Database: MEDLINE <: biomedical, nursing & dental literature, 1966 - Oct 2000.> Search Strategy (You Saved Citations 1-300 From Set 118): ----------------------------------------------------------------------------- 1 exp Tooth demineralization/ 22628 2 demineralization.mp. 1620 3 caries.mp. 15295 4 caires.mp. 1 5 craies.mp. 0 6 careis.mp. 4 7 carise.mp. 0 8 (teeth adj3 cavit:).mp. 422 9 (tooth adj3 cavit:).mp. 217 10 (dental adj3 cavit:).mp. 276 11 (dentin adj3 cavit:).mp. 254 12 (enamel adj3 cavit:).mp. 182 13 (teeth adj3 decay:).mp. 374 14 (tooth adj3 decay:).mp. 321 15 (dental adj3 decay:).mp. 250 16 (dentin adj3 decay:).mp. 12 17 (enamel adj3 decay:).mp. 20 18 (active adj decay).mp. 9 19 (rampant adj3 decay:).mp. 14 20 (recurrent adj3 decay:).mp. 30 21 (white adj spot:).mp. 509 22 carious.mp. 2077 23 cariology.ti,ab. 56 24 (non-cavitated adj3 lesion:).mp. 15 25 (noncavitated adj3 lesion:).mp. 2 26 Tooth remineralization/ 478 27 (dental adj3 fissure:).mp. 99 28 (tooth adj3 fissure:).mp. 50 29 (teeth adj3 fissure:).mp. 98 30 caries-free.mp. 603 31 cariesfree.mp. 17 32 Cariogenic agents/ 728 33 precavit:.mp. 8 34 (filled adj3 teeth).mp. 510 35 (filled adj3 tooth).mp. 117 36 (oral adj fissure:).mp. 6 37 (tooth adj3 remineraliz:).mp. 28 38 (teeth adj3 remineraliz:).mp. 24 39 dft.mp. 413 40 dfs.mp. 1258 41 dmf:.mp. 6397 42 cariogeni:.mp. 1787 43 or/1-42 32256 44 (pc or th).fs. 1011356 45 43 and 44 11962 46 exp Dental bonding/ 10476 47 exp Dental care/ 14573 48 Dental devices, home care/ 905 49 Dental implantation/ 2906 50 exp Dental restoration, permanent/ 21229 51 exp Dental restoration, temporary/ 9612 52 Dental restoration failure/ 796 53 Dental pulp capping/ 1277 54 Pulpectomy/ 769 55 Pulpotomy/ 831 56 exp Root canal therapy/ 9857 57 Enamel microabrasion/ 42 58 Mouth rehabilitation/ 997 59 Tooth extraction/ 8995 60 exp Preventive dentistry/ 18127 61 exp Tooth preparation/ 5601 62 (dental adj3 bond:).mp. 290 63 ((acid adj etch:) and (dent: or tooth or teeth)).mp. 1161 64 cementation.mp. 2032 65 ((dent: or tooth or teeth) adj3 (care or hygien: or 13394 prevent: or intervent:)).mp. 66 ((dent: or tooth or teeth) adj3 (implant: or restor:)).mp. 11268 67 (pulp adj4 cap:).mp. 551 68 pulpectomy.mp. 809 69 pulpotomy.mp. 858 70 ('root' adj canal adj3 (therap: or treat: or interven: or 1148 prepar: or prevent:)).mp. 71 (enamel adj3 microabrasion).mp. 34 72 ((tooth or teeth or dent:) adj3 (extract: or pull:)).mp. 5441 73 ((dent: or tooth or teeth) adj3 (prophylaxis or clean:)).mp. 1693 74 or/46-73 97112 75 Home care services/ 12282 76 exp Dentistry/ 207747 77 75 and 76 99 78 74 or 77 97122 79 Chlorhexidine/ 2890 80 chlorhexidine.mp. 3507 81 sebidin.mp. 3 82 tubulicid.mp. 21 83 or/79-82 3517 84 exp Cariostatic agents/ 19795 85 fluoride:.mp. 26332 86 ((sulfur or sulphur) adj3 hexafluoride:).mp. 520 87 difluoride:.mp. 458 88 tetrafluoride:.mp. 82 89 ossin.mp. 7 90 zymafluor.mp. 3 91 or/84-90 27713 92 78 or 91 119866 93 exp Decision support techniques/ 19211 94 exp Decision making/ 28700 95 exp Decision making, computer-assisted/ 16758 96 ((decision: or consensus) adj (making or make$1 or support 14407 or theory or trees or technique:)).mp. 97 exp "Sensitivity and specificity"/ 89544 98 Computer simulation/ 19925 99 Computer systems/ 3947 100 Computers/ 40006 101 (computer: adj5 (simulation: or system: or decision: or 23667 predict: or forecast:)).mp. 102 Forecasting/ 28594 103 Models, biological/ 101335 104 Likelihood functions/ 3382 105 exp risk/ 227197 106 risk:.mp. 414044 107 exp "Outcome assessment (health care)"/ 103983 108 or/93-107 824928 109 45 and 92 and 108 798 110 ("96119848" or "20020823" or "97180014" or "20098169" or 5 "92083572").ui. 111 109 or 110 799 112 limit 111 to (human and english language) 689 113 limit 112 to (infant < 1 to 23 months > or preschool child 391 < 2 to 5 years > or child < 6 to 12 years > or adolescence < 13 to 18 years >) 114 110 or 113 392 115 43 and 92 and 108 1625 116 limit 115 to (human and english language) 1419 117 limit 116 to (infant < 1 to 23 months > or preschool child 719 < 2 to 5 years > or child < 6 to 12 years > or adolescence < 13 to 18 years >) 118 110 or 117 721 119 from 118 keep 1-300 300 *************************** <1> UI - 20345681 AU - Reich E AU - Lussi A AU - Newbrun E IN - University of Saarland, Department of Periodontology and Conservative Dentistry, Homburg, Germany. zmkerei@med-rz.uni-sb.de TI - Caries-risk assessment. [Review] [157 refs] SO - International Dental Journal 1999 Feb;49(1):15-26 AB - Dental caries has a multifactorial aetiology in which there is an interplay of three principal factors: the host (saliva and teeth), the microflora (plaque), and the substrate (diet), and a fourth factor: time. There is no single test that takes into consideration all these factors and can accurately predict an individual's susceptibility to caries. The risk of dental caries can be evaluated by analysing and integrating several causative factors. These include caries experience (initial caries lesions and established caries defects, secondary caries and present caries activity), fluoride use, extent of plaque present, diet, bacterial and salivary activity and social and behavioural factors. [References: 157] <2> UI - 20321848 AU - Retnakumari N IN - Dept. of Pedodontics and Preventive Dentistry, Govt. Dental College, Thiruvananthapuram. TI - Prevalence of dental caries and risk assessment among primary school children of 6-12 years in the Varkala municipal area of Kerala. SO - Journal of the Indian Society of Pedodontics & Preventive Dentistry 1999 Dec;17(4):135-42 AB - This epidemiological survey attempted to establish the prevalence and severity of dental caries among primary school children of Varkala municipal area. The prevalence of dental caries was 68.5% with a standard error (SE) of 1.64% and 95%, confidence interval (CI) 65.18, 71.82. The highest caries prevalence was found among 10 year age group (75.9%) and lowest in the 8 year age group (63%). The highest dmft score was found in 9 year age group 2.73 +/- 0.443 and highest DMFT score was found in 12 year age group 2.06 +/- 0.3824. Statistically significant association was found with dental caries and oral hygiene status (Odds Ratio (OR) 3.59, 95% CI, 2.53, 5.06 and oral cleanliness OR 2.73, 95% CI 2.96, 3.82). Statistically significant association was found between low socioeconomic status and prevalence of caries (O.R. 1.89, 95% CI--1.28, 2.8). <3> UI - 20305622 AU - Martin-Iverson N AU - Pacza T AU - Phatouros A AU - Tennant M IN - School of Oral Health Sciences, University of Western Australia. TI - Indigenous Australian dental health: a brief review of caries experience. [Review] [17 refs] SO - Australian Dental Journal 2000 Mar;45(1):17-20 AB - The indigenous community in Australia is an at risk population for oral diseases such as dental caries. The majority of communities are isolated and dental services in these areas are limited. Oral hygiene standards are poor and this combined with a diet rich in refined carbohydrates has led to high incidences of dental caries. In addition, diabetes, which is related to obesity (and a diet high in sugar and fat) has been linked to increases in oral disease. Caries prevalence was found to be low in areas where fluoridation levels in the water were high. The fact that the fluoride supplementation appears to improve oral health to a significant degree suggests that implementation of fluoride treatment programmes for school children and, where viable, fluoridation of water sources would be appropriate. In addition, dental education programmes should receive high priority. As with the rest of the community, these preventive measures will result in less need for emergency dental treatment in the future, better oral health for the community and reduced financial burden on the State. It is under these circumstances that oral health planners and providers must, in consultation with the relevant community representatives, develop appropriate mechanisms to address the needs of this group. The development of strategies that integrate with the plethora of general health strategies currently being implemented is just one means of achieving improved oral health outcomes for indigenous Australians. [References: 17] <4> UI - 20305621 AU - Messer LB IN - School of Dental Science, University of Melbourne. TI - Assessing caries risk in children. [Review] [31 refs] SO - Australian Dental Journal 2000 Mar;45(1):10-6 AB - With the dramatic improvements in the oral health of children in Australia that have occurred over the past two decades, the option of, and the need for, targeted prevention of dental caries for those at high risk has become apparent. Since caries is of multifactorial aetiology, the clinical outcome varies depending on which factor, or combination of factors, is prominent in a particular individual; this may be related to both age and stage of life. Tests for caries risk can assist in prediction, but clinical signs and history are as important in assessing the main cause(s) of caries in an individual. In studies involving several factors, past caries experience (especially of the first permanent molar) continues to be the best predictor of future caries in children. Despite their ready availability, tests in the form of commercial kits are still expensive; no one test is an adequate predictor of caries risk, and the specificity and sensitivity of the tests are not reliably diagnostic for an individual. There is a need for regional longitudinal risk assessment studies in which potential risk factors are identified before the onset of caries in order to maximize predictive power and then validated against subsequent caries. Caries activity may not be able to be predicted in a population with low disease prevalence. Any risk assessment strategy must be followed by appropriate preventive interventions. [References: 31] <5> UI - 20247326 AU - Deery C AU - Fyffe HE AU - Nugent ZJ AU - Nuttall NM AU - Pitts NB IN - Dental Health Services Research Unit, Dental Hospital and School, University of Dundee, Park Place, Dundee, UK. c.h.deery@dundee.ac.uk TI - General dental practitioners diagnostic and treatment decisions related to fissure sealed surfaces. SO - Journal of Dentistry 2000 Jul;28(5):313-8 AB - OBJECTIVES: The purpose of this in-vitro study was to assess the validity and reproducibility of the diagnosis and treatment planned for occlusal surfaces prior to and following the placement of a clear sealant by a sample of general dental practitioners (GDPs). METHODS: 160 permanent posterior teeth were examined by 25 GDPs. The GDPs were not given any criteria and were therefore free to diagnose and plan care, as they felt appropriate. Each GDP conducted four examinations, two prior to and two after sealing. The teeth were serially sectioned to provide the validating criterion. RESULTS: After sealant placement, there was a statistically significant increase in specificity and decrease in sensitivity of both diagnostic and treatment decisions. The reproducibility expressed by the kappa-statistic was of the order of 0.5 prior to and after sealing with regard to diagnostic decisions. There was a general tendency to diagnose less disease after placement of a sealant (P<0. 