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The dental health status of five-year-old children in north and west Belfast.

OBJECTIVE: To investigate the influence of social deprivation upon the diet, dental health behaviours and dental health status of five-year-old children in Northern Ireland. DESIGN: Cross-sectional study. SETTING: Fifty-eight primary schools in North and West Belfast. SUBJECTS: A nine per cent (240) random sample of 2,666 five-year-old children resident and attending school in North and West Belfast. MAIN OUTCOME MEASURES: Dental health status measured by dmft index; parental assessments of the child's dental health behaviours: parental dental attendance patterns and attitudes towards dental health; parental assessments of the child's diet and snacking behaviours: parental attitudes towards snack foods; and demographic profile of child's family. RESULTS: One hundred and sixty-three children were examined, a 68 per cent response. The majority of the families were either in low income employment or unemployed. Sixty-eight per cent of children had experience of dental caries. Dental decay was unrelated to parental employment status but more children from unemployed families attended when in pain. The diet of the children was related to both employment status and parental attitude and was reflected in their caries experience. Caries experience was dependent upon parental dental attendance, the consumption of carbonated drinks and sugar containing bedtime drinks. CONCLUSIONS: The results suggest that unemployment and parental attitudes are important as determinants of dental caries in five-year-old children from North and West Belfast. These factors may influence the child's dental health care as well as type of diet.

Attitude to Health↗

Influence of the discontinuation of a school-based, supervised fluoride mouthrinsing programme on the prevalence of dental caries.

OBJECTIVE: Since 1984 a weekly supervised fluoride mouthrinsing programme has been implemented for schoolchildren in Hisayama, Japan. Consequently, four years after the start of the programme the DMFT index for 12.5-year-old schoolchildren in Hisayama decreased to a value of less than 3.0. However, since 1992 it has increased. The purpose of this study was to investigate the causes of this increasing prevalence of dental caries since 1992. PARTICIPANTS: One hundred and one schoolchildren aged 12 years in 1994 were selected. This age group showed the highest increase in the prevalence of dental caries in that year. OUTCOME MEASURES: Children who had discontinued the use of fluoride mouthrinse for one year or more were identified by means of a confidential questionnaire. Oral examination was carried out, by three examiners, under a suitable artificial light using a mirror and an explorer. RESULTS: The DMFT and DMFS indices of the continuous mouthrinsing (CM) group were significantly lower than those of the discontinuous mouthrinsing (DM) group (P < 0.001). Significant differences between the CM and DM groups were also observed in the DMFT rates for premolars (P < 0.05) and for the first molar (P < 0.001). CONCLUSIONS: The continuation of fluoride mouthrinsing for children of school age was important in achieving the advantages of the programme in Hisayama.

Bicuspid↗

The relationship between dental disease and cerebral vascular accident in elderly United States veterans.

We report here information obtained from a cross-sectional study of 401 veterans, who were at least 60 years of age, which showed that several dental/oral conditions can be significantly associated with the diagnosis of a cerebral vascular accident (CVA), when included in a multivariate logistic regression model with and without many of the known risk factors for a CVA. The dental findings relative to the prevalence of dental caries and periodontal disease were not distinctly different between the subjects with and without a CVA in the bivariate analysis. A higher stimulated salivary flow was negatively associated with a CVA in the multivariate models. The plaque index and oral hygiene habits relating to brushing, flossing, and frequency of having teeth cleaned by a dentist/hygienist were significantly associated with a CVA in the bivariate analysis. Among these oral hygiene parameters, *needing help in brushing one's teeth" and the reported annual visit to the dentist/hygienist for teeth cleaning remained significant in the multivariate models involving the dependent-living subjects. The need for help in brushing one's teeth could reflect the fact that many subjects had reduced manual dexterity as a result of the CVA and required this extra care. However, the finding that those dependent-living individuals who reported that they did not have their teeth cleaned at least once a year were 4.76 times more likely to have had a CVA, suggests that a pattern of oral neglect might be associated with developing a CVA. The implications of this in terms of an intervention strategy for CVA warrants further consideration. However, caution is recommended because the data were obtained from a convenience sampling of older veterans and may not be generalizable to other populations.

