelve- and twenty-four-month) with Vitremer showing superior results. As to caries incidence, there was a statistically significant difference (chi 2 test) between the experimental groups (A and B) and the control group indicating that glass ionomers are effective for prevention of caries in the occlusal surfaces. Two independent variables were correlated with the presence of caries or that of a restored tooth after twenty-four months (odds ratio) revealing that children who presented white spots (WS) had a probability of presenting caries or restorations that was 5.0, 3.07 and 1.93 times greater at six, twelve, and twenty-four months, respectively than that of children who did not show WS in the experimental groups A and B and in the control group, respectively. The variable represented by the "dmf" index showed a statistically significant correlation (chi 2 test) in the control group, in which there was a 3.26 times greater probability of children presenting a "dmf" index equal to or greater than 1 in the development of caries or who presented a restored tooth in relation to those who did not have a history of caries ("dmf" = 0).

Cariostatic Agents↗

The evaluation of dentition status in HIV-infected patients.

PURPOSE: The aim of the study was the evaluation of dentition status in patients infected with HIV. MATERIAL AND METHODS: We examined 30 HIV + patients, aged 20-46 and 30 non-infected subjects as the control group. Oral hygiene and dentition status were estimated. Oral hygiene status using simplified OHI-plague index according to Green and Vermilion. Dentition status was analysed using decay intensity index (DMF) as well as teeth loss index according to Rogowiec. The results were analysed in dependence on HIV infection with regard to infection time. RESULTS: The results point to a high intensity of decay in HIV+ patients (23.66). There was a positive correlation between infection time and decay intensity and teeth loss evaluated using Rogowiec index. Unsatisfactory oral hygiene status (OHI > or = 1) was observed in 53.33% of infected patients. There is a relation between infection time and oral hygiene status. OHI-plague index increased in patients with infection time longer than 5 years up to 2.99 (patients with shorter than 5 years infection time--1.17 and the control group--0.57). CONCLUSIONS: 1. There is a positive correlation between HIV infection and dentition status and oral hygiene. 2. Infection time influences index values: decay intensity, teeth missing, and oral hygiene. 3. HIV+ subjects are patients of high necessity of therapy and because of their basic disease they should come within broadened health education and prophylactic activities.

Adult↗

[Periodontopathies and fixed prosthetic appliances].

The authors examined a group of 979 subjects with fixed prosthetic appliances, admitted for treatment at the periodontological department on account of periodontopathy. The group was subdivided according to sex, age, periodontological diagnosis and type of fixed prosthetic appliance. Based on the results of the initial examination, the authors compared the state of the periodontium of teeth with a prosthetic appliance and the other teeth using Russell's clinical and X-ray PI index. They investigated the oral cavity, using the OHI-S index according to Green and Vermillion and the DMF index. The results confirmed the negative influence of fixed prosthetic appliances on the periodontium and revealed the necessity of X-ray check-ups of the periodontium of teeth white these appliances.

Adult↗

Oral health in women with pregnancy and delivery complications.

Oral health was retrospectively studied in 207 women (mean age 30 years) in the Helsinki Womens' Hospital with the hypothesis that women with pregnancy complications and/or delivery complications would present poorer dental status than women without complications. Computerized dental records of the City of Helsinki Health Department were used with decayed, missing, filled index (DMF) and community periodontal index (CPI) scoring systems and a summary dental health index (DHI) was constructed for statistics. In 72%, the delivery was uncomplicated, while 18% had Caesarean section. Of the women, 8% had gestational diabetes, 7.1% had gestational hypertension, and 1.8% had preeclampsia. Fifteen (6.6%) preterm babies were born; eight (3.5%) babies weighed <2.500 g, seven (3.2%) received a 1-min Apgar point <7 indicating less than satisfactory state of the newborn. DMF was 12.9+/-6.6 in women without complications compared to 15.3+/-6.7 in women with complications (n.s.). CPI values did not differ between the groups. The mean DHI values were 2.07 in women with normal pregnancy complications and no delivery complications, 2.23 in those with pregnancy complications, and 2.13 in those with delivery complications, respectively. In logistic regression analysis, no oral health parameters associated with any complications. Thus, this study failed to show an association between poor dental health and pregnancy or delivery complications.

Adolescent↗

Transactions of an international conference. Worldwide concern: better dental care for more people. An international collaborative study. How oral surveys were conducted.

