Showing papers in "Community Dentistry and Oral Epidemiology in 2004"

A meta-analysis of the prevalence of dental agenesis of permanent teeth

Abstract: OBJECTIVE: To gain more insight into the prevalence of dental agenesis. METHODS: Data from Caucasian populations in North America, Australia and Europe were included in a meta-analysis. For the prevalence of African American, Chinese and Arab groups only indications could be reported because of a limited number of studies. RESULTS: Agenesis differs by continent and gender: the prevalence for both sexes was higher in Europe (males 4.6%; females 6.3%) and Australia (males 5.5%; females 7.6%) than for North American Caucasians (males 3.2%; females 4.6%). In addition, the prevalence of dental agenesis in females was 1.37 times higher than in males. The mandibular second premolar was the most affected tooth, followed by the maxillary lateral incisor and the maxillary second premolar. The occurrence of dental agenesis was divided into three main groups: common (P2(i) > I2(s) > P2(s)), less common (I1(i) > I2(i) & P1(s) > C(s) & M2(i)) and rare (M2(s) & M1(s) > C(i) > M1(i) & I1(s)). Unilateral occurrence of dental agenesis is more common than bilateral occurrence. However, bilateral agenesis of maxillary lateral incisors is more common than unilateral agenesis. The overall prevalence of agenesis in the maxilla is comparable with that in the mandible, but a marked difference was found between both jaws regarding tooth type. Absence of one or two permanent teeth is found in 83% of the subjects with dental agenesis. A practical application of the results of the meta-analysis is the estimation of dental treatment need.

Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach.

Abstract: Despite great improvements in the oral health of populations across the world, problems still persist particularly among poor and disadvantaged groups in both developed and developing countries. According to the World Oral Health Report 2003, dental caries remains a major public health problem in most industrialized countries, affecting 60-90% of schoolchildren and the vast majority of adults. Although it appears that dental caries is less common and less severe in developing countries of Africa, it is anticipated that the incidence of caries will increase in several countries of that continent, due to changing living conditions and dietary habits, and inadequate exposure to fluorides. Research on the oral health effects of fluoride started around 100 years ago; the focus has been on the link between water and fluorides and dental caries and fluorosis, topical fluoride applications, fluoride toothpastes, and salt and milk fluoridation. Most recently, efforts have been made to summarize the extensive database through systematic reviews. Such reviews concluded that water fluoridation and use of fluoride toothpastes and mouthrinses significantly reduce the prevalence of dental caries. WHO recommends for public health that every effort must be made to develop affordable fluoridated toothpastes for use in developing countries. Water fluoridation, where technically feasible and culturally acceptable, has substantial advantages in public health; alternatively, fluoridation of salt and milk fluoridation schemes may be considered for prevention of dental caries.

How do age and tooth loss affect oral health impacts and quality of life? A study comparing two national samples.

Abstract: – Age and loss of teeth can be expected to have a complex relationship with oral health-related quality of life. This study aimed to explain how age and tooth loss affect the impact of oral health on daily living using the short form, 14-item Oral Health Impact Profile (OHIP-14) on national population samples of dentate adults from the UK (1998 UK Adult Dental Health Survey) and Australia (1999 National Dental Telephone Interview Survey). After correcting for key covariables, increasing age was associated with better mean impact scores in both populations. Those aged 30–49 years in Australia showed the worst (highest) scores. In the UK, those aged under 30 showed the highest scores. In both countries, adults aged 70+ showed much better scores than the rest (P < 0.001). When corrected for age, the independent effect of tooth loss was that the worst scores were found where there were fewer than 17 natural teeth in the UK and fewer than 21 teeth in Australia. People with 25 or more teeth averaged much better scores than all other groups (P < 0.001), although there were differences in pattern between countries. When Australians were analysed by region of birth, the pattern of scores by tooth loss for British/Irish immigrants was strikingly similar to that for the UK sample. First-generation immigrants from elsewhere showed much worse overall scores and a profoundly different pattern to the Australian- and British-born groups. Age, number of teeth and cultural background are important variables influencing oral health-related quality of life.

Socioeconomic inequalities in oral health in childhood and adulthood in a birth cohort

