Oral Health and Preventive Dentistry, 03/2006

Objectives: To assess whether or not opportunistic oral cancer screening by dentists to detect pre-malignant or early cancer lesions is feasible. The objective was to analyse the patterns of dental attendance of a national representative sample over a period of 10 years to ascertain whether individuals at high-risk of oral cancer would be accessible for opportunistic oral cancer screening. Methods: Secondary analysis of data extracted from the British Household Panel Survey, a national longitudinal survey (n = 5547). Analysis to ascertain whether patterns of attendance for dental check-ups for a period of 10 years (1991-2001) were associated with risk factors for oral cancer such as age, sex, education, social class, smoking status and smoking intensity. Results: Males, aged over 40 years, less educated manual workers and smokers were significantly less likely to attend for dental check-ups compared with females and younger, higher educated, higher socio-economic class non-smokers (p 0.05). Throughout the 10-year period, young people, more than older people, had progressively lower odds ratios of attending. Those with more education used dental services more. Heavy smokers were infrequent attendees. Conclusions: This study suggests that opportunistic oral cancer screening by dentists is not feasible to include high-risk groups as they are not regular attendees over 10 years. Those who would be screened would be the low-risk groups. However, dentists should continue screening all patients as oral precancers are also found in regular attendees. More should be done to encourage the high-risk groups to visit their dentists. Keywords: British men, dental attendance, opportunistic, oral cancer, screening

Objective: To gain more information on the oral health status of subjects with syndromic craniosynostosis. Design: A cross-sectional study. Materials and Methods: The present study took place at the Hospital for Rehabilitation of Craniofacial Anomalies of University of São Paulo (HRAC-USP). The sample was 19 patients with syndromic craniosynostosis (10 Apert, 5 Crouzon, 2 Pfeiffer and 2 Saethre-Chotzen), aged 5 to 15 years. An assessment of plaque, caries and gingival indices, and evaluation of the efficacy of toothbrushing was carried out. The measurements included PHP index, dmft and DMFT indices, gingival index, comparison of PHP before and after non-supervised toothbrushing and between individuals with and without severe syndactyly. Results: The patients displayed high plaque index and poor efficacy of toothbrushing, regardless of the presence of severe syndactyly; despite the plaque accumulation, the gingival index was not proportionally high. There was predominance of the D component for the DMFT index, which combined with the need for restorative treatment in 42.1% of the patients indicates poor access to dental care by these patients. Conclusions: The results show the need for a dental follow-up programme for these patients. Carers should be informed of the importance in aiding these patients during accomplishment of oral hygiene at home. Keywords: acrocephalosyndactylia, craniofacial dysostosis, craniosynostosis dental plaque index, DMF index, periodontal index, mouth breathing, toothbrushing

Objective: The aim of this study was to assess the occlusal/dental anomalies needing early treatment for maximal occlusal development among 11-12-year-olds in Ibadan, Nigeria. Materials and Methods: An epidemiological survey of 361 school students, 171 (47.4%) males and 190 (52.6%) females, was carried out in Ibadan, Nigeria. Subjects were randomly selected from different schools in the city. One examiner, under natural illumination in the school premises, examined all the children. Results: Prolonged retention of primary teeth with displacement of the permanent series was observed in 4.2% while dental anterior cross bite accounted for 5.5%. Oral habits with their deleterious effects on the occlusion were noted in 5.0%. Other findings were: clinically missing permanent teeth, 3.6%; supernumerary teeth, 1.4%; double teeth, 1.9%; carious lesions, 6.9%; conically shaped lateral incisors, 1.4%; and transposition, 0.6%. Proclination of the upper incisors with increased overjets of more than 5mm, as well as some fractures of the incisors, accounted for 22.4%. In all, 51.8% had one form of occlusal/dental need or another. No statistically significant gender differences were observed for all the various needs (p > 0.05) except the prevalence of supernumerary teeth, which was statistically higher in males (p 0.05). Conclusion: Over half of the children could benefit from one interceptive need or the other for proper occlusal development. Routine dental check ups are very much encouraged in developing countries like Nigeria, as in other developed parts of the world. Keywords: interception, occlusal/dental anomalies, prevalence, Nigerian children

Purpose: To estimate dental caries prevalence and severity among all 12- and 13-year-old schoolchildren enrolled in a public school in 2005 and to establish comparisons with the results of studies previously conducted in the same school in 1971, 1997 and 2002. Methods: A cross-sectional study involving 190 children was carried out. A single calibrated examiner collected the clinical data according to the World Health Organization (1997) criteria. Results: The response rate was 90.0%. Between 1971 and 2005, the observed reduction in caries prevalence was 58.2%, whereas the mean DMFT Index declined from 9.2 to 0.8, which corresponds to a reduction of 91.3%. The significant caries index (SiC) reduced from 3.4 (CI 95% 3.0-3.8) in 2002 to 2.2 (Cl 95% 1.8-2.5) in 2005. Conclusion: This study indicates an actual decline in dental caries prevalence and severity among the schoolchildren during the studied period, even though different diagnostic criteria were used. Keywords: caries, DMFT Index, oral health, significant caries index (SiC)

