The classification of malocclusion

Background Topical fluoride therapy (TFT) in the form of varnish, gel, mouthrinse or toothpaste has been used extensively as a caries-preventive intervention for over three decades. Objectives To determine the effectiveness and safety of fluoride varnishes, gels, mouthrinses, and toothpastes in the prevention of dental caries in children and to examine factors potentially modifying their effect. Search strategy We searched the Cochrane Oral Health Group's Trials Register (May 2000), CENTRAL (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. Selection criteria Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). Data collection and analysis Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects metaregression analyses. Main results There were 144 studies included. For the 133 that contributed data for meta-analysis (involving 65,169 children) the D(M)FS pooled prevented fraction estimate was 26% (95% CI, 24% to 29%; p Reviewer's conclusions The benefits of topical fluorides have been firmly established on a sizeable body of evidence from randomized controlled trials. While the formal examination of sources of heterogeneity between studies has been important in the overall conclusions reached, these should be interpreted with caution. We were unable to reach definite conclusions about any adverse effects that might result from the use of topical fluorides, because data reported in the trials are scarce.

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Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents

OBJETIVO: Analisar a evolucao da experiencia de carie dentaria entre escolares brasileiros no periodo de 1980 a 2003 e determinar a distribuicao da carie e o acesso dessa populacao ao tratamento da doenca. METODO: Foram utilizados dados secundarios produzidos no periodo de 1980 a 2003, empregando o indice dentes permanentes cariados, perdidos e restaurados (CPOD). Os estudos que deram origem aos dados variaram quanto ao tipo de investigacao, delineamento, plano amostral e criterio diagnostico para a doenca, mas produziram estimativas nacionais consideradas validas para os valores do indice CPOD, admitindo-se como possivel a presente analise de tendencia. RESULTADOS: Os valores de CPOD indicaram um nivel alto de carie dentaria nos anos 1980, declinando para um nivel moderado nos anos 1990. Em 2003, o valor do CPOD ainda era moderado (2,8). Entre 1980 e 2003, o declinio nos valores do CPOD foi de 61,7%. A porcentagem de escolares com CPOD igual a zero aumentou de 3,7% em 1986 para 31,1% em 2003. Por outro lado, enquanto no segmento menos atingido pela doenca (CPOD de 1 a 3), o indice de cuidados aumentou de 26,3% em 1986 para 34,7% em 2003, no segmento com CPOD de 4 a 5 o indice de cuidados caiu de 50,2% em 1986 para 39,3% em 2003. No segmento com CPOD de 6 ou mais, o indice de cuidados se manteve estavel (28.0%). Aproximadamente 20% da populacao passou a concentrar cerca de 60% da carga de doenca. CONCLUSAO: Um declinio relevante do CPOD foi observado no periodo do estudo, sendo a hipotese explicativa mais plausivel a elevacao no acesso a agua e creme dental fluorados e as mudancas nos programas de saude bucal coletiva. A despeito da melhora, a distribuicao da carie ainda e desigual. Os dentes atingidos por carie passaram a se concentrar numa proporcao menor de individuos. Ademais, nao se alterou a proporcao de dentes cariados nao tratados. A reducao das disparidades socioeconomicas e medidas de saude publica dirigidas aos grupos mais vulneraveis permanecem como um desafio para todos os que formulam e implementam as politicas publicas no Brasil.

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Cárie dentária no Brasil: declínio, polarização, iniqüidade e exclusão social

AIM: This was to review the literature published, to point out shortcomings and to suggest areas in need of improvement concerning the diagnosis and prevalence of MIH METHODS: A broad search of the PubMed database was conducted Relevant papers published in English were identified after a review of their titles, abstracts or full reading of the papers Papers were selected if the number of children with at least one first permanent molar affected by demarcated opacities could be deciphered Targeted publications were critically assessed by the author concerning examination criteria, selection and character of the study groups, examiners’ calibration and result presentation RESULTS: The initial search revealed 414 papers of which 24 met the inclusion criteria A wide variation in defect prevalence (24–402 %) was reported Cross comparison of the results of the various studies were difficult because of use of different indices and criteria, examination variability, methods of recording and different age groups CONCLUSIONS: Further standardization of study design and methods is needed to make the results comparable

Prevalence and Diagnosis of Molar-Incisor- Hypomineralisation (MIH): A systematic review.