Abstract: – Objectives: To determine whether adult oral health is predicted by (a) childhood socioeconomic advantage or disadvantage (controlling for childhood oral health), or (b) oral health in childhood (controlling for childhood socioeconomic advantage or disadvantage), and whether oral health in adulthood is affected by changes in socioeconomic status (SES). Methods: Participants in a longstanding cohort study underwent systematic dental examination for dental caries and tooth loss at ages 5 and 26 years. The examination at age 26 years included the collection of data on periodontal attachment loss and plaque level. Childhood SES was determined using parental occupation, and adult SES was determined from each study member's occupation at age 26 years. Regression models were used to test the study hypotheses. Results: Complete data were available for 789 individuals (47.4% female). After controlling for childhood oral health, those who were of low SES at age 5 years had substantially greater mean DFS and DS scores by age 26 years, were more likely to have lost a tooth in adulthood because of caries, and had greater prevalence and extent of periodontitis. A largely similar pattern was observed (after controlling for childhood SES) among those with greater caries experience at age 5 years. For almost all oral health indicators examined, a clear gradient was observed of greater disease at age 26 years across socioeconomic trajectory groups, in the following order of ascending disease severity and prevalence: ‘high–high’, ‘low–high’ (upwardly mobile), ‘high–low’ (downwardly mobile) and ‘low–low’. Conclusion: Adult oral health is predicted by not only childhood socioeconomic advantage or disadvantage, but also by oral health in childhood. Changes in socioeconomic advantage or disadvantage are associated with differing levels of oral health in adulthood. The life-course approach appears to be a useful paradigm for understanding oral health disparities.

Assessing the responsiveness of measures of oral health‐related quality of life

Abstract: – Objectives: This paper illustrates ways of assessing the responsiveness of measures of oral health-related quality of life (OHRQoL) by examining the sensitivity of the oral health impact profile (OHIP)-14 to change when used to evaluate a dental care program for the elderly. Methods: One hundred and sixteen elderly patients attending four municipally funded dental clinics completed a copy of the OHIP-14 prior to treatment and 1 month after the completion of treatment. The post-treatment questionnaire also included a global transition judgement that assessed subjects' perceptions of change in their oral health following treatment at the clinics. Change scores were calculated by subtracting post-treatment OHIP-14 scores from pre-treatment scores. The longitudinal construct validity of these change scores were assessed by means of their association with the global transition judgements. Measures of responsiveness included effect sizes for the change scores, the minimal important difference, and Guyatt's responsiveness index. An receiver operating characteristic (ROC) curve was constructed to determine the accuracy of the change scores in predicting whether patients had improved or not as a result of the treatment. Results: Based on the global transition judgements, 60.2% of subjects reported improved oral health, 33.6% reported no change, and only 6.2% reported that it was a little worse. These changes are reflected in mean pre- and post-treatment OHIP-14 scores that declined from 15.8 to 11.5 (P < 0.001). Mean change scores showed a consistent gradient in the expected direction across categories of the global transition judgement, but differences between the groups were not significant. However, paired t-tests showed no significant differences in the pre- and post-treatment scores of stable subjects, but showed significant declines for subjects who reported improvement. Analysis of data from stable subjects indicated that OHIP-14 had excellent test–retest reliability with an intraclass correlation coefficient (ICC) of 0.84. Effect size based on change scores for all subjects and subgroups of subjects were small to moderate. The ROC analysis indicated that OHIP-14 change scores were not good ‘diagnostic tests’ of improvement. The minimal important difference for the OHIP-14 was of 5-scale points, but detecting this difference would require relatively large sample sizes. Conclusions: OHIP-14 appeared to be responsive to change. However, the magnitude of change that it detected in the context described here was modest, probably because it was designed primarily as a discriminative measure. The psychometric properties of the global transition judgements that often provide the ‘gold standard’ for responsiveness studies need to be established.

Assessing the impact of oral health on the life quality of children: implications for research and practice

Abstract: Traditionally, child oral health has been assessed using clinical parameters of disease and deformity. However, there is a growing interest in the psychosocial impact of oral health among children. This commentary outlines the value and need for assessing child oral health-related quality of life (COHQoL). COHQoL has implications for oral health needs assessment (at an individual and population level) and for evaluating outcomes from specific treatments, initiatives and dental services overall. In addition, it could prove to be a useful adjunct tool for evidence-based dentistry research and practice. Theoretical and practical considerations in assessing the complex psychosocial construct of oral health among children are discussed: the use of general versus oral health-specific measures, the development of tools for children, the use of generic versus condition-specific measures, and the measurement of 'positive' oral health. Recommendations for research and practice are presented.

Demographic factors, denture status and oral health‐related quality of life

Abstract: – Objectives: This study investigated the association between denture status, demographic factors, and oral health-related quality of life (OHRQoL). Methods: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G, 53 items), which was administered in a personal interview to 2050 subjects (60% of eligible subjects responded) 16–79 years of age in a national survey. Median regression was used to analyze the influence of denture status (no, removable, complete dentures), age, gender, education (less than 10 years of schooling, 10–12 years, more than 12 years), and residential area (rural, urban) on the OHIP-G summary score. Results: In bivariable analyses, compared to the base category, the OHIP-G median increased 8.0 U for subjects with removable dentures, 20.0 U for subjects with complete dentures, 1.7 U for each 10-year age period, 2.0 U for men, 3.0 U for less than 10 years of schooling (compared to ≥10 years.), and 1.0 U for urban areas (P < 0.05 for all effects except for residential area). In the multivariable analysis, compared to subjects without dentures, subjects with removable dentures had a 7.5 (95% CI: 5.2–9.8) higher OHIP-G median and subjects with complete dentures had a 18.5 (95% CI: 14.7–22.4) higher median when demographic variables were controlled. No demographic variables were statistically significant except for residential area (P = 0.04). Conclusions: Denture status was a stronger predictor for impaired OHRQoL than demographic variables and rendered age and education almost negligible in their influence on OHRQoL.