Aged↗

The effect of frequency of toothbrushing on oral health of 14-16 year olds.

The aim of the present study was to evaluate the impact of toothbrushing frequency on dental plaque, caries and periodontal condition in 14-16 year old students. A total of 2083 students selected from 20 schools enrolling 8th and 9th grades were investigated by a questionnaire and a clinical examination. All participants were examined for oral hygiene, dental caries and periodontal condition using Silness & Löe plaque index (Pl.l), decayed, missing and filled teeth/surfaces (DMFT/S) indices and Community Periodontal Index of Treatment Needs (CPITN), respectively. It was revealed that about 49 per cent of males and 89 per cent of the females reported to brush their teeth on a regular basis. Such differences in toothbrushing frequency between the sexes were statistically significant (P = 0.0001). The mean (Pl.l) scores were lower in those who brushed than those who did not brush their teeth, with a significantly lower scores in females than in males (P = 0.0001). There were slight but nonsignificant differences in caries experience (MFT/S) amongst males and females as related to toothbrushing frequency (P = 0.121, 0.208 respectively). While bleeding on probing (43.0 per cent) was most prevalent in students who did not brush. Calculus scores were similar in all groups. The occurrence of shallow and deep pockets in students who brushed or didn't brush their teeth were minimal (6.6-8.4 per cent). The oral health status among those who did not brush or brushed their teeth on regular or irregular basis was found to be poor and slightly varied. Therefore, more emphasis should be placed on proper oral hygiene. Also, implementation of school based oral health promotion and prevention programs is urgently needed.

Adolescent↗

Dental pain prevalence and association with dental caries and socioeconomic status in schoolchildren, Southern Brazil, 2002.

The objective of this study was to assess the relation between dental pain, dental caries and socioeconomic status among 12- and 13-year-old schoolchildren enrolled in a public school in Florianópolis, SC, Brazil in 2002. This study was a cross-sectional study involving 181 schoolchildren. Dental pain experience was the dependend variable analyzed. Socioeconomic data of the children's families were obtained through a questionnaire. Dental caries experience was registered according to the DMFT index (WHO, 1997). The field workteam consisted of an examiner and a recorder. The statistical analysis was performed using the chi-square test and the non-conditional multiple logistic regression. The response rate was 93.4%. The intraexaminer agreement measured on a tooth by tooth basis was high (kappa > 0.73). Dental pain prevalence was 33.7% (CI95% 26.0-42.0). The multiple regression analysis, adjusted by sex and other variables, showed that children with DMFT > 1 presented 2.9 (OR CI95% 1.4-6.1, p < 0.01) more chances of having dental pain when compared with those with DMFT < or = 1. Children whose mother's schooling level was equal or less than 4 years presented 2.5 (OR CI95% 1.2-5.6, p = 0.02) more chances of having dental pain when compared with others whose mothers had more than 5 years of schooling and, finally, children whose family income was up to U$ 67.00 showed 3.2 (OR CI95% 1.2-8.4, p = 0.02) more chances of having dental pain when compared with the ones whose families had higher income. High levels of caries attack, low mother schooling level and low family income were associated to dental pain.

Adolescent↗

Prevalence and determinants of enamel fluorosis in Flemish schoolchildren.