BACKGROUND: Dental caries is a major public health problem in most industrialised countries, affecting 60% to 90% of school children. Community water fluoridation was initiated in the USA in 1945 and is currently practised in about 25 countries around the world; health authorities consider it to be a key strategy for preventing dental caries. Given the continued interest in this topic from health professionals, policy makers and the public, it is important to update and maintain a systematic review that reflects contemporary evidence. OBJECTIVES: To evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries.To evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis. SEARCH METHODS: We searched the following electronic databases: The Cochrane Oral Health Group's Trials Register (to 19 February 2015); The Cochrane Central Register of Controlled Trials (CENTRAL; Issue 1, 2015); MEDLINE via OVID (1946 to 19 February 2015); EMBASE via OVID (1980 to 19 February 2015); Proquest (to 19 February 2015); Web of Science Conference Proceedings (1990 to 19 February 2015); ZETOC Conference Proceedings (1993 to 19 February 2015). We searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization's WHO International Clinical Trials Registry Platform for ongoing trials. There were no restrictions on language of publication or publication status in the searches of the electronic databases. SELECTION CRITERIA: For caries data, we included only prospective studies with a concurrent control that compared at least two populations - one receiving fluoridated water and the other non-fluoridated water - with outcome(s) evaluated at at least two points in time. For the assessment of fluorosis, we included any type of study design, with concurrent control, that compared populations exposed to different water fluoride concentrations. We included populations of all ages that received fluoridated water (naturally or artificially fluoridated) or non-fluoridated water. DATA COLLECTION AND ANALYSIS: We used an adaptation of the Cochrane 'Risk of bias' tool to assess risk of bias in the included studies.We included the following caries indices in the analyses: decayed, missing and filled teeth (dmft (deciduous dentition) and DMFT (permanent dentition)), and proportion caries free in both dentitions. For dmft and DMFT analyses we calculated the difference in mean change scores between the fluoridated and control groups. For the proportion caries free we calculated the difference in the proportion caries free between the fluoridated and control groups.For fluorosis data we calculated the log odds and presented them as probabilities for interpretation. MAIN RESULTS: A total of 155 studies met the inclusion criteria; 107 studies provided sufficient data for quantitative synthesis.The results from the caries severity data indicate that the initiation of water fluoridation results in reductions in dmft of 1.81 (95% CI 1.31 to 2.31; 9 studies at high risk of bias, 44,268 participants) and in DMFT of 1.16 (95% CI 0.72 to 1.61; 10 studies at high risk of bias, 78,764 participants). This translates to a 35% reduction in dmft and a 26% reduction in DMFT compared to the median control group mean values. There were also increases in the percentage of caries free children of 15% (95% CI 11% to 19%; 10 studies, 39,966 participants) in deciduous dentition and 14% (95% CI 5% to 23%; 8 studies, 53,538 participants) in permanent dentition. The majority of studies (71%) were conducted prior to 1975 and the widespread introduction of the use of fluoride toothpaste.There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries across socioeconomic status (SES) levels.There is insufficient information to determine the effect of stopping water fluoridation programmes on caries levels.No studies that aimed to determine the effectiveness of water fluoridation for preventing caries in adults met the review's inclusion criteria.With regard to dental fluorosis, we estimated that for a fluoride level of 0.7 ppm the percentage of participants with fluorosis of aesthetic concern was approximately 12% (95% CI 8% to 17%; 40 studies, 59,630 participants). This increases to 40% (95% CI 35% to 44%) when considering fluorosis of any level (detected under highly controlled, clinical conditions; 90 studies, 180,530 participants). Over 97% of the studies were at high risk of bias and there was substantial between-study variation. AUTHORS' CONCLUSIONS: There is very little contemporary evidence, meeting the review's inclusion criteria, that has evaluated the effectiveness of water fluoridation for the prevention of caries.The available data come predominantly from studies conducted prior to 1975, and indicate that water fluoridation is effective at reducing caries levels in both deciduous and permanent dentition in children. Our confidence in the size of the effect estimates is limited by the observational nature of the study designs, the high risk of bias within the studies and, importantly, the applicability of the evidence to current lifestyles. The decision to implement a water fluoridation programme relies upon an understanding of the population's oral health behaviour (e.g. use of fluoride toothpaste), the availability and uptake of other caries prevention strategies, their diet and consumption of tap water and the movement/migration of the population. There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across SES. We did not identify any evidence, meeting the review's inclusion criteria, to determine the effectiveness of water fluoridation for preventing caries in adults.There is insufficient information to determine the effect on caries levels of stopping water fluoridation programmes.There is a significant association between dental fluorosis (of aesthetic concern or all levels of dental fluorosis) and fluoride level. The evidence is limited due to high risk of bias within the studies and substantial between-study variation.