The association between dental anxiety and oral health-related quality of life in Britain

Abstract: – Objective: The aim of this study was to identify associations between level of dental anxiety and the impact of oral health on quality of life (OHQOL) in Britain, controlling for sociodemographic and oral health status (self-reported) factors. Methods: The basic research design included a cross-sectional study involving a random probability sample of 3000 UK residents. The outcome measures were: levels of dental anxiety, which were measured on the Corah Dental Anxiety Scale (DAS), and the impact of OHQOL, which was assessed using UK oral health-related quality of life instrument (OHQoL-UK (W)©). Results: DAS was correlated with OHQoL-UK (W)© scores (P < 0.01). Having controlled for sociodemographic factors (age, gender and social class) and oral health status factors (self-reported number of teeth possessed and denture status), known confounding factors associated with OHQOL, those with high levels of dental anxiety (DAS ≥ 15) were approximately two times as likely to be among those experiencing the poorest OHQOL (below the population median OHQoL-UK (W)© score) in Britain (P < 0.001; OR = 1.93; 95% CI 1.41, 2.65). Conclusion: Dental anxiety is associated with the impact oral health has on life quality. Those experiencing high levels of dental anxiety are among those with the poorest oral health-related quality of life in Britain.

Measuring inequalities in the distribution of dental caries

Abstract: – Objectives: To evaluate different measurements of prevalence and inequality in the distribution of dental caries as to their partial collinearity, and ability in expressing associations with the supply of fluoridated tap water, indices of socioeconomic status and provision of dental services. Methods: The DMFT, the Significant Caries (SiC) Index, the proportions of children with high- (DMFT ≥ 4) and rampant- (DMFT ≥ 7) caries experience, caries-free children (DMFT = 0), the Gini coefficient and the Dental Health Inequality Index (DHII) were the dental outcomes appraised in a sample comprising 18 718 oral examination records for 11- and 12-year-old schoolchildren in 131 towns of the state of Sao Paulo, Brazil. Spatial data analysis assessed the association between aggregate figures of dental indices and several covariates. Results: The DMFT, the SiC Index and the proportions of children with high- and rampant-caries experience presented strong linear associations (Pearson r near or higher than 0.95), and an analogous profile of correlation with indicators of socioeconomic status, dental services and access to fluoride tap water. The same was observed for the DHII, the Gini coefficient and the proportion of caries-free children. These observations involve the perception of variables in each set as interchangeable tools for ecological studies assessing factors influencing, respectively, prevalence levels and inequality in the distribution of dental disease. Conclusion: An improved characterization of the skewed distribution of caries experience demands the concurrent estimation of figures of prevalence and inequality in dental outcomes. This strategy may contribute to the design of socially appropriate programmes of oral health promotion.

Dental fear in adults: a meta‐analysis of behavioral interventions

Abstract: – Objectives: The aim of this meta-analytic and systematic quantitative approach is to examine the effects of behavioral interventions for dental anxiety and dental phobia. Methods: Eighty studies were identified where dental fear treatment with behavioral methods was evaluated. Thirty-eight of 80 met entry criteria and were included in a meta-analysis. Results: The calculated effect sizes (ESs) for self-reported anxiety after intervention indicate positive changes in 36 of the 38 studies and no changes in two. The overall ES = 1.8 (95% CI: 1.6, 1.8). The percent of subjects with post-treatment dental visits in the first 6 months post-treatment varied between 50 and 100%. The overall ES for attendance at dental visits, weighted by sample size, is 1.4 (95% CI: 1.3, 1.6). The homogeneity analysis indicates that the studies cannot be adequately described in one ES. The reported percentage of subjects with a dental visit between 6 months and 4 years post-treatment varied from 48 to 100%. The overall weighted ES for visiting the dentist, adjusted for drop-outs in the studies, is 1.2 (95% CI: 0.99, 1.4). Conclusions: Despite extensive heterogeneity, changes in self-reported anxiety represent medium to large ESs. Patients signing up for a behavioral intervention for dental fear can be expected to report a significant reduction in their fear, and this effect generally seems to be lasting. Mean long-term attendance (>4 years after treatment) is 77%.

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.

Abstract: 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.

Early childhood caries in children aged 6-19 months.