As part of an epidemiological study on the oral health of Flemish schoolchildren, fluoride use was studied together with risk factors (medical history, tap water fluoride concentration, use of fluoride supplements, toothpaste and brushing habits). Fluorosis was scored according to the Thylstrup-Fejerskov index (TFI) in children aged 11 years (4,128 children examined). Explanatory variables were recorded yearly, starting at the age of 7. Earliest toothpaste use was reported at the age of 1. By age 7, 99.7% of the children reported the use of toothpaste (90% fluoride-containing), but only 13.9% reported using a pea-sized amount. At age 7, 66% of the children had received systemic fluoride supplements during at least part of their childhood. At 11 years, 92% of the children used a fluoride-containing toothpaste and 6% still received systemic fluoride supplements. Fluorosis was present in about 10% of all the children examined, mainly TFI score 1 (7.3% in upper central incisors). Logistic regression established tooth brushing frequency and fluoride supplement use, in addition to tap water fluoride concentrations above 0.7 mg/l, as significant risk factors when the presence of fluorosis on at least one tooth was used as outcome variable. Children having fluorosis had a lower risk of caries, both in the primary (median dmft 1, range 0-10 vs. 2, range 0-12) and permanent dentition (median DMFT 0, range 0-5 vs. 0, range 0-11).

Analysis of Variance↗

Five-year incidence of coronal and root caries in 60-, 70- and 80-year-old Swedish individuals.

The 5-year incidence of caries was studied in a random sample of 60-, 70- and 80-year-old inhabitants of Göteborg, with 69, 51 and 28 individuals in the different age groups. One aim of the study was to introduce a root caries index (DMFRS%) in which the missing root surfaces are taken into account. This study, as well as other recent studies, has shown that dental caries is the main reason for tooth extraction. The study also revealed that coronal and root caries occurred more frequently in elderly than younger people and the incidence of root caries was positively correlated with coronal caries (r = 0.3, p < 0.001) and negatively correlated with the number of remaining teeth (r = 0.4, p < 0.0001). The 5-year DMFRS% increment values increased with advancing age from 2.7 involved root surfaces per 100 susceptible ones in the 60-year-olds to 4.8 in the 70-year-olds and 10.7 in the 80-year-olds. It should be mentioned, however, that only people able to come to the clinic were enrolled in the study and an analysis of the attrition bias indicated that oral health may be worse in those who are too ill to participate. The frequent utilization of dental care among the participants was reflected in the finding of several new fillings and prosthetic crowns. Most of the very elderly people with carious lesions at baseline, however, had developed new lesions at the margins of the newly made restorations.

Aged↗

Caries experience in deciduous dentition of rural Chinese children 3-5 years old in relation to the presence or absence of enamel hypoplasia.

The association of enamel hypoplasia (EHP) with dental caries of the deciduous dentition was determined in 1,344 rural Chinese children aged 3-5 years. The degree of EHP was determined using a modified DDE Index. Number of decayed, missing, and filled teeth and tooth surfaces were determined for all subjects. Anthropometric assessment of body weight and height was done as an indirect measure of the nutritional status of the children. Results from the study showed that the prevalence of EHP was 22.3% in the total study population. The prevalence of dental caries was 82.3%. There was no difference in the caries experience between males and females. Significantly greater caries experience was observed among the children living in a low socioeconomic county and children with low height for age. Children with low birth weight showed a slightly higher percentage of caries than those born with normal birth weight. Children with enamel hypoplasia demonstrated a significantly higher caries experience than those who did not have such defects. The results of this study consistently support previous studies that found nutritional deficiency to have an important impact on tooth development and susceptibility to dental diseases. This study also indicates that the presence of enamel hypoplasia may be a predisposing factor for initiation and progression of dental caries, and a predictor of high caries susceptibility in a community, particularly if fluoride programs are not implemented.

Birth Weight↗

Prevalence of dental caries in 4- to 5-year-old children partly explained by presence of salivary mutans streptococci.