001). There was also significantly less care (preventive or restorative) planned after sealant placement (P<0.001). CONCLUSIONS: The placement of a sealant resulted in the diagnosis of less disease and less restorative treatment. This may be appropriate as evidence exists to support the use of sealants as caries therapeutic agents. <6> UI - 20291716 AU - Dennison JB AU - Straffon LH AU - Smith RC IN - Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor 48109, USA. TI - Effectiveness of sealant treatment over five years in an insured population. SO - Journal of the American Dental Association 2000 May;131(5):597-605 AB - BACKGROUND: The authors analyzed an insurance claim database to evaluate the use and effectiveness of placing sealants on first and second permanent molars of children in private dental practices. METHODS: A retrospective study was conducted using an insured population with sealant coverage at 70 percent of the usual fee in a preferred provider organization than that limited reapplication to once every three years. Children were selected who were eligible for sealant benefits from July 1, 1990, to June 30, 1991. Two groups were selected for analysis, based on age, as determined by permanent molar eruption dates. Children who received sealants were compared with those who did not to determine post-sealant restorative outcomes after five years. RESULTS: During the full year of coverage, sealants were used in only 16.3 percent of first permanent molars and 11.6 percent of second permanent molars. The five-year incidence of an occlusal restoration having been placed was 13.7 percent and 20.8 percent, respectively, on nonsealed first and second molars and 6.5 percent and 10.4 percent, respectively, on sealed first and second molars. From years three to five, sealant placement provided only nominal additional preventive effect. CONCLUSIONS: In the population selected, both the incidence of occlusal caries and the use of sealants were lower than expected for both age groups. However, within these groups, molar occlusal surfaces were only half as likely to have been restored in sealed teeth than in nonsealed teeth after five years. CLINICAL IMPLICATIONS: Based on the five-year data from a population with a low incidence of caries, the authors found that 15 sealed first permanent molars or 10 sealed second permanent molars prevented placement of one occlusal restoration. Therefore, sealants are more effective when placed in patients with risk factors for occlusal caries. <7> UI - 20274724 AU - Rolling I AU - Clausen N AU - Nyvad B AU - Sindet-Pedersen S IN - Department of Oral and Maxillo-facial Surgery, Aarhus University and University Hospital, Denmark. TI - Dental findings in three siblings with Morquio's syndrome. [Review] [23 refs] SO - International Journal of Paediatric Dentistry 1999 Sep;9(3):219-24 AB - Three siblings with Morquo's syndrome are described. Cultured fibroblasts from the youngest sibling demonstrated a total absence of N-acethylgalactosamine-6-sulphate-sulphatase whereas beta-galactocidase activity was normal, thus verifying the diagnosis of MPS-IV A. Dental features such as pointed cusps, spade-shaped incisors, thin enamel and pitted buccal surfaces were observed in all three children. Furthermore, in all three siblings the TMJ was affected with severe resorption of the head of the condyle. Histological examination of exfoliated primary molars showed a band of increased porosity following the striae of Retzius in the outer part of the enamel. These developmental disturbances were occasionally associated with minor localized defects in the enamel surface. The importance of close monitoring of dental development and regular dental care in order to prevent attrition of the teeth, loss of vertical face height and subsequent risk of TMJ dysfunction is emphasized. [References: 23] <8> UI - 20274720 AU - Hamilton FA AU - Davis KE AU - Blinkhorn AS IN - Salford Community Health Care NHS Trust, UK. TI - An oral health promotion programme for nursing caries. SO - International Journal of Paediatric Dentistry 1999 Sep;9(3):195-200 AB - AIM: To evaluate an oral health promotion programme involving health visitors and mothers of 8-month-old babies in order to address some of the risk factors associated with nursing caries. DESIGN: Two cross-sectional studies using postal questionnaires. SAMPLE: A random sample of 250 mothers who had not received the oral health promotion programme and 250 mothers who had received the programme. SETTING: The City of Salford. RESULTS: The oral health promotion programme significantly improved mothers recall of advice given by health visitors encouraging the use of a feeder cup, brushing their babies' teeth with fluoride toothpaste and restricting sugary foods and drinks. Significant improvements were also found in recall of advice regarding the use of sugar-free medicine and registering babies with a dentist. The programme encouraged a higher proportion of the mothers to bring their children to clinics for a hearing check. CONCLUSION: A simple oral health promotion programme facilitated by health visitors improved recall of advice and clinic visiting behaviour. <9> UI - 99313124 AU - Moss ME AU - Lanphear BP AU - Auinger P IN - Eastman Department of Dentistry, The University of Rochester School of Medicine and Dentistry and Children's Hospital Medical Center, NY 14642, USA. moss@prevmed.rochester.edu TI - Association of dental caries and blood lead levels [see comments]. CM - Comment in: JAMA 1999 Jun 23-30;281(24):2340-2, Comment in: JAMA 2000 Jan 25;283(4):476-7; discussion 477 SO - JAMA 1999 Jun 23-30;281(24):2294-8 AB - CONTEXT: Experiments show that dental caries rates are higher among lead-exposed animals, but this association has not been established in humans. OBJECTIVE: To examine the relationship between blood lead levels and dental caries. DESIGN: Cross-sectional survey conducted from 1988 to 1994 that included a dental examination and venipuncture blood lead assay. SETTING AND PARTICIPANTS: A total of 24901 persons aged 2 years and older who participated in the Third National Health and Nutrition Examination Survey, which assessed the health and nutritional status of children and adults in the United States. MAIN OUTCOME MEASURES: For children aged 2 to 11 years, the sum of decayed and filled deciduous or primary surfaces; for persons aged 6 years and older, the sum of decayed and filled permanent surfaces; for those 12 years and older, the sum of decayed, missing, and filled surfaces. RESULTS: The log of blood lead level was significantly associated with the number of affected surfaces for both deciduous and permanent teeth in all age groups, even after adjusting for sociodemographic characteristics, diet, and dental care. Among children aged 5 to 17 years, a 0.24-micromol/L (5-microg/dL) change in blood lead level was associated with an elevated risk of dental caries (odds ratio, 1.8; 95% confidence interval, 1.3-2.5). Differences in blood lead level explained some of the differences in caries prevalence in different income levels and regions of the United States. We estimated the population attributable risk of lead exposure to be 13.5% and 9.6% of dental caries occurring in 5- to 17-year-olds exposed to the high and moderate levels, respectively. CONCLUSIONS: Environmental lead exposure is associated with an increased prevalence of dental caries in the US population. Findings may help explain the distribution of caries by income and region of the United States. <10> UI - 99139138 AU - Gelbier S IN - King's College London, UK. TI - The present and future role of the community dental services [see comments]. CM - Comment in: Community Dent Health 1999 Jun;16(2):67 SO - Community Dental Health 1998 Dec;15 Suppl 1:306-11 <11> UI - 99139131 AU - Morgan MV AU - Campain AC AU - Adams GG AU - Crowley SJ AU - Wright FA IN - School of Dental Science, University of Melbourne, Victoria, Australia. TI - The efficacy and effectiveness of a primary preventive dental programme in non-fluoridated areas of Victoria, Australia [see comments]. CM - Comment in: Community Dent Health 1999 Jun;16(2):123 SO - Community Dental Health 1998 Dec;15(4):263-71 AB - OBJECTIVE: To determine the efficacy and effectiveness of a primary preventive dental programme. DESIGN: A field trial comparing an intervention and control group over three years. The intervention group received a preventive programme which consisted of a weekly fluoride mouthrinse (0.2% neutral NaF), an annual application, replacement or repair of pit and fissure sealants, and an annual oral hygiene education programme. The control group received the oral hygiene education programme only. Examinations to record dental caries status were conducted annually for both study groups. SETTING: Five secondary colleges in two non-fluoridated regions of Victoria, Australia. SUBJECTS: 522 subjects aged 12-13 years and considered at high risk of developing dental caries were recruited for the study; 256 received the preventive programme and 266 acted as controls. OUTCOME MEASURES: Dental caries was diagnosed according to World Health Organization criteria. RESULTS: Subjects in the intervention group who completed the three-year preventive programme (efficacy) incurred an average of 1.49 fewer decayed, missing or filled tooth surfaces than the control group. The difference was highly statistically significant. The programme also had a statistically significant impact when analysed by intention-to-treat (effectiveness), even when it was assumed that subjects lost to follow-up received minimal future benefit. Approximately 70% of the improvement in oral health was in the pit and fissure surfaces, with the remainder in the smooth surfaces. CONCLUSION: A comprehensive preventive dental programme introduced into adolescent populations at high risk of developing dental caries can result in significant improvements in their dental health. Further research is required to clarify the public health impact of school-based fluoride mouth rinsing. <12> UI - 20180952 AU - Tyrer GL IN - Birch Hill Hospital, Rochdale. TI - Referrals for dental general anaesthetics--how many really need GA? [see comments]. CM - Comment in: Br Dent J 2000 Jan 8;188(1):3; discussion 3-4 SO - British Dental Journal 1999 Oct 23;187(8):440-3 AB - AIM: To find out how many patients for whom dental general anaesthesia was requested actually needed it in order to complete treatment. DESIGN: Analysis of clinical outcomes supported by telephone canvassing of parents. METHOD: In summer 1998, eighty two child patients were seen in the Community Dental Service in Rochdale with a request for the provision of dental general anaesthesia (DGA) for the extraction of teeth. Their ages ranged from 3 to 14 years and all were required to attend for a pre-anaesthetic visit. Unless objective indicators of a need for DGA applied, the parents and children were actively discouraged from having DGA, and the alternative of local anaesthetic (LA) was offered. Clinical outcomes and parent satisfaction were recorded after treatment was finished. RESULTS: In 75% of cases it proved possible to complete the extractions without need for DGA; in the 10% of cases where DGA was necessary, it was to deal with the sequelae of dental caries. Fifteen percent of subjects failed to complete treatment. Subjects found to have a need for DGA tended to be younger and with treatment required in more than one sextant. Pain as a presenting symptom, young age and multiple treatment needs were found to be poor predictors of need for DGA and did not automatically preclude successful treatment without DGA. The satisfaction ascertained from users of the service was high and explanation of proposed treatments, especially the comparative risks and benefits of DGA versus LA, was well received. CONCLUSION: There is scope for significant reduction in provision of dental general anaesthesia if current professional guidelines are followed. <13> UI - 20198789 AU - Eklund SA AU - Pittman JL AU - Heller KE IN - University of Michigan, School of Public Health, Department of Epidemiology, Ann Arbor 48109-2029, USA. saeklund@umich.edu TI - Professionally applied topical fluoride and restorative care in insured children. SO - Journal of Public Health Dentistry 2000 Winter;60(1):33-8 AB - OBJECTIVES: This study evaluates the association between use of professionally applied topical fluoride and use of interproximal restorations in primary and permanent teeth of children. METHODS: Insurance claims from 15,190 children, for treatment provided by 1,556 different dentists, were analyzed to look for associations between frequency of use of professionally applied topical fluoride and use of interproximal restorations. The average follow-up period for the children included in the analysis was 5.3 years, with the range from 3.0 to 7.9 years. RESULTS: Both tabular and regression results failed to demonstrate an association between frequency of use of professionally applied topical fluoride and use of interproximal restorations in either the primary or permanent dentition. The most powerful predictor of restorative care for these children was the overall propensity of the dentist to place restorations in children. CONCLUSIONS: In this group of insured children, we were unable to find an association between the frequency of use of professionally applied topical fluoride and restorative care. Further, despite numerous recommendations that professionally applied topical fluorides should be used only in moderate- and high-caries children, approximately two-thirds of these children received topical fluoride at every recall visit, nearly two times per year. <14> UI - 20198787 AU - Griffin SO AU - Gooch BF AU - Beltran E AU - Sutherland JN AU - Barsley R IN - Centers for Disease Control and Prevention/Division of Oral Health/Surveillance, Investigations and Research Branch, Chamblee, GA 30341, USA. sig1@cdc.gov TI - Dental services, costs, and factors associated with hospitalization for Medicaid-eligible children, Louisiana 1996-97. SO - Journal of Public Health Dentistry 2000 Winter;60(1):21-7 AB - OBJECTIVE: This study compared types and costs of dental services rendered to children who had received care in a hospital operating room (H) with children who had not (NH). METHODS: The study population consisted of all children aged 1-5 years who received a dental service reimbursed by the