Showing papers in "Community Dental Health in 1994"

Development and evaluation of the Oral Health Impact Profile.

Abstract: The capacity of dental clinicians and researchers to assess oral health and to advocate for dental care has been hampered by limitations in measurements of the levels of dysfunction, discomfort and disability associated with oral disorders The purpose of this research was to develop and test the Oral Health Impact Profile (OHIP), a scaled index of the social impact of oral disorders which draws on a theoretical hierarchy of oral health outcomes Forty nine unique statements describing the consequences of oral disorders were initially derived from 535 statements obtained in interviews with 64 dental patients The relative importance of statements within each of seven conceptual subscales was assessed by 328 persons using Thurstone's method of paired comparisons The consistency of their judgements was confirmed (Kendall's mu, P < 005) The reliability of the instrument was evaluated in a cohort of 122 persons aged 60 years and over Internal reliability of six subscales was high (Cronbach's alpha, 070-083) and test-retest reliability (intraclass correlation coefficient, 042-077) demonstrated stability Validity was examined using longitudinal data from the 60 years and over cohort where the OHIP's capacity to detect previously observed associations with perceived need for a dental visit (ANOVA, p < 005 in five subscales) provided evidence of its construct validity The Oral Health Impact Profile offers a reliable and valid instrument for detailed measurement of the social impact of oral disorders and has potential benefits for clinical decision-making and research

Dental fear in an urban Swedish child population: prevalence and concomitant factors.

Abstract: In order to establish normative data on the dental subscale of children's fear survey schedule (CFSS-DS), measuring child dental fear, and to study the influence of general fears, parental fears and socio-economic correlates on children's dental fear levels, a questionnaire was sent to parents of a representative sample of 4,505 children aged 4-6, and 9-11-years-old in Goteborg, Sweden. The questionnaire contained the CFSS-DS, a short form of the CFSS measuring general fears, Corah's dental anxiety scale (DAS) (measuring parents' dental fear) and specific questions on parents' employment and the native language in the family. A total of 3,204 responses was received. The overall mean score on CFSS-DS was 23.1, and 6.7 per cent of the children were found to be fearful. Dental fear decreased with increasing age and was positively correlated to general fears. Three variables: age, general fears and maternal dental fear, were found to have a significant impact on the variance of CFSS-DS.

The prevalence of tooth wear in 14-year-old school children in Liverpool.

Abstract: The prevalence of tooth wear was assessed in a random sample of 14 year old school children in Liverpool. A total of 1035 children were examined in 10 schools of whom 526 (50.8 per cent) were male and 509 (49.2 per cent) were female. Three hundred and seven children (30 per cent) had exposed dentine, mainly incisally, and this occurred significantly more often in males than females (P < 0.01). Of these children, 80 (8 per cent) also exhibited exposed dentine on occlusal and/or lingual surfaces. This occurred mainly on the occlusal surfaces of the first mandibular molars and the lingual aspects of the upper incisors. A slight positive association was found between tooth wear and the level of social deprivation in the electoral ward in which the school was located.

Does dental health education affect inequalities in dental health

Abstract: The aim of the study was to evaluate the Lothian 1991 dental health campaigns on 5-year-old schoolchildren's oral hygiene and gingival health in relation to deprivation. A stratified random sample of 486 children was selected from 92 primary schools in the city of Edinburgh. Clinical examinations took place immediately before (T1), a month after (T2) and 4 months after the campaign (T3). A total of 342 (70 per cent) children received all 3 examinations. Oral hygiene and gingival health were examined using a modified Silness and Loe and the Ainamo and Bay Index. Toothbrushes and take-home materials were distributed to all children. Dental officers provided 20 minute information sessions for each class and encouraged teachers to continue dental health activities within the classes. For the purpose of the evaluation, schools were categorised as deprived and non-deprived according to established social indicators. The results showed a statistically significant improvement in plaque scores at T2 and T3 (P < 0.05, P < 0.01). Also gingival health improved at T2 and T3 (P < 0.01, P = 0.001). However, the improvements took place only in the non-deprived schools. Thirty-one per cent of children in non-deprived schools and 18 per cent in deprived schools had a total plaque score of 0 at T1 and 41 per cent and 19 per cent respectively at T3. The differences in gingival health scores between deprived and non-deprived schools were statistically significant at T2 and T3 but not at T1. The campaign was therefore successful when evaluating the population as a whole.(ABSTRACT TRUNCATED AT 250 WORDS)

Orthodontic treatment need of secondary schoolchildren in Heidelberg, Victoria: an epidemiologic study using the Dental Aesthetic Index.

