Database: MEDLINE <: biomedical, nursing & dental literature, 1966 - Oct 2000.> Search Strategy (You Saved Citations 1-300 From Set 70): ----------------------------------------------------------------------------- 1 exp Decision support techniques/ 19211 2 exp Decision making/ 28700 3 exp Decision making, computer-assisted/ 16758 4 ((decision: or consensus) adj (making or make$1 or support 14407 or theory or trees or technique:)).mp. 5 exp "Sensitivity and specificity"/ 89544 6 Computer simulation/ 19925 7 Computer systems/ 3947 8 Computers/ 40006 9 (computer: adj5 (simulation: or system: or decision: or 23667 predict: or forecast:)).mp. 10 Forecasting/ 28594 11 Models, biological/ 101335 12 Likelihood functions/ 3382 13 exp Risk/ 227197 14 exp "Outcome assessment (health care)"/ 103983 15 or/1-14 649701 16 exp Tooth demineralization/ 22628 17 demineralization.mp. 1620 18 caries.mp. 15295 19 caires.mp. 1 20 craies.mp. 0 21 careis.mp. 4 22 carise.mp. 0 23 (teeth adj3 cavit:).mp. 422 24 (tooth adj3 cavit:).mp. 217 25 (dental adj3 cavit:).mp. 276 26 (dentin adj3 cavit:).mp. 254 27 (enamel adj3 cavit:).mp. 182 28 (teeth adj3 decay:).mp. 374 29 (tooth adj3 decay:).mp. 321 30 (dental adj3 decay:).mp. 250 31 (dentin adj3 decay:).mp. 12 32 (enamel adj3 decay:).mp. 20 33 (active adj decay).mp. 9 34 (rampant adj3 decay:).mp. 14 35 (recurrent adj3 decay:).mp. 30 36 (white adj spot:).mp. 509 37 carious.mp. 2077 38 cariology.ti,ab. 56 39 (non-cavitated adj3 lesion:).mp. 15 40 (noncavitated adj3 lesion:).mp. 2 41 Tooth remineralization/ 478 42 (dental adj3 fissure:).mp. 99 43 (tooth adj3 fissure:).mp. 50 44 (teeth adj3 fissure:).mp. 98 45 caries-free.mp. 603 46 cariesfree.mp. 17 47 Cariogenic agents/ 728 48 precavit:.mp. 8 49 (filled adj3 teeth).mp. 510 50 (filled adj3 tooth).mp. 117 51 (oral adj fissure:).mp. 6 52 (tooth adj3 remineraliz:).mp. 28 53 (teeth adj3 remineraliz:).mp. 24 54 dft.mp. 413 55 dfs.mp. 1258 56 dmf:.mp. 6397 57 cariogeni:.mp. 1787 58 or/16-57 32256 59 15 and 58 2571 60 limit 59 to (human and english language and yr=1980-2000) 2084 61 limit 60 to (infant < 1 to 23 months > or preschool child < 735 2 to 5 years > or child < 6 to 12 years >) 62 limit 60 to (adolescence < 13 to 18 years > or adult < 19 1117 to 44 years > or middle age < 45 to 64 years > or "aged < 65 and over >" or "aged, < 80 and over >") 63 61 and 62 393 64 60 not 61 1349 65 64 or 63 1742 66 (disease adj free adj (survival or patient:)).mp. 6825 67 65 not 66 1490 68 "Root caries"/ 297 69 exp "Tooth root"/ 7047 70 67 not (68 or 69) 1390 71 from 70 keep 1-300 300 72 from 70 keep 301-600 300 73 from 70 keep 601-900 300 74 from 70 keep 901-1200 300 *************************** <1> UI - 93161714 AU - Isokangas P AU - Alanen P AU - Tiekso J IN - Ylivieska Health Care Center, Finland. TI - The clinician's ability to identify caries risk subjects without saliva tests--a pilot study. SO - Community Dentistry & Oral Epidemiology 1993 Feb;21(1):8-10 AB - The average clinician's ability to identify caries risk children without any saliva tests was studied in field conditions. The results suggest that a clinician can reach a high level in prediction of future caries occurrence through the use of clinical and sociodemographic information routinely available at annual clinical examinations. <2> UI - 93161705 AU - Hawley GM AU - Hamilton FA AU - Worthington HV IN - Dental Health Unit, University of Manchester, United Kingdom. TI - An investigation into the use of a voice operated data input system. SO - Community Dentistry & Oral Epidemiology 1993 Feb;21(1):24-6 AB - The aim of this study was to evaluate a voice operated data collection system intended for use in epidemiological surveys. Three groups of 45 adolescents, with similar caries experience, were examined by one examiner in schools. The caries data resulting from these examinations were collected in three ways; keyboard activated input to a portable computer, paper chart recording followed by manual input on return to base and examiner voice activated input direct to the computer. Maximum levels of accuracy were found with all three methods. The quickest method of collection in the field was by paper chart with a mean collection time per subject of 2.59 min, followed by 3.15 min for the manual keyboard method and 4.07 min for the voice activated method. When all the factors affecting time were taken into consideration it was found that overall the manual keyboard method was significantly faster than both the paper chart method and the voice activated method. <3> UI - 93139335 AU - Leverett DH AU - Featherstone JD AU - Proskin HM AU - Adair SM AU - Eisenberg AD AU - Mundorff-Shrestha SA AU - Shields CP AU - Shaffer CL AU - Billings RJ IN - Department of Community Dentistry, Eastman Dental Center, Rochester, New York 14620. TI - Caries risk assessment by a cross-sectional discrimination model. SO - Journal of Dental Research 1993 Feb;72(2):529-37 AB - Although the prevalence of dental caries is continuing to decline, it still affects a majority of the US population and can be a serious problem for those afflicted. The objective of this project was to develop and perfect a model for assessment of risk of dental caries onset in children. In the first study, reported herein, a set of clinical, microbiological, biochemical, and socio-demographic variables was identified that distinguished, with an acceptable level of sensitivity and specificity, between children who had no previous caries experience and children who had high caries levels. A total of 313 children--age 12-15 years, 140 from a fluoridated community and 173 from a fluoride-deficient community--was selected on the basis of previous caries experience, either zero DMFS or high DMFS (> or = 6 in the fluoridated or > or = 8 in the fluoride-deficient community). Clinical exams for DMFS, dental fluorosis, and plaque were conducted. Stimulated whole saliva was collected for analysis of mutans streptococci, lactobacilli, total viable flora, and fluoride concentration. A questionnaire was used for collection of demographic data as well as information on prior fluoride exposure, dietary habits, and oral hygiene practices. By means of discriminant analyses, with use of seven key clinical and laboratory variables, it was possible for zero-DMFS subjects to e classified correctly (specificity) in 77.6% of cases in the fluoridated community and in 86.1% of cases in the fluoride-deficient community. High-caries subjects were classified as such (sensitivity) in 79.3% and 88.1% of cases, respectively. <4> UI - 93115355 AU - Caufield PW AU - Cutter GR AU - Dasanayake AP IN - University of Alabama, School of Dentistry, Department of Oral Biology, Birmingham 35294. TI - Initial acquisition of mutans streptococci by infants: evidence for a discrete window of infectivity. SO - Journal of Dental Research 1993 Jan;72(1):37-45 AB - Oral bacterial levels of 46 mother-child pairs were monitored from infant birth up to five years of age so that the acquisition of mutans streptococci (MS) by children could be studied. The initial acquisition of MS occurred in 38 children at the median age of 26 months during a discrete period we designated as the "window of infectivity". MS remained undetected in eight children (17%) until the end of the study period (median age of 56 mo). The levels of both MS and lactobacilli in saliva of mothers of children with and without MS were not significantly different. Comparisons between a caries-active cohort colonized by MS (nine of 38) and children without detectable MS revealed similar histories in terms of antibiotic usage, gestational age, and birth weight. Interestingly, half of the children between the ages of one and two years who were not colonized by MS were attended by caretakers other than the mother, while all of the caries-active children during this same time period were cared for by their mothers; the difference was statistically significant. Here we report for the first time that MS is acquired by infants during a defined period in the ontogeny of a child. Support for the notion of a discrete window of infectivity comes from other sources, including animal models. <5> UI - 93115364 AU - Locker D AU - Leake JL IN - Department of Community Dentistry, Faculty of Dentistry, University of Toronto, Ontario, Canada. TI - Risk indicators and risk markers for periodontal disease experience in older adults living independently in Ontario, Canada. SO - Journal of Dental Research 1993 Jan;72(1):9-17 AB - This study examined risk indicators and risk markers for periodontal disease experience in 624 adults aged 50 years and over living independently in four communities in Ontario, Canada. The data were collected as part of the baseline phase of a longitudinal study of the oral health and treatment needs of this population. Periodontal disease experience was assessed in terms of attachment loss, measured at two sites on each remaining tooth. Bivariate and multivariate analyses were used to examine the relationship between a number of sociodemographic, general health, psychosocial, and oral health variables and three indicators of periodontal disease experience. These were: mean attachment loss, the proportion of sites examined with loss of 2 mm or more, and the probability of the subjects having severe disease, arbitrarily defined as a mean attachment loss in the upper 20th percentile of the distribution. Mean attachment loss was 2.95 mm (SD = 1.41 mm), and 76.6% of sites examined had loss of 2 mm or more. In bivariate analyses, the most consistent predictors of periodontal disease experience were: age, education, income, smoking, dental visiting, the number of remaining teeth, the number of decayed coronal surfaces, and the number of decayed root surfaces. In multivariate analyses, age, education, current smoking status, and the number of teeth had the most consistent independent effects. These data confirm the results of recent US studies indicating that periodontal disease experience is influenced by social and behavioral factors. <6> UI - 93288818 AU - Mertz-Fairhurst EJ AU - Smith CD AU - Williams JE AU - Sherrer JD AU - Mackert JR Jr AU - Richards EE AU - Schuster GS AU - O'Dell NL AU - Pierce KL AU - Kovarik RE AU - et al IN - Department of Restorative Dentistry, Medical College of Georgia, School of Dentistry, Augusta 30912. TI - Cariostatic and ultraconservative sealed restorations: six-year results. SO - Quintessence International 1992 Dec;23(12):827-38 AB - The objective of this clinical study was to determine the ability of an ultraconservative, sealed composite resin restoration, without a traditional cavity preparation and without the removal of the carious lesion, to arrest Class I caries. Tooth preparation was limited to placing a bevel in the enamel. These restorations were compared, over 6 years, with (1) ultraconservative, localized, sealed amalgam restorations with no extension for prevention and (2) traditional, unsealed amalgam restorations with the usual extension for prevention outline form. Caries was arrested by the ultraconservative, sealed composite resin restorations for 6 years. Complete sealant retention on the sealed amalgam restorations was somewhat lower than that on the sealed composite resin restorations; conversely, partial sealant retention was higher for the sealed amalgam group. The marginal integrity of the sealed amalgam restorations was significantly superior to that of the unsealed amalgam restorations. The sealant also protected Class I posterior composite resin restorations against wear. <7> UI - 93239834 AU - Joseph VP AU - Rossouw PE AU - Harris AM AU - Adams L IN - Department of Orthodontics, Oral and Dental Teaching Hospital, University of Stellenbosch, Tygerberg, South Africa. TI - Stereometric evaluation of the enamel-stripping effect of hydrochloric acid. SO - Journal of Clinical Orthodontics 1992 Dec;26(12):761-4 <8> UI - 93226635 AU - Newbrun E IN - Department of Stomatology, University of California, San Francisco. TI - Dental caries in the future: a global view. [Review] [25 refs] SO - Proceedings of the Finnish Dental Society 1992;88(3-4):155-61 AB - Although the prevalence of caries has decreased markedly in children, adolescents, and young adults in most industrialized countries, caries continues to be the main reason for tooth loss, particularly among the high risk segment of the population. In many developing countries, where traditional dietary patterns have changed to include sugar-containing foods and beverages, caries prevalence has increased and will continue to do so in the immediate future. Accordingly, it would be a serious mistake to be complacent about caries prevention. In future industrialized countries will see computers playing a significant role in cariology, finding applications not only in research and practice administration but directly in clinical practice as well. They will be used in every operatory in the assessment of caries risk, the recording of caries prevalence, the direct storing of radiographic information, and the restoration of carious teeth, assisted by computer-aided design and computer-aided manufacture (CAD/CAM) technology. Fluoride therapy, both systemic and topical, will continue to be the basis of caries prevention. Dental sealants, which are highly effective in protecting pits and fissures when applied soon after the teeth erupt, will be more widely used in the future when insurance plans will pay for prevention. Substitution of sucrose and syrups by non-fermentable sweetening agents can also reduce caries increments, but most agents are more expensive than sucrose and require consumer education to pay for the additional cost. Caries, as an infectious and transmissible disease, is amenable to prevention by interfering with the chain of transmission or by suppressing the putative pathogens, the mutans streptococci, in infected patients.