Louisiana Medicaid EPSDT program from October 1996 through September 1997. Claim files were provided by the Louisiana Bureau of Health Services Financing. A treatment intensity index [TII = 3 x (: extractions) + 2 x (: pulpotomies + : crowns) + : simple restorations] was calculated for H children (n = 2, 142) and NH children (n = 38,423). Using logistic regression, a dichotomous hospitalization variable (H vs NH) was regressed against treatment intensity and selected personal and parish (county) characteristics for each of the five age groups. Total and average reimbursement per child were calculated for both groups of children, by age. RESULTS: The mean treatment intensity scores for H and NH children were 24.02 (SD = 11.82) and 2.16 (SD = 4.78), respectively. For all age groups, children with treatment intensity scores greater than 8 were at least 132 times more likely to be hospitalized than were children with scores less than or equal to 8. The mean cost for care provided to H children was $1,508 compared with $104 for NH. Total costs for dental care rendered to H children (5% of the study population) were $3,229,851 (45% of total dental costs for the study population). CONCLUSION: Reducing severe caries through early interventions could provide substantial cost savings. <15> UI - 20200895 AU - Marks LA AU - van Amerongen WE AU - Borgmeijer PJ AU - Groen HJ AU - Martens LC IN - Department of Cariology, Endodontology, Pedodontology at Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. TI - Ketac Molar Versus Dyract Class II restorations in primary molars: twelve month clinical results. SO - ASDC Journal of Dentistry for Children 2000 Jan-Feb;67(1):37-41, 8-9 AB - The aim of the present clinical study was an in vivo evaluation of an improved conventional glass ionomer cement Ketac Molar (ESPE), compared to a polyacid modified composite resin, Dyract (Dentsply/De Trey), used in primary molars. Fifty-three Ketac Molar and fifty-two Dyract restorations were placed in box-only preparations in primary molars. The application time for the chemically cured Ketac Molar, was longer compared to the light-cured Dyract. In comparing the materials, no differences were found, comparing both materials regarding secondary caries, marginal adaptation, wear and fracture toughness. One case of recurrent caries adjacent to a Ketac Molar restoration and two cases in the Dyract group were reported. Two Ketac Molar restorations and one Dyract showed bulk fracture at the time of evaluation. At the twelve-month evaluation, no difference between the investigated materials was registered, which indicates that Ketac Molar can be used as a proximal restoration in the primary dentition. It should be emphasized, however, that one-year data should not be extrapolated to indicate the long-term success of restorations. <16> UI - 20205735 AU - Kneckt MC AU - Syrjala AM AU - Knuuttila ML IN - Institute of Dentistry, University of Oulu, Finland. mkneckt@hotmail.com TI - Attributions to dental and diabetes health outcomes. SO - Journal of Clinical Periodontology 2000 Mar;27(3):205-11 AB - Previous studies have proposed common psychological factors between oral health behavior and diabetes self-care. The aim here was to describe and analyse more comprehensively the relationships between dental and diabetes health behavior on the basis of attribution theory. The likeness between subjects' own assessments, similarities of the causes given to success and failure, and the predictive power of own dental assessments concerning the metabolic balance of diabetes were studied. The research population was composed of 149 IDDM patients. Data were collected by means of a quantitative questionnaire, a clinical oral examination and from patient records. It was found that from the patients reporting success with avoiding gingivitis 82% also reported success with metabolic status and they also had lower mean HbA1c levels than patients assessing failure with gingivitis. There were some correlations between causes of failure: not bothering to clean approximal surfaces correlated with non-adherence to diabetes treatment instructions, and laziness as the cause of caries correlated with non-adherence to diabetes treatment instructions and with poor motivation for diabetes care. It can be concluded that there are some common determinants for both dental health behavior and diabetes self-care. This connection should be taken into account in health education by health care professionals. <17> UI - 20262473 AU - Reusens B AU - D'hoore W AU - Vreven J IN - University of Louvain, School of Dental Medicine and Stomatology, Department of Operative Dentistry, Brussels, Belgium. TI - In vivo comparison of a microfilled and a hybrid minifilled composite resin in Class III restorations: 2-year follow-up. SO - Clinical Oral Investigations 1999 Jun;99(2):62-9 AB - An in vivo comparison was made of two different types of restorative resins over a 2-year period: a microfilled resin (-1158262462Silux Plus, 3M-1158262462, USA) and a hybrid minifilled composite resin (-1158262461Herculite XRV, Kerr-1158262461, USA); 56 restorations were placed in 28 patients by one experienced dentist and examined by two independent evaluators using the United States Public Health Service (UPSHS) rating system for marginal adaptation, marginal discoloration, surface roughness, anatomic form and modified criteria for color match (direct and indirect evaluation). Modified criteria divided the classic A score into A1 for "not detectable" filling and A2 for "slightly discernible filling". Restorations were evaluated at baseline, 1 week, 6 months, 1 year and 2 years later. After 2 years, all materials were considered satisfactory for marginal adaptation, anatomic form and surface roughness (no "Charlie", or "Delta" ratings). No recurrent caries was observed. Clinical evaluation showed a significantly higher rate of marginal discoloration for the microfilled composite resin than the other resin. Hybrid composite resin materials may be expected to perform well as an anterior restorative material. Photographic ratings confirmed the clinical evaluation. The modified evaluation for color match demonstrated differences, which are not discernible with the USPHS system and showed, more rapidly, differences that appear later with the USPHS system. <18> UI - 20194477 AU - Eidelman E AU - Faibis S AU - Peretz B IN - Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Israel. TI - A comparison of restorations for children with early childhood caries treated under general anesthesia or conscious sedation. SO - Pediatric Dentistry 2000 Jan-Feb;22(1):33-7 AB - PURPOSE: There is no data in the dental literature concerning the quality of the restorations performed in young children with early childhood caries (ECC) under sedation as compared with those treated under general anesthesia (GA). The aim of this study was to compare the quality of restorations and recurrent caries in 65 children with ECC who had dental treatment under GA or sedation. METHODS: Thirty-four children, mean age 34.4 months were treated under GA and 31 children with a mean age of 37.2 months were treated under sedation and re-examined 6-24 months after completion of treatment. The quality of the restorations was evaluated using a modified Cvar & Ryge index. RESULTS: Fifty-nine percent of children treated under GA required further dental treatment compared to 74% of children treated under sedation. The majority of the required treatment was due to new caries: 57% in the GA group and 60% in the sedation group. A total of 248 restorations were evaluated for the GA group, with a 94% success rate for marginal adaptation, 92% success for anatomic form, and 97% had no secondary caries. In the sedation group, out of 224 restorations, 78% demonstrated perfect marginal adaptation, 79% showed adequate anatomic form, and 90% had no secondary caries. Successful marginal adaptation was found in 90% of strip crowns placed under GA, compared to 63% of those placed under sedation. CONCLUSION: It is concluded that the outcome of treatments related to quality of the restorations performed under GA is better for all parameters examined. <19> UI - 20221513 AU - Haselton DR AU - Diaz-Arnold AM AU - Hillis SL IN - University of Iowa, College of Dentistry, Iowa City, Iowa 52242, USA. debra-haselton@uiowa.edu TI - Clinical assessment of high-strength all-ceramic crowns. SO - Journal of Prosthetic Dentistry 2000 Apr;83(4):396-401 AB - STATEMENT OF PROBLEM: All-ceramic crowns are being used extensively. Little data are available on their clinical performance. PURPOSE: This study evaluated the clinical performance of In-Ceram (Vita Zahnfabrik) crowns. MATERIAL AND METHODS: Forty-one patients (16 men, 25 women; mean age 47.3 years, range 18 to 77 years) were examined with a total of 80 In-Ceram all-ceramic crowns fabricated at the University of Iowa College of Dentistry from 1994 to 1997. The percentage distribution for crowns included: 67% anterior single crowns, 26% posterior single crowns, 6% anterior implant crowns, and 1% posterior implant crowns. This study documented the integrity of the junction between crown and tooth, color match to adjacent teeth, secondary dental caries, wear of crown and opposing dentition, and visible cracks in the crown. Alpha, Bravo, and Charlie ratings were assigned with a modified USPHS criteria. The patients were also surveyed with respect to oral hygiene and satisfaction of treatment. Estimations of 4-year success rates and corresponding confidence intervals were calculated by fitting a constant hazard function model with the SAS procedure GENMOD. RESULTS: Marginal integrity for 88% of artificial crowns was rated Alpha or Bravo. Shade match for 99% was Bravo or better. Only 1% of the crowns were carious, and 1 crown exhibited occlusal wear. One premolar crown had a small fracture of veneering porcelain. One molar crown was remade after core fracture. All patients (100%) expressed satisfaction with their crowns. The estimated 4-year success rates (Alpha or Bravo), with 95% confidence intervals in parentheses were calculated as: 83.5% (65.7%-94.6%) for marginal integrity, 95.8% (82.9%-99.8%) for shade match, and 95.5% (81.6%-99.7%) for secondary caries, 100% (88%-100%) for wear, and 100% (88%-100%) for cracks. <20> UI - 20235761 AU - Venugopal T AU - Kulkarni VS AU - Nerurker RA AU - Damle SG AU - Patnekar PN IN - Department of Pediatrics, Dr. R.N. Cooper Municipal General Hospital, Mumbai. TI - Epidemiological study of dental caries. SO - Indian Journal of Pediatrics 1998 Nov-Dec;65(6):883-9 AB - A total of 2000 children (1-14 year age group) attending pediatric OPD, school clinic & well body clinic of Dr. R.N. Cooper Municipal Hospital & K.E.M Hospital, Mumbai were examined for caries prevalence and 35.6% had dental caries. Parental income was not shown to have any bearing on caries prevalence. Parental literacy, particularly maternal literacy was shown to influence caries prevalence in children. The prevalence was low in well-nourished children and in those taking vegetarian type of diet. Frequency of sweet consumption was shown to be associated with prevalence of dental caries. In 1-4 year age group it was noted that bottle fed children were more affected by dental caries. Tooth brush with paste was the commonest method used for cleaning their teeth in all age groups in our study. Caries prevalence was low in those children using tooth brush than in those using tooth powder. Those children who were using neem datun were found to be less affected with dental caries. Dental caries was also found to be low in those who rinsed their mouth with water after food. <21> UI - 20260031 AU - Moynihan P IN - Department of Child Dental Health, University of Newcastle Dental School, Newcastle upon Tyne. p.j.moynihan@ncl.ac.uk TI - The British Nutrition Foundation Oral Task Force report--issues relevant to dental health professionals. SO - British Dental Journal 2000 Mar 25;188(6):308-12 AB - A recent report on diet and oral health by the British Nutrition Foundation reviews the anatomy, microbiology and pathology of a number of oral diseases including dental caries, tooth-wear, oral cancer, periodontal disease and enamel defects. The role of nutritional factors in the aetiology and prevention of these oral diseases is discussed. The report states that improvements in the levels of caries in the UK are halting and remain unacceptably high in some 'at risk groups'--including the socially deprived. It states that a two-pronged attack, i.e. reduced frequency of consumption of sugary foods and use of fluoride is necessary to address the problem. To address the increased prevalence of oral cancer avoiding tobacco, limiting alcohol and increasing fruit and vegetable consumption are recommended. Recommendations for approaches to improve