Abstract: Using the Dental Aesthetic Index (DAI), this study was performed to measure the distribution, prevalence and severity of malocclusion and orthodontic treatment need in a selected population of adolescents, and to determine if the malocclusion so defined was affected by sociodemographic variables such as age, gender, ethnic and socioeconomic background. Two hundred and sixty-eight secondary schoolchildren, aged 12 to 16 years from Heidelberg, Victoria participated in the study. Each subject was administered a questionnaire eliciting standard demographic information such as age, gender, parent's occupation, and ethnic origin. Intra-oral examination for occlusal status using the DAI was performed for each subject. The findings demonstrated that most subjects (63.4 per cent) had a dental appearance requiring no treatment. Only six per cent of the subjects had malocclusions that needed mandatory treatment. Malocclusion, as defined in the study, was found to be significantly associated with age.

Factors of deprivation associated with dental caries in young children.

Abstract: Quantitative and qualitative data were collected on the communities in the Tameside and Glossop Health Authority district served by the five primary schools with the highest prevalences of dental caries among their 5-year-old children and contrasted with similar information from communities served by five schools whose 5-year-old pupils had the lowest prevalences of caries. Quantitative data were collected from a variety of sources including the health and education authorities, and qualitative information was gathered by interviewing health and education personnel with special knowledge of the primary and pre-school children involved. It was found that communities with a high caries activity among their primary school children had lower proportions of babies of normal birth weight and uptake of poliomyelitis vaccination, while more children were born to single parent families. They also had lower percentages of private housing, homes with a car and households in social classes 1 and 2. The high caries schools had more children receiving clothing allowances and free school meals. The communities they served had higher Townsend mean deprivation Z scores and lower percentages of crime rates per household. The high caries communities tended to bottle feed their babies, wean them earlier, use infant feeding bottles longer and give babies fruit juices more regularly. The parents in the high caries communities were reported to have higher proportions of social and financial problems, were less likely to form parent-teacher associations, their children had poorer attendance and punctuality records, worse behaviour and greater consumption of confectionery after school.(ABSTRACT TRUNCATED AT 250 WORDS)

Participation, willingness and abilities of school-teachers in oral health education in Tanzania.

Abstract: In Tanzania, teachers in primary schools conduct oral health education as part of the school syllabus, most of them without any training for the task. The participation, willingness and abilities of teachers involved in this duty were studied by means of questionnaire, interviews, oral hygiene examinations and practical exercises. The teachers' knowledge of oral health matters and their skills in toothbrushing were poor. Health lessons in general were not accorded high priority. The teachers preferred parents to instruct their children on toothbrushing, and were reluctant to teach pupils about dietary matters. They stressed the shortage of time and materials for teaching health lessons and their heavy workload at school. These findings indicate a necessity, and a point of departure, for organising training for oral health education and encouraging teachers to undertake this task.

The use of tobacco and betel quid ('pan') among Bangladeshi women in West Yorkshire.

Abstract: The high prevalence of oral cancer in South Asia has been linked to tobacco use particularly in conjunction with chewing betel quid or 'pan'. However, it is not known whether and to what extent these habits are practised by Asian people in the United Kingdom. Home based interviews using semi-structured questionnaires were undertaken among 296 first generation Bangladeshi women resident in inner-city Leeds and Bradford, West Yorkshire. 'Pan' was reportedly chewed by 282 (95 per cent) of the women, of whom 174 (62 per cent) added tobacco in leaf form, and 75 (27 per cent) as a component of zarda. Those who consumed more 'pans' daily were significantly older, less literate, had a lower educational attainment, and were more likely to believe that chewing betel quid was beneficial. Cigarette smoking was practised by 9 per cent, this group being older and having lived in the UK longer. Burnt tobacco leaves were used as an oral hygiene aid by 20 per cent. Over half (58 per cent) of the sample had never visited a dentist, the majority deeming it unnecessary. The use of tobacco and 'pan' imply an increased risk for oral cancer and precancer. Since 'pan' chewing is a traditional custom, health promotion within these communities would require a sensitive approach. Health personnel likely to be consulted by Asian groups who chew 'pan' should be aware of the danger to oral health posed by this practice.