The correlation between dental caries and the number of oral mutans group streptococci (ms) present has been shown to be weak. The aim of this investigation was to study associations between caries experience (decayed, missing, and filled surfaces [dmfs]) and the number of ms in stimulated saliva, with emphasis on the level of disease and the confounding effect of regular intake of sweets, the presence of salivary lactobacilli, and oral hygiene. In some 2,700 4- to 5-year-old South African children of different ethnic origins, caries was diagnosed on the basis of World Health Organization criteria and saliva samples were analyzed for ms after cultivation on mitis salivarius-bacitracin agar and for lactobacilli by using the Dentocult kit. Oral hygiene was scored on the basis of the Greene and Vermillion simplified debris index, while data on intake of sweets were derived from extensive interviews. Pearson's coefficient of correlation was computed, and multiple regression analysis was performed to correct for confounding factors. The distribution of the children in the eight caries classes was strongly associated with the ms class (P < 0.001), with those in the lower ms classes generally having low dmfs scores and those in the higher ms classes having dmfs scores distributed over the whole range. The r value for the two variables was 0.25 for the total material; this was reduced to 0.18 by correction for confounding factors. The corresponding values for children with caries were 0.21 and 0.17, for those in the 1 to 6 dmfs interval they were 0.07 and 0.03, and for those in the 7 to 81 dmfs interval they were 0.16 and 0.14. The data imply that the explanatory values for ms, those for the lower caries interval not counted, ranged from 6 to 2%. The unexpected results for children with caries might be due to their distribution pattern. It is concluded that there is a need for reevaluation of ms as a risk factor in dental caries.

Candy↗

The prevalence of development defects of enamel and dental caries in New Zealand children receiving differing fluoride supplementation, in 1982 and 1985.

Seven hundred and twenty-seven 9-year-old children resident in Hawke's Bay were examined in 1985, 3 years after a baseline survey of a cohort of the same age group. Children were allocated to one of four fluoride-history groups on the basis of the responses of parents to a questionnaire, which also gave information on infant feeding and household water source. Examination conditions were duplicated, and children were examined by the same examiner using a modification of the DDE Index. The prevalence of diffuse defects in the low fluoride (LF) group (24.3 percent) was lower (P less than 0.001) than in the fluoridated water (WF) group (50.8 percent), the PT group who had used tablets to 5 to 6 years of age (53.1 percent), and the CT group who had used tablets continuously (54.7 percent). There were 2.9 percent of children with contralateral pairs of teeth with diffuse opacities in the LF group compared with 22.9 percent in the WF group, 18.7 percent in the PT group, and 36.0 percent in the CT group. For European children, 9.7 percent had post-eruptive defect sub-types. Defect prevalence could not be related to infant feeding or water source in unfluoridated areas. There had been a significant increase in the prevalence of diffuse defects in the WF, PT, and CT groups, but not the LF group since the baseline survey. There was also an increase in the numbers of children considered to have an unsatisfactory appearance due to either continuous or diffuse opacities--from none in 1982, to 24 (3.7 percent) in 1985. In the 3 years since the baseline survey there had been considerable reductions in the caries prevalence in all groups (P less than 0.001).

Child↗

Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients.

OBJECTIVES: To document in intensive care unit (ICU) patients the effect of dental plaque antiseptic decontamination on the occurrence of plaque colonization by aerobic nosocomial pathogens and nosocomial infections. DESIGN: Single-blind randomized comparative study. SETTING: A 16-bed adult intensive care unit in a university hospital. PATIENTS: Patients consecutively admitted in the ICU with a medical condition suggesting an ICU stay of 5 days and requiring mechanical ventilation. INTERVENTIONS: After randomization, the treated group received dental plaque decontamination with 0.2% chlorhexidine gel, three times a day during the ICU stay. The control group received standard oral care. SPECIFIC MEASUREMENTS: Dental status was assessed by the Caries-Absent-Occluded index; the amount of dental plaque was assessed by a semi-quantitative plaque index. Bacterial sampling of dental plaque, nasal and tracheal aspirate, blood, and urine cultures were done on days 0, 5, 10, and every week. MAIN RESULTS: Sixty patients were included; 30 in the treated group and 30 in the control one (mean age: 51 +/- 16 years; mean Simplified Acute Physiological Score II: 35 +/- 14 points). On admission, no significant differences were found between both groups for all clinical and dental data. Compared with the control group, the nosocomial infection rate and the incidence densities related to risk exposition were significantly lower in the treated group (18 vs 33% days in the ICU and 10.7 vs 32.3% days of mechanical ventilation; P < 0.05). These results were consistent with a significant preventive effect of the antiseptic decontamination (Odds Ratio: 0.27; 95% CI: 0.09; 0.80) with a 53% relative risk reduction. There was a trend to a reduction of mortality, length of stay, and duration of mechanical ventilation. CONCLUSIONS: An antiseptic decontamination of dental plaque with a 0.2% chlorhexidine gel decreases dental bacterial colonization, and may reduce the incidence of nosocomial infections in ICU patients submitted to mechanical ventilation.