oral health are made for health authorities, industry, schools and health professionals and it is recommended that the Government make adequate resources available to improve oral health preventive strategies. <22> UI - 20236898 AU - Stephen KW IN - Dental Public Health Unit, University of Glasgow Dental School, Scotland. TI - Fluoride prospects for the new millennium--community and individual patient aspects. [Review] [47 refs] SO - Acta Odontologica Scandinavica 1999 Dec;57(6):352-5 AB - Over the past 2 decades, it has been suggested that with the generalized availability of fluoridated dentifrices, and coupled with a possible increased likelihood of fluorosis, the benefits of community-based fluoridation have receded. However, while this may be so for dentally motivated populations, there are convincing data to suggest that the least fortunate amongst us could still benefit from communally delivered fluoride. Furthermore, the deleterious effects of such program withdrawals have been demonstrated and, with respect to fluorosis fears, client assessment of their own fluorosis status has indicated few concerns. Alternative, centrally delivered means of fluoride dispensing, e.g. via schools, etc., although effective in the short-term, are impractical over longer time-spans. Nonetheless, at the individual level, fluoride supplements and dentifrices, in particular, are successful caries inhibitors. This is especially so if these vehicles are employed in their most effective, proven manners. Finally, fears relating to disfiguring fluorosis should be allayed, but where fluoride abuses result in mild mottling, a simple remineralizing technique obviates the need for traumatic restorative procedures. [References: 47] <23> UI - 20236890 AU - Honkala S AU - Honkala E AU - Tynjala J AU - Kannas L IN - Department of Health Sciences, University of Jyvaskyla, Finland. TI - Use of xylitol chewing gum among Finnish schoolchildren. SO - Acta Odontologica Scandinavica 1999 Dec;57(6):306-9 AB - The preventive, and partly the remineralizing, effect of xylitol was shown in Finland in the Turku Sugar Studies in 1971-73. Since then, several clinical trials in many countries have confirmed these results. In Finland, oral health personnel have recommended daily use of xylitol chewing gum in their dental health education. Moreover, commercial companies have advertised xylitol, emphasizing in particular its caries preventive effects. All Nordic dental associations have given their recommendations for xylitol use. The aim of this study was to describe how this health habit has been adopted by Finnish schoolchildren. The study was part of the comprehensive cross-national survey on Health Behavior in School-aged Children (HBSC Study)--a WHO Collaborative Study. The data were collected using standardized questionnaires to which pupils in grades 5 (11 years), 7 (13 years) and 9 (15 years) responded anonymously in school classrooms during the spring term 1998. The response rate varied between 87% (15-year-old boys) and 94% (11- and 13-year-old girls). Among boys, the percentages of daily users of xylitol chewing gum were 47% (11 years), 46% (13 years), and 44% (15 years), and among girls, 57% (11 years), 65% (13 years), and 69% (15 years), respectively. Use of sugar-sweetened chewing gum was very rare (1%), as also was use of chewing gum with other artificial sweeteners (1%). It may be concluded that since 1991 the use of xylitol chewing gum has further increased in Finland and currently more than a half of all schoolchildren benefit from it. <24> UI - 20041235 AU - Tomar SL AU - Winn DM IN - Centers for Disease Control and Prevention, Division of Oral Health, Atlanta, Ga. 30341, USA. TI - Chewing tobacco use and dental caries among U.S. men [published erratum appears in J Am Dent Assoc 1999 Dec;130(12):1700]. SO - Journal of the American Dental Association 1999 Nov;130(11):1601-10 AB - BACKGROUND: Chewing tobacco has high levels of sugars and may be cariogenic, but few studies have investigated such an association. This study examined the relationship between chewing tobacco use and dental caries among U.S. adult men. METHODS: Participants in the Third National Health and Nutrition Examination Survey conducted from 1988 to 1994 were interviewed about tobacco use and examined by dentists. The authors included in their analysis dentate men 18 years of age or older. They calculated the mean number of decayed or filled permanent teeth, or DFT, and decayed or filled coronal tooth surfaces, or DFS, as well as the mean number and percentage of decayed or filled root surfaces, or RDFS, and decayed root surfaces, or RDS, by tobacco-use status. They used multiple logistic regression to examine the association between chewing tobacco use and root-surface caries. RESULTS: Men who currently used only chewing tobacco had a higher adjusted mean number of DFT than did those who currently used only snuff, only cigarettes or more than one form of tobacco or who never used tobacco. Mean DFS also was higher among chewing tobacco users than among those who used only snuff, only cigarettes or more than one form of tobacco. Chewing tobacco users had a higher mean RDFS and RDS than did the users of other forms of tobacco or nonusers. Current users of chewing tobacco were more than four times as likely as those who never used tobacco to have one or more RDFS or RDS, with a dose-response relationship between number of packages used per week and odds of having root-surface caries. CONCLUSIONS: In addition to its established role as a carcinogen, chewing tobacco may be a risk factor in the development of root-surface caries and, to a lesser extent, coronal caries. This may be due to high sugar content, increased gingival recession and enhanced collagenase activity. CLINICAL IMPLICATIONS: Interventions by dentists and other members of the oral health care team to prevent tobacco use and help users quit can reduce the risk of developing oral and systemic disease. <25> UI - 20228706 AU - Dyment HA AU - Casas MJ IN - Faculty of Dentistry, University of Toronto, Ontario, Canada. TI - Dental care for children fed by tube: a critical review. [Review] [35 refs] SO - Special Care in Dentistry 1999 Sep-Oct;19(5):220-4 AB - No guidelines for the oral care of children fed by tube have been published. Poor oral health (unrestored caries lesions, poor oral hygiene, dependence for oral care) and tube-feeding are associated with the development of aspiration pneumonia. Children fed by tube have abundant calculus, and low caries activity. The potential for dental erosion related to gastro-esophageal reflux and oral hypersensitivity is high. To optimize oral health and reduce the risk of aspiration pneumonia, this population should receive dental care at more frequent intervals than children fed orally. Modifications to dental procedures are suggested to minimize the risks associated with dental treatment. Evidence-based treatment guidelines are indicated to optimize dental care for children fed by tube. [References: 35] <26> UI - 20228681 AU - Ribeiro CC AU - Baratieri LN AU - Perdigao J AU - Baratieri NM AU - Ritter AV IN - Department of Pedodontics, Federal University of Maranhao, School of Dentistry, Sao Luis, Brazil. TI - A clinical, radiographic, and scanning electron microscopic evaluation of adhesive restorations on carious dentin in primary teeth. SO - Quintessence International 1999 Sep;30(9):591-9 AB - OBJECTIVE: The purpose of this project was to evaluate the performance of a dentin adhesive system on carious and noncarious primary dentin in vivo. METHOD AND MATERIALS: Forty-eight primary molars with carious lesions were randomly assigned to 2 different treatments: group 1 (control, n = 24)--All identifiable, irreversibly infected dentin was removed prior to the application of the bonding agent and restorative material; group 2 (experimental, n = 24)--Irreversibly infected dentin was partially removed prior to the application of the bonding agent and restorative material. The control and experimental teeth were clinically monitored every 3 months and evaluated 12 months after restoration. The teeth were extracted around the time of exfoliation and processed for scanning electron microscopy. RESULTS: Retention rate, marginal integrity, and pulpal symptoms were identical in both groups. Radiographically, the radiolucent area associated with the experimental restorations did not increase with time in 75% of the cases. For the control group, the adhesive system formed a hybrid layer. In the experimental group, there was morphologic evidence of the formation of an acid-resistant "altered hybrid layer." An acid-resistant tissue, resulting from the interdiffusion of adhesive resin within the area of carious dentin, was observed adjacent to and under the altered hybrid layer. CONCLUSION: Application of an adhesive restorative system to irreversibly infected dentin did not affect the clinical performance of the restoration. <27> UI - 20228676 AU - Vrbic V IN - Department of Cariology and Endodontics, Medical Faculty, University of Ljubljana, Slovenia. TI - Retention of a fluoride-containing sealant on primary and permanent teeth 3 years after placement. SO - Quintessence International 1999 Dec;30(12):825-8 AB - OBJECTIVE: The aim of this study, conducted in 132 randomly selected children, was to evaluate the retention of a fluoride-containing sealant on primary and permanent teeth. METHOD AND MATERIALS: In autumn 1995, a total of 195 primary molars in 36 children aged 4.5 years on average and 391 permanent premolars and molars in 96 children aged 10.5 years on average were sealed with Helioseal-F. The manufacturer's instructions were followed closely. The teeth were cleaned with a slurry of pumice and a rotating brush, isolated with cotton rolls, dried with air, etched for 60 seconds with an etching gel (37% phosphoric acid), rinsed with an air-water combination spray, and dried. Sealant was applied with a cannula and polymerized for 60 seconds. A saliva ejector was used throughout the procedure. Sealant retention was checked 3 years after placement. RESULTS: In the primary molars, full retention was found in 95.04%, partial retention in 3.12%, and loss of the sealant in 1.84% of the treated teeth. In the permanent molars, the corresponding rates were 95.81%, 2.83%, and 1.36%, respectively. CONCLUSION: Very good sealant retention was found 3 years after placement. The observed difference in retention between primary and permanent molars was not statistically significant. <28> UI - 20227030 AU - Mattila ML AU - Rautava P AU - Sillanpaa M AU - Paunio P IN - Dept. of Child Neurology, University of Turku, Public Health Center, Finland. TI - Caries in five-year-old children and associations with family-related factors. SO - Journal of Dental Research 2000 Mar;79(3):875-81 AB - It is generally understood that the teeth of pre-school-aged children are healthy, but the improvement in the dmft index has halted in the industrialized countries. Those few children who have caries have more of it than before. Little is known of the family-related factors which are associated with this polarization of caries. A representative population-based sample consisted of 1443 mothers expecting their first child. The children were followed at well-baby clinics and public dental health clinics for over five years. The objective was to study the prevalence of dental caries and its predictors in five-year-old children and to assess children's own dental health habits and the meaning of family-related factors in dental health. The findings were based on questionnaire data from parents and on clinical dental examinations of the five-year-old children as completed by 101 public health dentists. In firstborn five-year-old children, dental health was found to be good in 72%, fair in 20%, and poor in 8% of the cases. The final multivariate analysis illustrated that the dmft index > 0 was independently associated with the mother's irregular toothbrushing (OR 2.2; 95% CI 1.4-3.5), annual occurrence of several carious teeth in the father (OR 2.6; 95% CI 1.9-3.6), daily sugar consumption at the age of 18 months (OR 2.4; 95% CI 1.4-4.1), occurrence of child's headaches (OR 3.7; 95% CI 1.5-8.8), parents' cohabitation (OR 3.3; 95% CI 1.5-7.6), rural domicile (OR 2.4; 95% CI 1.2-4.5), and mother's young age (OR 5.0; 95% CI 1.3-19.8). The findings indicated that attention should be paid not only to the child's dental health care but also to that of the whole family. Parents should be supported in their upbringing efforts and encouraged to improve their children's dental health habits. In everyday life, parents function as role models for their children, and therefore, parents' own dental hygiene habits are very meaningful. <29> UI - 20191322 AU - Burt BA AU - Keels MA AU - Heller KE IN - Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA. bburt@umich.edu TI - The effects of a break in water fluoridation on the development of dental caries and fluorosis. SO - Journal of Dental Research 2000 Feb;79(2):761-9 AB - Durham, NC, fluoridated since 1962, had an 11-month cessation of fluoridation between September, 1990, and August, 1991. The purpose of this study was to assess the effects of this break on the development of caries and fluorosis in children. Study participants were continuously-resident children in Kindergarten through Grade 5 in Durham's elementary schools. There were 1696 children, 81.4% of those eligible, for whom a questionnaire was completed and clinical data recorded. Age cohorts were defined by a child's age at the time that fluoridation ceased. Caries was recorded in children in the Birth Cohort through Cohort 3, and fluorosis for children in Cohorts 1 through 5. Caries was assessed in the primary first and second molars according to the decayed-filled index; fluorosis on the labial surfaces of the upper permanent central and lateral incisors was assessed by the Thylstrup-Fejerskov (TF) index. Mother's education was associated with caries; higher education of the mother had an odds ratio of 0.53 (95% CI 0.40, 0.76) for caries in the child. No cohort effects could be discerned for caries. Overall prevalence of fluorosis was 44%. Prevalence in Cohorts 1, 2, 3, 4, and 5 was 39.8%, 32.3%, 33.0%, 62.3%, and 57.1%, respectively. These cohort differences remained statistically significant in regression analysis. It was concluded that while the break had little effect on caries, dental fluorosis is sensitive to even small changes in fluoride exposure from drinking water, and this sensitivity is greater at 1 to 3 years of age than at 4 or 5 years. <30> UI - 20205076 AU - Kowash MB AU - Pinfield A AU - Smith J AU - Curzon ME IN - Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds. TI - Effectiveness on oral health of a long-term health education programme for mothers with young children. SO - British Dental Journal 2000 Feb 26;188(4):201-5 AB - AIM: To determine the effect of dental health education (DHE) on caries incidence in infants, through regular home visits by trained DH Educators over a period of 3 years. METHOD: A randomly selected cohort of 228 children born between 1st January and 30th September 1995, in a low socioeconomic/high caries suburb of Leeds (UK) were divided into the following groups: A) DHE focused on diet; B) DHE focused on oral hygiene instruction (OHI) using fluoride toothpaste; and C) DHE by a combined diet and OHI message. DHE was given using an interview and counselling for at least 15 minutes at home every 3 months for the first 2 years and twice a year in the third year of the study. A fourth group D was given diet and OHI, at home, once a year only. All children and mothers were examined for caries and oral hygiene. A fifth group E (control) received no DHE and were never visited but examined at 3 years of age only. RESULTS: In the groups of children visited regularly only two developed caries and three had gingivitis (all in group A). In group E, however, 33% of children had caries and nine (16%) had gingivitis. The differences in caries levels and caries risk factors between study and control groups were statistically significant (P < 0.001). Mothers of the study groups also showed an improvement in their own levels of gingivitis, debris and calculus scores by the second and third examinations (P < 0.001). CONCLUSION: Regular home visits to mothers with infants, commencing at or soon after the time of the eruption of the first deciduous teeth, was shown to be effective in preventing the occurrence of nursing caries. <31> UI - 20190758 AU - Udin RD IN - Department of Pediatric Dentistry, USC School of Dentistry 90089, USA. TI - Newer approaches to preventing dental caries in children. SO - Journal of the California Dental Association 1999 Nov;27(11):843-51 AB - Although the incidence of dental caries has shown a general decline during the past few decades, it still remains a significant health problem in children. The role of mutans streptococci in the caries process is discussed, including its transmission from mother to child during a discrete "window of infectivity." Anticipatory guidance--an approach used to better intercept the caries process to prevent it from progressing--is discussed. This program is introduced during infancy and is adapted to the child's particular needs as he or she matures. Anticipatory guidance allows for the implementation of some newer preventive strategies. Following the determination of mutans streptococci levels in at-risk infants and their mothers, a prevention program can be provided to both. Through proper education, various forms of topical fluoride supplementation, and antimicrobial therapy, it is hoped that newer preventive strategies can more effectively reduce the threat of caries at a much younger age than previously possible. <32> UI - 20162073 AU - Frame PS AU - Sawai R AU - Bowen WH AU - Meyerowitz C IN - Tri-County Family Medicine, Cohocton, New York 14826, USA. TI - Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines. [Review] [16 refs] SO - American Journal of Preventive Medicine 2000 Feb;18(2):159-62 AB - INTRODUCTION: The purpose of this article is to compare published evidence supporting procedures to prevent dental caries and periodontal disease, in low-risk patients, with the actual preventive recommendations of practicing dentists. METHODS: Methods included (1) a survey questionnaire of general dentists practicing in western New York State concerning the preventive procedures they would recommend and at what intervals for low-risk children, young adults, and older adults; and (2) review of the published, English-language literature for evidence supporting preventive dental interventions. RESULTS: The majority of dentists surveyed recommended semiannual visits for visual examination and probing to detect caries (73% to 79%), and scaling and polishing to prevent periodontal disease (83% to 86%) for low-risk patients of all ages. Bite-wing radiographs were recommended for all age groups at annual or semiannual intervals. In-office fluoride applications were recommended for low-risk children at intervals of 6 to 12 months by 73% of dentists but were recommended for low-risk older persons by only 22% of dentists. Application of sealants to prevent pit and fissure caries was recommended for low-risk children by 22% of dentists. Literature review found no studies comparing different frequencies of dental examinations and bite-wing radiographs to determine the optimal screening interval in low-risk patients. Two studies of the effect of scaling and polishing on the prevention of periodontal disease found no benefit from more frequent than annual treatments. Although fluoride is clearly a major reason for the decline in the prevalence of dental caries, there are no studies of the incremental benefit of in-office fluoride treatments for low-risk patients exposed to fluoridated water and using fluoridated toothpaste. CONCLUSIONS: Comparative studies using outcome end points are needed to determine the optimal frequency of dental examinations and bite-wing radiographs for the early detection of caries, and of scaling and polishing to prevent periodontal disease in low-risk persons. There is no scientific evidence that dental examinations, including scaling and polishing, at 6 month intervals, as recommended by the dentists surveyed in this study, is superior to annual or less frequent examinations for low-risk populations. There is also no evidence that in-office fluoride applications offer incremental benefit over less costly methods of delivering fluoride for low-risk populations. [References: 16] <33> UI - 20172928 AU - Paulus D AU - Wolf M AU - Meller S AU - Niemann H IN - Lehrstuhl fur Mustererkennung (Informatik 5), Universitat Erlangen-Nurnberg, Erlangen, Germany. paulus@informatik.uni-erlangen.de TI - Three-dimensional computer vision for tooth restoration. [Review] [50 refs] SO - Medical Image Analysis 1999 Mar;3(1):1-19 AB - If a person with carious lesions needs or requests crowns or inlays, these dental fillings have to be manufactured for each tooth and each person individually. We survey computer vision techniques which can be used to automate this process. We introduce three particular applications which are concerned with the reconstruction of surface information. The first one aims at building up a database of normalized depth images of posterior teeth and at extracting characteristic features from these images. In the second application, a given occlusal surface of a posterior tooth with a prepared cavity is digitally reconstructed using an intact model tooth from a given database. The calculated surface data can then be used for automatic milling of a dental prosthesis, e.g. from a preshaped ceramic block. In the third application a hand-made provisoric wax inlay or crown can be digitally scanned by a laser sensor and copied three dimensionally into a different material such as ceramic. The results are converted to a format required by the computer-integrated manufacturing (CIM) system for automatic milling. [References: 50] <34> UI - 20162444 AU - Waterhouse PJ AU - Nunn JH AU - Whitworth JM IN - Department of Child Dental Health, The School of Dentistry, Newcastle upon Tyne. TI - An investigation of the relative efficacy of Buckley's Formocresol and calcium hydroxide in primary molar vital pulp therapy. SO - British Dental Journal 2000 Jan 8;188(1):32-6 AB - OBJECTIVE: To compare the clinical and radiological outcomes following two different, single visit vital pulp therapy techniques, in cariously exposed primary molar teeth. SETTING: A paediatric dental clinic within the Dental Hospital, Newcastle upon Tyne, UK. SUBJECTS: Fifty two child patients were sequentially enrolled in the clinical investigation, 26 males and 26 females with an age range of 3.3-12.5 years. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). The total number of teeth treated was 84. DESIGN: Recruitment was on the basis of strict inclusion criteria. Coronal pulp amputation was prescribed only in teeth with vital, cariously exposed pulp tissue. Treatment was undertaken between October 1994 and December 1996. All cases were reviewed using predefined clinical and radiological criteria. The statistical tests used were logistic regression of a triple nested data structure, chi-squared analysis of equality of treatment and probability of success with relation to subject age. RESULTS: Eighty-four cariously exposed primary molars required vital pulp therapy. Forty six (55%) teeth were included in the F group and 38 (45%) allocated to the C group. Five teeth were lost to follow-up, leaving 79 teeth: forty four (56%) in group F and 35 (44%) in group C. Eighty four percent (37/44) of teeth treated with formocresol and 77 percent (27/35) treated with calcium hydroxide were classed as clinically and radiographically successful at the cut-off date, December 1997, after a mean clinical review of 22.5 months (range 6.1-38.5 months) and a mean radiographic review of 18.9 months (range 1.3-36.9 months). CONCLUSION: This investigation confirms the clinical efficacy of a one-fifth dilution of Buckley's Formocresol as an agent in pulp treatment of cariously exposed, vital primary molar teeth. However, calcium hydroxide in its pure, powder form is a clinically acceptable alternative when combined with strict selection criteria for this method of restorative care. There was a statistically insignificant difference in successful clinical and radiological outcome between the two treatment groups. Success was unrelated to the duration of time taken to achieve haemostasis and the presence or absence of bleeding after placement of the medicament. <35> UI - 20146916 AU - Burt BA IN - Program in Dental Public Health, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA. bburt@umich.edu TI - The case for eliminating the use of dietary fluoride supplements for young children. [Review] [72 refs] SO - Journal of Public Health Dentistry 1999 Fall;59(4):269-74 AB - Fluoride supplements have been used for years to prevent dental caries; nevertheless, there are three reasons why their use is inappropriate today among infants and young children in the United States. Evidence for the efficacy of fluoride supplements when used from birth or soon after is weak, supplements are a risk factor for dental fluorosis, and fluoride has little preeruptive effect in caries prevention. While there are many reports on the caries-preventive efficacy of supplements, few meet standards for acceptability as clinical trials, and those that do have tested chewable tablets or lozenges under supervision in school-aged children. North American