Patterns of breast and bottle feeding and their association with dental caries in 1- to 4-year-old South African children. 2. A case control study of children with nursing caries.

Abstract: In a case control study, 109 children with nursing caries (> or = 2 decayed, missing, or filled labial or palatal surfaces of primary incisor teeth) were matched for age, race, gender, and social class to 109 children without nursing caries from the same study areas. Mean dmfs and dmft scores were statistically higher in the nursing caries group but no statistically significant differences were found for feeding patterns between the groups in relation to the prevalence of nursing caries. In the present study nursing caries was found to be unrelated to the length of type of feeding (breast or bottle).

Subjective orthodontic treatment need and perceived dental appearance among young Finnish adults with and without previous orthodontic treatment.

Abstract: Subjective orthodontic treatment need and perceived oral condition were studied in a sample of 226 young adult Finns with and without previous orthodontic treatment. The subjects, applicants to enter the University of Helsinki, were interviewed immediately after their entrance examination. Altogether 38.5 per cent of the subjects had received some form of orthodontic treatment. A higher percentage of subjects who had been orthodontically treated reported a current subjective need for treatment than did the untreated ones but this only reached statistical significance in men (P < 0.05). Appearance was the reason for the treatment need among 64.7 per cent of treated and among 80.0 per cent of untreated subjects. The differences in proportions were non-significant. Men were more often satisfied with their dentition than women. Most, 56.3 per cent of treated and 66.2 per cent of untreated subjects, considered their anterior teeth regularly positioned. The most prevalent type of malocclusion noted in the anterior segments was crowding (27.0 per cent), followed by malpositioned (18.6 per cent) and protruding (9.3 per cent) teeth. It is likely that those who had received orthodontic treatment, had initially had more, and more severe malocclusions than those who were untreated. Thus, it may be that orthodontic treatment had raised the perceptions of the dentition of the treated individuals to the same level as the untreated individuals.

The relative contribution of dental services to the changes and geographical variations in caries status of 5- and 12-year-old children in England and Wales in the 1980s.

Abstract: The aim of this study was to assess the relative contribution of dental services to the changes and geographical variations in caries status of 5- and 12-year-old children in England and Wales in the 1980s. A secondary aim was to assess the association between caries experience and social factors. An ecological study analysing data at a district health authority level in England and Wales was conducted. Twenty-eight, 43 and 34 per cent of the variations in 5-year-old dmft in 1985, 1987 and 1989 respectively were explained by dental service activity indicators and 53, 62 and 57 per cent by social factors. Twenty-nine per cent of the variation in 12-year-old DMFT in 1988 was explained by dental service activity indicators and 46 per cent by social factors.

The dental caries experience of 5-, 12- and 14-year-old children in Great Britain. Surveys coordinated by the British Association for the Study of Community Dentistry in 1991/92, 1992/3 and 1990-91.