Abstract: ObjectivesTo investigate the relationship between socioeconomic factors, behaviors and the severity of early childhood caries (ECC) in 6–19 month-old Thai children. The severity of ECC was estimated using the proportion of ECC teeth to erupted teeth. This was termed the ‘Intensity of ECC’ (I

The relationship between dental caries and dental fluorosis in areas with moderate- and high-fluoride drinking water in Ethiopia

Abstract: Objective The aim of the study is to assess the relationship between caries and dental fluorosis in Ethiopian children living in Rift Valley areas known for endemic fluorosis. Method A total of 306 children (12-15 years old), selected from areas with moderate (0.3-2.2 mg/l), or high (10-14 mg/l) fluoride concentration in the drinking water were interviewed and examined for caries and dental fluorosis. Scorings were recorded according to the DMF system, and the Thylstrup-Fejerskov (TF) Index. Results Prevalence of dental fluorosis (TF-score > or = 1) was 91.8% (moderate area) and 100% (high-fluoride area). The corresponding caries prevalence and mean DMFT in the areas were 45.3% versus 61.6%, and 1.2 versus 1.8, respectively. Age and severity of dental fluorosis were found to be independent predictors for DMFT > or = 1. When compared with 12-year olds with TF-scores 0-4, odds ratios were 3.0 (95% CI 1.6-5.7) and 2.0 (95% CI 1.2-3.2) if TF-scores were > or = 5 and age 13-15 years, respectively. A positive relationship between caries and fluorosis was observed across tooth types in both areas. The percentage of children with DMFT > or = 1 was highest in groups with TF-score > or = 5 in the second molar, followed by the first molar. Conclusion The present findings indicate that the second molar is the tooth most severely affected by dental fluorosis and dental caries. Dental caries increased with increasing severity of dental fluorosis, both in moderate- and high-fluoride areas. Thus, a positive relationship between dental caries and dental fluorosis was observed across various tooth types, in both areas.

A review of fluorosis in the European Union: prevalence, risk factors and aesthetic issues.

Abstract: Fluoride has played a key role in caries prevention for the past 50 years but excessive ingestion of fluoride during tooth development may lead to dental fluorosis. Throughout Europe many vehicles have been, and are currently, employed for optimal fluoride delivery including drinking water, toothpaste, fluoride supplements, salt and milk. Several indices, both descriptive and aetiological, have been developed and used for measuring fluorosis. This factor, combined with the lack of use of a standardized method for measurement of fluorosis, has made comparison between studies difficult and assessment of trends in fluorosis prevalence unreliable. Overall the evidence would appear to indicate, however, that diffuse enamel opacities are more prevalent in fluoridated than in nonfluoridated communities and that their prevalence at the very mild level may be increasing. In addition to fluoridated drinking water, risk factors for fluorosis include inadvertent ingestion of fluoride toothpaste and the inappropriate use of fluoride supplements. The risk is of aesthetic concern primarily during the period of enamel development of the permanent central incisors, although this largely appears to be a cosmetic rather than a public-health issue. It is concluded that there is a need to co-ordinate studies measuring fluorosis throughout Europe and that development of a standardized photographic method would be useful. Furthermore, the aesthetic importance of fluorosis needs to be determined in more detail in each country in the light of each country's respective risk factors and dental health policies.

Complete dentures and oral health-related quality of life -- do coping styles matter?

Abstract: – Oral health-related quality of life (OHRQOL) in edentulous patients with complete dentures is often impaired. This paper investigates the effect of different coping styles on OHRQOL. Purpose: (a) To assess OHRQOL of edentulous patients with conventional complete dentures, and (b) to investigate if individual differences in these patients’ styles of coping with stress affect their OHRQOL. Materials and methods: Data were collected from 249 fully edentulous patients with complete dentures (mean age: 66.0 years) who responded to a mailed survey (adjusted response rate: 48.8%). OHRQOL was measured with the 14-item short form of the oral health impact profile (OHIP). Ratings of coping strategies were obtained using the 28-item Brief COPE, an instrument measuring various styles of coping with stress. Linear regression analyses were used to explore the relationships between coping styles, background variables such as age, gender, income, and age of prosthesis, and the patients’ OHRQOL. Results: About 35% of the respondents reported impacts from their oral conditions on their overall OHRQOL (OHIP-14 total score) occasionally, fairly often, or often. Physical pain was even more prevalent, with 53.3% of the respondents reporting pain impacts. The linear regression model (P < 0.0001) explained 31.1% of the variation in the OHIP-14 total score. The coping variables instrumental support, behavioral disengagement, substance abuse, denial, and religion were significant negative predictors of OHRQOL. Only emotional support was a significant positive predictor of OHRQOL. Conclusion: Wearing conventional complete dentures has a significant impact on OHRQOL. This impact is moderated by the styles a patient uses to cope with stress. Using emotional support has a positive effect on OHRQOL, while other coping styles, namely instrumental support, behavioral disengagement, substance abuse, denial, and religion are significant negative predictors of OHRQOL.