A special form and field manuals defining examination criteria were prepared for recording the following: 1. Number of teeth present both primary and permanent 2. Periodontal disease (a) Oral hygiene using the simplified oral hygiene index. (b) Periodontal condition using a modified P.I. index. (c) Periodontal treatment requirements. 3. Dental caries The DMF index was used with separate coding for filled or crowned teeth having additional primary or secondary decay. 4. Dento facial anomalies Both treatment need and treatment status were recorded. 5. Prosthetic status Possession and requirements for partial or full dentures and bridges were recorded for the age groups 13-14 and 35-44. 6. Oral pathology Pathological conditions of the gingiva and oral mucosa. 7. Need for immediate attention Conditions causing or likely to cause pain or danger to general health unless immediate treatment was given. The recording was carried out using fibre optic illumination, disposable mirrors and sickle probes. X-rays were not utilized. Two roving epidemiologists first established reproducible criteria and then calibrated the local examiners. Re-calibration took place at intervals and repeat examinations of a small sample population ensured reproducibility of recordings. The completed charts were sent to the WHO Oral Health Unit where they were edited and the data transferred to computer tape for analysis. For the present reports three variables--number of carious teeth, caries treatment/need ratio and number of teeth with gingivitis were selected for special study.

Adolescent↗

[Primary and secondary prevention through a public agency].

In our work we have tried to realize an oral prevention program in a public body. From 1978 to 1983 we observed 1489 children from 6 to 11 years old. Our positive results show that also all public structures should organize a complete prevention program to obtain a diminution of DMF indexes.

Child↗

[The oral health status in a sample of recruits form different regions of Italy].

The present epidemiological study was carried out 700 national servicemen doing service at the barracks Carlo Alberto Dalla Chiesa of Fosano (Cuneo) in the period April-August 1989, for the purposes of determining the state of oral health in a large sample of the Italian young male population and the diffusion of actions aimed at caries prophylaxis. The DMF index of the group in question is 7.14. 83.44% of DMF teeth were subjected to conservative dental treatment, 5.58% were extracted and 10.98% presented ongoing processes of caries requiring treatment. The results obtained show that, although caries is still very widespread in Italy in relation to other European countries and the United States, considerable progress has been made compared to the past as regards the secondary prevention of the pathology. Nevertheless, much remains to be done for the primary prophylaxis of caries. These data were confirmed by those obtained on periodontopathies. Although, the serious forms of periodontal disease in youth are very rare, very few conscripts are aware of the most elementary principles of oral hygiene.

Adult↗

[Report on dental health activities in Konan-town, Koriyama-city].

Konan-town in Fukushima-pref. has high-level decay of deciduous teeth of the young. The individual level (guardians of the young), the professional level (the medicalcare and the administration), and the dental health activities level (the systematist and the residents of the district) all together have practiced dental health activities by "Shiroi-ha Kyoshitsu" for 73 one-year-old infants starting in 1986 for three years. This report is based on the results of the activities which have been conducted for the first 18 months. "Shiroi-ha Kyoshitsu" has practiced activities such as surveys on oral hygiene practice, teaching how to chose snacks and mouth cleaning and dental examination. The information on improving dental hygiene was given to the district level to stress the importance of good dental practices. In the study group, the rate of high-level caries increased from 2.4% to 58.6% (over 18 month period); however, it decreased to 4.6% if we compared with the rate among the comparative group of infants (at the age of 2 to 4 as of 1985) when they were 18 months old. The rate of B or C type caries is 3.2% which was only a half of what it was before. On the other hand, when using the dmft index for the study group of infants, the rate of the dmf index changed from 0.05 teeth (at date started) to 2.45 teeth (over an 18 month period).(ABSTRACT TRUNCATED AT 250 WORDS)

DMF Index↗

A treatment need index: a pilot study.

The traditional caries index, DMF, provides inadequate information to assess dental treatment needs of a community. Dental health planners are often called upon to estimate the treatment needs, costs, time and personnel required for a proposed programme. A treatment needs index (TNI) is presented which provides important data for dental health planning. The index defines seven basic levels of treatment: (0) no treatment needed; (1) preventive treatment; (2) fissure sealants; (3) initial conservative restorations; (4) moderate conservative restorations; (5) advanced conservative restorations; and (6) radical treatment, including pulp therapy, prosthetic restorations and extractions. A pilot study and an example comparing data of both DMF and TNI demonstrates the values of the latter index. The Treatment Needs Index provides a more accurate description of caries severity and extent than does the traditional DMF index, and can be used to estimate the time required to treat a community.

Adolescent↗

The extent of oral fungal flora in 353 students and possible relationships with dental caries.