Adult↗

Dental caries in postwar Bosnia and Herzegovina.

OBJECTIVES: To present the prevalence of dental caries in postwar Bosnia and Herzegovina (BH). METHODS: A survey focused on dmft and DMFT indices was carried out in four cantons of the Federation of BH in 1997. The dental health of 6- and 12-year-olds was assessed in random samples (n = 238 and 318, respectively). DMFT index in adult population was assessed in clients coming to dental offices in the same area (35-44-year-olds; n = 401). All the subjects were clinically investigated. RESULTS: During the 1991-95 war, all four cantons were affected by the migration of population. The population per dentist ratio considerably increased in three cantons. In 6-year-olds, the average dmft (+/-SD) was 4.9 +/- 4.0, and 86% of the children were affected with dental caries. The average DMFT of 12-year-olds was 6.2 +/- 3.9. On the average, 94% of the 12-year-olds were affected with dental caries. Mean DMFT of adult clients was 15.1 +/- 7.0. Almost every adult (98%) was affected with dental caries. CONCLUSIONS: The dental status in postwar BH is rather poor and the mean DMFT in all investigated age groups may be considered high. The detrimental effect of 1991-95 war on social conditions and the health care system should be considered in explaining such poor dental health. Despite the limitations, the presented data may be used to assess the treatment needs, assure the visibility for dental issues in BH, and help the west European countries to plan dental services for refugees from BH.

Adult↗

Oral health survey of 5-12-year-old children of National Guard employees in Riyadh, Saudi Arabia.

OBJECTIVES: To assess the oral health status, preventive practices and mutans streptococci (MS) levels among the children of National Guard personnel living in Riyadh, Saudi Arabia. DESIGN: Cross-sectional study of schoolchildren. SETTING: Dental Clinic of the National Guard Hospital in Riyadh, Saudi Arabia. SAMPLE AND METHODS: A sample of 272 5-12-year-old children, 154 males and 118 females (95% Bedouin), were selected from approximately 35 National Guard schools in the Riyadh area. An examination was performed in the dental clinic in the National Guard hospital. Oral hygiene was assessed using the Simplified Debris Index (DI-S); Gingival Index (GI) was used to measure gingival health; dental fluorosis was recorded according to the criteria of Dean. Dental caries (dmft, dmfs, DMFT and DMFS) was recorded according to the recommendations of Haugejorden. Concentration of MS in saline rinse samples was assessed by routine laboratory methods and expressed as colony forming units (CFU) per ml (log10). RESULTS: There was a high level of dental caries (mean dmft = 3.8 +/- 3.2; mean dmfs = 21.5 +/- 15.7; mean DMFT = 2.0 +/- 1.9; mean DMFS = 3.1 +/- 3.7). Only 0.7% of the children had no caries experience (dmft + DMFT). MS levels ranged from 0 to 7.5 x 10(5) CFU per ml (mean MS = 4.10 +/- 0.90 log10 CFU per ml). A significant relationship between MS and caries experience was observed (P = 0.003). Mild fluorosis was observed in 14% of the children. Oral hygiene scores indicated that most of the examined tooth surfaces had detectable plaque (mean DI-S = 1.78). Gingivitis was present in 100% of the children and was considered moderate to severe in 14% (mean GI = 1.18). CONCLUSIONS: The study revealed a high level of oral diseases and poor oral hygiene in the study population and a need for therapeutic and preventive measures.

Arabs↗

Social indicators of dental caries among Sierra Leonean schoolchildren.