(ABSTRACT TRUNCATED AT 250 WORDS) [References: 25] <9> UI - 93180939 AU - Schwartz GG IN - Department of Clinical, Epidemiology and Preventive Medicine, University of Pittsburgh School of Medicine, PA 15261. TI - Multiple sclerosis and prostate cancer: what do their similar geographies suggest?. SO - Neuroepidemiology 1992;11(4-6):244-54 AB - Mortality rates from multiple sclerosis show a well-known north-south gradient, both within the United States and internationally. Mortality rates from prostate cancer show a similar gradient and are significantly correlated with multiple sclerosis (MS) mortality and MS prevalence. This finding adds prostate cancer to the set of diseases whose geographic distributions are significantly correlated with MS and whose members include colon cancer, dental caries, and Parkinson's disease. Review of the literature indicates that these clinically dissimilar diseases may share an aberration in vitamin (hormone) D. Recent evidence demonstrating a multi-faceted role for vitamin D in immunoregulation suggests that a vitamin D aberration may also contribute to the etiology of MS. A vitamin D hypothesis can illuminate several unexplained features of the epidemiology of MS and suggests opportunities for epidemiologic, laboratory, and clinical investigation. <10> UI - 93178707 AU - Pitts NB IN - Department of Dental Health, University of Dundee, UK. TI - The diagnosis of dental caries: 3. Rationale and overview of present and possible future techniques. [Review] [62 refs] SO - Dental Update 1992 Jan-Feb;19(1):32, 34, 37-8, possim AB - A number of changes have taken place recently which may influence a practitioners choice of diagnostic methods for detecting and monitoring dental caries. The first two articles described the use of current diagnostic methods at various specific sites. This third paper discusses the rationale behind the use of these techniques and provides an overview of present techniques and those which may be useful in the future. [References: 62] <11> UI - 93183286 AU - Douglass CW IN - Department of Dental Care Administration, Harvard School of Dental Medicine, Boston, MA 02115. TI - Future needs for dental restorative materials. SO - Advances in Dental Research 1992 Sep;6:4-6 AB - While the population of the United States increases from 250 to 310 million people, the number in older age groups will increase dramatically from 28 million to about 64 million. Tooth retention has improved remarkably in the 65-74 age groups, from 7.4 in 1962 to 17.9 in 1986. While younger age groups will require less treatment due to decline in dental caries, older age groups appear to require more treatment than did similar age cohorts in previous generations. Hence, the need for restorative procedures by the United States population will be on an upward trend for the next decade or two. <12> UI - 93193120 AU - Penning C AU - van Amerongen JP AU - Seef RE AU - ten Cate JM IN - Department of Cariology and Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. TI - Validity of probing for fissure caries diagnosis. SO - Caries Research 1992;26(6):445-9 AB - One hundred extracted molar teeth with discoloured fissures but without any visible carious cavitation were selected from a large supply, using standardized criteria. The teeth were mounted, placed on a mechanical balance, and probed with a force of 500 g in every fissure, at as many places as possible. Every time the probe was found to stick, the spot was marked. After probing colour slides were made of the occlusal faces. Subsequently, the crowns were embedded in epoxy resin. 700 microns thick sections were cut in a facial-lingual direction with a diamond wheel. From the sections X-rays were taken which were scored as follows: a measuring grid was placed on the X-ray image of a section, and the caries score (0-4) for every millimetre was determined. By scoring every section of a tooth in this way, an overview was obtained of the location of all caries lesions in the occlusal surface. By comparing this overview with the colour slide of the tooth, the relationship between the sticky spots and the lesions was visualized. The results indicate that only 24% of the caries lesions were discovered by probing for stickiness (low sensitivity), but that the probe seldom stuck in a sound fissure (high specificity, > 99%). Probing proved to be unreliable for the diagnosis of fissure caries. <13> UI - 93193123 AU - Downer MC IN - Institute of Dental Surgery, Eastman Dental Hospital, London, UK. TI - Time trends in caries experience of children in England and Wales. SO - Caries Research 1992;26(6):466-72 AB - Regular national surveys of child and adult dental health and regionally coordinated surveys of caries experience in children provide a comprehensive picture of secular changes in disease levels in England and Wales. The substantial decrease in mean dmft in 5-year-olds between 1973 and 1983, amounting to 7.7% per annum, slowed to 0.9% per annum between 1983 and 1989/90. Conversely the decline in DMFT in older children and adolescents has accelerated more than twofold since 1983. In some parts of the country, caries experience at 5 years has shown a small increase and possible reasons for this are discussed. The validity of the survey data is examined and ways of consolidating and maintaining the downward trend in disease are considered. <14> UI - 93173972 AU - Whitehead SA AU - Wilson NH IN - Department of Restorative Dentistry, University of Manchester Dental Hospital, England. TI - Restorative decision-making behavior with magnification. SO - Quintessence International 1992 Oct;23(10):667-71 AB - Assessment of occlusal fissure systems and restorations of amalgam in 100 extracted teeth were carried out by four examiners. An initial assessment, made with the naked eye, was repeated with binocular magnification (x 3). The data indicated that restorative decision-making behavior was modified when magnification was used, with an increase in the number of restorations planned for replacement and an increase in the number of tooth surfaces planned for restoration. Statistical analysis indicated that one of the examiners was particularly sensitive to the use of magnification and modified his treatment planning behavior considerably. As part of the process of adapting to the use of magnification, clinicians should review their decision-making behavior. <15> UI - 93134354 AU - Masalin K AU - Murtomaa H IN - Department of Dental Public Health, University of Helsinki, Finland. TI - Work-related behavioral and dental risk factors among confectionery workers. SO - Scandinavian Journal of Work, Environment & Health 1992 Dec;18(6):388-92 AB - The dietary habits and dental health behavior of 294 employees in a Finnish confectionery company were studied to determine the reasons for their dental caries experience and their caries-promoting salivary microbiological findings. A diary and a questionnaire were used. A caries risk index was constructed for salivary microbiological findings. Daily dietary acidogenic exposures were calculated, and differences between low and high caries-risk groups were analyzed. Statistically significant differences in dietary habits between the low- and high-risk groups were found for the entire study population and for the men, the cookie markers, and the sweets makers. A significant positive correlation was found between untreated caries and the number of sugary meals. No differences were found in dental health behavior or dental knowledge between the study groups. The results show that the nature of between-meal snacks and confectionery workers' freedom to consume their products constitutes a potential hazard to dental health. <16> UI - 93137134 AU - Deery C AU - Pitts NB IN - Department of Dental Health, University of Dundee, Dental School. TI - The differentiation of sealant restorations from preventive fissure sealants, in subjects with clear sealants. SO - Community Dental Health 1992 Dec;9(4):385-90 AB - The aim of this study was to assess whether preventive fissure sealants could be differentiated from sealant restorations. The problem of being unable to differentiate between these two tooth states has implications for practitioners and epidemiologists (Davies, 1990). One hundred and seventeen permanent molar teeth, all sealed with a clear sealant, were examined under two types of conditions. These were the Daray 'Versatile light'; mirror, wet teeth, and the Daray 'Operating light 2'; mirror, dry teeth. The subjects' records were subsequently consulted to provide the validating criteria. The results suggest that in a dental hospital environment, when a clear sealant material is in place, it is possible to differentiate between preventive fissure sealants and sealant restorations. It would seem, however, that the 'sealant-alone' variety of sealant restoration was the one most often mistaken for a preventive fissure sealant. The different examination conditions did not markedly affect the examiners' ability to differentiate between the two tooth stage. <17> UI - 93139342 AU - Anusavice KJ IN - Department of Dental Biomaterials, College of Dentistry, University of Florida, Gainesville 32610-0446. TI - Decision analysis in restorative dentistry. [Review] [74 refs] SO - Journal of Dental Education 1992 Dec;56(12):812-22 AB - Standardization of clinical decisions in restorative dentistry should be based on the tenets of the Hippocratic Oath. Although there is wide variability in preventive and operative treatment decisions, some of these decisions may lead along parallel courses to similar, clinically ethical outcomes. However, what parameters must be considered in judging the relative magnitude of positive and negative outcomes? This paper proposes several decision-making strategies for selecting optimum treatment plans for preventive and restorative situations. The caries-risk level of patients must first be identified in a systematic way and then it must be coupled with treatment options that are consistent with the potential future caries increment. A decision-tree approach and/or the treatment-index concept can then be applied to specific clinical conditions and preventive-restorative options to derive an "expected value" for each possible outcome. [References: 74] <18> UI - 93139344 AU - Hollender L IN - University of Washington, Department of Oral Medicine, Seattle 98195. TI - Decision making in radiographic imaging. [Review] [33 refs] SO - Journal of Dental Education 1992 Dec;56(12):834-43 AB - In 1987, the U.S. Department of Health and Human Services issued guidelines for prescription of dental radiographic examinations, and although these recommendations have been reprinted in several widely circulated publications, it seems that the adoption of these guidelines is far from common, even among U.S. dental schools. The recommended criteria are founded on the existing knowledge of prevalence and progression of the most common dental diseases and on the fact that occult diseases within the jaws are uncommon. There are, however, other factors that may influence the decision on the time and extent of a radiographic examination, which may lead to deviations from the suggested guidelines. These factors include: education, peer influence, patient's preference, legal considerations, the dentist's field of interest or specialty, the training of the staff, and practice routine. The diagnostic interpretation of radiographs is far from a completely objective process, even if it is a question as simple as the presence and/or extent of a carious lesion. Numerous studies have shown a large variation among observers, both with regard to the occurrence and extent of carious lesions, in bite-wing radiographs. Caries diagnosis is only one example of many situations where significant observer variation is found. The more complex the diagnostic task, the more variation can be expected. The effect of observer variation on treatment decisions regarding carious lesions is used as an example of the problems encountered daily in the dental practice. [References: 33] <19> UI - 93141225 AU - Wenzel A AU - Halse A IN - Royal Dental College, Aarhus, Denmark. TI - Digital subtraction radiography after stannous fluoride treatment for occlusal caries diagnosis. SO - Oral Surgery, Oral Medicine, Oral Pathology 1992 Dec;74(6):824-8 AB - The material in this study consisted of 38 fully erupted, extracted third molars without clinical cavitation in the occlusal surface. A radiograph was made of each tooth before and after 5, 10, and 20 minutes of stannous fluoride treatment. The radiographs were digitized and subtraction performed between the images obtained after stannous fluoride treatment and the pretreatment image. Two observers assessed the stannous fluoride treated radiographic and the subtraction images on a monitor: 0 = no change, 1 = intensity increase (white area interpreted as a carious lesion) in dentinoenamel area. Caries was assessed on conventional film radiographs made before treatment: 0 = no caries in dentin, 1 = caries in dentin. The presence of caries in dentin was validated histologically. Sensitivity for intensity increase as a sign of caries was overall higher for the subtraction images based on 20-minute treatment than for the radiographic images (0.025 > p > 0.01) but not significantly higher than for the conventional radiographs. However, neither observer gave false-positive scorings in the subtraction images, whereas observer 1 had five false-positive scorings on the conventional films. Observer 2 had none. The subtraction method did not provide a higher sensitivity for dentinal occlusal caries than conventional film radiography, but the intensity increase could be trusted more than the traditional radiolucency as a sign of a dentinal lesion. <20> UI - 93099759 AU - Bedi R AU - Sutcliffe P AU - Donnan P AU - Barrett N AU - McConnachie J IN - Department of Preventive Dentistry, University of Edinburgh, UK. TI - Dental caries experience and prevalence of children afraid of dental treatment. SO - Community Dentistry & Oral Epidemiology 1992 Dec;20(6):368-71 AB - The aim of this study was to examine the clinical outcome with regard to dental caries of high self reported dental anxiety in a group of Scottish secondary schoolchildren. 