An epidemiological study was conducted on 353 students to determine the potential relationships between oral saprophytism with Candida albicans and dental status. For each student included, an interview, a dental examination, a mycological investigation and determination of oral pH were conducted. Various factors liable to affect the presence of oral fungus were investigated using the chi(2) test. 58.6% of samples were positive when cultured, with C. albicans in 93.7% of cases. The mean DMF index was 7.6. C. albicans was more frequently isolated in men, smokers, when pH was lower than 7, when dental plaque was abundant and when the time since the teeth had last been brushed was more than 8 h. DMF and F indexes were greater when C. albicans was present but not when it was abundant, while decay was more often present in subjects with abundant C. albicans. Although the specific role of the various factors is difficult to establish, the results suggest that further research to elucidate the possible role of C. albicans in caries aetiology would be valuable.

Adult↗

[Dental caries and pregnancy].

In a Berlin population comprising 588 women aged between 18 to 50 years, no increase of the DMF index was observed in multiparae. Nevertheless, complete dental treatment was stated in them less often.

Berlin↗

The utility of the zero-inflated Poisson and zero-inflated negative binomial models: a case study of cross-sectional and longitudinal DMF data examining the effect of socio-economic status.

OBJECTIVES: To examine the utility of the zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) modelling approaches for modelling four sets of dental caries data from the same cohort study [with particular attention to the influence of childhood socioeconomic status (SES)]: cross-sectional data on the deciduous dentition at age 5 years; cross-sectional data on the permanent dentition at age 18 and 26 years; and longitudinal data on caries increment between ages 18 and 26 years. METHODS: Data on dental caries occurrence at ages 5, 18 and 26 years were obtained from the Dunedin Multidisciplinary Health and Development Study (DMHDS). ZIP and ZINB models were fitted to the cross-sectional (n = 745) and longitudinal (n = 809) data sets using Stata (Intercooled Stata 7.0). The dependent variables for the three cross-sectional analyses were the DMFS indices at age 5, 18, and 26 years, and net DFS increment (NETDFS) was the dependent variable for the longitudinal analysis. RESULTS: The empty ZIP model was a poor fit for all four data sets, whereas the empty ZINB model showed good fit; consequently both the cross-sectional and longitudinal analyses were conducted using ZINB modelling. Being in the high-SES group during childhood was associated with a greater probability of being caries-free by age 18 years, over and above that which would be expected from the negative binomial process. Low childhood SES also had the largest coefficient in the modelling of the negative binomial process, but at age 5 years, where the adjusted mean dmfs score in the low-SES group was 6.8 (compared with 4.7 and 2.9 in the medium- and high-SES groups, respectively). The substantial SES differences which existed at age 5 years (in the deciduous dentition) had reduced somewhat by age 18 years, and had widened again by age 26 years. In the longitudinal analysis, "baseline" caries experience (age 18-year DMFS) was a predictor both of being an extra zero and of caries severity. CONCLUSION: This investigation of the utility of the zero-inflated approach for modelling both cross-sectional and longitudinal caries data has shown that ZIP/ZINB models can provide new insight into disease patterns. It is anticipated that they will become increasingly useful in epidemiological studies that use the DMF index as the outcome measure.

Adolescent↗

[Change of clinical stomatological parameters in ageing (author's transl)].

Morphological-functional changes occur in the oral cavity also in depended from the age. The morphological changes of the enamel, dentin, dental pulp, periodont, oral mucosa, salivary glands, tongue, maxillary bone and temporo-mandibular-joint change not only the functional cooperation of all parts in the orofacial system. They show effects for the whole body also. A complete gerostomatological standard does not exist for the whole gnathological system. But single indices for some partial components are known. For the judgement of the caries involvement it is possible to use the DMF-index, for which a special gerostomatological type exist. The periodontal diseases are classified adequately to the ARPA-nomenclature. For the judgement of odontolithiasis and oral hygienic conditions you can use the so called odontolith-Index (CI), the OH (oral hygienic debris) and the so called calculus-index (OHI-S). It is refered to different possibilities for classification of dentition with gaps.

Aged↗

[Epidemiological survey of the prevalence of dental caries in young thalassemia major patients].

47 patients with thalassemia major treated with blood transfusions were studied by the authors. The aim was to carry out an investigation on caries incidence. From the data collected in this investigation it was found that 90% of males and 66% of females showed caries, then there was a difference in percentage of caries between males and females. On the other hand the dmf and the DMF index showed quite the same values in males and in females.

Adolescent↗