Investigating dental caries and fluorosis prevalence over time is an important measure for monitoring trends in oral health. Purpose: This work aimed to describe the prevalence of dental caries and dental fluorosis of 11- to 12-year-old schoolchildren from Iracemapolis, Brazil, in 2004 (n=236) and to compare the current prevalence rates with those from previous surveys carried out in 1991 (n=200), 1995 (n=160), 1997 (n=314) and 2001 (n=244). Materials and Methods: The schoolchildren of both genders from all public schools were examined by two calibrated dentists (Kappa>0.81), using dental probes and buccal mirrors under natural light in an outdoor setting. Dental caries and fluorosis were measured using the DMFT and Thylstrup-Fejerskov (T-F) indexes, respectively. The variation of DMFT index over time was assessed by analysis of regression and the fluorosis prevalence (T-F>1) was compared over time by the Chi-square test at 5% significance level. Results: In 2004, the mean value for DMFT was 1.2; 50% of the children were caries-free, and 15.7% presented dental fluorosis (T-F>1). A significant caries reduction (82.1%) and a significant increase (685%) of fluorosis prevalence have been observed from 1991 to 2004 (p0.01). Conclusion: The results suggest a continuous decrease of dental caries experience and an increase of dental fluorosis prevalence in 11- to 12-year-old schoolchildren from this Brazilian town as well as indicate that further epidemiological surveys should be carried out in order to monitor these trends. Keywords: dental caries, dental fluorosis, schoolchildren

Purpose: The collection of comprehensive epidemiological data for dental caries of Italian schoolchildren in both rural and urban areas. Materials and Methods: The dft and DMFT indices were recorded from 27163 6-to-9-year-old children attending the primary schools of Abruzzo, a region of Central Italy, according to the World Health Organization recommendations. Results: The number of surveyed children were 5413, 8359, 8362 and 5026 in the 6-, 7-, 8- and 9-year-old groups respectively; the percentages of children positive for caries were 39.5, 48.3, 54.4 and 60.8 respectively. The mean dft (SD) values of the age groups were 1.57 (2.67), 1.79 (2.59), 1.88 (2.47) and 2.02 (2.45) respectively, with mean DMFT (SD) values of 0.07 (0.37), 0.18 (0.62), 0.37 (0.90) and 0.55 (1.09) respectively. All outcomes were significantly greater in schoolchildren living in rural areas compared with those living in urban areas, and these differences were more pronounced in the permanent dentition of the older groups. Of particular note, there was a SiC Index (DMFT) of 2.22 for the 9-year-old children living in rural areas. Conclusion: This survey initially reports the dental caries prevalence in a very large sample of Italian schoolchildren and shows that the WHO global goal for 2000 has been largely achieved in 6-year-old children, although more efforts are needed to reach the new global goal for 2015. The large differences in caries prevalence between different areas (rural and urban) and their behaviour related to the age group of the samples constitute useful findings if prevention programs are to be established in Italy. Keywords: dental caries, epidemiology, Italy, schoolchildren, urbanisation level

Purpose: To analyse possible changes in the severity and distribution of dental caries within the dentition in five groups of 4-year-old children examined with the same methods and criteria between 1980 and 2002. Materials and Methods: The material consisted of retrospective caries recordings from cross-sectional studies performed in 1980, 1987, 1992, 1997 and 2002 in Umeå, Sweden. The distribution of dmfs within the dentition was analysed in the whole groups and in one third of each group with the highest dmfs-values (mSiC-index). Results: When comparing the whole groups, no statistically significant changes were found over the years concerning total dmfs, or dmfs in molars and canines or in occlusal surfaces (p > 0.05). There was a significant increase in dmfs-values in incisors observed between 1980 and 1987, while a similar reduction was observed between 1987 and 1992 (p 0.05). When comparing subgroups constituting 33% of those with the highest dmfs-values for all teeth in each group, the mean values of dmfs for all teeth was higher in 2002 than in 1997 (6.0 compared with 5.3), but the rank sum test of dmfs-values displayed a non-significant difference (p > 0.05). There was, however, a statistically significant increase in the dmfs-values for molars and canines between 1997 and 2002 (p 0.05). Between 1987 and 1992, a statistically significant decrease in dmfs-values in incisors (p 0.01) was found, while the opposite trend occurred between 1992 and 1997 (p 0.05). Conclusion: By analysing caries distribution within the dentition and in subgroups, trends can be detected over time that otherwise are obscured. The findings should be considered in future epidemiological studies, as even significant changes could be overlooked and disregarded. Keywords: caries, children, significant caries, subgroups

Purpose: The aim of this study was to assess risk indicators for reduced marginal bone level in the individual, with emphasis on apical periodontitis. Materials and Methods: Six hundred and sixteen randomly selected Danish adults (304 women and 312 men), mean age of 42 years, underwent a full-mouth radiographic survey. The marginal bone level was measured from the cemento-enamel junction to the marginal bone. The measurements were performed at the mesial (Am) and distal (Ad) aspect of the tooth. The marginal bone level for each individual was calculated: Aind = Σ Ateeth/nteeth, and Aind >= 4 mm was considered as reduced marginal bone level. The periapical status was assessed by the periapical index (PAI), which was dichotomised (healthy = PAI scores 1 and 2, and diseased = PAI scores 3, 4 and 5). Coronal restorations (crowns, fillings and inlays) and smoking status were also recorded. All variables were analysed in a logistic regression model with reduced marginal bone level as the outcome. Results: The impact of age (odds ratio (OR) = 3.3), smoking (OR = 10.5) and apical periodontitis (OR = 4.7) on reduced marginal bone level was statistically significant (p 0.01). Conclusions: Not surprisingly, this study showed that smoking and older age were risk indicators for having reduced marginal bone level >= 4 mm. Even when adjusted for these factors, individuals with >= 1 tooth with apical periodontitis were five times more at risk of having a reduced marginal bone level than those with no periapical infection.