1103 children participated in the study, mean age 14 yr (sd 0.35 yr), and the prevalence of high dental anxiety was 7.1% (95% CI = 5.6%, 8.6%). When these children were compared with their contemporaries their DMFT and all its components were higher but only the mean MT reached statistical significance after adjusting for gender and social class. Children with a high dental anxiety were 62% more likely to have at least 1 missing tooth due to caries. In addition this group when compared to the rest of the study population, had a significantly lower mean number of teeth fissure sealed and a lower proportion of children with sealants. No similar trend was obvious for children who had a high general fear. The dentally anxious more accurately perceived their treatment need and were more likely to defer, cancel or not turn up for dental appointments. <21> UI - 93101916 AU - Hansen EK IN - Department of Dental Materials and Technology, Royal Dental College, Copenhagen, Denmark. TI - Dentin hypersensitivity treated with a fluoride-containing varnish or a light-cured glass-ionomer liner. SO - Scandinavian Journal of Dental Research 1992 Dec;100(6):305-9 AB - Dentin hypersensitivity in 112 teeth was randomly treated with Duraphat or Vitrabond. No patients were included unless they, without being asked, complained about daily pain for a long period of time caused by cold, warm, sweet, sour, touch or any combination of these five variables. Patients were excluded if the dentin hypersensitivity could have been caused by cervical abrasion/erosion lesions deeper than 1 mm, cracked-tooth syndrome, caries lesions, operative caries treatment, and/or periodontal surgery or root scaling within the last 6 months. The pain was registered on a binary scale: 1) pain before the treatment; and 2) pain/no pain after the treatment. With Duraphat, 22% of the treatments failed within 1 wk and the cumulative 1-yr success rate was 41%. With Vitrabond, 2% failed within the first week and the 1-yr success rate was 79%. The difference between the two treatments was highly significant. Patients in whom Duraphat failed were treated with Vitrabond and vice versa; the 1-yr success rate for the retreated teeth was 68% when "Duraphat-failures" were treated with Vitrabond and 42% when "Vitrabond-failures" were treated with Duraphat. <22> UI - 93085030 AU - Wenzel A AU - Verdonschot EH AU - Truin GJ AU - Konig KG IN - Department of Oral Radiology, Royal Dental College, Aarhus, Denmark. TI - Accuracy of visual inspection, fiber-optic transillumination, and various radiographic image modalities for the detection of occlusal caries in extracted non-cavitated teeth. SO - Journal of Dental Research 1992 Dec;71(12):1934-7 AB - Occlusal caries lesions may progress into the dentin without this resulting in a macroscopic breakdown of the enamel surface. Imaging methods may therefore be needed to aid in the visual detection of occlusal caries. It was the aim of this study to evaluate diagnostic accuracy in a laboratory set-up of visual inspection (VI), fiber-optic-transillumination (FOTI), conventional radiography (CR), and two digital radiographic image modalities (DRm and DRr) for detection of occlusal caries in clinically non-cavitated teeth. Eighty-one extracted third molars from 18-20-year-old males were assessed by four observers on a five-rank confidence scale by the five methods. Ground sections (500-600 microns) served as validation for true state of disease: 1 = no caries in dentin, 2 = caries just beyond dentino-enamel junction, or 3 = deep dentinal caries, halfway or more to the pulp. ROC analysis was performed on the basis of the confidence rank scale data on two diagnostic thresholds, T1 = caries in dentin (disease state 2+3) and T2 = caries deep in dentin (state 3). On the T1 level, use of the FOTI method gave on average the most accurate diagnosis, closely followed by VI, both performing better than use of radiography. On the T2 level, all five diagnostic methods performed equally well. <23> UI - 93085007 AU - Davis MH AU - Harden RM AU - Pitts NB IN - Centre for Medical Education, Ninewells Hospital and Medical School, Dundee, UK. TI - GDPs' and specialists' decisions in the management of fissure caries. SO - Journal of Dentistry 1992 Dec;20(6):345-7 AB - As part of a continuing education programme in dentistry, four specialists and 27 selected general dental practitioners were asked to rate 58 clinical management options relating to fissure caries in six simulated patient management problems called challenges. Their ratings are presented and the advantages and disadvantages of the approach are discussed. Areas of agreement and disagreement are highlighted and possible reasons for these explored. <24> UI - 93082550 AU - Davenport ES AU - Day S AU - Hardie JM AU - Smith JM IN - Department of Child Dental Health, London Hospital Medical College, UK. TI - A comparison between commercial kits and conventional methods for enumeration of salivary mutans streptococci and lactobacilli. SO - Community Dental Health 1992 Sep;9(3):261-71 AB - Mutans streptococci (ms) and lactobacilli levels were determined by conventional and commercial dip-slide methods in three groups of young subjects, aged 5-6 years (93 subjects), 12-13 years (78 subjects) and 18-20 years (81 subjects). Using the same paraffin-stimulated saliva samples, ms and lactobacilli were estimated by conventional viable counts on modified mitis-salivarius agar (MSB) and Rogosa agar plates, and by inoculation of Dentocult SM and Dentocult LB dip-slides (Orion Diagnostica, Finland). The salivary ms and lactobacilli counts obtained from conventional agar plates were significantly correlated (P < 0.0001) with the dip-slide estimates of these organisms (Kendal Tau = 0.56, 0.71 respectively). Subjects in Group 2 showed the highest proportion (77 per cent) of individuals with salivary ms levels above 2.5 x 10(5) cfu/ml saliva; 99 per cent of that group had detectable levels of lactobacilli. Significantly different median salivary ms and lactobacilli levels were demonstrated between all groups except for lactobacilli levels between Groups 2 and 3. These dip-slide tests provided suitable and simple methods for screening salivary lactobacilli and ms levels which may have a useful role in the assessment of caries risk. <25> UI - 93047805 AU - Kalsbeek H AU - Verrips E AU - Dirks OB IN - Department of Community Dental Health and Epidemiology, TNO Institute for Preventive Health Care, Leiden, The Netherlands. TI - Use of fluoride tablets and effect on prevalence of dental caries and dental fluorosis. SO - Community Dentistry & Oral Epidemiology 1992 Oct;20(5):241-5 AB - A study was executed to investigate the relation between the use of fluoride tablets by children in the age period 1.5-6 yr on the one hand and the caries experience at the age of 6 and 15 yr and the prevalence of fluorosis at the age of 15 yr on the other hand. The year of birth of the child, the motivation of the mother to engage in preventive dental behavior, the level of her school education and her place of birth were taken into account as possible confounding factors. A significant relation was found between the use of fluoride tablets and the prevalence of fluorosis. The most important predicting factor for the caries experience of the child was the mother's motivation to engage in preventive dental behavior. An effect of fluoride tablets on the caries experience could not be demonstrated. <26> UI - 93055795 AU - Cutress T AU - Howell PT AU - Finidori C AU - Abdullah F TI - Caries preventive effect of high fluoride and xylitol containing dentifrices. SO - ASDC Journal of Dentistry for Children 1992 Jul-Aug;59(4):313-8 AB - Dental examinations were conducted in 1987 on 520 of the 753 children who fully participated in a three-year field-trial, 1983-1986, of the anticaries effect of dentifrices containing fluoride and xylitol. The prevalence of decayed (D), missing (M) and filled (F) permanent teeth differed significantly among the five treatment groups. Caries prevalence was inversely related to the level of fluoride, 1250, 2500 and 5000 ppm, in the dentifrice used, but was not associated with the presence or absence of 15 mg percent xylitol. The age, number of children, and number of erupted teeth were unequally dispersed among treatment groups. The DMF teeth scores showed non-normal distributions and nonhomogeneous variances. Following an exploratory scrutiny, the DMFT data were transformed to normal distributions for intra- and inter-treatment-group evaluation. All groups showed positive, significant regressions of DMF scores with the age of the children and an inverse significant regression with DMFT scores in relation to the fluoride content of the dentifrice under test. <27> UI - 93055829 AU - Weems RA AU - Firestone AR AU - Heaven TJ IN - Department of Diagnostic Sciences, University of Alabama School of Dentistry, Birmingham. TI - Preliminary evaluation of an educational outcomes assessment process for dental interpretive radiography. SO - Journal of Dental Education 1992 Nov;56(11):746-50 <28> UI - 93041657 AU - Pollard MA AU - Curzon ME IN - Department of Child Dental Health, University of Leeds. TI - Dental health and salivary Streptococcus mutans levels in a group of children with heart defects. SO - International Journal of Paediatric Dentistry 1992 Aug;2(2):81-5 AB - One-hundred children aged 2-16 years who were attending the Outpatients Department of the Yorkshire Regional Cardiac Centre were examined for dental caries, gingivitis, plaque and calculus. A control group of 100 children was also examined. A saliva sample was taken from each child in the study group to assess the level of Streptococcus mutans colonization. Comparing study and control groups, dental caries experience (dmft) was significantly higher only in the primary teeth of 5-9-year-old children in the study group, and there were no significant differences in gingivitis, plaque or calculus. The S. mutans count was found to be positively correlated to the number of decayed teeth in the study group. <29> UI - 93065559 AU - Mjor IA AU - Toffenetti F IN - NIOM Scandinavian Institute of Dental Materials. TI - Placement and replacement of resin-based composite restorations in Italy. SO - Operative Dentistry 1992 May-Jun;17(3):82-5 AB - The use of resin-based composite restorations, the reasons for failure, and the longevity of these restorations have been surveyed in 62 Italian private practices. Almost two-thirds of the 1025 restorations inserted were class 3 and 5 restorations, while 18% were class 1 and 2 restorations. Secondary caries was the most common reason reported for replacement of resin-based composite restorations (44%), followed by discoloration (21%), and bulk and margin fracture (14%). The age of restorations needing replacement was reported for 53% of the sample. The median longevity in this sample was calculated to be 3.3 years. <30> UI - 93047816 AU - Arneberg P AU - Bjertness E AU - Storhaug K AU - Glennas A AU - Bjerkhoel F IN - Dental Faculty, University of Oslo, Norway. TI - Remaining teeth, oral dryness and dental health habits in middle-aged Norwegian rheumatoid arthritis patients. SO - Community Dentistry & Oral Epidemiology 1992 Oct;20(5):292-6 AB - The aim of the study was to assess the effect of rheumatoid arthritis (RA) upon dental health. A questionnaire was mailed to all seropositive rheumatoid arthritis (RA) patients aged 44-56 yr in the files of the two main departments of rheumatology in South Eastern Norway. Data were obtained from 125 patients, constituting 91% of the target group. The number of remaining teeth in these patients was not related to disease duration or physical dysfunction, whereas a relationship to prolonged use of medication for pain relief was indicated. Factors known to affect tooth loss in the general population, such as smoking habits, dental attendance, interdental cleaning habits, previous dental disease, and place of residence were found to be important in RA patients as well. The RA patients from Oslo had a mean number of 25 remaining teeth, which is the same as reported for the general Oslo population at this age. Oral dryness was reported by more than 50% of the RA patients, but was not related to the number of teeth. The conclusion is that serious and long lasting rheumatoid arthritis had little influence on the number of remaining teeth in this middle-aged group of Norwegians. <31> UI - 93047811 AU - Fyffe HE AU - Kay EJ IN - Department of Dental Health, Dental School, University of Dundee, Scotland. TI - Assessment of dental health state utilities. SO - Community Dentistry & Oral Epidemiology 1992 Oct;20(5):269-73 AB - The term "health state utility" implies the assigning of a numerical value to a state of health. Assessment of the success of health care procedures, using health state utilities, enables evaluation of available treatments and procedures in terms of differing health outcomes and therefore facilitates cost-benefit analyses. Although measurement of general health state utilities has become increasingly common in medicine using a variety of techniques, few attempts have as yet been made in dentistry to place valuations on different dental health states. The absence of tried and tested methods for measuring tooth quality make the benefits gained from preventive and restorative dental programmes difficult to quantify. The aim of this study was to assess the average utility values, held by a group of dentists and a group of members of the general public, for four different tooth states which it was hypothesised would have different values. These were 1) a decayed and painful posterior tooth; 2) a decayed and non-painful posterior tooth; 3) a posterior tooth which had been restored and would need further restorative treatment and 4) a permanently restored posterior tooth. A standard gamble questionnaire was used to elicit the utility values which were then substituted as "weightings" in a modified version of the "T-health" index (1). The results show that it is possible to assess dental health state utility values using the standard gamble method and that the average utility values of the dentists in the study were consistently higher than those of the general public.