children today are exposed to fluoride from many sources--drinking water, toothpaste, gels, rinses, and in processed foods and beverages. The additional cariostatic benefits that accrue from using supplements are marginal at best, while there is strong risk of fluorosis when young children use supplements. Available evidence suggests that the public is more aware of the milder forms of fluorosis than was previously thought; thus, it is prudent for caries-preventive policies to aim to maximizing caries reductions while minimizing the risk of fluorosis. It is therefore concluded that the risks of using supplements in infants and young children outweigh the benefits. Because alternative forms of fluoride for high-risk individuals exist, fluoride supplements should no longer be used for young children in North America. [References: 72] <36> UI - 20146915 AU - Newbrun E IN - newbrun@itsa.ucsf.edu TI - The case for reducing the current Council on Dental Therapeutics fluoride supplementation schedule. SO - Journal of Public Health Dentistry 1999 Fall;59(4):263-8 AB - The milder forms of dental fluorosis have increased in prevalence since the original epidemiologic surveys of the 1930s. Most studies of fluorosis have identified the use of supplements as a major risk factor. Fluorosis could be prevented, in part, by stopping the improper prescription of fluoride supplements in optimally fluoridated areas and by lowering the dosage currently recommended by the Council on Dental Therapeutics supplemental fluoride schedule. At a 1991 workshop at the University of North Carolina, five alternatives to the present ADA Council on Dental Therapeutics schedule were suggested; however, no consensus on dosage was reached. Recently, the Federation Dentaire International adopted a dosage schedule of 0.25 mg F from birth to 3 years of age, 0.5 mg F from 3 to 5 years, and 1 mg F thereafter. At a 1992 Canadian workshop it was proposed that supplements should not be started until age 3, should be given only to those "at high risk" of caries, and only 0.25 mg F should be prescribed from 3 to 5 years of age. Similarly, in some European countries supplements are not recommended until 3 years, at which time 0.5 mg F is prescribed, but only "for children at risk." Australia is considering a dosage schedule starting with 0.25 mg F at 6 months, again only for those "particularly at risk of caries." Serious problems exist in limiting fluoride supplementation only to high-caries-risk children because they are not easily identifiable at a young age. Ideally, a dosage schedule should be based on body surface area or weight rather than simply age, and supplements should be in the form of lozenges for children over 2 years of age. A reduced fluoride supplement dosage schedule is proposed. <37> UI - 20146914 AU - Moss SJ IN - Health Education Enterprises, New York, NY 10017, USA. healthee@ix.netcom.com TI - The case for retaining the current supplementation schedule. SO - Journal of Public Health Dentistry 1999 Fall;59(4):259-62 AB - Following ingestion of dietary fluoride, microquantities of fluoride return to the mouth in saliva, but in quantities large enough to facilitate the maintenance and reparative functions of enamel. Dietary fluoride supplements alone are unlikely to be the cause of the reported increase in fluorosis. Compliance continues to be extremely poor and few children use supplements for more than a year and a half. The amount of background fluoride resulting from dietary fluoride supplements appears to be very small. Considering the almost ubiquitous presence of fluoride dentifrice and the strong possibility of additional unintentional fluoride ingestion from many sources, the present fluorosis data is too amorphous to use as a basis for making reasonable risk/benefit evaluations. Very mild and mild fluorosis is not a serious problem for either the clinician or the patient. By altering the present recommended dosage we may deprive children from receiving a proven effective dose. One cannot make a risk/benefit decision concerning an esthetic problem without involving the patient's perception as well as the caries score. The apparent severity of the milder forms of fluorosis lessens with age and a community fluorosis index should be used only on populations who are older than 15 years. <38> UI - 20144636 AU - McDaniel RJ AU - Davis RD AU - Murchison DF AU - Cohen RB IN - Department of TMJ and Orofacial Pain, University of Minnesota Dental School, USA. TI - Causes of failure among cuspal-coverage amalgam restorations: a clinical survey. SO - Journal of the American Dental Association 2000 Feb;131(2):173-7 AB - BACKGROUND: Investigations of cuspal-coverage amalgam restorations suggest that tooth fracture is the leading cause of failure, while for Class I and II restorations, the leading cause is caries. In this study, the authors evaluated the causes of failure for a large number of cuspal-coverage restorations. METHODS: The causes of failure for 706 cuspal-coverage amalgam restorations were determined through the use of a questionnaire. Dentists from a variety of dental schools; Army, Navy, Air Force, Public Health and Veterans Affairs dental clinics; and private practice were asked to record pertinent information regarding patients and restoration failures from choices provided on a survey form. RESULTS: The survey documented 706 failed restorations. Mandibular first molars accounted for 36.25 percent of all failures. The majority of failures were caused by fractured teeth (24.3 percent), caries (20 percent) and fractured restorations (17.1 percent). Among all of the failed restorations, 82.15 percent were restorable, 9.35 percent were repairable and 8.50 percent were nonrestorable. Among the fractured teeth, 80 percent were restorable, 14.5 percent were nonrestorable and 5.5 percent were repairable. Among the carious teeth, 84 percent were restorable, 8 percent were nonrestorable and 8 percent were repairable. A chi 2 analysis revealed that tooth fracture was more likely to be associated with nonrestorability than either caries (chi 2 = 5.013, P < .05) or restoration fracture (chi 2 = 6.202, P < .05). CONCLUSIONS: The leading cause of failure among the 706 restorations was tooth fracture, which resulted in significantly greater numbers of nonrestorable teeth than either caries or fractured restorations. CLINICAL IMPLICATIONS: Tooth fracture creates a greater risk of nonrestorability than any other cause of failure. Replacement or coverage of fracture-prone cusps is likely to improve the life expectancy of complex amalgam restorations. <39> UI - 20128565 AU - Helminen SE AU - Vehkalahti M AU - Lammi R AU - Ketomaki TM AU - Murtomaa H IN - Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Finland. TI - Dentists' decisions as to mode of preventive treatment in adolescents and young adults in Finland. SO - Community Dental Health 1999 Dec;16(4):250-5 AB - OBJECTIVE: To evaluate dentists' real-life decisions as to mode of preventive treatment in adolescents and young adults, in relation to these patients' oral-health status, and to the dentists' characteristics. DESIGN: A random sample of 206 adolescents and 239 young adults (mean ages 13 and 27 years) produced 411 (92%) individual oral health records providing data on actual clinical examinations and treatment courses carried out by 56 dentists in one administrative unit of the Finnish public oral health service during 1994-1996. OUTCOME MEASURES: Preventive measures were defined as active and passive, active including any kind of motivation or instructions given to a patient concerning home self-care, and passive prevention being topical application of fluoride. RESULTS: More adolescents had received both active and passive prevention than had young adults (active: 27% vs. 20%; passive: 85% vs. 70%). Of adolescents, 7% and of young adults 25% were given no preventive treatment. The mean number of active preventive measures per adolescent during the treatment course was 0.3 and of passive measures 1.0; for young adults 0.2 and 0.8, respectively. A subject's oral health status made no significant difference in active prevention given. Active measures were more frequently given to all patients by male dentists, 35% vs. 22% (P < 0.02), and passive measures by females, 82% vs. 52% (P < 0.001). The odds of active prevention for adolescents were 7.4 comparing male dentists to female; of passive 13.8 comparing female to male. CONCLUSIONS: Dentists should be motivated to make considered treatment decisions on preventive treatment. <40> UI - 20128562 AU - Hawley GM AU - Wainwright-Stringer Y AU - Craven R AU - Blinkhorn AS IN - Mancunian Community Health NHS Trust, Manchester, UK. TI - An investigation into the use of a dental hygienist in school screening. SO - Community Dental Health 1999 Dec;16(4):232-5 AB - OBJECTIVE: A pilot study to measure the validity of using a hygienist to carry out school screening. DESIGN: Following a standard training programme a dental hygienist (DH), recruited from general practice, a newly appointed dental officer (DO) and an epidemiologist (SDO), who acted as the standard, all screened the same group of school children on two occasions. SETTING: An inner city school with known high levels of disease. PARTICIPANTS: Ninety-eight 7- and 8-year-old children attending school. MAIN OUTCOME MEASURES: For each clinician the levels of referral, the reasons for referral and the repeatability were measured. RESULTS: The hygienist referred 26 children (27%) for further examination while the DO and the SDO both referred 61 (62%). The DO achieved the required standards of sensitivity and specificity when results were compared with the SDO but the hygienist did not. Intra-examiner reliability in all three clinicians was good. CONCLUSIONS: The standard training programme used to prepare dental officers to carry out school screening to an agreed standard was insufficient for this hygienist's needs. <41> UI - 20113836 AU - Bader JD AU - Shugars DA AU - White BA AU - Rindal DB IN - Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. jim:bader@unc.edu TI - Evaluation of audit-based performance measures for dental care plans. SO - Journal of Public Health Dentistry 1999 Summer;59(3):150-7 AB - OBJECTIVES: Although a set of clinical performance measures, i.e., a report card for dental plans, has been designed for use with administrative data, most plans do not have administrative data systems containing the data needed to calculate the measures. Therefore, we evaluated the use of a set of proxy clinical performance measures calculated from data obtained through chart audits. METHODS: Chart audits were conducted in seven dental programs--three public health clinics, two dental health maintenance organizations (DHMO), and two preferred provider organizations (PPO). In all instances audits were completed by clinical staff who had been trained using telephone consultation and a self-instructional audit manual. The performance measures were calculated for the seven programs, audit reliability was assessed in four programs, and for one program the audit-based proxy measures were compared to the measures calculated using administrative data. RESULTS: The audit-based measures were sensitive to known differences in program performance. The chart audit procedures yielded reasonably reliable data. However, missing data in patient charts rendered the calculation of some measures problematic--namely, caries and periodontal disease assessment and experience. Agreement between administrative and audit-based measures was good for most, but not all, measures in one program. CONCLUSIONS: The audit-based proxy measures represent a complex but feasible approach to the calculation of performance measures for those programs lacking robust administrative data systems. However, until charts contain more complete diagnostic information (i.e., periodontal charting and diagnostic codes or reason-for-treatment codes), accurate determination of these aspects of clinical performance will be difficult. <42> UI - 20113835 AU - Bader JD AU - Shugars DA AU - White BA AU - Rindal DB IN - Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7590, USA. jim:bader@unc.edu TI - Development of effectiveness of care and use of services measures for dental care plans. SO - Journal of Public Health Dentistry 1999 Summer;59(3):142-9 AB - OBJECTIVES: Standardized measures to assess clinical aspects of the performance of managed dental care plans are not available. This project sought to develop and evaluate measures for effectiveness of care and use of services that could be calculated using a plan's administrative data. METHODS: Two panels of stake holders representing dental plans, purchasers, and dental providers participated in a modified Delphi process to refine initial sets of effectiveness of