The effect of pre‐operative information in relieving anxiety in oral surgery patients

Abstract: UNLABELLED Appropriate stress management of patients is essential for smooth running of invasive or surgical dental procedures conducted under local anaesthesia. OBJECTIVE The current study analysed the effectiveness of pre-operative information provision for anxiety reduction during dentoalveolar surgery in patients with high- or low-trait anxiety. METHODS Patients scheduled for oral surgical procedures performed by six private dental practitioners were invited to participate in the study. They were randomly assigned to four groups and received the following pre-operative information: (i) basic information only, (ii) basic information with details of the operative procedures, (iii) basic information with details of the expected recovery, and (iv) basic information with details of both the operative procedures and recovery. The participants' trait anxiety level was measured with the Depression Anxiety Stress Scales (DASS), then they were divided into high- or low-trait anxiety groups with the method of median-split on the basis of the DASS score. Self-rated anxiety was recorded immediately before, during and 10 min after the surgical procedures. RESULTS High-trait anxiety subjects gave higher self-reported anxiety levels (repeated-measures ANOVA, P < 0.05). Pre-operative provision of details about the expected recovery only or details concerning both the operative procedures and recovery led to significant reduction in self-reported anxiety among the participants throughout the procedure (P < 0.01). However, information on operative procedures led to anxiety reduction in low (P < 0.05) but not high-trait anxiety participants. CONCLUSION Provision of pre-operative information of the recovery process leads to significant anxiety reduction in all patients who undergo surgical/invasive procedures with local anaesthesia.

Reported bruxism and biopsychosocial symptoms: a longitudinal study.

Abstract: – Objectives and Methods: In this follow-up study of 30–50-year-old employees (n=211) of the Finnish Broadcasting Company (YLE), respondents completed questionnaires in both 1999 and 2000 containing items on demographic data, tobacco use, levels of perceived bruxism, affective disturbance, sleep disturbance, somatic symptoms, pain symptoms and temporomandibular disorder (TMD) symptoms. Results: Bruxism was significantly more prevalent among smokers (P=0.005). Age, marital status, and gender were not associated with bruxism. Subjects in the frequent bruxism group (n=74) reported the TMD-related painless symptoms, affective disturbance and early insomnia significantly more often than average. In the multivariate analyses, clustered pain symptoms (P=0.001), TMD-related painless symptoms (P=0.004) and smoking (P=0.012) were significantly positively associated with frequent bruxism, when the independent effects of age and gender were controlled for. Conclusions: It was concluded that successful management of TMD necessitates smoking cessation, as tobacco use may both amplify the patient's pain response and provoke bruxism. Psychosocial factors and perceived stress should not be ignored, however.

The effectiveness of a 6-year oral health education programme for primary schoolchildren

Abstract: – Objectives: The aim of this study was to evaluate the effect of a 6-year oral health education programme in primary schoolchildren. Methods: This programme was part of the Signal-Tandmobiel® project, a longitudinal collaborative project combining the registration of oral health data and oral health promotion. The intervention group comprised 3291 children with a mean age of 7.1 years (SD 0.43) at the start of the programme. Every year these children were examined clinically and a questionnaire, to be filled in by the parents, was administered to assess oral health behaviour. These children received an oral health education programme which consisted of a yearly 1-h instruction. Data collected using the same questionnaire and clinical examination in 676 12-year-old children were included as control group. The samples were obtained using stratified cluster sampling. The effect of the interventional programme was assessed by measuring differences in caries prevalence and incidence, levels of dental care and reported oral health behaviour. Results: Mean DMFT/S values, although higher in the control group, were not significantly different. The reported frequency of brushing was the same in both groups. Significant differences in favour of the intervention group were found in the number of between-meal snacks (P < 0.001) and the proper use of topical fluorides (P < 0.05). Children in the control group showed a significantly lower proportion of filled teeth than those in the intervention group (P < 0.01), with a care index of 73% versus 80%.Conclusion: In conclusion, the implemented minimal school-based oral health education programme did not result in a significant reduction of the caries prevalence measured. The programme has been effective in improving reported dietary habits and the proper use of topical fluorides and resulted in a higher care index.

Four years of clinical experience with an adverse reaction unit for dental biomaterials.