(ABSTRACT TRUNCATED AT 250 WORDS) <32> UI - 93047810 AU - Kay EJ AU - Nuttall NM AU - Knill-Jones R IN - Department of Dental Health, University of Dundee, Scotland. TI - Restorative treatment thresholds and agreement in treatment decision-making. SO - Community Dentistry & Oral Epidemiology 1992 Oct;20(5):265-8 AB - It has been recognised for many years that treatment decision-making among dentists often shows wide variation. This study sought to examine the effect of dentists' stated treatment thresholds as a source of variation between them. Twenty dentists made 360 treatment decisions about the approximal surface of extracted teeth seen in simulated bitewing radiographs. They also stated their personal treatment thresholds, i.e. the depth of lesion which they intended to restore. One hundred and ninety pairwise comparisons of treatment decisions showed that only 16% of the dentist pairs showed substantial agreement. Dentist pairs who reported that they held the same interventive threshold achieved exactly the same mean level of agreement in treatment decision-making as dentist pairs who disagreed about the appropriate threshold for restorative intervention. The study suggests that restorative thresholds which are reported to be used by dentists may be poorly correlated with the number of positive treatment decisions actually made. <33> UI - 93045694 AU - Aoba T AU - Moreno EC AU - Shimoda S IN - Forsyth Dental Center, Boston, MA 02115. TI - Competitive adsorption of magnesium and calcium ions onto synthetic and biological apatites. SO - Calcified Tissue International 1992 Aug;51(2):143-50 AB - Magnesium (Mg) is a conspicuous constituent of hard tissues but its possible role in biomineralization is poorly understood. It is possible that Mg2+ adsorbed onto bioapatites may contribute to the modulation of crystal growth as such inhibitory activity has been reported for synthetic apatites. The present study was undertaken to determine the adsorption isotherms of Mg ions onto synthetic apatites and biominerals in tooth and bone tissues in the presence of other ions of natural occurrence. Synthetic crystals used as adsorbents were hydroxyapatite and, as a better prototype for the biomineral, Mg-containing carbonatoapatite. Human enamel and dentin materials were obtained from extracted, caries-free, permanent teeth. Porcine dentin materials at two developmental stages were obtained from erupted deciduous and unerupted permanent teeth of a 6-month-old slaughtered piglet. Porcine bone was obtained from the cortical portion of the mandible of the same animal. All biomineral samples were pulverized and then treated by plasma ashing (deproteination) at about 60 degrees C. Each of the powdered samples was equilibrated in solutions containing various initial concentrations of Mg2+, Ca2+, and Na+ (or K+) as nitrate salts. Following equilibration, concentrations (and activities) of magnesium and calcium ions in the experimental solution were determined. The pH values of the equilibrium solutions were in the range of 6.2-6.5. Experimental data of the Mg adsorption onto hydroxyapatite were interpreted on the basis of a Langmuir-type model for binary systems assuming competition of Mg2+ and Ca2+ for the same adsorption sites on the crystal surfaces of the apatites.(ABSTRACT TRUNCATED AT 250 WORDS) <34> UI - 93045597 AU - Dibdin GH IN - Medical Research Council Dental Group, University of Bristol Dental School, UK. TI - A finite-difference computer model of solute diffusion in bacterial films with simultaneous metabolism and chemical reaction. SO - Computer Applications in the Biosciences 1992 Oct;8(5):489-500 AB - This finite-difference computer model is designed to simulate complex diffusion/reaction events in bacterial films. It is modular, each module mirroring closely a particular physical, chemical or biochemical factor. It is capable of handling > 20 diffusing/reacting species, but can be easily expanded or simplified to match particular systems. It was originally designed for modelling the events in dental plaque leading to tooth decay, but should find application in other fields. It allows for ion-exchange interactions with, for example, fixed charges on bacterial surfaces, which can act as pH and cation buffer sites. pH-dependent utilization of substrate is modelled implicitly, combining Michaelis-Menten kinetics with diffusion in a single iterative procedure. Advantages are given for computing diffusion of all other species explicitly using single-species diffusion coefficients, with charge-coupling by means of the algorithm Q-COUPLE. Activity corrections and enzyme pH-dependence are included. Chemical equilibria and mineral deposition/dissolution are computed iteratively node by node. The program is tested against some problems having analytical solutions, and an example is given of its application to demineralization of teeth as a result of bacterial action in dental plaque. <35> UI - 93012161 AU - Nummikoski PV AU - Martinez TS AU - Matteson SR AU - McDavid WD AU - Dove SB IN - University of Texas Health Science Center at San Antonio. TI - Digital subtraction radiography in artificial recurrent caries detection. SO - Dento-Maxillo-Facial Radiology 1992 May;21(2):59-64 AB - The diagnostic accuracy of digital subtraction radiography in detection of artificial recurrent caries lesions was assessed in this project. The use of digital subtraction radiography has been shown to markedly increase the accuracy of the detection of destruction in the periodontal bone, but the method has not been evaluated in secondary caries detection. Defects of three different sizes, simulating recurrent caries, were sequentially prepared in the interproximal cavity preparation margins of 28 teeth. Two composite restorative materials with different radiographic densities were used as posterior restorations, and a radiograph was obtained of each defect size and restorative material. The radiographs were digitized and subtracted from the reference images, and the conventional radiographs and the subtraction images were evaluated by seven observers. The data were analysed with ROC statistics. Subtraction radiography was found to be superior to conventional radiography in recurrent caries detection, mainly by reducing the false-positive diagnoses. The radiopacity of the restorative material had a significant effect on accuracy with conventional but not with subtraction radiography. <36> UI - 93012172 AU - Dove SB AU - McDavid WD IN - University of Texas Health Science Center, San Antonio. TI - A comparison of conventional intra-oral radiography and computer imaging techniques for the detection of proximal surface dental caries. SO - Dento-Maxillo-Facial Radiology 1992 Aug;21(3):127-34 AB - The detection of proximal surface caries by the visual interpretation of bitewing radiographs is known to be relatively inaccurate. The present study was designed to examine whether computer image processing could improve the diagnostic accuracy. A computer-aided, software-driven, TV-based system was used to digitize conventional radiographs and digitally process the images using histogram equalization and grey-scale inversion to enhance the images. The computer-enhanced images were compared with conventional intra-oral radiographs for the detection of proximal surface caries using receiver operating characteristic analysis. The results indicate that the digital image processing techniques used did not improve the diagnostic accuracy of dental radiographs. No significant difference in diagnostic accuracy could be detected between the non-enhanced digital images and conventional film-based images for the detection of proximal surface caries. <37> UI - 93014257 AU - Larmas M IN - Department of Preventive Dentistry and Cariology, University of Oulu, Finland. TI - Saliva and dental caries: diagnostic tests for normal dental practice. [Review] [21 refs] SO - International Dental Journal 1992 Aug;42(4):199-208 AB - Salivary diagnostics is now entering the surgery of the modern dentist, although no test yet available is so specific and sensitive that caries can be diagnosed from saliva samples only. The present tests are useful for estimating the caries activity due to bad dietary habits (salivary lactobacilli), establishing the presence of infection (salivary mutans streptococci), and identification of salivary yeasts for the determination of the medical condition of the patient. Buffer capacity reveals the most important host response factor acting against caries, while measures of flow rate form the diagnostic basis for treatment planning. These tests, alone or in combination, are now so easy to perform that they should be used in every dental practice. [References: 21] <38> UI - 93017475 AU - Kaminsky LS AU - Mahoney MC AU - Miller MJ IN - New York State Department of Health. TI - Fluoride: benefits and risks of exposure. The preparation of a report. SO - Journal of the American College of Dentists 1992 Fall;59(3):4-7 <39> UI - 93017291 AU - Weinstein P AU - Domoto P AU - Wohlers K AU - Koday M IN - Dental Public Health Sciences, University of Washington, Toppenish. TI - Mexican-American parents with children at risk for baby bottle tooth decay: pilot study at a migrant farmworkers clinic. SO - ASDC Journal of Dentistry for Children 1992 Sep-Oct;59(5):376-83 AB - Treatment of severe BBTD in very young children often requires the use of general anesthetic. In 1987, the cost was estimated at $700-$1,000; add another $1,000, if hospitalization is needed. Informal surveys of dentists across the country indicate that in 1991-1992, the cost of treatment has increased substantially. <40> UI - 93017472 AU - Atchison KA IN - Center for the Health Sciences, UCLA School of Dentistry. TI - The ethical issues of fluoridation. SO - Journal of the American College of Dentists 1992 Fall;59(3):14-7 <41> UI - 93020717 AU - Hunt RJ AU - Fann SJ AU - Kantor ML AU - Morris AL IN - College of Dentistry, University of Iowa, Iowa City. TI - Assessing dental practice quality by evaluating radiology items. SO - Journal of Public Health Dentistry 1992 Fall;52(5):264-8 AB - The DEMCAD dental office assessment instrument was developed to evaluate practice quality using Donebedian's quality assessment model of structure, process, and outcome. This previously validated instrument takes about six hours to complete. Subsequent analysis was undertaken to determine whether an abbreviated office assessment based on the evaluation of radiology items was sufficiently sensitive, specific, and practical to be used as a screening instrument for identifying dental offices with very low evaluation scores. Data for this analysis were obtained from 300 volunteer general dental practices evaluated in the field testing of the DEMCAD instrument. The nine radiology structure items predicted very poorly the overall structure scores. However, 13 radiology process items predicted overall process scores quite accurately. Four of the 13 radiology process items (periodontal diagnoses recorded, interdental bone shown on x-rays, caries diagnoses recorded, and current x-rays mounted) produced a combined R2 of .58. These four radiology variables predicted the 10 percent of the dental practices with the lowest overall process score with 87 percent sensitivity and 93 percent specificity. This analysis showed that an abbreviated dental practice process quality assessment using oral radiology items in an audit of patients' records may be feasible as a screening test for dental office assessment. <42> UI - 93020721 AU - McGuire SM IN - Department of Dental Care Administration, Harvard School of Dental Medicine, Boston, MA 02115. TI - A review of methods to forecast restorative treatment needs. [Review] [31 refs] SO - Journal of Public Health Dentistry 1992 Fall;52(5):292-8 AB - Decision makers in the areas of health policy, resource allocation, and manpower requirements rely implicitly on estimations of treatment needs on which to base their forecasts. The less specific the treatment-need estimate, the less precise the forecast. In previous decades, high caries rates were so prevalent that the dental profession could risk having inexact projections because overwhelming need and demand existed. However, rampant decay is no longer a common occurrence. Decay levels are declining in our nation's children and adults have fewer missing teeth. Therefore, restorative treatment needs and patterns in adult populations are transforming at a time when health care costs are spiraling and budget analysts at all levels of government are questioning the priority of continued support of dental care, dental education, and dental research at current levels. The purpose of this review is to present the existing methods of forecasting restorative treatment needs and to postulate the development of a new method based on the collective experiences of practicing dentists nationwide, an empirical method, to convert surface-specific oral health status data to restorative treatment need information. Need estimations based on empirical data would more accurately reflect the actual distribution of services that practicing dentists provide. [References: 31] <43> UI - 93026600 AU - Macpherson LM AU - MacFarlane TW AU - Geddes DA AU - Stephen KW IN - University of Glasgow Dental School. TI - Assessment of the cariogenic potential of Streptococcus mutans strains and its relationship to in vivo caries experience. SO - Oral Microbiology & Immunology 1992 Jun;7(3):142-7 AB - Strains of Streptococcus mutans isolated from the plaque of 6 subjects were studied using an in vitro model to determine whether differences in their cariogenic potential could be detected, and if so, whether the results correlated with the caries experience of the individuals. Each strain was incubated with a bovine enamel slab and 5% (w/v) sucrose for 24-h periods. The acidogenic potential was assessed by pH measurement and analysis of acid anion production. Microradiographic and microdensitometric assessment of the enamel, together with measurement of the change in calcium concentration of the reaction mixture were used to determine the demineralizing potential of each strain. Significant differences in cariogenic potential were found between some of the strains tested, and correlations were found between 3 of the test parameters and the decayed-missing-filled-surface score of the individuals. The results suggest that the caries experience of individuals may be related, to some extent, to the cariogenic potential of their S. mutans strains. <44> UI - 92399328 AU - Randell DM AU - Harth S AU - Seow WK IN - University of Queensland Dental School, Australia. TI - Preventive dental health practices of non-institutionalized Down syndrome children: a controlled study. SO - Journal of Clinical Pediatric Dentistry 1992 Spring;16(3):225-9 AB - Although Down syndrome children are known to be greatly predisposed to periodontal disease when compared with normal children, the preventive dental