Abstract: A series of caries prevalence surveys across Great Britain has been coordinated by the British Association for the Study of Community Dentistry (BASCD) since 1985/86 with the aim of monitoring caries experience in representative samples of school children aged 5, 12 and 14 years of age. The purpose of this report is to present the findings of the surveys of 14-, 5- and 12-year-old children carried out in 1990/91, 1991/92 and 1992/3 respectively. These point prevalence surveys were conducted at the caries into dentine level of diagnosis using clinical examination only and a standardised, predominantly visual, diagnostic method employed by trained and calibrated teams of examiners from each country/region of Great Britain. For the 14-year-old age group, 114,126 children from 179 health authorities/boards were examined. The weighted mean DMFT for the participating countries and regions was 2.30 (range, 1.42-3.55). At age 5 years, 205,444 children from 184 health authorities/boards were examined. The weighted mean dmft for the participating countries and regions was 1.86 (range, 1.04-2.88). At age 12 years, 151,143 children from 186 health authorities/boards were examined. The weighted mean DMFT for the participating countries and regions was 1.27 (range, 0.84-2.08). A wide geographical variation in the results was evident for all three age groups, demonstrating a consistent north-south pattern, with higher levels towards the north of Britain. Trends in caries experience in permanent teeth indicate that the decline is now much slower for 12-year-old than for 14-year-old children and slower than the rate for 12-year-old children during the previous 4 year interval between examinations. For 5-year-old children, overall, the general decline in caries experience has ceased, while increases in dmft and in proportions with untreated dentinal decay are now seen in most parts of Great Britain. The pattern of restorative care provided has deteriorated with a fall in the care index for 5- and 12-year-old children, this finding may be related to changes in service provision within the UK.

The role of traditional healers in the treatment of toothache in Tanga Region, Tanzania.

Abstract: The study was conducted in five villages in each of two districts in the Tanga Region of Tanzania. Seventy-three traditional healers and 408 villagers of 14 years and above (selected through systematic random sampling) were interviewed. Most of the traditional healers had practised for more than ten years and the majority had been trained by their father or grandfather. Sixty per cent of the traditional healers claimed, that they treated dental patients with an average of three patients per month. A large variety of local herbs was used and about 40 per cent of the traditional healers claimed that they would refer the client to a modern health facility, if their treatment did not work. Half of the villagers interviewed had experienced toothache and 60 per cent of those who had experienced toothache within the last two years had sought treatment from traditional healers, where they had all been treated with local herbs. Relief was obtained for more than six months for 40 per cent of the patients, who sought this service. The establishment of modern emergency oral care in rural health centres and dispensaries did not influence the villagers' use of the traditional healers.

Ethanol and pH levels of proprietary mouthrinses

Abstract: This study measured the pH and alcohol (ethanol) content of a number of proprietary mouthrinses available for purchase by the general public, as well as assessing the influence of the alcohol content on police exhaled air analysis (breathalysing) procedures. The majority of the mouthrinses were acidic, some with a pH as low as 3.40. Only one was found to be alkaline and one near neutral in pH. The ethanol content varied from 0 to 27 per cent. The effect of the alcohol content on the results of the exhaled air analysis were transient and would be unlikely to influence any legal proceedings.

Prevalence of long-term use of liquid oral medicines by children in the northern region, England.

Abstract: The aim of the study was to assess the prevalence of frequent administration of liquid oral medicines, long-term, in children aged 1-16 years in a number of districts within the Northern Region in 1989-91. This was achieved through two surveys, one conducted amongst consultant paediatricians in five districts, and the other in four general medical practices in two districts within the region. The consultant survey identified 243 children aged 1-16 years currently taking long-term liquid oral medicines frequently, under consultant paediatric care. This represented a prevalence of 1:916 children (0.11 per cent) in the five districts studied. The general medical practice survey showed that the prescribing of liquid oral medicines for prolonged periods was not confined to those children who had been referred to and were under the care of consultant paediatricians. It indicated that the prevalence of long-term medication with prescription-based liquid oral medicines in children under the care of consultant paediatricians or general medical practitioners or both, was approximately 1:361 (0.28 per cent). Of the 67 different liquid oral medicine preparations which were used long-term, 39 per cent were sugar-based, 33 per cent sugar-free, and the rest 'variable'; either sugar-based or sugar-free depending on how specifically they were prescribed.

An evaluation of a school-based comprehensive public oral health care programme.