Abstract: – Objectives: We describe the function of, and results from, the Norwegian National Dental Biomaterials Adverse Reaction Unit after 4 years of activity from 1993 to 1997. Methods: During this period of time, 296 patients were examined at the unit, which is located at the Dental School, University of Bergen. The most prevalent age group was 40–49 years, and 70% were women. Dental amalgam was the primary reason for referral to the unit for nearly 85% of the patients, followed by metals in crowns and bridges (11%). Materials in removable dentures, resin-based filling materials and cements, endodontic materials, and others, including temporary materials, were also involved. Nearly all (96%) patients reported general subjective symptoms, such as muscle and joint pain, fatigue, and memory problems. Complaints involving the orofacial region (lips, face, temporomandibular joint) and intraoral subjective symptoms were also common. Results: Of the patients who were patch tested with substances in dental materials, 23% were positive to gold, 28% to nickel, 14% to cobalt, 9% to palladium, 6% to mercury, and 8% to one or more components of resin-based materials. Mercury concentrations in blood and urine were statistically higher in the patients with amalgam fillings compared with those without. Conclusions: Generally, we could not establish a straightforward cause-and-effect relationship between the presence of dental biomaterials and general symptoms. Twenty patients were advised to replace restorative materials because of contact lesions. Another 20 patients were recommended replacement of materials because of allergy verified with positive patch tests. The complex nature of most of the reactions requires a multidisciplinary approach to the care taking of patients who are concerned about reactions from dental materials, particularly amalgam.

Perception of general and oral health in White and African American adults: assessing the effect of neighborhood socioeconomic conditions1

Abstract: Objectives: This study investigates the independent and joint effects of family income and neighborhood socioeconomic status (SES) on general health and oral health before and after controlling for traditional risk factors in a representative sample of adults aged 18+ years residing in the Detroit tri-county area, Michigan. Methods: Individuals data were obtained through interviews, while neighborhood data came from the 1990 US Census. SUDAAN was used to accommodate the complex sampling design and correlation of outcomes within the same neighborhoods. Results: Whites in disadvantaged neighborhoods were four times more likely to rate their oral health as fair or poor (odds ratio (OR): 4.0; 95% confidence intervals (CI): 1.6-10.3) than their counterparts in advantaged neighborhoods. When evaluating the joint effects of family income and neighborhood SES, low-income Whites in disadvantaged neighborhoods were six times more likely to rate their oral health as fair or poor (OR: 6.4; 95% CI: 1.6-26.5) than their high-income counterparts in advantaged neighborhoods. The odds of rating general health as fair or poor was six times greater in low- income African Americans in disadvantaged neighborhoods (OR: 6.1; 95% CI: 1.6-23.8) than high-income African Americans in advantaged neighborhoods. Similarly, low-income African Americans in disadvantaged neighborhoods were almost three times (OR: 2.8; 95% CI: 1.0-8.1) more likely to rate their oral health as fair/poor than high-income African Americans in advantaged neighborhoods. Conclusions: SES conditions at the neighborhood-level, independently or jointly with individual-level income, appear to be important in evaluating racial/ethnic differences in self-rated oral health. Neighborhood conditions could tap into constructs not captured by individual-level variables on self-rated oral health.

Children's coping with pain during dental care.

Abstract: – Objectives: The purpose of this study was (i) to assess the coping strategies of 11-year-old children when dealing with pain at the dentist, (ii) to determine the extent to which the level of the children's dental fear and their experience with pain at the dentist are related to their ability to cope and their choice of strategies, and (iii) to analyse the possible differences between subsamples concerning dental caries Methods: The coping strategies were investigated using the Dental Cope Questionnaire (n = 597); the level of dental fear was assessed using the Children's Fear Survey Schedule (CFSS-DS); a question is asked whether a child had experienced pain at the dentist in the past and dental caries was assessed using the DMFS index Results: The results show that 11-year olds use a variety of coping strategies Internal strategies are used most frequently, external coping strategies are used less frequently, and destructive strategies are hardly used The subjects rate internal and external strategies as effective Children with pain experience and fearful children use more coping strategies, with fearful children using more internal strategies Reported pain and anxiety were related to the dental status Conclusions: The use and choice of coping strategies seems to be at least partly determined by the level of dental fear and the child's experience with pain

Periodontal epidemiology: towards social science or molecular biology?

Abstract: – Terms such as ‘molecular epidemiology’ and ‘genetic epidemiology’ have been coined to depict the change from ‘traditional epidemiology’, concerned with disease determinants at the community or society level, over to ‘modern epidemiology’, which is concerned with determinants operating at the individual level or even below, i.e. at the organ, tissue, cell, or molecular level. In this commentary, we point out to the limitations of this development and suggest that more emphasis is placed on making the presumed causal disease models explicit, when investigating the relationship between putative determinants and disease. Understanding the disease processes at the micro-level is insufficient for understanding disease at the individual level; and disease patterns at the population level cannot be understood unless it is realized that individuals exist in a variety of contexts that cannot be reduced to individual attributes.

Relative effects of pre- and post-eruption water fluoride on caries experience by surface type of permanent first molars.