health practices of non-institutionalized Down syndrome children have not been well reported. This questionnaire study of 25 Down syndrome children aged 1-14 years compared with 25 normal control children showed that Down syndrome children have poorer dental health practices compared with normal children. Significantly greater numbers of Down syndrome children were weaned from the bottle at greater than 18 months of age (56% vs 24%, p less than 0.05) or had taken a bottle to bed (40% vs 12%, p less than 0.05), indicating their increased risk for the development of nursing bottle caries. In addition, Down syndrome children were receiving less help during tooth brushing (60% vs 84%, p less than 0.05), were older when they first visited the dentist, and less likely to be taking regular fluoride supplements. These results indicate that Down syndrome children are further disadvantaged by poor preventive dental health practices and should be targeted for increased preventive dental care. <45> UI - 92381695 AU - Joshi A AU - McDermott S AU - Marcus P AU - Douglass CW AU - Jette A IN - Department of Dental Care Administration, Harvard School of Dental Medicine, Boston, MA 02115. TI - Improving dental epidemiologic data collection with computers. SO - Journal of Public Health Dentistry 1992 Summer;52(4):232-8 AB - A computerized dental data recording system (DDRS) was developed for the New England Elder Dental Study to improve data quality and increase field staff efficiency. The DDRS displays video screens similar to traditional paper forms to record data on coronal and root caries, dentate and denture status, subacute bacterial endocarditis screening, gingival bleeding, calculus, and periodontal attachment level. DDRS provides facilities for date and exam-component time tracking, on-line contextual comments, random record retrieval, editing, data backup, and data output in various data formats. This study compared the DDRS with a paper-form system for data entry accuracy. Dental caries and periodontal disease measurement data from 38 subjects were recorded on paper forms and independently entered using DDRS. The DDRS identified 150 illogical data errors, 39 inconsistent data errors, 7 invalid data and 34 miscellaneous data errors. Four technicians with field experience using both paper forms and DDRS reported time savings using DDRS in the field. DDRS has the potential for additional time savings by minimizing the time for data coding, cleaning, and management. Results demonstrate that DDRS could improve the quality of oral epidemiologic data by mandating strict adherence to protocols, preventing errors, and increasing field efficiency. <46> UI - 92405513 AU - Jones RB AU - McCallum RM AU - Kay EJ AU - Kirkin V AU - McDonald P IN - Department of Public Health, University of Glasgow, UK. TI - Oral health and oral health behaviour in a population of diabetic outpatient clinic attenders. SO - Community Dentistry & Oral Epidemiology 1992 Aug;20(4):204-7 AB - The control of oral health in individuals suffering from diabetes mellitus may affect a diabetic individual's insulin requirements. This study examined the oral health status and behaviours of a group of diabetic patients and compared the results to those obtained in a recent UK national survey of oral health. The results showed that, despite reporting higher levels of oral self-care, the diabetic population suffered from higher rates of caries than "normal" individuals. These differences could not be accounted for by the treatment received from dentists. It is concluded that diabetic patients are more caries prone than the general population and that the cause of this difference should be sought, as the traditional aetiological agent for caries cannot account for the increased caries rate. If the aetiology of the findings of this study were determined, progress could be made in the search for indicators of increased caries risk. <47> UI - 92405508 AU - Lith A AU - Grondahl HG IN - Department of Oral Radiology, School of Dentistry, University of Gothenburg, Sweden. TI - Intervals between bitewing examinations in young patients when applying a radiologic algorithm. SO - Community Dentistry & Oral Epidemiology 1992 Aug;20(4):181-6 AB - Every prescription of a radiograph should be based on an evaluation of the individual patient benefit. An algorithm developed to make it possible to individualize the frequency of bitewing radiographs was applied on a group of young patients in order to evaluate if its application could increase the time intervals between bitewing examinations. The time intervals between bitewing examinations actually performed on 221 patients from exfoliation of all primary teeth up to and including 18 yr of age were determined. The number of surfaces with carious lesions as well as restorations in the posterior approximal surfaces were diagnosed from the radiographs. The intervals between bitewing examinations according to the algorithm were estimated and compared to the actual ones. For most patients the time intervals between examinations increased when the algorithm was applied, without a concomitant risk of missing lesions developing into the deeper parts of the dentin. The results render support to an individualized scheduling of bitewing radiographs based on number of and extent of approximal lesions in baseline radiographs. <48> UI - 92405507 AU - Mileman PA AU - Mulder E AU - van der Weele L IN - Department of Oral Radiology, Free University, Amsterdam, The Netherlands. TI - Factors influencing the likelihood of successful decisions to treat dentin caries from bitewing radiographs. SO - Community Dentistry & Oral Epidemiology 1992 Aug;20(4):175-80 AB - The purpose of this study was to describe the role played by the ability to estimate caries depth in successfully deciding to treat dentin caries when making use of bitewing radiographs as a diagnostic test. A 10% random sample (n = 444) of Dutch dental practitioners was sent a two-wave questionnaire concerning radiographic caries diagnosis and restorative treatment decision making. The second wave consisted of simulated bitewing radiographs of 105 tooth surfaces with and without dentin caries according to two measuring standards: (a) a micro-radiographic "gold" standard and (b) a norm of expert observers. The dentists were asked to diagnose caries at 4 depths of penetration using a 5-point certainty scoring system to measure diagnostic ability; and to make a treatment decision for each surface. The overall response was 61% (273). A regression analysis was carried out using the chance per dentist of correctly deciding to treat dentin caries as the dependent variable. The degree of agreement with the experts' diagnosis of radiographic caries depth was used to create variables measuring diagnostic ability. Five significant (P less than 0.05) variables explained 60% (R2 = 0.60) of the variation in decision making. The best diagnostic ability variable explained 47% of the variation while the treatment criterion reportedly used explained 3%. We conclude that the ability of practitioners to interpret radiographs plays a major role in treatment decision making and that their reported treatment decision making criteria should not be taken at face value. <49> UI - 92393776 AU - Pitts NB AU - Rimmer PA IN - Department of Dental Health, Dental School, Dundee, UK. TI - An in vivo comparison of radiographic and directly assessed clinical caries status of posterior approximal surfaces in primary and permanent teeth. SO - Caries Research 1992;26(2):146-52 AB - At general dental practices in Scotland 211 children between the ages of 5 and 15 years were examined by 1 observer. A comparison of the status of 1,468 permanent and 756 primary posterior approximal surfaces was made on the basis of their appearance on posterior bite-wing radiographs and the findings of a direct in vivo visual examination, made after temporary tooth separation had been achieved over 1 week using elastomeric separation. For permanent tooth surfaces, 0% of radiolucencies in the outer half of enamel, 10.5% in the inner half of enamel, 40.9% extending to the outer half of dentine, and 100% extending to the inner half of the dentine were found clinically to be cavitated. The analogous results for primary teeth were that 2.0, 2.9, 28.3, and 95.5%, respectively, of radiolucencies appeared to be cavitated. Although further research with larger numbers of permanent teeth is indicated, these results may contribute to a re-evaluation of the optimal threshold for restorative intervention at approximal sites. Greater numbers of approximal radiolucencies and carious lesions (p less than 0.001) were found in those surfaces which initially had a normal anatomical contact when compared to those which did not. <50> UI - 92371522 AU - D'Hoore W AU - Van Nieuwenhuysen JP IN - School of Public Health, Catholic University of Louvain, Brussels, Belgium. TI - Benefits and risks of fluoride supplementation: caries prevention versus dental fluorosis. SO - European Journal of Pediatrics 1992 Aug;151(8):613-6 AB - To assess the risks (dental fluorosis) and the benefits (caries prevention) of fluoride (F) tablets and F toothpaste, we surveyed 2003 schoolchildren aged 5-20 years old (mean = 10.82, SD = 3.40). Children were scored for dental caries by means of the decayed, missing, filled teeth index (DMFT index). Frequent use of F toothpaste (toothbrushing frequency) is poorly linked to caries (Spearman r = 0.05, P = 0.02) and dental fluorosis (r = 0.05, P = 0.03). Children who use F tablets regularly and appropriately exhibit mild fluorosis more often than non- or occasional users (odds ratio = 9.58), and have a mean DMFT index 50% lower than other children. We conclude that using F tablets is an effective means of preventing caries. When used appropriately in non fluoridated areas, using F tablets results in minor damage. <51> UI - 92372783 AU - Blake-Haskins JC AU - Mellberg JR AU - Snyder C IN - Colgate Palmolive Company, Technology Center, Oral Research and Development Division, Piscataway, New Jersey 08854. TI - Effect of calcium in model plaque on the anticaries activity of fluoride in vitro. SO - Journal of Dental Research 1992 Aug;71(8):1482-6 AB - The uptake of calcium by a polysaccharide (agarose) gel used as a model for plaque from a two-step treatment (consisting of a calcium rinse followed by a fluoride treatment) and the effect of the deposited calcium in model plaque on caries lesion formation in enamel were determined. Calcium uptake was measured by treatment of the model plaques with [45Ca]-CaCl2 solutions with or without NaF. A two-step treatment consisting of calcium followed by fluoride produced a 100% increase in calcium content of model plaque, presumably due to the formation of CaF2, compared with a treatment with artificial saliva followed by calcium alone. The effects of these increased plaque minerals on caries lesion formation were studied by subjecting model-plaque-covered enamel blocks to a cyclic demineralization-remineralization treatment. Artificial-plaque-covered enamel blocks were treated daily with 180 ppm calcium for ten min, then 100 ppm fluoride for ten min, followed by demineralization for 16 h, and finally, remineralization for seven h and 40 min. After five days, the blocks were sectioned, and lesion formation was determined by microradiography-microdensitometry. Artificial plaque treated with a calcium rinse followed by a fluoride rinse reduced lesion size by 90%, compared with a 68% reduction by a fluoride rinse alone. When the experiment was repeated with a simulated pre-brush calcium rinse (180 ppm calcium) followed by a fluoride dentifrice suspension (110 ppm fluoride), lesion size was reduced by 46%, compared with a 32% reduction by the fluoride dentifrice suspension alone. <52> UI - 92350867 AU - Mormann W AU - Krejci I IN - University of Zurich, Dental Institute, Switzerland. TI - Computer-designed inlays after 5 years in situ: clinical performance and scanning electron microscopic evaluation. SO - Quintessence International 1992 Feb;23(2):109-15 AB - Eight mesio-occlusodistal adhesive inlays, fabricated from ceramic blocks using a computer-aided design/machining method, were reexamined after 5 years of clinical service. The inlays wre evaluated according to modified US Public Health Service criteria. The results indicated excellent clinical performance, with eight Alfa ratings for wear, recurrent caries, and color match, and five Alfa and three Bravo for marginal discoloration and marginal integrity. Under scanning electron microscope, 81.0% of the tooth-cement interfaces and 84.1% of the cement-inlay interfaces were rated continuous at the occlusal margin. Axially, 73.6% of the tooth-cement interfaces and 87.0% of the cement-inlay interfaces were rated continuous. Although this long-term investigation revealed good clinical performance of the inlays, improvements in the ceramic structure and its properties, the cavosurface design, and the luting composite resin were recently introduced to further optimize quality. <53> UI - 92375494 AU - Ruttimann UE AU - Webber RL AU - Hazelrig JB IN - Diagnostic Systems Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, Md. TI - Fractal dimension from radiographs of peridental alveolar bone. A possible diagnostic indicator of osteoporosis. SO - Oral Surgery, Oral Medicine, Oral Pathology 1992 Jul;74(1):98-110 AB - The purpose of this study was to investigate whether a radiographic estimate of osseous fractal dimension is useful in the characterization of structural changes in alveolar bone. Ten dry mandibular bone segments were radiographed from three controlled projection angles (-5, 0, +5 degrees), before and after acid-induced partial decalcification. Fractal dimension was estimated by regression analysis of power spectra computed by Fourier transform of selected regions of interest in digitized images of the radiographs. Repeated-measures ANOVA showed that fractal dimension so determined varied over anatomic locations (p less than .01), but increased after acid-induced demineralization (p less than .0005), irrespective of the radiographic projection angles (p greater than .99). In vivo fractal dimension was computed from randomly selected intraoral radiographs of six premenopausal (ages, 32.8 +/- 3.9) and six postmenopausal (ages, 62.5 +/- 