Abstract: This study evaluates a comprehensive oral health care programme seven years after it started in 1986 at a public dental health clinic in Cape Town. Five primary schools served by the clinic were selected for a community trial. Three schools were randomly allocated to receive the programme and two to a non-participating control group. An evaluation to assess the effectiveness of the programme was carried out by comparing the mean DMFS scores of the experimental (programme) schools with control (non-programme) schools. One hundred and ten children who entered the programme in 1986 and 102 non-programme children of similar age were examined and compared in 1992. In the experimental group the mean DMFS score was 1.94 compared to a mean DMFS of 6.12 in the control group. The percentage of caries-free children in the experimental group was 62.5 per cent and in the control group 37.5 per cent. The frequency distribution of the DMFS scores showed that one subject from the programme group had a score of > or = 15 and thirteen non-programme subjects had scores > or = 15. All the comparisons between the two groups reported above were highly significant (P < 0.005). The study shows that the programme has been very effective in reducing the prevalence of dental caries in the schools that received the programme.

The shortened dental arch: supplementary analyses from the 1988 adult dental health survey.

Abstract: Information on 2297 dentate adults, aged 15-75+ years, who participated in the 1988 national survey of adult dental health in the United Kingdom, was reviewed in order to determine what proportion in each age group fulfilled the criteria for a 'shortened dental arch'. The proportion of people with four good quadrants was 90 per cent at 16-24 years falling to 2 per cent at 65-74 years. Overall, 54 per cent of the sample had four good quadrants. This is a more stringent measure of dental health than the proportion with 21 or more standing teeth, where the corresponding values were 100 per cent, 24 per cent and 80 per cent.

The demographic and social variation in the prevalence of dental enamel opacities in north Wales.

Abstract: The variation in the prevalence of developmental defects of enamel in areas of North Wales with low levels of fluoride in the drinking water was studied. Significant differences in the prevalence of diffuse opacities were found for the ten county districts in the study area. In addition, there was an association between area deprivation, as measured using the Townsend index, and diffuse opacity prevalence. The prevalence of subjects with one or more diffuse opacities was lower in more deprived electoral wards than those less deprived. For demarcated opacities and hypoplastic defects in the ten county districts, the prevalences were not significantly different and there was no association with area deprivation.

A campaign encouraging dental attendance among adolescents in Scotland: the barriers to behaviour change.

Abstract: Qualitative consumer research was used to develop a health promotion campaign for school pupils aged 15-17 years to encourage them to attend a dentist for examination. The campaign used a combination of conventional health education about the benefits of dental care together with incentives for attending. The emphasis throughout was to establish an association with young style and group norms of social attractiveness. This study was part of the evaluation of the campaign. The aim was to identify the characteristics of those who responded positively to the campaign and to identify barriers to behaviour change. Those who responded were mainly female, intended to stay on at school beyond the age of 16 years and were more likely to be frequent attenders. Apathy and a lack of felt need were the main barriers to responding. Easier access to care and targeting a younger age group might enhance the success of similar interventions.

Correlates of toothbrushing in preschool children by their parents in four ethnic groups in The Netherlands

Abstract: A previous study among Amsterdam 5-year-old children showed that on average, the older the child at the onset of toothbrushing and the less frequent the toothbrushing, the more life time caries experience it had. The aim of the present study was to assess correlates of these two caries risk factors, in four ethnic groups. A further aim was to evaluate the putative role of correlates as intervening variables between ethnicity and caries risk factors. Questionnaire data were available from the Amsterdam study, in which a stratified sample of 103 Turkish, 258 Moroccan, 59 Dutch and 56 Surinamese parents were interviewed at home in their mother tongue. Results showed 69 per cent of the Turkish, 45 per cent of the Moroccan, 17 per cent of the Dutch and 11 per cent of the Surinamese parents had commenced brushing their child's teeth only after its second birthday or even never at all. Moreover, many parents had not brushed their child's teeth every day. Almost all potential correlates in six domains, namely parental habits, attitudes, evaluative beliefs, behavioural beliefs, perceived role of the child and that of the partner, were found to be related crudely to the risk factors. Large differences in score patterns on the correlates were observed between ethnic groups. Multiple logistic regression analyses showed substantial parts of the differences in risk factor scores between the Turkish group and a combined Dutch and Surinamese reference group could be attributed to the intervening role of the correlates, as could only minor parts of the difference in risk factor scores between the Moroccan group and the reference group.

Productivity in dental care for children. Factors influencing the time spent delivering dental care.