care and use of services measures modeled after HEDIS measures for medical care. The refined measures were then pilot tested in two dental health maintenance organizations. RESULTS: The development process resulted in specification of seven effectiveness of care measures assessing disease activity classification, and prevention and outcomes for caries, periodontal disease, and tooth loss. Six use of services measures focusing on prophylaxes, third molar surgery, preventive, restorative, prosthetic, surgical, and endodontic care also were specified. Pilot testing of the measures indicated reasonable reliability and sensitivity, but also demonstrated the need for supervision or auditing of the process. CONCLUSIONS: These standardized measures for dental care plan performance are available for immediate use. However, because the measures depend on diagnostic information (periodontal probing data and diagnoses associated with restorative treatments) in the administrative data set, their adoption will require changes in most plans' data systems and data collection policies. <43> UI - 20113834 AU - Crall JJ AU - Szlyk CI AU - Schneider DA IN - Department of Pediatric Dentistry, University of Connecticut Health Center, Farmington 06030-1610, USA. crall@nso.uchc.edu TI - Pediatric oral health performance measurement: current capabilities and future directions. SO - Journal of Public Health Dentistry 1999 Summer;59(3):136-41 AB - This paper offers an overview of performance measurement in health care, provides a synopsis of the findings and recommendations of an Oral Health Expert Panel organized by the National Committee for Quality Assurance (NCQA) under contract with the Health Care Financing Administration (HCFA), and discusses challenges and possible future directions for pediatric oral health care performance measures development. Existing performance measures for pediatric oral health care are extremely limited; however, several new measures have been proposed and are in various stages of development and testing. Measures capable of being implemented in the short-term focus on access and use of services, rely on administrative data sources, and represent refinements and enhancements of current measures. Measures proposed for future implementation focus more on the effectiveness of care, consumer assessments of care and plan performance, and the value of services provided to enrolled children. Recommendations are targeted toward high-risk children who, for the most part, are covered by public programs (e.g., Medicaid and the Children's Health Insurance Program). Nevertheless, the entire set of recommended measures is considered to be relevant to all pediatric populations and applicable to all forms of dental care coverage, including state-administered programs and commercial third party arrangements. <44> UI - 20099336 AU - Fuks AB AU - Ram D AU - Eidelman E IN - Hadassah School of Dental Medicine, Department of Pediatric Dentistry, Hebrew University, Jerusalem, Israel. TI - Clinical performance of esthetic posterior crowns in primary molars: a pilot study. SO - Pediatric Dentistry 1999 Nov-Dec;21(7):445-8 AB - PURPOSE: The aim of this pilot study was to assess the clinical performance of esthetic crowns and to compare these to conventional stainless steel crowns (SSC). METHODS: Twenty two crowns (11 conventional and 11 esthetic) were placed in mandibular primary molars obeying the following criteria: the tooth was not mobile; no fistulae were present; the tooth had at least one caries free or properly restored antagonist and had to be in contact with one adjacent tooth mesially, in the case of the primary second molars or distally in the case of the primary first molars. Crown preparation was done in a conventional manner, but reduction was more extensive for the thicker esthetic crowns, to allow for proper occlusion. The crowns were evaluated clinically and radiographically after 6 months and the following parameters were assessed: gingival health, marginal extension, crown adequacy, proper position or occlusion, proximal contact, chipping of the facing (for esthetic crowns) and cement removal. RESULTS: At the 6 month evaluation all esthetic crowns were intact, without chipping of the facing, and no excess of cement was observed in both groups. No difference was found for marginal extension, occlusion, proximal contact, crown adequacy, and bone resorption, but a significant difference was found for periodontal health between esthetic crowns and conventional SSC (P < 0.001 McNemar test). CONCLUSIONS: The esthetic crowns assessed had several inconveniences, as they resulted in poor gingival health, are very expensive, and, although not measured, are bulky and without a natural appearance. <45> UI - 20105831 AU - Varsio S AU - Vehkalahti M AU - Murtomaa H IN - Department of Oral Public Health, University of Helsinki, Finland. TI - Dental care of six-year-old high-caries patients in relation to their cooperation. SO - Community Dental Health 1999 Sep;16(3):171-5 AB - OBJECTIVE: To evaluate caries occurrence in, and dental care given to, 6-year-old high-caries patients in relation to their cooperation as judged by the dentist. DESIGN: Retrospective evaluation study. SETTING: Children selected on the basis of their high number of decayed teeth (dt + DT). Data from personal oral health records. PARTICIPANTS: High-caries children aged 6 years (n = 97) clinically examined and treated in public dental clinics in Helsinki, Finland, with mean dt + DT = 8.7, range 4-18. OUTCOME MEASURES: Data covering ages 3 to 7 years: utilization of dental services, operative and preventive treatment by visit. RESULTS: Treatment strategy for the 6-year-old high-caries patients was not preventive-oriented. High-caries patients had three to four times as many visits as all 6-year-old children on average, but the visits had mostly served for operative treatment. Dentists had judged 34% of the high-caries patients to be non-cooperative. These patients had more past and present caries in their deciduous teeth (P < 0.01), more dental visits (P < 0.01), and received more demanding treatment (P < 0.001) than the cooperative high-caries patients. Caries preventive treatment given to all high-caries patients was rare, number of preventive interventions per patient and per visit (intensity) tended to correlate negatively with patients' cooperation (r = -0.12 and r = -0.23). Treatment courses were completed in 39% among the non-cooperative and in 63 per cent among the cooperative high-caries patients (P < 0.05). CONCLUSION: Dentists should be encouraged to integrate preventive interventions more closely into the treatment of non-cooperative high-caries children. <46> UI - 20105829 AU - Flinck A AU - Kallestal C AU - Holm AK AU - Allebeck P AU - Wall S IN - Department of Epidemiology and Public Health, Umea University, Sweden. TI - Distribution of caries in 12-year-old children in Sweden. Social and oral health-related behavioural patterns. SO - Community Dental Health 1999 Sep;16(3):160-5 AB - OBJECTIVE: To describe the distribution of caries in 12-year-old children in Sweden according to socio-demographic and oral health related behaviour. PARTICIPANTS: The study group consisted of 3,373 12-year-old children residing in catchments of 26 different public dental health clinics in Sweden, geographically well represented. METHOD: The clinical examination for dental caries was performed by 28 calibrated dentists. A questionnaire on lifestyle was distributed to the children with questions on ethnicity, socio-economic level and oral health as well as overall health attitudes. RESULTS: The proportion of 12-year-old children with no experience of dentine caries was 47% and 35% were completely free from all caries. Intraoral distribution of caries showed most lesions on the first molar mesial surface, with 80% enamel and 20% dentine caries. Almost all children brushed their teeth twice a day and a third of the children had an extra intake of fluoride. Decayed surfaces including enamel caries (DeS) was chosen as a measure of ongoing caries and used when dividing children into three caries groups; caries free (50%), 1-3 lesions (40%) and the high caries group (10%) with more than 3 lesions. These groups showed distribution differences. More non-Swedish children, children from workers' homes, and children who brushed their teeth less than twice a day were found in the high caries group. More children from workers' homes living in big cities and snacking more than once a week were also found in the high caries group. This could not be shown for other social groups. Also children who had an extra intake of fluoride were classified in the high caries group. <47> UI - 20105820 AU - Mascarenhas AK IN - Ohio State University, Columbus, USA. TI - Determinants of caries prevalence and severity in higher SES Indian children. SO - Community Dental Health 1999 Jun;16(2):107-13 AB - OBJECTIVES: Recent epidemiological studies in the economically developing countries show that the prevalence and severity of dental caries has increased with industrialization and exposure of these populations to western diets. The aim of this study was to quantify the caries experience, and identify determinants associated with caries, in a population which has a higher socio-economic status (SES), and is the most westernized in India. BASIC RESEARCH DESIGN: The study site was Goa, a former Portuguese colony, which became part of India in 1961. Data came from a cross-sectional survey of 1,189 seventh grade children in private schools, consisting of a clinical dental examination and a self-administered questionnaire to their parents. MAIN OUTCOME MEASURES: The study used the cavitated/non-cavitated criteria to score for caries, the TF index for fluorosis, and the Silness and Loe index for plaque. RESULTS: The mean age of the children was 12.2 years. The proportion of children caries-free in the permanent dentition was 22.2%. The mean DMFT and DMFS in the study group were 2.78 and 4.20, respectively. The decayed component accounted for over 87% of the DMFT, DMFS, dft, and dfs. Results of the crude, stratified, and multivariate regression analyses showed that poor oral hygiene, mother's highest level of education, use of fluoride toothpaste before the age of six years, and higher frequency of tooth brushing were risk indicators of caries prevalence and severity. CONCLUSION: The findings suggest that risk indicators of caries in this study population were similar to those in developed countries. <48> UI - 20069257 AU - Ekstrand KR AU - Kuzmina IN AU - Kuzmina E AU - Christiansen ME IN - Department of Cariology and Endodontics, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Denmark. KIM.EKSTRAND@ODONT.KU.DK TI - Two and a half-year outcome of caries-preventive programs offered to groups of children in the Solntsevsky district of Moscow. SO - Caries Research 2000 Jan-Feb;34(1):8-19 AB - This study examined the 2.5-year outcome of preventive programs - based on the Nexo method - offered to three groups of children from Solntsevsky, a district of Moscow. Study group A consisted of 45 3-year-olds, study group B of 50 6-year-olds, and study group C of 50 11-year-olds. A similar number of children were selected as control groups and they followed the normal dental service provided by the local Health Service System in the district. The caries-preventive programs offered to the study groups were based on: (1) education of the child, parents and teachers in the caries disease, (2) training in toothbrushing. In addition, the children in study groups B and C were offered professional plaque removal, applications of sodium fluoride (2%) and sealant applications according to individual needs. The children in groups B and C were clinically examined in March 1994 (baseline) after 1 and 2.5 years, respectively. Because of the age of the children in group A, these children were only examined once, after the study had been completed. After 2.5 years the children in all three study groups had improved their oral health status significantly compared to the children in the control group. The caries experience among the children in study group A was about half of that observed among children in the control group (4.91 def-s versus 8.60 def-s). The program was highly effective in controlling dental caries in the permanent dentition among the children in the study groups, who finished with a mean DMF-S of 0.28 (group B) and 3.12 (group C) compared to 2.24 and 6.35 among the children in the corresponding control groups. Nearly all the children used fluoridated toothpaste. The mean number of visits to the clinic decreased from year 1 to year 2 (5 versus 3.4 in study group B and 4.5 versus 3.3 in study group C). In conclusion, the preventive programs were highly effective with regard to improving