4.1) women. A significantly (p less than .01) higher fractal dimension was observed in the older group. <54> UI - 92358874 AU - Linke HA AU - Moss SJ IN - Department of Microbiology, New York University Dental Center. TI - Quantitation of carbohydrate sweeteners and organic acids in human oral fluid using HPLC analysis. SO - Zeitschrift fur Ernahrungswissenschaft 1992 Jun;31(2):147-54 AB - A sensitive high performance liquid chromatography (HPLC) assay was developed for the qualitative and quantitative determination of carbohydrate sweeteners and organic acids in oral fluid. To separate these compounds, an ion-moderated partition resin HPLC column (Aminex HPX-87H) was used. All components of the HPLC system were interconnected using stainless steel capillary tubing. Isocratic elution with 0.01N sulfuric acid provided the profile of both compound classes. The compounds were detected using a refractive index detector. The method employed computerized data collection and integration (Omega-2 system) with a detection sensitivity of 0.1 micrograms compound per HPLC assay (80 microliters). This method is useful in caries research, because it detects minute amounts of sugars and organic acids in oral fluid during clearance studies of various foods in the mouth. <55> UI - 92375412 AU - Pearce EI AU - Cutress TW AU - Sissons CH AU - Coote GE IN - Dental Research Unit, Health Research Council of New Zealand, Wellington. TI - Supplementation of domestic sugar (sucrose) with fluoride. Effects on experimental dental caries, plaque pH, and fluoride levels in plaque and enamel. SO - New Zealand Dental Journal 1992 Jul;88(393):84-8 AB - The minimum amount of fluoride which, when added to sucrose, will reduce caries in an intra-oral test was determined. Removable lower-arch appliances were worn by three adult subjects for 1 week, during which time plaque-covered enamel on one side was immersed in a 10 percent sucrose solution containing fluoride for 10 minutes four times per day. The effect of sucrose alone (control) was similarly determined on the other side of the appliance. Concentrations of 2 and 5 ppm F in sucrose solutions (20 and 50 ppm F dry weight) produced highly significant reductions in experimental caries of 43 and 44 percent respectively. A reduction in enamel dissolution due to re-precipitation of fluoride-rich apatite is probably largely responsible for the anti-caries effect. However, decreased plaque acid production may also play a role since the addition of 1 ppm F to 5 percent sugar reduced the plaque pH drop in artificial mouth experiments. Our results substantiate previous reports that fluoridation of sucrose to a level of 20 to 50 ppm F dry weight has potential benefits in caries prevention and may be useful when the F intake is otherwise low. <56> UI - 92370487 AU - Downer MC TI - The quality of caries data from the national and BASCD surveys [editorial]. SO - Community Dental Health 1992 Jun;9(2):107-8 <57> UI - 92308487 AU - Pollard MA AU - Curzon ME IN - Dept. of Child Dental Health, School of Dentistry, University of Leeds, England. TI - Conference report: the efficacy of caries-preventive strategies. SO - Journal of Dental Research 1992 Jun;71(6):1345-6 <58> UI - 92335779 AU - Nytun RB AU - Raadal M AU - Espelid I IN - Department of Pedodontics, School of Dentistry, University of Bergen, Norway. TI - Diagnosis of dentin involvement in occlusal caries based on visual and radiographic examination of the teeth. SO - Scandinavian Journal of Dental Research 1992 Jun;100(3):144-8 AB - The purpose of the present study was to examine the validity of visual, radiographic and combined visual-radiographic examination of occlusal caries, with special reference to the diagnosis of dentin lesions, using the microscopic diagnosis after sectioning the teeth as validating criterion. Thirty extracted permanent molar teeth with signs of occlusal caries were selected and radiographed using a standard method similar to bitewing. Ten dentists, five from the Department of Cariology and Endodontics and five from the Department of Pedodontics, were asked to make a visual, radiographic and combined visual-radiographic caries examination with an interval of at least 1 month between different examinations. The teeth were sectioned bucco-lingually and the caries assessed as enamel or dentin lesion in a stereomicroscope. The sensitivity/specificity of the diagnoses of dentin lesions was 0.72/0.41 for the visual, 0.66/0.50 for the radiographic, and 0.86/0.64 for the combined visual-radiographic examinations. The Receiver Operating Characteristic (ROC) method revealed a statistically significant difference between combined visual-radiographic examination and the two other, but not between the isolated visual or radiographic examination. It is concluded that the combined use of visual and radiographic examination is better than either visual or radiographic examination alone. <59> UI - 92336743 AU - Bjertness E AU - Eriksen HM IN - Department of Epidemiology, National Institute of Public Health, Oslo, Norway. TI - Design of a socio-ecologic caries model and testing on 50-year-old citizens of Oslo, Norway. SO - Acta Odontologica Scandinavica 1992 Jun;50(3):151-62 AB - The purpose of the present study was to design a socio-ecologic caries model based on a general health model and to test the fit of data collected from a random sample of 200 50-year-old Oslo citizens to this designed model. The intention was also to investigate the relative importance of the four items environmental, behavioral, human biology, and health care organization factors. The dependent variable, number of carious surfaces, was recorded clinically and radiologically. The mean number of carious surfaces was 3.0 (SD, 3.5), with a range from 0 to 17, and the four items explained 5%, 25%, 28%, and 13% of the variance in number of carious surfaces, respectively. The complete model explained 42%, whereas traditionally used variables on the basis of the Keyes triad explained only 22% of the variance. The findings from the present study indicate that dental caries is a multifactorial disease with both behavioral and biologic determinants, and the socio-ecologic caries model represents a relevant supplement to the Keyes triad. <60> UI - 92332854 AU - Qvist V AU - Johannessen L AU - Bruun M IN - Department of Cariology and Endodontics, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Denmark. TI - Progression of approximal caries in relation to iatrogenic preparation damage. SO - Journal of Dental Research 1992 Jul;71(7):1370-3 AB - The aim of the present study was to evaluate the effect of iatrogenic preparation damage on the need for operative caries treatment of approximal surfaces, adjacent to Class II amalgam restorations. The material was collected by 77 dentists from the Public Dental Child Health Service in Denmark. It consisted of die-stone models of 187 first-time Class II preparations, adjacent to 190 unfilled approximal surfaces of 58 primary and 132 permanent teeth. The cavity preparations were performed in children between 4 and 17 years of age. They were all filled with amalgam. Information about operative treatment and exfoliation or extraction of the preparation teeth and the adjacent teeth during the following seven years was obtained from the patients' records. Stereomicroscopic examination of the models revealed preparation damage on 64% of the unfilled approximal surfaces in primary teeth and on 69% of the corresponding test surfaces in permanent teeth. During the observation period, operative treatment was performed on 10% of the undamaged test surfaces in primary teeth and on 35% of the damaged ones (p less than 0.05). The corresponding figures for test surfaces in permanent teeth were 6% and 15% (p less than 0.05). It is concluded that iatrogenic preparation damage is a frequent side-effect of operative intervention with approximal caries lesions, and represents a dental health problem, since the damage increases caries progression and the perceived need for restorative therapy of the adjacent teeth. <61> UI - 92332853 AU - Navazesh M AU - Christensen C AU - Brightman V IN - University of Pennsylvania School of Dental Medicine, General Clinical Research Center, Philadelphia. TI - Clinical criteria for the diagnosis of salivary gland hypofunction. SO - Journal of Dental Research 1992 Jul;71(7):1363-9 AB - There is considerable difficulty in the making of initial clinical decisions as to whether a given patient has salivary gland hypofunction, and hence requires additional salivary gland evaluation. This study identified a set of four clinical measures that, together, successfully predicted the presence or absence of salivary gland hypofunction. The four measures were: dryness of lips, dryness of buccal mucosa, absence of saliva produced by gland palpation, and total DMFT; they were derived from discriminant analysis of data collected from 71 individuals with normal and low salivary flow rates. These measures are proposed as criteria for clinical decision-making, as well as for classification of patients in studies of salivary gland dysfunction syndromes. This study also identified unstimulated whole salivary flow rates of 0.12-0.16 mL/min as the critical range separating individuals with salivary gland hypofunction from those with normal gland function. <62> UI - 92331086 AU - Downer MC AU - Worthington HV IN - Institute of Dental Surgery, Eastman Dental Hospital, London, UK. TI - The status of bite-wing radiographs in enhancing discriminatory ability in caries prophylactic clinical trials. SO - Caries Research 1992;26(3):195-200 AB - Data were taken from six randomised controlled trials of caries prophylactic agents in order to investigate the capacity of bite-wing radiographs of posterior approximal tooth surfaces to enhance discrimination between test and control group measurements. The findings showed that, where an active control agent was employed, the addition of radiographic to clinical examination data failed to improve discriminatory power in comparisons between 3-year caries increments. <63> UI - 92331085 AU - Wenzel A AU - Fejerskov O IN - Department of Oral Radiology, Royal Dental College, Aarhus, Denmark. TI - Validity of diagnosis of questionable caries lesions in occlusal surfaces of extracted third molars. SO - Caries Research 1992;26(3):188-94 AB - This study was to evaluate the accuracy of visual inspection, conventional radiography, and digital radiographic methods for the detection of occlusal carious lesions in third molars from a present-day adolescent population. Seventy-eight third molars, considered clinically to be without occlusal cavities, were extracted from young soldiers. Before extraction, an intra-oral radiograph was obtained. After extraction, the teeth were examined visually as per the criteria: 0 = no caries, 1 = chalky/stained fissure indicative of enamel caries, 2 = chalky and dark-stained fissure considered indicative of a dentinal lesion, and 3 = as per criterion 2, but with small surface defects (microcavities). The radiographs were digitised, and image enhancement with contrast stretch and a filtering procedure was performed, respectively. The three types of radiographic image were assessed as per the criteria: 1 = no caries/caries confined to enamel, 2 = caries involving the outermost dentine, and 3 = deep dentinal caries extending half-way or more to the pulp. Ground sections (500-600 microns in thickness) served as validation for lesion depth. The digital radiographic method with contrast stretch performed overall best of the four methods (greater than 70% detection rate) while visual inspection (53% detection rate) performed better than conventional radiography (48% detection rate). When results from visual inspection and conventional radiography were combined, an increase in the detection rate of 11% was obtained with a 7% increase in false-positive scorings. When digitally contrast-manipulated radiographs were combined with visual inspection, a gain of 33% was obtained with an 11% increase in false positives.(ABSTRACT TRUNCATED AT 250 WORDS) <64> UI - 92328680 AU - Dawson AS AU - Makinson OF IN - Royal Australian Air Force. TI - Dental treatment and dental health. Part 2. An alternative philosophy and some new treatment modalities in operative dentistry. SO - Australian Dental Journal 1992 Jun;37(3):205-10 AB - In this, the second of two papers on the relationships between dental treatment and dental health, the philosophical basis of Minimum Intervention Dentistry is presented. This approach to patient care has several distinct treatment modalities. These range from preventive measures and fissure sealants, through monitoring carious lesions for active progression or arrest, to minimal cavity designs such as tunnel preparations and preventive resin restorations which employ adhesive dental restorative materials. This paper discusses these techniques and the implications of this change in philosophy for dental teaching, research and manpower considerations. <65> UI - 92314995 AU - Masalin K IN - Finnish Dental Care Ltd., Helsinki. TI - Caries-risk-reducing effects of xylitol-containing chewing gum and tablets in confectionery workers in Finland. SO - Community Dental Health 1992 Mar;9(1):3-10 AB - Two-hundred and thirty-two workers who had taken part in a comprehensive study on occupational risks in the Finnish confectionery industry and who were still in the same employment, were tested for their willingness to use xylitol-containing products for caries prevention and for the effects of voluntary use of these products on their caries-promoting salivary characteristics. Xylitol-sorbitol chewing-gum and xylitol tablets were provided at the places of work for free use over a three-month period. The consumption was measured, the workers were asked for their opinions of the xylitol, and the effects of the products used on salivary characteristics were studied by means of a caries-risk index. Eighty-six per cent of the workers on the production lines reported having used xylitol-containing products during the study period. About 70 per cent consumed on average either 6.9 pieces of chewing-gum (range 0-20) or 1.2 tablets (range 0-15) per day. Eighty-one per cent thought that use of xylitol was good for their dental health. Five per cent thought the opposite. Use of