Abstract: The cost of dental services is related to their productivity. The purpose of the study was to identify factors influencing productivity, measured as time spent providing dental care per child under care, per year, in public dental clinics. The time was expected to vary with characteristics of the patients, the personnel and the clinics. Time spent by dentists and dental hygienists delivering dental care for children aged three to 18 years was obtained from 137 public dental clinics. The data showed substantial variation in productivity between clinics. Multiple regression analysis revealed that the time spent per child was associated with interval between examinations, proportion of male dentists, ratio of dental assistants to dentists, proportion of child treatment time given by dental hygienists and proportion of all treatment time spent on child patients. These variables explained 43 per cent of the variance in the total time spent by dentists and hygienists and 41 per cent of the variance in dentists' time. Individual dentists and hygienists may reduce the mean time spent per child by extending recall intervals. On an administrative level, dentists' time per child may be reduced by employing more dental assistants or dental hygienists and allowing dentists to treat patient groups other than children. It is concluded that productivity in dental care for children in the public dental services may be influenced in several ways, both by clinical and administrative decisions.

A critical review of methods for the economic evaluation of fissure sealants.

Abstract: Economic evaluation provides a method of systematically comparing the costs and outcomes of alternative health care programmes. It is being used increasingly to provide planning information. However, a review of the literature on economic evaluation of fissure sealants revealed a number of problems within studies. These included; the incorrect use of terms in labelling analyses, the choice of comparative procedures influencing the conclusions and equating different outcomes without regard for their disparate utilities. In addition, many studies did not report adjustment for differential timing of costs and consequences, or the use of incremental or sensitivity analyses. Future economic evaluations need to address these problems, in order that veracious information is supplied to decision-makers.

Utilisation of dental services in Cambodia and the role of traditional dentists.

Abstract: Cambodia has a small, but growing number of qualified dentists, as well as about 300 traditional dentists. This study describes the current level of utilisation of dental services in Cambodia in Phnom Penh and in 6 provincial areas. 548 adults aged 35-45 and 60-80 years of age were interviewed concerning previous dental attendance, type of service used and preference for qualified or traditional practitioner services. Only 38 per cent had ever had dental treatment, with 87 per cent of attenders last visiting the dentist because of toothache. Although 34 per cent of attenders received their last course of treatment from a traditional dentist, 77 per cent of all subjects said they would prefer to visit a qualified dentist if they had the choice. The role of traditional practitioners may therefore diminish as numbers of qualified dentists increase.

Use of linear multiple regression analysis on dental survey data.

Abstract: The use of multiple regression analysis in dental research has increased greatly in recent years. However, in most cases insufficient or no details are given to assess the validity of the results obtained through this statistical approach. Since multiple regression is the method of choice when dealing with three or more variables, provided the assumptions are fulfilled, this study reports the use of this technique on caries data from a random sample of schoolchildren from Andalucia, Spain. Linear multiple regression was used to analyse caries experience, expressed as dmft or DMFT, a quantitative dependent variable. The explanatory or independent variables considered for each age group were gender, type of area, social class and province, following the basic survey method recommended by the World Health Organization. Laborious data transformation procedures had to be employed to comply with necessary assumptions for this statistical technique. The difficulties encountered may be partly due to the fact that all the independent variables considered in the study were categorical or qualitative variables. In the process of ensuring valid results, several helpful statistics were identified. In addition, statistically significant influences on the dependent variable studied were easily detected, as well as the order of importance of the independent variables included in the model. However, the complex data transformation procedures required to validate assumptions in this study suggested that in some instances it could prove extremely difficult to use linear multiple regression on survey data.

Prevalence of fluorosis and other enamel defects related to caries among adults in communities with optimal and low water fluoride concentrations.

Abstract: The aim of this Swedish study, performed in 1982, was to determine the prevalence of fluorotic and nonfluorotic enamel defects among adults in areas with optimal and low fluoride concentrations in water. The fluorosis prevalence was also related to caries prevalence in these areas. The study was based on clinical examinations of subjects born between 1939-1951 who had been drinking water with a fluoride content representative of their area of residence all their lives. This water was the only appreciable source of fluoride during tooth formation. Two hundred and sixty individuals living in the optimal fluoride area were included in the study and 236 individuals from the low fluoride area. The results showed first, a low prevalence of mild dental fluorosis in the area with optimal fluoride content in its drinking water; secondly, a low prevalence of non-fluorotic enamel defects, which was, however, higher in the low fluoride area than in the optimal fluoride area; thirdly, that caries prevalence was lower among those with fluorotic enamel defects in the optimal fluoride area; and lastly, caries prevalence was not influenced by non-fluorotic enamel defects.

