Oral Health and Preventive Dentistry, 02/2003

Patients' compliance with periodontal maintenance therapy is important for the treatment outcomes, however, most studies report compliance rates ranging from only 11% - 45%. The aims of this study were to report on the acceptance of proposed treatment and the long-term compliance of patients treated in a specialist periodontal office in Norway. This was part of an internal quality control measure for this practice. 152 consecutive patients who completed periodontal therapy in 1988 were retrospectively assessed after 10 years. In addition, the case records of 624 consecutive patients referred for periodontal assessment between 1989 and 1993 were examined to determine how many decided to accept the proposed therapy. The majority 132 (87%) of those who completed treatment in 1988 had attended for the prescribed maintenance therapy over a ten-year period. It was not possible to detect any differences between the compliers and non-compliers in terms of age, gender, severity of disease, cost and national insurance coverage. The 152 patients were originally referred by 18 general dental practitioners. The 'high referring' dentists (>8 referrals) had significantly more non-complying patients than dentists who made less than 7 referrals. 20 (3%) of the 624 periodontal referrals over a 5-year period chose not to proceed with the proposed therapy. There was a high level of patient compliance in the population group studied in this specialist periodontal practice. Geographic and cultural factors as well as a stable rural population may be important factors in the high level of compliance with maintenance therapy in this practice. The referring general dental practitioners may also play an important role in patient compliance. Keywords: periodontal maintenance, patient compliance, acceptance of therapy, specialist periodontal practice

Dental services utilization varies and access to periodontal therapy is not uniform. The objectives were to study an adult population of Medicaid eligible subjects in the Kitsap County, State of Washington, USA: (1) to assess their oral health status, specifically periodontal conditions, and (2) to assess their use of dental services and behavioral beliefs in relation to dental diseases. 1500 randomly selected eligible households were invited to a cost-free dental examination. The Periodontal Screening and Recording (PSR) index and six bitewing x-ray films were obtained. Subjects responded to a service utilization questionnaire. A telephone interview was performed with 100 randomly selected eligible subjects to assess their behavioral beliefs about dentistry. 132 (8.8%) of the contacted subjects responded while only 4.5% came to the clinical examination. The mean age of the subjects was 35.0 years (S.D. 13.6, range 18 to 78 years) and 73.4% were women. Bleeding on probing was found in 82.8%, and 7.8% of the subjects had teeth with suppurating gingival conditions. Supra, or sub-gingival calculus could be identified in 95.3% of the subjects. Probing depths > 5.5 mm (not accounting for surfaces of third molars) were found in 11.3%, and radiographic evidence of vertical defects >= 3 mm in 47% of the subjects. Tooth decay in need of urgent dental care was found in 75% of the subjects. Cost (63.2%) and lack of dental insurance (51.3%) were primary factors for not seeking care but 48.7% had no desire to enroll in a "no cost" dental therapy program. Dental fear was an obstacle to care in only 2.6% of the subjects. Primary barriers to the utilization of dental services in low income, uninsured populations were: (1) a pre-occupation with other daily issues, financial being the greatest, (2) an attitude of waiting for a problem to occur before seeking dental care, (3) that tooth extraction is the solution or only available treatment option. Keywords: adult, periodontitis, tooth decay, Medicaid, low income, tooth loss, self-perception, self-efficacy, oral radiographs, alveolar bone loss