xylitol-containing products was found to increase salivary flow and salivary buffer capacity of the subjects. A decrease in the number of workers with high salivary S. mutans count was observed. On examining shifts from risk groups to non-risk groups, a statistically significant positive change was noted. The results indicate that an ordinary commercial xylitol-containing chewing-gum can be used to decrease caries risk factors in confectionery workers. <66> UI - 92315117 AU - Rifat S TI - Fluoridation: a prophylaxis program for dental caries and dementia? [editorial]. SO - Canadian Journal of Public Health. Revue Canadienne de Sante Publique 1992 Mar-Apr;83(2):93-6 <67> UI - 92325278 AU - Inokoshi S AU - Van Meerbeek B AU - Willems G AU - Lambrechts P AU - Braem M AU - Vanherle G IN - Department of Operative Dentistry and Dental Materials, Catholic University of Leuven, Belgium. TI - Marginal accuracy of CAD/CAM inlays made with the original and the updated software. SO - Journal of Dentistry 1992 Jun;20(3):171-7 AB - The software driving the Cerec CAD/CAM system has recently been updated. In this study, the marginal accuracy of computer-machined porcelain inlays was determined using the original and the updated software. Two types of MOD cavities in Frasaco resin teeth were prepared with either sharp or rounded box corners. The distance of the occlusal and proximal marginal interface was determined using a measuring microscope. The mean occlusal interfacial distance was 52 microns for both programs. Only the box corners showed a significantly larger space, of which the mean value was approximately 200 microns. The updated version improved the marginal accuracy at the box corners. Further reduction of the interfacial distance was accomplished by rounding the sharp box corners. <68> UI - 92323882 AU - Kay EJ AU - Knill-Jones R IN - Department of Dental Health, University of Dundee, Scotland. TI - Variation in restorative treatment decisions: application of Receiver Operating Characteristic curve (ROC) analysis. SO - Community Dentistry & Oral Epidemiology 1992 Jun;20(3):113-7 AB - It has been evident for many years that dentists, when planning treatment for patients, do not act in a standard manner, and previous research has shown there to be wide variations in treatment planning amongst groups of dentists. Signal detection theory and Receiver Operating Characteristic (ROC) analysis allows measurement of an observer's ability to detect a lesion, while at the same time allowing examination of how a lesion, once perceived, is judged to be in need of treatment. An ROC curve is constructed by plotting the sensitivity (or true positive rate) of decisions made, against the false positive rate (equivalent to 1-specificity) when various decision attitudes, from interventionist to non-interventionist, are held. Fifteen pairs of simulated bitewing radiographs were shown to 20 dentists, who were asked to specify, for each approximal lesion, whether or not they would place a conventional restoration. The 7200 decisions made by the dentists were validated by sectioning and microscopically examining the teeth. The mean sensitivity of the dentists' decisions, when the strictest operating thresholds were held and caries into dentine was the validating criterion, was 0.26 and the mean specificity was 0.96. ROC analysis shows that when operating at the strictest threshold, the dentists were implying that specificity was weighted as being 2.7 times more important than sensitivity. ROC analysis leads to insight into how dentists differentially weight the true and false, positive and negative, outcomes of their decisions and thus allows explanation of why two dentists would rarely make exactly the same treatment plan for one patient, and also why different treatments might be offered to two patients exhibiting the same levels of disease. <69> UI - 92317512 AU - Peterson LJ IN - Department of Oral and Maxillofacial Surgery, College of Dentistry, Ohio State University, Columbus 43210. TI - Rationale for removing impacted teeth: when to extract or not to extract [see comments]. [Review] [22 refs] CM - Comment in: J Am Dent Assoc 1992 Oct;123(10):14 SO - Journal of the American Dental Association 1992 Jul;123(7):198-204 AB - Age, crowding, disease and root resorption all influence the decision to remove impacted teeth. While not every impacted tooth causes a significant problem, each has that potential. [References: 22] <70> UI - 92321097 AU - Dubowitz H AU - Feigelman S AU - Zuravin S AU - Tepper V AU - Davidson N AU - Lichenstein R IN - Department of Pediatrics, University of Maryland School of Medicine, Baltimore 21201. TI - The physical health of children in kinship care. SO - American Journal of Diseases of Children 1992 May;146(5):603-10 AB - OBJECTIVE--The objectives of this study were to assess the current and chronic health problems and the adequacy of primary health care of children placed with a relative (kinship care) by a public agency. RESEARCH DESIGN--Population survey. SETTING--Children in kinship care in Baltimore, Md. PARTICIPANTS--Four hundred seven (78%) of 524 children in kinship care in 1989. INTERVENTIONS--None. MEASUREMENTS/MAIN RESULTS--Information on the child's health status and care was obtained via a review of medical records; questionnaires sent to primary care physicians, parents, care givers, and caseworkers; and clinical assessment of the child by a nurse, pediatrician, and child psychologist. The children were found to have health problems similar to those in foster and poor children, but more problems than American children in general. Frequent diagnoses included impaired visual acuity and hearing, obesity, dental caries, and asthma; often, these problems had not been identified or treated. Gaps in the medical records precluded firm conclusions concerning the children's primary care, but suggest an inadequate system for ensuring their health care. CONCLUSIONS--There is a need for improving the system of health care for children in kinship care. There is also a need for additional research on this high-risk group of children. <71> UI - 92284132 AU - Newbrun E IN - School of Dentistry, University of California San Francisco 94143-0512. TI - Preventing dental caries: current and prospective strategies. [Review] [42 refs] SO - Journal of the American Dental Association 1992 May;123(5):68-73 AB - Strategies of caries prevention can be directed at the resistance of the host/teeth, at the diet, at the microflora or all three. The appropriate preventive interventions depend on the level of caries risk. [References: 42] <72> UI - 92299739 AU - Mellberg JR AU - Petrou ID AU - Grote NE IN - Colgate-Palmolive Company, Technology Center, Piscataway, New Jersey 08854. TI - A study of the ability of an in situ remineralization model to differentiate between the effects of two fluoride dentifrices that produced significantly different clinical caries results. SO - Journal of Dental Research 1992 May;71(5):1169-72 AB - The purpose of this study was to determine whether an in situ remineralization model was able to show a difference in the effects of two dentifrices of different fluoride concentrations and significantly different clinical efficacies. Three dentifrices were tested in a double-blind, cross-over study design. The products contained 0 ppm F, 250 ppm F, or 1000 ppm F from sodium fluoride and were formulated with a silica base according to the formulations used in a human caries trial (Koch et al., 1990). Nineteen subjects each carried three or four thin sections of enamel in their partial dentures. The thin sections, containing artificial caries lesions, were covered with a steel mesh to provide space for plaque formation and then brushed in situ three times daily with the dentifrices. Following the two-week treatment periods, the specimens were removed from the dentures and analyzed for changes in mineral content. The findings showed that the placebo dentifrice (0 ppm F) resulted in 56.8 +/- 74.3% demineralization, the 250-ppm-F dentifrice produced 12.9 +/- 41.3% demineralization, thereby showing partial caries protection, and the 1000-ppm-F dentifrice produced 17.3 +/- 32.1% remineralization. Linear regression analysis showed that the percent remineralization was significantly related to the fluoride concentration in the dentifrice (p less than 0.001). The 250-ppm-F dentifrice was also significantly less effective than the 100-ppm-F dentifrice (p = 0.04, one-tailed Fisher Protected LSD test). These findings are in accord with the human caries trial and support the use of the present in situ remineralization model for prediction of the anticaries efficacy of fluoride dentifrice products. <73> UI - 92277495 AU - Selwitz RH AU - Colley BJ AU - Rozier RG IN - Epidemiology and Oral Disease Prevention Program, National Institute of Dental Research, National Institutes of Health, Bethesda, MD 20816. TI - Factors associated with parental acceptance of dental sealants. SO - Journal of Public Health Dentistry 1992 Spring;52(3):137-45 AB - Whereas a number of surveys have documented oral disease preventive behaviors and associated factors, little is known about public knowledge and beliefs about dental sealants. In this study, factors associated with the presence of sealants were studied in first and second graders residing in Columbia, SC. From a sample of 1,119 children, 88 were found clinically to have sealants; 508 did not have, but needed them. Parents of the sealant children (n = 87) and of a random sample of the no-sealant children (n = 289) were interviewed by telephone to obtain information regarding (1) factors related to parents' inclination to obtain sealants for their children, (2) ability of the family to obtain oral disease preventive services, and (3) the influence of others in the family's decision-making efforts. Analysis of 16 factors thought to be related to sealant presence revealed that parents were more likely to obtain dental sealants for their children if dentists or their staffs recommended them, if the parents were knowledgeable about dental sealants, if the parents were more highly educated, and if the parents had dental insurance coverage. Parents were less likely to obtain dental sealants for their children if they heard about them from mass media. The latter finding is unexpected and may have been influenced by conflicting or negative opinion expressed by some dental practitioners through mass media or other channels of communication.(ABSTRACT TRUNCATED AT 250 WORDS) <74> UI - 92276626 AU - Featherstone JD TI - Consensus conference on intra-oral models: evaluation techniques. [Review] [0 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:955-6 <75> UI - 92276625 AU - Wefel JS IN - College of Dentistry, University of Iowa, Iowa City 52240. TI - Consensus conference on intra-oral models: patient selection, appliance design, and substrate. [Review] [0 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:954 <76> UI - 92276624 AU - Chilton N TI - Consensus conference on intra-oral models: experimental design and analysis. [Review] [0 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:953 <77> UI - 92276623 AU - Proskin HM AU - Chilton NW AU - Kingman A IN - Division of Biostatistics and Computing, Eastman Dental Center, Rochester, New York 14620. TI - Interim report of the ad hoc committee for the consideration of statistical concerns related to the use of intra-oral models in submissions for product claims approval to the American Dental Association. SO - Journal of Dental Research 1992 Apr;71 Spec No:949-52 AB - Subsequent to the American Dental Association Symposium on Intra-oral Studies, held in Chicago in September, 1990, the Council on Dental Therapeutics decided that further consideration should be given to statistical issues relating to intra-oral models. The authors accepted the request of Council staff to assist in the development of Guidelines concerning the validity, reliability, and combinability of data obtained from these models. The ensuing work in this area, which began in the fall of 1990 and has continued to date, has thus far focused on the tissue of validity. The purpose of the present paper is to provide the interested community at large with an update on the progress made thus far, and to provide some perspective as to where all of the work in this area may eventually be leading. It is anticipated that a more comprehensive and definitive report will be produced at the completion of this process. <78> UI - 92276621 AU - Duckworth RM AU - Gilbert RJ IN - Unilever Dental Research, Port Sunlight Laboratory, Wirral, Merseyside, United Kingdom. TI - Intra-oral models to assess cariogenicity: evaluation of oral fluoride and pH. [Review] [120 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:934-44 AB - The main purpose of this paper is to review the various methods used for evaluation of fluoride retention in saliva, plaque, and enamel following application of topical anti-caries treatments such as F dentifrices and F mouthwashes. Such methods monitor delivery of fluoride to the site of action, the mouth, and so can be regarded as assessing potential for treatment action. It is concluded that intra-oral fluoride measurements are appropriate to support bioequivalence claims for anti-caries treatments, provided that particular chosen methods have been calibrated against clinical data. Studies purporting to show superiority are of interest mechanistically, but links to caries are not sufficiently understood to define superiority claims. A wide variety of methods has been used for determination of the fluoride content of enamel. Of these, well-established methods such as the micro-drill and acid-etch procedures are appropriate for routine comparative testing, whereas sophisticated instrumental techniques such as SIMS are more appropriate for detailed mechanistic studies. Intra-oral pH measurements are also relevant to many topical treatments. Single-site determinations in plaque are preferred, but for comparative studies non-specific determinations may be adequate. [References: 120] <79> UI - 92276619 AU - Arends J AU - ten Bosch JJ IN - Laboratory for Materia Technica, University of Groningen, The Netherlands. TI - Demineralization and remineralization evaluation techniques. [Review] [26 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:924-8 