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Water fluoridation for the prevention of dental caries

INTRODUCTION: Molar incisor hypomineralization (MIH) is a developmental disturbance of enamel affecting the first permanent molars and permanent incisors. The epidemiological evidence on MIH prevalence shows it to be in the range of 3.6 to 25%. The prevalence of MIH has not been documented in Bulgaria which warranted the conduction of the present study. AIM: To find the prevalence of molar incisor hypomineralisation in Bulgarian children. PATIENTS AND METHODS: The study included randomly selected 2960 children aged 7 to 14 years from Plovdiv and born between 1992 and 1999. The children were allocated to age groups which were matched in number--each of them included 370 children and consisted of approximately equal number of girls and boys. The defect was assessed by visual and tactile inspection using directed light without the enamel surface being preliminary dried. The prevalence of MIH was determined totally and for each age group; also we determined the degree of damage by type of teeth, and the average number of affected teeth of one person with MIH. The results were analysed using alternative analysis at a level of significance P 0.05). The mean number of affected teeth per person with MIH was 3.99 of which 2.08 were first permanent molars, 1.86--incisors and 0.5--canines. The incisors and the first permanent molars were approximately equally affected (P > 0.05). CONCLUSIONS: The results of the study suggest that molar incisor hypomineralization can be found in Bulgarian children too. The prevalence of MIH and the mean number of affected teeth of one individual are lower than the data reported in similar studies in other countries.

Molar incisor hypomineralisation in 7-to-14-year old children in Plovdiv, Bulgaria--an epidemiologic study.

AIM The aim of the study was to investigate the hypothesis of a higher risk of demineralization in regions adjacent to brackets at earlier age. METHODS A prospective cohort study of 42 persons (22 persons aged 11-15 years and 20 persons aged 19-24 years) in the process of orthodontic treatment with brackets was performed. The duration of the observation was 18 months. The object of evaluation were 508 vestibular surfaces of permanent teeth that had brackets fixed. The statistical analysis included non-parametric analysis and comparison of percentages. The attributive risk (AR) and the relative risk (RR) were also determined. RESULTS After removal of brackets, 51.61% of the surfaces of the 11-15 year olds showed demineralization. In the 19-24 year age group this result was 6.92%. The difference was statistically significant (P < 0.001). The attributive risk was 86.59% and the relative risk was 7.45%. This indicates that age is a risk factor for demineralization adjacent to brackets. CONCLUSION The results of the study support the hypothesis of a higher risk of demineralization in regions adjacent to brackets at earlier age. This is a direct consequence of the lower resistance of the dental tissues and the poorer cooperation from the younger patients in the orthodontic treatment process.

Comparative age study of the risk of demineralization during orthodontic treatment with brackets.

INTRODUCTION Available data show that Early Childhood Caries (ECC) has a very wide range of prevalence (5% to 55%). Contemporary studies investigate the specific etiologic factors contributing to the appearance of ECC. As these questions are inadequately addressed in the stomatological literature in Bulgaria, we decided to investigate them in the present study. AIM To determine the prevalence of ECC and the risk factors in children aged 12 to 47 months in Plovdiv. METHODS The study is representative by design and is conducted in compliance with the requirements of World Health Organization. It includes 370 children 1 to 3 years of age, selected randomly. The dental caries was diagnosed by the visual-tactile method with a dental explorer and mirror at the cavitation level. A survey for determining the risk factors for ECC is carried out among the mothers of all affected children. RESULTS The results of the study demonstrate high prevalence of ECC in the studied populations--20.82% in 1-year-old children, 40.0% in 2-year-old children and 56.15% in 3-year-old children. The analysis of the questionnaire data shows that the knowledge of mothers about the appropriate feeding of their children is insufficient. The use of baby's comforter with honey is not the only risk factor for developing caries. It is ascertained that frequent consumption of quickly soluble carbohydrates, as well as their prolonged contact with the tooth surface is highly significant risk factors too. CONCLUSIONS The prevalence of ECC is high in the studied populations. The results of the questionnaire survey demonstrate the need for recommending adequate feeding practices of children till the age of 3 years to their mothers.