Most of the caries of African child populations is found in limited fractions of that population. The purpose of the present study was to analyze the caries situation of Sierra Leonean schoolchildren in relation to demographic, socioeconomic, and behavioral variables, in order to develop an appropriate index for prediction of caries. A total of 610 students from primary class 1 (mean age: 7 yr) and secondary form 1 (mean age 15 yr) were dentally examined by three examiners and interviewed by their teachers. Intra- and interexaminer reproducibilities were 82 and 70%, and interinterviewer reliability was 67-100% for the individual questions. Urban students had more caries than rural. In class 1, dmfs+DMFS was 4.1 and 1.8, respectively; in form 1, DMFS was 5.3 and 3.5. Two tribes (the Fulas and the Madingos) had higher caries means than the rest, especially in class 1, where dmfs+DMFS was 6.5 and 2.4, respectively. Form 1 students with literate parents had a higher caries mean, and class 1 pupils with defective school uniforms a lower mean. The apparently high-risk groups did not consume more sweet snacks or clean their teeth less frequently. There was clearly more caries among the quartiles of children with most visible plaque on molars, but all social and demographic subgroups had similar amounts of plaque. Multivariate analyses of class 1 children showed that pupils living in urban areas, Fulas and Madingos, and children wearing complete school uniforms had caries significantly more frequently, other factors being equal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Variables associated with oral hygiene levels in 7-year-olds in Belgium.

OBJECTIVES: The present investigation aimed to delineate the extent of the correlation between each of a number of possible associated variables and the amount of plaque (as measured by a plaque index) present in 7-year-old Flemish children and to investigate the potential relation between caries experience and the amount of dental plaque. PARTICIPANTS: A sample of 4,468 children representative of children living in Flanders and born in 1989 was obtained. Their mean age was 7.1 (SD = 0.4) years with a boys/girls ratio of 51.8%-48.2%. METHODS: Analyses were performed with ordinal plaque index outcome, considering the children's school (i.e. class) as a random effect. Random effect models were estimated with the SAS procedure Proc NLMIXED. RESULTS: From the multiple logistic regression analysis, it could be concluded that the older the subjects the more dental plaque was observed (OR = 1.35; CI 1.08-1.68; p = 0.0081). Moreover, four explanatory variables could be identified as significant determinants for dental plaque in the mixed dentition: 'start of brushing after the age of 2' (OR = 1.161; CI: 1.09-1.23; p < 0.0001), 'brushing frequency of < 1x/day' (OR = 1.369; CI: 1.012-1.66; p = 0.0019), 'more than two in between meal snacks' (OR = 1.18; CI: 1.023-1.36; p = 0.0111) and 'daily intake of sugar containing drinks' (OR = 1.24; CI: 1.08-1.42; p = 0.0023). Further, being male was associated with a higher amount of plaque (OR = 1.16; CI: 1.00-1.34; p = 0.0506) and finally, a weak but significant correlation (Spearmans' rho: r = 0.23, p < 0.0001) between caries experience and the amount of cervical plaque was shown. CONCLUSION: The amount of cervical plaque in the mixed dentition was significantly related to variables associated with oral hygiene and dietary habits. A low but significant correlation between the amount of dental plaque and caries experience was observed.

Age Factors↗

Introducing a clinical-behavioural scoring system for children's oral hygiene.