To compare the cleaning efficacy of (A): a newly developed manual toothbrush with tapered filaments (meridol®, GABA International, CH-Münchenstein) with (B): a standard flat trim manual toothbrush (ADA reference toothbrush) in vivo. 87 healthy participants took part in this study. Subjects were asked to abstain from all oral hygiene procedures for 48 hours. After plaque was scored (Turesky modification of the Quigley Hein Index), the subjects brushed their teeth under supervision with the two manual toothbrushes according to a split-mouth design. In total, a cleaning time of two minutes was given for the whole procedure with an alert after every 30 seconds. Immediately after brushing, plaque was scored again by the same investigator, who was blind with respect to the toothbrush used. Using the non-parametric Wilcoxon test for paired samples (p0.05) the overall plaque scores were reduced for (A) from 1.95±0.48 to 1.02±0.41 (p0.001), and (B) from 1.93±0.52 to 1.09±0.44 (p0.001). At proximal surfaces the plaque scores were reduced (A) from 2.02±0.49 to 1.11±0.43 (p0.001) and (B) from 2.01±0.52 to 1.20±0.45 (p0.001). The relative plaque reductions overall were (A) 47.4±18.0% and (B) 44.1±15.6% (p=0.039), at proximal surfaces (A) 44.2±18.8% and (B) 40.5±15.9% (p=0.015), and at lingual surfaces (A) 30.6±28.1% and (B) 24.0±27.1% (p=0.016). Both brushes removed a significant amount of plaque. Overall and in areas difficult to reach, the meridol® toothbrush was superior to the ADA reference brush. Keywords: manual toothbrush, plaque removal, mechanical plaque control, controlled clinical trial

Non-surgical therapy, including scaling, root planing, and personal plaque control continues to be a powerful effective treatment modality for treating chronic periodontal diseases. Reports in the literature have suggested that adjunctive procedures such as systemic antibiotics and topical antiseptics may enhance the clinical outcomes of non-surgical treatment. Three retrospective case reports spanning an evaluation period of 9-36 months are presented. The patients were treated in a private periodontal practice and had advanced periodontal disease. A significant positive clinical and radiographic response was achieved with non-surgical and adjunctive therapy. The teeth that were treated initially had deep angular bony defects with probing depths ranging 5-8 mm. Following non-surgical and adjunctive therapy, probing depths were considerably reduced and ranged 3-5 mm. As well, a significant degree of radiographic osseous fill of the angular defects was observed. In light of the dramatic healing responses observed in these cases, the healing potential of deep periodontal defects with non-surgical and adjunctive therapy requires further investigation. Once the critical elements contributing to the positive responses noted can be identified, then perhaps a more predictable outcome may be achieved in future cases. Keywords: non-surgical, adjunctive therapy, clinical, radiographic, response

Water fluoridation was the first breakthrough in the practice of preventive cariology on a community level and has remained one of the cornerstones of prevention in dentistry. The concepts regarding the mechanisms of the caries-inhibitory effect, however, have changed in several respects. Today there is general agreement that topical effects on the erupted enamel are most important. The contention that there is no pre-eruptive effect whatsoever has created confusion; there is in fact evidence for a minor pre-eruptive protective effect. Around 1980 many experts believed that fluorides should not be used in high concentrations, for instance above those in dentifrices, because this could block remineralisation in the body of pre-cavity lesions. However, it is now known that such undesirable effects are negligible or non-existent. In the fifties and sixties, fluoride tablets were widely used in Europe and helped to make the concept of caries prevention popular. From 1980 onwards, fluoride dentifrices were found to have a much greater impact and were recognized as being able to lead to a decline of caries prevalence in entire countries, and fluoride tablets gradually lost their importance. Antifluoridationists were unable to delay or hinder the widespread use of fluoride toothpastes but in many cases have successfully opposed public health measures such as fluoridation of water or of salt. The spread of these methods, beneficial for all social strata, might have been more rapid if some of the experts had not propounded the erroneous supposition that fluoride dentifrice will be sufficient for caries prevention. Sale of fluoridated salt has been authorized in several countries on a nationwide scale. However, only Latin American countries have introduced salt fluoridation for entire populations. In Central and Eastern Europe where caries prevalence continues to be high and where the level of usage of topical fluorides including dentifrices will presumably remain at a low level for many years, salt fluoridation would be beneficial. Keywords: fluoride, fluoridation, caries prevention, historical aspects

