Oral Health and Preventive Dentistry, 03/2003

This study was designed to validate the SiC index in a 12-year-old population, and also considers the level of the disease, expressed as DMFS index, with the aim of comparing the capability of the two indices for preventive and prognostic goals. Data from a previous study (Campus et al, 2001) based on 403 12-year-old subjects (205 females and 198 males) were reconsidered, and the SiC was calculated both on DMFT and DMFS. Several background factors were evaluated: classified as socio-economic levels (SOCFAM), Oral Hygiene Habits (OHH), Onset of Toothbrushing Habits (OTH), and gingival conditions expressed as the presence of plaque or calculus. Several regression models were built-up to estimate the dependence of each index - DMFT, DMFT (SiC), DMFS and DMFS (SiC) - on background variables. The four groups, picked out by the 66th percentiles on the ranking series of DMFT and DMFS following the SiC method were compared. Mean ± standard deviation, median and percentiles (p25 - p75) were 5.5 ± 2.1, 5 (p25 = 4 - p75 = 6) for DMFT (SiC) and 8.9 ± 5.8, 8 (p25 = 5 - p75 = 11) for DMFS (SiC). Intrinsic variability in SiC groups was lower, but the distributions remained skewed. In the multiple regression procedure, using DMFT and DMFS scores as dependent variables, OTH, bleeding and calculus were statistically significant. OHH (p 0.05) and calculus (p 0.05) gave a significant contribution to DMFS in the SIC group, while the model for DMFT (SiC) was not significant. In a stepwise logistic regression model, OTH, bleeding and calculus played a significant role (p 0.05) on DMFT (SiC) and DMFS (SiC), as the likelihood for an individual to have a value >= 66th percentile. The concordance between the two selected series was rather good (kappa = 0.82; 95%CI: 0.73 - 0.91). No association with background factors was found on the two discordant groups. However, a linear trend in proportions between the two groups across SOCFAM categories was observed (p = 0.027). The use of SiC may solve the problem related to skewed caries distribution. Nevertheless if only SiC is used, it can lead to a lack of relevant information especially in countries where high caries prevalence is still present. Keywords: dental caries, epidemiology, SiC index, Italy

The 2001 Austrian oral health survey investigated a representative sample of 6-year-old Austrian children. 516 6-year-old Austrian children were investigated with respect to d1-3mft and d1-3mfs and visible plaque index (VPI). Forty-nine per cent of the children were caries free (d3ft = 0). The children had 2.1 d3ft (3.5 d1-3mft) and 3.9 d3fs (6.1 d1-3fs). 2.6 d3s unrestored carious lesions (d3s) predominated over 1.3 filled surfaces (fs). There was no statistical difference between girls and boys. The prevalence of caries showed a very skewed distribution: 50% of all d3s were concentrated in 8% of the children with 86% of all carious lesions in 25% of the children. The prevalence of caries was inversely related to the educational level of the parents (Spearman rank test p 0.001; r = -0.219) and family income (p 0.001; r = -0.173): Children of parents with low educational levels (9 years of schooling) had 3.3 d3ft whereas children of parents with university degrees had only 1.0 d3ft. Six-year-old Austrian children showed a very skewed distribution of the prevalence of caries and high need for dental treatment. There is a great need for pediatric dentistry in Austria. Keywords: caries prevalence, dmf, dental care, preschool children

The whole salivary flow rates and microbial conditions were examined in a 10-year follow-up and cross-sectional study in a random sample of elderly inhabitants of Gothenburg. Of the 208 individuals examined at baseline, forty-nine per cent participated in the follow-up, 56, 37 and nine persons, respectively, in the age groups of 65, 75 and 85 years. In addition, a new random sample of 98 individuals aged 55 year was examined. The mean secretion rate decreased significantly with increasing age in terms of unstimulated and stimulated whole saliva. Of the 200 participants, 50% were taking medication, which could have hyposalivatory side-effects. Persons with a daily intake of >=4 drugs had significantly lower unstimulated and stimulated secretion rates. Forty-five persons reported subjective dryness in the mouth. The mean saliva secretion rates among these persons were significantly lower and the number of drugs consumed significantly higher than in people with no such complaints. The overall salivary counts of lactobacilli and mutants streptococci increased with age. Higher counts of these bacteria were found in persons wearing removable dentures than in persons without dentures. The salivary and microbial conditions ought to be continuously monitored in old people, in order to identify those who need oral health promotive measures. Keywords: elderly subjects, incidence, lactobacilli, mutans streptococci, salivary flow

The aim of this study was to evaluate the lactic acid concentration in supragingival plaque from caries-active pre-school children after a short-term use of either xylitol- or sorbitol-containing chewing gums. The investigation consisted of a prospective crossover design with 10 healthy children aged 2-4 years each with at least two caries lesions within the dentine (ds >= 2). The children were instructed to chew 6 pieces of a test or a control gum every day for a 14-day period. The test gum contained 65% xylitol and the control gum was sweetened with sorbitol. At baseline and after 14 days, salivary mutans streptococci were enumerated with a chair-side test (Strip mutans) and dental plaque was collected from the upper maxillary incisors. After a washout period of 6 weeks, the same procedure was repeated with the corresponding test or control gum. Lactic acid was determined enzymatically in glucose-challenged plaque suspensions. The lactic acid concentration was significantly reduced (p0.05) by 22% compared with baseline following the xylitol gum regimen but was unaltered after the control gum. The levels of salivary mutans streptococci were mainly unaffected by both chewing gums. A 14-day use of xylitol-containing chewing gums, corresponding to a daily amount of 5 grams of xylitol, could diminish glucose-initiated lactic acid formation in supragingival plaque in caries-active pre-school children. Keywords: caries, chewing gum, lactic acid, xylitol