OBJECTIVES: Developing and testing a clinical-behavioural scoring system for assessing children's oral hygiene. MATERIALS AND METHODS: One clinical variable (the presence of dental plaque, measured using Silness and Loe's index) and one behavioural variable (self-reported tooth brushing frequency) were combined into secondary data analysis of research databases for 3-6-year-olds and 6-13-year-olds in a Mexican community. The combined scoring is an ordinal scale that depicts suitable, moderate and inadequate hygiene. Blinded dental examiners also collected dmft/DMFT data in standardised conditions. Data was analysed with Spearman's rho, Kruskall-Wallis, non-parametric tests for trends and Pearson's chi2 tests. RESULTS: 1303 children aged 3-6 years old and 1644 children aged 6-13 years old participated in the study. Clear relationships existed between the combined scoring system and dmft (p < 0.01) and between the scoring system and DMFT (p < 0.01), suggesting that the combined clinical-behavioural scoring system is a reasonably accurate measurement of the relationship between caries experience and oral hygiene in children in the given setting. CONCLUSIONS: The combined clinical-behavioural scoring system is a simple, easy-to-use tool that incorporates clinical and behavioural data commonly found in dental systems. Whether the clinical-behavioural scoring system can be generalised remains to be established.

Adolescent↗

Assessment of periodontal disease in an adult population survey in Taipei city using CPITN and GPM/T indices.

The community periodontal index of treatment needs (CPITN) has been recommended for epidemiological surveys of periodontal status and treatment needs. The prevalence of gingivitis, periodontitis and missing teeth in a study population has been determined using the CPITN and GPM/T (gingivitis: periodontitis: missing teeth) indices. In this study, a survey of periodontal disease was performed among the adult population of Taipei City using the CPITN index. A total of 673 dentated persons (male 339, 50.4%; female 334, 49.6%) were examined and surveyed. Data were then divided into five age groups, 15-19, 20-29, 30-44, 45-64 and 64+. The prevalence of periodontal disease was analyzed using the percentage or sextant from all teeth. Treatment needs were determined by the worst periodontal score per sextant. It was found that about 91% of subjects suffered from various degrees of periodontal disease in at least one tooth. Gingivitis and periodontitis were 86.9% and 33%, respectively. Among them 48.9% had missing teeth. The prevalence of periodontitis and missing teeth increased with age. Most of them involved oral hygiene instruction and scaling. About 11.0% of the subjects needed periodontal surgery. Higher proportions of attachment loss with gingival recession caused by destructive periodontal disease were found in older persons who did not require periodontal surgery. It was concluded that endemic gingivitis and calculus, a moderate prevalence of shallow pockets and a low prevalence of deep pockets were observed among adults in this group in Taipei City and that the CPITN is a practical epidemiological and public health method for screening the periodontal status and treatment needs of a population.

Adolescent↗

[Dental caries in Brazil: decline, polarization, inequality and social exclusion].

OBJECTIVE: To examine the caries situation in Brazilian schoolchildren between 1980 and 2003 and to determine the distribution of caries and access to treatment in this population group. METHODS: We employed secondary data concerning the number of decayed, missing or filled teeth (DMFT). The studies whose data were used differed in terms of study type, study design, sampling methods, and diagnostic criteria, but yielded national estimates that are considered valid for the DMFT index. Therefore, a trend analysis based on these studies was thought to be feasible. RESULTS: Analysis of DMFT values revealed a high frequency of dental caries in 1980 and a moderate frequency in the 1990s. In 2003, the DMFT index was still within the moderate range. Between 1980 and 2003, a 61.7% decrease in DMFT frequency was observed. The percentage of children with no DMFT increased from 3.7% in 1986 to 31.1% in 2003. On the other hand, in the segment of the study population least affected, the percentage of children who received care increased from 26.3 in 1986 to 34.7 in 2003, yet in the group with DMFT this percentage fell from 50.2 in 1986 to 39.3 in 2003. In the segment with DMFT >/=6, the percentage of those who received care remained stable (28%). During the study period, 60% of the dental caries were found in 20% of the study population. CONCLUSION: An important decline in DMFT was observed between 1980 and 2003, perhaps as a result of increased access to fluoridated water and toothpaste and of changes in the goals of public oral health programs. Despite the improvement, caries is unevenly distributed in the pediatric population; a small proportion of individuals carries most of the disease burden. In addition, the proportion of teeth with caries that went untreated did not change between 1980 and 2003. Reducing socioeconomic disparities and adopting public health measures that target and reach the most vulnerable groups remain a challenge for policy makers in Brazil.

Brazil↗