Prevalence of early childhood caries and risk factors in children from 1 to 3 years of age in Plovdiv, Bulgaria.

INTRODUCTION The polarization of dental caries is a notion defined as a small percentage of persons with high dental caries rate and a large percentage of caries-free persons. This phenomenon has not been studied sufficiently in children aged 12 to 47 months which has justified the undertaking of this study. AIM To determine the percentages of persons with different levels of caries incidence and the percentages of their carious and filled teeth (dft) of the total number of dft in the respective age group. MATERIAL AND METHODS The study is representative and was conducted in accordance with the World Health Organization requirements for epidemiological study of dental caries. It comprises 370 children from 12 to 47 months of age selected by a random sampling method. Three age groups were formed: group I (12-23 months), group II (24-35 months) and group III (36-47 months). Dental caries on a cavitation level was diagnosed by means of a probe and a mirror. In all groups we further divided the subjects into subgroups of different level of dft (carious and filled teeth): subgroup I--dft = 0 (caries free), subgroup II--dft = 1, subgroup III--dft = 2 and subgroup IV--dft > or = 3. RESULTS Marked dental caries polarization is observed in all studied age groups--a large percentage of persons free of caries and a small percentage of persons with high dental caries rate--P < 0.001. In one-year-old children 8.33% are carriers of 63.08% of the total dft in that age group, in two-year-old children 18.33% are carriers of 81.50% of the total dft in that age group, and in three-year-old children 25.38% are carriers of 74.58% of the total dft of that age group. CONCLUSION This study support the assertion that early childhood caries affects predominantly high-risk individuals, which requires differentiated approach to caries prevention and treatment.

A study of caries polarization in 1-, 2- and 3-year-old children.

INTRODUCTION The decline in dental caries prevalence in many countries of the world in the last decades requires the adoption of new approaches towards determination of prevention strategies. The individuals and groups at high risk of developing caries should be differentiated from the rest of the population with the aim of carrying out selective prevention. Of particular interest is the determination of the risk of developing caries before it is clinically manifested as this would allow execution of a timely and adequate prevention. The aim of the present study was to determine the prevalence of caries incipiens on the teeth and on the dental surfaces in 7-, 12- and 14-year-old children and to compare it with the prevalence of clinical caries in the same population groups. METHODS The study is representative by design and compares 600 children aged 7, 12 and 14 years from Plovdiv. The study is designed and carried out in compliance with the guidelines of WHO for conducting clinico-statistical study of dental caries. The diagnostic procedure of caries incipiens is visual-tactile. The test of vital staining with 2% water solution of Methylene Blau was also used. RESULTS Caries incipiens prevalence was found to be higher than that of clinical caries in 7-year-old children (P < 0.001). In 12- and 14-year-old children the ratio of caries incipiens to clinical caries shifts in favour of clinical caries (P < 0.001). CONCLUSIONS The higher prevalence of caries incipiens compared to clinical caries in 7-year-old children (P < 0.001) justifies its more extensive investigation as a predictive factor for developing caries in the 7-12 years age range groups.

Maria P Kukleva

Papers

Molar incisor hypomineralisation in 7-to-14-year old children in Plovdiv, Bulgaria--an epidemiologic study.

Comparative age study of the risk of demineralization during orthodontic treatment with brackets.

Prevalence of early childhood caries and risk factors in children from 1 to 3 years of age in Plovdiv, Bulgaria.

A study of caries polarization in 1-, 2- and 3-year-old children.

A study on the prevalence of caries incipiens in 7-, 12- and 14-year-old children from Plovdiv.