AB - This paper compares the experimental techniques utilized to assess the de- or remineralization of enamel or dentin in intra-oral studies. In in situ studies, it is important for one to know how much mineral has been lost or gained, and where the loss or gain occurred. The main emphasis in this paper is on techniques suitable for direct or indirect mineral quantification. The measuring techniques considered are microradiography, iodine absorptiometry, various microhardness tests, polarized light, light-scattering, iodide permeability, and wet chemical analysis. The various techniques are compared concerning suitability for the determination of mineral content in vol% (or wt%), mineral changes in vol% micron (or kg.m-2), and mineral distributions. Furthermore, sample preparation, the importance of protein penetration, nominal mineral loss range, the estimated mineral loss threshold, and the applicability to dentin are compared and considered. It is concluded that, although more than ten techniques are available for the measurement of changes after de- or remineralization in situ, transverse microradiography is the most practical technique for the direct and quantitative measurement of mineral content, mineral changes, and mineral distributions. Cross-sectional microhardness testing and light-scattering are also practical indirect techniques for quantitative mineral loss (or gain) determination in intra-oral studies. [References: 26] <80> UI - 92276618 AU - Ogaard B AU - Rolla G IN - Dental Faculty, University of Oslo, Blindern, Norway. TI - Intra-oral models: comparison of in situ substrates. [Review] [44 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:920-3 AB - Numerous intra-oral caries models have been designed for clinical and mechanistic purposes. Several factors--such as human vs. bovine enamel, sound vs. demineralized tissues, lesion type, dentin vs. enamel, the severity of the cariogenic challenge, and the microflora--may influence the reactivity of the hard tissue and hence lesion development and progression. Some models use unextracted teeth and are true in vivo models, whereas in situ models are based on hard-tissue substrates in the form of slabs or sections. Models producing a moderate cariogenic challenge usually show a fluoride dose response. However, caries is increasingly becoming a problem limited to some high-risk patients and to lesions located to areas where severe challenges exist (e.g., fissures and pits). There is thus need for models that could mimic such situations. One of the requirements for intra-oral models producing severe cariogenic challenge conditions should probably be that it should be able to demineralize fluorapatite. A challenge for future caries research is to develop agents that have a better clinical effect in fissures and pits than those presently available. Because, in the past, much emphasis has been placed on remineralization of artificial lesions, more research on the demineralization process should be performed in the future, since this may give improved clinical effects. Ideally, an intra-oral caries model should take into account as many of the natural oral conditions as possible and minimize the degree of artificiality. [References: 44] <81> UI - 92276617 AU - Mellberg JR IN - Colgate-Palmolive Company, Technology Center, Piscataway, New Jersey 08854. TI - Hard-tissue substrates for evaluation of cariogenic and anti-cariogenic activity in situ. [Review] [88 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:913-9 AB - Hard-tissue substrates include primarily human and bovine enamel and human dentin. They have been used for in situ studies in a natural or sound condition, as well as flattened or containing an in vitro-formed caries-like lesion. Human enamel and dentin are generally the substrates of choice for studies of coronal and root-surface caries, respectively, but bovine enamel appears to offer a suitable alternative for many studies of enamel caries. Substrates with caries-like lesions will respond more rapidly to changes in the intra-oral mineral equilibrium and will allow both demineralization and remineralization to be determined. Findings from some studies suggest that caries-like lesions may respond somewhat differently, depending upon the degree of mineralization of the surface layer. Because in vitro findings with dentin show it to be significantly more soluble in acid than enamel, results from a study that used dentin may not be directly applicable to enamel. Both enamel and dentin substrates can be used in thin-section models. Hard-tissue substrates can also differ, depending upon their intra-oral location. Locations that result in the accumulation of plaque will behave differently from those that are plaque-free. So that plaque would accumulate, substrates have been placed approximally, beneath a fabric or steel mesh, in a protected trough, beneath a metal band or within a depression on the buccal surface. For studies requiring a determination of both demineralization and remineralization, human enamel or dentin containing a surface-softened caries-like lesion and covered with a uniform natural plaque are the substrates of choice. [References: 88] <82> UI - 92276616 AU - Stookey GK IN - Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis 46202. TI - Reactor paper concerning patient selection and appliance design in intra-oral models. SO - Journal of Dental Research 1992 Apr;71 Spec No:911-2 AB - Patient selection and appliance design are important factors in the development of intra-oral models. Adults, rather than children, are recommended as panelists due to their similarity to children in response to fluoride for caries prevention, greater likelihood of compliance with all study requirements, and greater availability for appointments. It may be desirable for additional factors--including the presence of cariogenic micro-organisms and the characteristics of their saliva with regard to remineralization--to be used in the selection of panelists. Cross-over test designs may be desirable to minimize the impact of these variables as well as of dietary differences. Appliances should be designed to approximate the normal oral conditions to the maximum extent possible. Intra-oral models should be capable not only of detecting the effects of clinically-proven fluoride treatments but also of detecting fluoride dosage responses. <83> UI - 92276615 AU - ten Cate JM IN - Department of Cariology and Endodontology, Academic Centre for Dentistry Amsterdam, The Netherlands. TI - Patient selection and appliance design in intra-oral models. [Review] [16 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:908-10 AB - The conclusions derived from in situ studies are influenced by the choices made with respect to parameters of the intra-oral model systems. In an attempt to reach a consensus, this paper considers the variables (a) selection of panelists and (b) appliance design. On both topics, a short review of available systems is given. The objectives of the intra-oral study may vary from the determination of oral physiological parameters to assessment of the effects of caries-preventive treatments. This objective is a factor influencing the choice of experimental conditions. Recommendations for panelist selection and appliance design are given for different types of studies. It is concluded that relatively little information is available about the effects of individual parameters on the performance of a model. Therefore, for an assessment of caries-preventive effectiveness, an intra-oral model should be validated against clinical trials. In addition, conditions should be chosen such as to limit the degree of artificiality of the model. [References: 16] <84> UI - 92276614 AU - Stephen KW IN - Department of Oral Medicine and Pathology, University of Glasgow Dental School, Scotland, United Kingdom. TI - Technical advances in intra-oral model systems used to assess cariogenicity: experimental design and analysis (reactor paper). SO - Journal of Dental Research 1992 Apr;71 Spec No:905-7 AB - In situ cariogenicity-testing models must show evidence of compliance with valid clinical parameters, and this has been achieved with respect to pyrophosphate-, monofluorophosphate-, and zinc citrate trihydrate-containing dentifrices, where earlier in vitro studies failed to predict clinical efficacy. Parameters for validity testing should include the use of enamel fluoride uptake, plaque and/or saliva fluoride assessments, re-/demineralization assays of appliance-borne enamel slabs or slices, and plaque microbial, biochemical, and pH studies. Model reliability must be capable of withstanding repeat calibration experiments where the dosage, frequency of application, and/or duration of exposure to a new product may be varied. Furthermore, the number of enamel slabs/slices carried per appliance (and the number of artificial caries lesions per enamel insert) requires to be defined. Such studies should be repeated, but whether in the same or different subjects, or with or without cross-over, has to be determined. However, the capability of reproducing a clinically proven dose-response is essential. Models must be sensitive enough to detect changes in any test product F-concentration, but only equivalence claims should be permitted. Thus, superiority cannot be established, since accuracy may not be assumed beyond the upward limits of a clinically validated range. Finally, models should not be so exclusive in design as to preclude independent verification of their findings. <85> UI - 92276613 AU - Proskin HM IN - Division of Biostatistics and Computing, Eastman Dental Center, Rochester, New York 14620. TI - Statistical considerations related to intra-oral studies. SO - Journal of Dental Research 1992 Apr;71 Spec No:901-4 AB - Intra-oral studies use caries models from which conclusions are drawn concerning the caries process in the clinical environment. Recently, attention has been drawn to the issue of proper analysis and interpretation of the data from such studies, with particular emphasis placed on a consideration of the role such studies can and should play as a component of product claim submissions to the American Dental Association (ADA). This presentation discusses a number of issues relevant to this consideration, including the validity and reliability of the intra-oral modeling process, the relationship between these concepts and the requirements imposed by the ADA Guidelines for superiority and equivalence claims, and a brief enumeration of several other statistical issues which ought to be considered in the handling of data from such studies. <86> UI - 92276612 AU - Manning RH AU - Edgar WM IN - School of Dentistry, University of Liverpool, England. TI - Intra-oral models for studying de- and remineralization in man: methodology and measurement. [Review] [46 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:895-900 AB - A wide range of different methodologies and measurement techniques has been employed in laboratories around the world for the study of de- and remineralization of enamel and dentin in intra-oral systems. These different approaches are summarized and discussed in relation to the nature of the different research questions to be studied by means of the intra-oral model. [References: 46] <87> UI - 92276611 AU - White DJ IN - Procter and Gamble Company, Sharon Woods Technical Center, Cincinati, Ohio 45241. TI - The comparative sensitivity of intra-oral, in vitro, and animal models in the 'profile' evaluation of topical fluorides. [Review] [166 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:884-94 AB - The development of predictive and rapid methods for the assessment of the anticaries activity of topical fluorides has been a long-standing objective of caries researchers. These methods can provide useful benefits in a number of applications, ranging from the identification of novel agents to progress into clinical testing to the regulatory screening of commercial product variations. In the latter applications, combinations of test methods (so-called profiles) are used by manufacturers to prove that changes in formulations do not alter the efficacy of the products. Historically, combinations of in vitro and animal models have been used for basic research as well as for profile testing purposes; however, in recent years, the use of intra-oral or in situ models has increased. In this paper, in vitro, animal, and in situ methods are reviewed in terms of the historical basis for their development, protocols currently used in testing, and the primary advantages and limitations of each as applied to 'profile' applications. Recommendations are provided concerning circumstances for the appropriate use of modern test methods in formulation screening. [References: 166] <88> UI - 92276610 AU - ten Cate JM AU - van de Plassche-Simons YM AU - van Strijp AJ IN - Department of Cariology and Endodontology, Academic Centre for Dentistry Amsterdam, The Netherlands. TI - Importance of model parameters in the assessment of intra-oral remineralization. [Review] [37 refs] SO - Journal of Dental Research 1992 Apr;71 Spec No:879-83 AB - Since the introduction of the Intra-oral Cariogenicity Test by Koulourides et al. (1974), many groups around the world have been developing and using intra-oral models to test new caries-preventive products, as well as to study physiological processes in the oral cavity. In spite of the large numbers of papers reporting these methods, very little research has been done to determine the importance of the many variable parameters which influence the performance of these models. Among these, the following can be identified: (a) panelist criteria, (b) the use of sound vs. pre-demineralized enamel of human or bovine origin, (c) the use of gauze or a recess to accumulate plaque, (d) the method to create incipient lesions, (e) the duration of the experiment, (f) the number of panelists required for statistical significance to be obtained, (g) the assessment techniques for mineral and/or fluoride uptake/loss, and (h) the choice of contralateral, 'cross-over', or 'monadic' experimental designs. Our results, supported by data from the literature, indicate that the choices made with respect to these parameters are of paramount importance in determination of the outcome of the respective study.