The aim of this study was to evaluate the performance of two different glass ionomer cements using the Atraumatic Restorative Treatment (ART) technique in permanent teeth. A total of 473 ART restorations were placed in 208 schoolchildren (7-12 years of age) by two previously trained operators, using high density and resin-modified glass ionomer cements. All the restorations were photographed at baseline and the patients were asked about postoperative sensitivity. After a period of 8 months, 193 patients were present after recall and 428 restorations were evaluated and photographed. Two independent examiners carried out the evaluation. The results showed a success rate of 86.2% for occlusal restorations with Fuji IX and 88.4% for those restored with Fuji Plus. A total of 86.7% of the approximal restorations with Fuji Plus were also judged to be successful after 8 months. No association was found between the materials and the clinical performance of the ART restorations in class I cavities. The type of restorative material did not influence the success or failure rates in class I cavities within this period. Fuji IX showed promising performance for occlusal ART restorations and Fuji Plus is also a promising material for occlusal and approximal ART restorations. Keywords: glass-ionomer cements, atraumatic restorative treatment, ART

To assess the methodological quality of epidemiological studies on dental pain and review the published literature for its prevalence, and association with age, gender and socio-economic status. Medline and reference lists of relevant articles were searched for observational studies published in English from 1966 to 2001 carried out on humans aged 19 years and over. Articles for reading of the full text were selected by two reviewers independently. Selected articles were assessed independently by the two reviewers according to a set of 8 standardized criteria. Inter-rater agreement was measured using the kappa statistic. Disagreements were discussed and a final score for each study agreed. Data on prevalence estimates and their distribution by age, gender and socio-economic factors were extracted. 422 studies were identified, and 23 selected for review. Inter-rater agreement was high for all 8 criteria used (kappa > 0.6). Methodological quality was poor with the number of criteria fulfilled by each study ranging from 1 to 6, median score 3. The prevalence estimates for 5 case definitions identified were: 'toothache' 7-32%, 'pain in teeth with hot, cold or sweet things' 25-38%, 'pain and discomfort needing medication or treatment' 7-9%, 'pain or discomfort in the mouth, teeth or gums' 19-66%, and 'oral and facial pain'40-44%. Younger subjects and those from lower socio-economic groups were more likely to report pain. Gender was not associated with dental pain. Epidemiological data on dental pain are sparse and of poor quality. There is a need for well-designed surveys using randomly selected community samples and standardized measurement criteria to fill this knowledge gap. Keywords: dental pain, toothache, prevalence

The aim of this study was to compare oral health status on a geriatric rehabilitation ward among patients who were assessed using the Revised Oral Assessment Guide (ROAG) on admission and at discharge; and to investigate in what respect the oral health procedures (OHP) suggested in ROAG were applied when oral health problems were detected. Registered nurses on the ward performed oral health assessments using ROAG with 107 patients on admission and at discharge. When oral health problems were detected measures to be taken were suggested using ROAG. Oral health problems were common among the patients on admission (86%), as well as at discharge (51%). The frequency of the problems was significantly lower at discharge compared to admission. The OHP that were recommended in ROAG were completely followed when saliva flow-related problems were detected. Regarding other oral health problems, measures other than the recommended ones were often performed. This study demonstrated that the oral health was better at the end of the hospital stay compared to admission. Keywords: geriatric rehabilitation patients, nursing care, oral assessment guide, oral health procedures, oral health status

The aim of the present study was to compare changes in salivary pH after intake of apple juice and its various dilutions with mineral water, in children and adults. 15 children (mean age 4.4 ± 0.9 years), and 15 adults (mean age 30 ± 2.4 years) participated in this study. Carbonated mineral water, apple juice and its various dilutions with carbonated mineral water were tested. The pH-value of unstimulated whole saliva was measured at the same time of day. The pH-value was measured again immediately after intake of a beverage, and 5, 10, 15 and 25 min later. The flow rate and buffering capacity of stimulated saliva, and the buffering capacity, calcium and phosphorus contents of the beverages were measured. The statistical evaluation of the data was performed employing the Wilcoxon test for paired samples. The mean base value of the pH of whole saliva was 7.0 ± 0.2 (children), and 6.8 ± 0.3 (adults). The differences in the flow rates of stimulated saliva in children and adults were statistically significant (p = 0.0003). The intake of mineral water led to a statistically significant rise in the salivary pH-value (p 0.05). Undiluted and diluted apple juice caused a reduction in the salivary pH-values. Within the first 10 min the changes of pH in saliva only differed significantly between mineral water and the other beverages (p 0.01). In the pH range of 5.8 - 7.0, mineral water had a weak buffering capacity, while undiluted apple juice had a high buffering capacity. With regard to dental and general health, only mineral water can be recommended for children. Keywords: apple juice, salivary pH, children, adults