The use of logistic discrimination and receiver operating characteristics (ROC) analysis in dentistry.

Abstract: Logistic regression is a statistical method which allows an investigator to 'explain' or 'predict' a binary response variable from a set of independent variables. In particular, it may be used to classify persons for example, as diseased or healthy, high risk or low risk etc. (logistic discrimination). During recent years this method has been of increasing interest and importance in dentistry. Since this demanding statistical method may not be easily accessible to dentists, a description is provided of its basic characteristics in an introductory and condensed form. A worked example, 'identification of children with high caries risk', is presented in order to demonstrate the application and use of the method. Following the presentation of the logistic model, evaluation of the performance of a classification model by means of 'receiver operating characteristic (ROC) analysis' is demonstrated. The presentation of these statistical tools here, puts more weight on verbal explanation and on graphical representations than on mathematical details. This statistical tools here, puts more weight on verbal explanation and on graphical representations than on mathematical details. This may help to make the methods accessible to readers who have insufficient time to study a more comprehensive discourse.

Cosmetic dental treatment in an adult Dutch population.

Abstract: In 1992 a follow-up to the Dutch national dental survey of 1986 (DNDS) was performed. The main objective was to analyse changes in oral self care, dental attendance, and oral health status. A postal questionnaire was used: 936 persons (44 per cent response) participated in the study. This paper will focus on the results concerning cosmetic dental treatment. Stepwise regression analyses were used to study the effect of dental and social variables. Relative risks (RR) were computed to clarify the effect of these variables. Of the group of respondents, 90 persons reported having been treated with veneers on their anterior teeth. The variables indicating cosmetic dental treatment needs established during the DNDS clinical dental examination, showed a statistically significant influence. 'Objective need': RR = 2.6; 'Subjective need': RR = 2.1. Out of 877 respondents with restorations present in 1986, 19 per cent reported having one or more of them replaced by composite or porcelain. Four variables were found to have a statistically significant influence: 'Subjective need': RR = 1.7; 'Number of filled tooth surfaces': RR = 1.6; 'Number of decayed tooth surfaces': RR = 1.4; and 'Frequency of toothbrushing': RR = 1.6. Whereas the dentists' opinions had the most influence on having veneer treatments, the patients' opinions had more influence on having amalgam restorations replaced with composite or porcelain.

Dental caries experience in 7-, 12- and 14-year-old children in Andalucia, Spain.

Abstract: This study reports the first epidemiological survey specific to the region of Andalucia. The study was conducted with trained and standardised examiners, according to a multi-stage sampling process which ensured that a representative sample of children in the relevant age groups was examined. 2,961 subjects aged 7, 12 and 14 years were selected from schools in the eight provinces of the region. The percentage of 7-year-old children with no experience of caries in the deciduous dentition was 28 and in the permanent teeth 66; 29 per cent of 12- and 18 per cent of 14-year-old children were caries-free. The mean dmft at age 7 years was 3.45, while average DMFT values at ages 7, 12 and 14 years were 0.66, 2.70 and 4.01 respectively. When only children with past or present caries experience were considered, mean dmft at 7 years was 4.80 while mean DMFT at ages 7, 12 and 14 years was 1.92, 3.81 and 4.87. Children of non-manual background had lower caries experience than those from a manual background. Caries experience was consistently higher in Sevilla, Malaga and Granada while Almeria and Jaen had significantly higher numbers of children caries-free in all age groups. Variations in the proportions of caries-free subjects between provinces were associated with the natural fluoride content of the water supplies, though variations in sugar consumption could not be excluded. The results showed that caries experience was moderate. However, the large amount of untreated disease and increases in sugar consumption indicated a need for population based health promotion strategies and school based preventive and treatment programmes.