Abstract: – Objectives: To determine the relative pre- and post-eruption exposure effects of fluoridated water on the caries experience of different surface types of first permanent molars. Methods: Parental questionnaires covering residential history of participants were linked to the oral examinations of 6–15-year-old Australian children conducted in 1992 by the School Dental Services of South Australia and Queensland. Percentage of lifetime exposed to optimally fluoridated water pre- (PRE) and post-eruption (POST) was calculated with respect to tooth eruption age. Combined pre- and post-eruption categories were created to test PRE against POST exposure: PRE and POST = 0, PRE POST and, PRE and POST ≥ 90% lifetime exposure. These categories were used as indicator variables in linear regression models with PRE and POST = 0 as reference in an analysis of first permanent molar DMFS scores overall and by surface type. Results: Participation rates were 69.7% in South Australia (n = 9690) and 55.6% in Queensland (n = 10 195). Compared with the reference, the categories PRE > POST (β = −0.033), PRE = POST (β = −0.028) in the range 0–90% and, PRE and POST ≥ 90% (β = −0.055) showed significantly lower caries overall (P < 0.01), with a similar pattern for pit and fissure surface caries (β = −0.035, −0.031 and −0.052, respectively). Only a high PRE and POST exposure decreased caries levels significantly in the approximal (β = −0.038; P < 0.01) and free smooth surfaces (β = −0.023; P = 0.03). Conclusions: Pre-eruption exposure was important for a caries preventive effect on first permanent molars in children 6–15 years old since post-eruption exposure alone could not lower caries levels significantly. For pit and fissure surfaces, a high pre-eruption exposure could decrease caries levels significantly. However, for other surface types, only a high pre- and post-eruption exposure produced a caries preventive effect.

A follow-up study of the use of DIAGNOdent for monitoring fissure caries in children.

Abstract: – Objectives: The aim of this study was to evaluate the utility of the laser fluorescence device DIAGNOdent for monitoring occlusal caries longitudinally as part of a routine dental check-up in a public dental clinic. Methods: Children aged 7–8 and 13–14 years at baseline participated in the study. As part of two consecutive dental check-ups with a mean interval of 1,19, years, 423 permanent molars and 315 primary molars in 81 children were examined visually and using DIAGNOdent by one dentist. In teeth where, as judged by visual examination, caries had emerged or progressed during the follow-up, the DIAGNOdent values had increased significantly from the baseline. Results: In permanent teeth with a change in visual score from sound to enamel or dentin caries, the mean DIAGNOdent value increased from 24 to 37 and in primary teeth from 8 to 40. The increase in DIANGOdent values correlated positively with the increase in visual score. The mean DIAGNOdent value at baseline was significantly higher in teeth that became carious than in those that remained sound during the follow-up. For permanent teeth with a visual reversal from inactive or acitve enamel caries to a sound surface, the mean DIAGNOdent value decreased from 36 to 24. Conclusions: These results suggest that DIAGNOdent is useful in monitoring occlusal caries in both permanent and primary molars.

A standardized photographic method for evaluating enamel opacities including fluorosis.

Abstract: - Objectives: The objective of this study was to demonstrate the reproducibility of a standardized photographic technique for recording fluorosis when used by a group of epidemiologists as part of a large multicentred European study. Methods: Studies were first carried out to develop the equipment specification and photographic method. The author (JAC) was then trained and calibrated in this method. She was then responsible for the training and calibration of examiners from a further six European study sites. The method involved taking two transparencies of the permanent maxillary central incisors of 8-year-old children, the first after 8 s while the teeth were still wet and the second after 105 s when the teeth had been allowed to dry out naturally. Data were collected at a central location during a training/calibration exercise and subsequently, during the conduct of a large study to measure fluorosis prevalence, at the seven sites. Intra- and interexaminer reproducibility of the photographic method were measured by grading the transparencies produced by all the examiners according to the DDE and TF indices. Results: The time period in which the transparencies were taken was to within 4 s among the examiners. Transparencies scored according to the TF index gave a range of Kappa values of 0.45-0.66 for intraexaminer reliability and 0.32-0.55 for interexaminer reliability. When using the DDE index Kappa values ranged from 0.43 to 0.70 for intraexaminer reliability and from 0.34 to 0.69 for interexaminer reliability. Conclusion: The photographic method was mostly robust and reproducible when used by epidemiologists from seven European study sites.

A comparison of the prevalence of fluorosis in 8-year-old children from seven European study sites using a standardized methodology.

Abstract: - Objectives: The objectives of this study were to report on the prevalence of enamel opacities from seven European study sites using a standardized photographic method, and to investigate the importance of variables responsible for enamel fluorosis. Methods: The sample comprised a randomly selected group of 300 8-year-old children in each of the study areas. One examiner from each area was trained and calibrated in the use of a standardized photographic technique. Two transparencies were taken of each child's permanent maxillary central incisor teeth; one to represent the teeth ‘wet’ and one when the teeth had been allowed to dry out naturally for 105 s. The transparencies were viewed ‘blind’ by the author (JAC) and scored using the DDE and TF indices. Data relating to variables considered to be associated with enamel fluorosis were also collected. Results: The prevalence of diffuse opacities ranged from 61% in fluoridated Cork (Ireland) to 28% in Athens (Greece). The percentage of subjects with a TF score of three or more ranged from 4% in Cork and nonfluoridated Haarlem (the Netherlands) to zero in Oulu (Finland) and Athens. Fluoridated water and the prolonged use of fluoride tablets were found to be significant contributory factors to fluorosis. Conclusions: The prevalence of fluorosis was found to be highest in fluoridated Cork. The prolonged use of fluoride supplements was also found to be a significant risk indicator associated with fluorosis.