High-fluoride drinking water represents a health hazard to millions of people, not least in the East African Rift Valley. The aim of the present project was to establish a simple method for removing excessive fluoride from water. Based on geological maps and previous experience, 22 soil samples were selected in mountainous areas in central Ethiopia. Two experiments were performed: 1. After sieving and drying, two portions of 50 g were prepared from each soil and subsequently mixed with solutions of NaF (500 mL). Aliquots (5 mL) of the solutions were taken at pre-set intervals of 1 hour to 30 days for fluoride analysis - using an F-selective electrode. 2. After the termination of the 30-days test, liquids were decanted and the two soil samples that had most effectively removed fluoride from the NaF solutions were dried, and subsequently exposed to 500 mL aqua destillata. The possible F-release into the distilled water was assessed regularly. Great variations in fluoride binding patterns were observed in the different soils. The percent change in F-concentration in the solutions, as compared to the original |F-|, varied: at 1 hour from a decrease of 58% to an actual increase of 7.7%, while - at 30 days - all soil samples had caused a decrease in the F-concentration, varying from 0.5% to 98.5%. Only minute amounts of fluoride would leach from the fluoride-enriched soils. Lateritic soils may remove excessive fluoride from drinking water. Methods for practical application of this principle should be tested at household level. Keywords: fluoride, defluoridation, drinking water, health

The aim of this study was to assess the caries prevalence in the adult population of Pomerania, Germany in comparison to national and international data. The study sample comprised 4,022 randomly selected subjects who were examined from October 1997 to May 2001 within the "Study of Health in Pomerania" (medical and dental, population-based cross-sectional study in Pomerania, Northeast Germany. Response rate: 69%. Age range of subjects: 25 - 79 yrs). Carious defects, fillings and missing teeth were diagnosed and the DMFT/S scores were calculated according to WHO guidelines (1997). These figures were compared to other German, Swedish and US data. Women exhibited higher mean DMFT and DMFS values in all age groups than men. The mean DMFT/S scores were slightly higher than the values for the only two available nationally representative age groups in Germany. The prevalence of primary carious lesions or secondary caries was very low, resulting in minor treatment needs (decayed surfaces: mean 0.95 ± 3.3) and high care indices (FS/DFS) for all age groups (90 - 95%). In contrast to this, the mean numbers of fillings in adults and especially of missing teeth in seniors were much higher in Pomerania for all age groups than in the Swedish and US adult population, where a caries decline was demonstrated. In spite of a very low prevalence of primary carious lesions and secondary caries, the mean number DMFT/S and especially MT/S scores in the Pomeranian adult population are high in comparison with Swedish and US data, but differed only slightly from the limited available national data for Germany. Keywords: caries prevalence, DMFT, Germany, missing teeth, oral health

When restoring deciduous teeth with extensive lesions, preformed stainless steel crowns are increasingly used in addition to resin-based materials. The aim of the present clinical study was to examine the influence of composites and stainless steel crowns on the cariogenic bacteria S. mutans and Lactobacilli by means of a commercially available salivary test (CRT® bacteria) in 100 children. For 50 children (30 boys, 20 girls, mean age 5.7 ± 2.4 years) only composites have been used as a restorative material (an average of 9 fillings per child, total number: n=450), which had been in situ for an average of 15.9 months at the time of the examination. In another group of 50 children (33 boys, 17 girls, mean age 5.9 ± 2.5 years), stainless steel crowns and composites have been used for restorations (an average of 3.5 stainless steel crowns per child, total number: n=174, an average of 7 composite fillings per child, total number n=348), which had been in place for a mean period of 17.2 months. The salivary examination of the children with composite restorations showed a high proportion of patients (64%, n=32) with high numbers (>=10 5) of S. mutans and Lactobacilli (54%, n=27). Only 22% (n=11) of the children with additional stainless steel crown restorations were found to have high numbers (>=10 5) of S. mutans and Lactobacilli (34%, n=17). This study shows a potential positive inhibitory effect of stainless steel crown restorations as compared to composite fillings with respect to the oral bacterial colonization. Keywords: restorations of the primary dentition, composite, preformed steel crowns, salivary tests