Assessment of different methods for diagnosing dental caries in epidemiological surveys.

Abstract: – Aims: The aims of the study were: (i) to assess different clinical diagnostic methods of dental caries during epidemiological surveys; (ii) to determine which combinations of methods and diagnostic adjuncts show the best performances in epidemiological surveys when compared with examinations performed in a traditional dental setting (standard); (iii) to evaluate the influence of including noncavitated (NC) lesions in dental caries estimation. Methods: Forty 12-year-old children were divided into low and moderate caries prevalence groups. The individuals were submitted to 12 epidemiological examinations (in an outdoor setting), which combined three methods (blade, mirror and mirror + CPI (Community Periodontal Index) dental probe) with or without diagnostic adjuncts (previous dental brushing and dental drying). The last examination was performed in a traditional dental setting (standard examination). The unit of measure was the DMFS (decayed, missing and filled surfaces) index according to WHO criteria. The variance analysis, Dunnet's and Tukey's tests were applied. Results: For the DMFS analysis, the visual/tactile method, with or without diagnostic adjuncts, was the best method for both groups, presenting a performance higher than 90% when compared with the standard examination, except for the examinations without previous dental brushing for the low caries prevalence group. Previous dental brushing was more relevant than dental drying (P = 0.0054). All of the epidemiological examinations underestimated the NC diagnosis even with the association of diagnostic adjuncts when compared with the standard examination. Conclusion: The visual–tactile (for both groups) and the visual (mirror) methods plus dental brushing (for the moderate group) are appropriate for diagnosing cavitated lesions, but not NC lesions.

Stability of oral health-related behaviour in a Norwegian cohort between the ages of 15 and 23 years.

Abstract: – Objective: To assess the stability in self-reported oral health behaviour in a Norwegian cohort between the ages of 15 and 23 years. Methods: Self-administered questionnaires were used as part of a longitudinal cohort study. In 1992, a representative sample of 963 15-year-old adolescents participated, of which 676 (70%) and 567 (58%) remained in the study at ages 18 and 23 years. A total of 389 (40% of baseline) participated at each data collection, i.e. at ages 15, 18, 19, 21 and 23 years. Results: General linear model (GLM) repeated-measures anova revealed statistically significant main effect of time with respect to soft drink and sweet consumption (F=22.4, P < 0.001 and F=4.3, P < 0.05, respectively). Adjusted mean scale scores of soft drink intake increased from 2.3 at age 15 years to 3.4 at age 23 years. The corresponding figures for consumption of sweets were 2.6 and 2.8. Two-way interactions achieved statistical significance with gender for soft drink consumption and toothbrushing. GLM repeated-measures with each gender revealed that soft drink consumption increased with time more extensively in boys (from 2.9 to 4.2, F=13.5, P < 0.001) than in girls (from 1.9 to 2.6, F=8.1, P < 0.001). Tracking or maintenance across time of the relative ranking at age 15 years occurred with all the four behaviours investigated. A total of 68–92% remained active and inactive regarding soft drink and sweet consumption, flossing and toothbrushing. Conclusion: The results provide evidence of tracking and early consolidation of oral health behaviour. This adds support for the assumption given for early intervention to prevent oral diseases.

The impact of childhood sexual abuse on dental fear.

Abstract: – Objective: Dental fear is a risk factor for poor oral health Thus, treatment of dental fear is a challenge to dentists The consequences of childhood sexual abuse (CSA) may include dental fear A history of CSA complicates dental fear treatment, and it is often a secret The aim of this study was to explore differences in subjective evaluations of use of dental services, experiences of dental treatment situations, dental appearance and dental problems in women who report both CSA and dental fear, and women who report dental fear only Methods: In an anonymous survey, 58 women with dental fear and a history of CSA were compared with 25 women with dental fear without CSA Twenty-five women without dental fear acted as a control group Results: No differences between dental fear patients with and without a history of CSA were found in subjective evaluations of use of dental services, dental appearance and dental problems, or in the scores on the Dental Fear Scale (DFS) Women who reported a history of CSA and dental fear had statistically significant higher scores on the Dental Belief Scale (DBS) Conclusion: The results suggest that women who report dental fear and a history of CSA assess interpersonal factors concerning communication, trust, fear of negative information and lack of control as more fear evoking than women who report dental fear without a history of CSA