the level of oral hygiene, and thereby reducing or even controlling the plaque-induced disease activity. <49> UI - 20098169 AU - Hausen H AU - Karkkainen S AU - Seppa L IN - Institute of Dentistry, University of Oulu, Finland. hannu.hausen@oulu.fi TI - Application of the high-risk strategy to control dental caries. SO - Community Dentistry & Oral Epidemiology 2000 Feb;28(1):26-34 AB - OBJECTIVE: The aim of this prospective study was to determine whether a child population with low overall caries frequency benefits when prevention is targeted to high-risk individuals. METHODS: Data from clinical examinations and salivary tests were used to assess caries risk in 12-year-olds (n=1465). Children who were regarded as being at high risk of developing caries were randomized into two groups. Half (HRI group) were offered intensive prevention (counseling, F-varnish applications, F-lozenges, sealants, chlorhexidine), and the other half (HRB group) were provided the same basic prevention given to low-risk children (counseling, one F-varnish application/year). A random sample of the low-risk children (LRB) was followed up for the same 3-year period as the high-risk children. The number of children completing the study was 216 in the LRB group, 199 in the HRI group and 174 in the HRB group. RESULTS: The mean (SD) 3-year DMFS increment was 2.0 (2.4), 4.4 (4.7) and 5.1 (5.0) in the LRB, HRI and HRB groups, respectively. Comparison between the LRB and HRB groups revealed that risk assessment was fairly successful in terms of mean DMFS increment. However, 63% of the children in the LRB group developed at least one new lesion (max. 12). CONCLUSIONS: The negligible difference between the HRI and HRB groups implies that intensifying prevention produced practically no additional benefit. By offering all children only basic prevention, virtually the same preventive effect could have been obtained with substantially less effort and lower costs. <50> UI - 20088438 AU - Skaret E AU - Raadal M AU - Berg E AU - Kvale G IN - Center for Odontophobia, Faculty of Odontology, University of Bergen, Norway. erik.skaret@odont.uib.no TI - Dental anxiety and dental avoidance among 12 to 18 year olds in Norway. SO - European Journal of Oral Sciences 1999 Dec;107(6):422-8 AB - The aim of this study was to explore the prevalence and possible explanatory factors of dental avoidance due to dental anxiety among 12 to 18 year olds treated within the Norwegian Public Dental Service. A total of 754 20-yr-olds completed a questionnaire and three psychometric scales, the Dental Fear Scale (DFS), the Dental Beliefs Survey (DBS) and the Geer Fear Scale (GFS), and gave their consent to collect data from their dental records. A total of 169 subjects (22.4%) had high dental anxiety (DFS>59 or DBS>47 at age 20 yr), and 124 subjects (16.4%) had high frequency of missed/cancelled appointments (20% or more) during the period 12-18 yr. Forty-seven subjects (6.2%) fulfilling both of the above criteria constituted the dental avoidance group. An analysis using a stepwise regression model indicated that having had more than one painful or unpleasant treatment experience increased the risk of being included in the avoidance group by a factor of 10.9. Equally, adolescents who were not attending school (working or without specified occupation) increased the risk by a factor of 6.9, having a high caries experience by a factor of 5.0, and not having their dental treatment completed at the age of 18 yr by a factor of 4.4. <51> UI - 20039828 AU - Lin YT AU - Tsai CL IN - Department of Dentistry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan. TI - Caries prevalence and bottle-feeding practices in 2-year-old children with cleft lip, cleft palate, or both in Taiwan. SO - Cleft Palate-Craniofacial Journal 1999 Nov;36(6):522-6 AB - OBJECTIVE: The purposes of this study were to investigate the caries prevalence in cleft lip, cleft palate, or both in children under the age of 2 years and to evaluate parental attitudes toward bottle-feeding, dental care, and their relationship to baby bottle tooth decay (BBTD) in Taiwan. DESIGN: Randomized and prospective study. SETTING: Institutional setting. PATIENTS AND METHODS: One hundred twenty-three 2-year-old children (68 boys and 55 girls) with cleft lip, cleft palate, or both were selected for this study. A questionnaire that asked questions about knowledge of oral health, knowledge and beliefs about BBTD, children's feeding habits, children's dental care, and parenting attitudes toward children with clefts was completed by the parents or caretakers. Children were divided into bottle-feeding and non-bottle-feeding groups according to the questionnaire responses of parents or caretakers. Each child was examined with a dental mirror and explorer under focused flashlight using defs index to determine the presence of BBTD. RESULTS: Thirty-nine percent (48) subjects reported a bottle-feeding habit; the overall prevalence of BBTD was 15.4%. The habit of bottle-feeding was significantly related to BBTD (p = .019). The defs score for children who were bottle-fed was significantly higher than children who were not bottle-fed (p = .045). Parents or caretakers of both bottle-feeding and non-bottle-feeding children showed no significant differences in their attitudes toward bottle-feeding and feeding habits (p > .05). However, parents of non-bottle-fed children had significantly better dental care than parents of bottle-fed children in brushing frequency (p < .001) and brushing before bed (p < .001). CONCLUSIONS: Children with clefts who took a bottle to bed showed an increased risk of developing BBTD. The parents or caretakers of bottle-fed children also showed a lack of motivation to perform regular preventive dental home care for their children. This suggests that oral health promotion programs should begin in infancy for children with clefts and their parents. <52> UI - 20006942 AU - Pyk N AU - Mejare I IN - Ektorp Public Dental Health Clinic and Eastman Dental Institute, Stockholm County Council, Sweden. TI - Tunnel restorations in general practice. Influence of some clinical variables on the success rate. SO - Acta Odontologica Scandinavica 1999 Aug;57(4):195-200 AB - Using bitewing radiographs and clinical inspection, the success rate for tunnel restorations was assessed in a population with low caries activity. The material consisted of 242 tunnel restorations in permanent premolars and molars in 142 individuals (mean age = 18.8 years). The median DFSappr value (decayed and filled approximal surfaces) at the time of restoration was 4.0. The mean follow-up time was 25 months. Bivariate associations between the outcome variable (success/failure of the tunnel restoration) and conceivable explanatory variables were investigated. In a multivariate logistic regression analysis, the independent variables tooth type (premolars vs molars), surface site (mesial vs distal), radiographic stage of approximal carious progression and age of patient at the time of restoration (9-15 years vs > 15 years) were used to estimate the effect on the dependent variable success/failure. Using the life table method, the estimated cumulative proportion of successful restorations was 81% after 2 years and 64% after 3.5 years. The success rate was not related to caries activity and did not differ between the two types of tunnel preparation techniques nor between different follow-up periods. In the multivariate regression analysis, tooth type (molars vs premolars) was the only factor significantly associated with failure. Thus, a failure occurred about 5 times as often in molars as in premolars. Of the failures, half were due to caries; either radiographically observed adjacent to the restoration or progressing enamel caries on the outer proximal surface. Marginal ridge fractures constituted 26% of the failures. From the present results it can be concluded that in a population with low caries activity, the tunnel restoration technique can be recommended for premolars. <53> UI - 20057414 AU - Jalevik B AU - Sjostrom O AU - Noren JG IN - Specialist Clinic for Pedodontics, Molndal, Sweden. TI - Evaluation of three years of dental care of adolescents in the Public Dental Service in west Sweden. SO - Swedish Dental Journal 1999;23(4):141-8 AB - 107 individuals, randomly selected from the County of Goteborg and Bohuslan, all born in 1970 were followed regarding the dental care received 1987-1989. The records of each individual from the actual time were collected and information on diagnosis and treatment measures was gathered. Radiographs from the actual time were studied by one of the authors. Sixty-two per cent of the adolescents had been examined and treated all 3 years. Six percent had not been seen at all. The sample was divided into three groups depending on the patient's DFSa value at the examination the first year. This classification appeared to correlate well with caries development in the following years. One-fourth of the sample was responsible for the major part of the non-attendance and late cancellations. The dental health of these subjects was below average, and non-attendance seemed to be a further risk factor. The preventive measures undertaken during the study appeared to correlate poorly with the actual situation of the patient and the presence or absence of potential risk factors. <54> UI - 20051365 AU - Rashid SA AU - Al-Wahadni AM AU - Hussey DL IN - Department of Restorative Dentistry, School of Clinical Dentistry, Queen's University, Belfast, Northern Ireland. TI - The periodontal response to cantilevered resin-bonded bridgework. SO - Journal of Oral Rehabilitation 1999 Nov;26(11):912-7 AB - This study investigated 84 cantilevered resin-bonded bridges (CRBB) in 60 patients. These CRBB (single retainer, single pontic) had been in place for an average of 43.6 months. Periodontal health was assessed on abutment teeth and contralateral control teeth. Periodontal indices utilized were Plaque Index (PI), Gingival Index (GI), Bleeding Index (BI), Pocket Depth (PD) and mobility. The marginal adaptation, the gingival extension of the retainers and the presence or absence of caries around each retainer margin were also assessed. Information about the history of debonding was collected and a success rate of 93% was reported. PI, GI and mean PD compared statistically significantly, less favourably, with scores of the control teeth. Marginal adaptation of the retainers was of a high standard and caries did not appear to be a problem. <55> UI - 99408158 AU - Mejare I AU - Sundberg H AU - Espelid I AU - Tveit B IN - Eastman Dental Institute, Stockholm County Council, Sweden. ingegerd.mejare@ftv.sll.se TI - Caries assessment and restorative treatment thresholds reported by Swedish dentists. SO - Acta Odontologica Scandinavica 1999 Jun;57(3):149-54 AB - The aim was to study any variability in approximal and occlusal caries diagnoses and restorative treatment decisions among Swedish dentists. The material consisted of a pre-coded questionnaire sent to a random sample of 923 dentists with 4 items concerning approximal and occlusal caries diagnosis and restorative treatment decisions. Responses were received from 651 (70.5%) dentists. In an adolescent with low caries activity and good oral hygiene, more than 90% of the dentists stated that they would not automatically restore a primary approximal caries lesion if its radiographic appearance did not show obvious progression in the outer 1/3 to 1/2 of the dentin. Moreover, 67% of the dentists would only consider immediate restorative treatment of an occlusal surface if obvious cavitation and/or radiographic signs of dentin caries could be observed. When diagnosing questionable occlusal caries, the dentists largely relied on the radiographic appearance. Concerning both approximal and occlusal caries, the threshold for restorative treatment differed between the metropolitan regions in Sweden, and younger more often than older dentists would postpone restorative treatment of approximal caries until the lesion had reached a relatively advanced stage of progression. The responses also showed that dentists in private practice would restore approximal caries at an earlier stage of progression than the dentists in the Public Dental Health Service. <56> UI - 99408154 AU - Kneckt MC AU - Syrjala AM AU - Knuuttila ML IN - Institute of Dentistry, University of Oulu, Finland. mkneckt@hotmail.com TI - Locus of control beliefs predicting oral and diabetes health behavior and health status. SO - Acta Odontologica Scandinavica 1999 Jun;57(3):127-31 AB - Our study evaluates the correlation between dental and diabetes locus of control beliefs and the potentiality of locus of control beliefs in predicting oral health behavior, dental status, diabetes compliance, and HbA1c level by using situation-specific locus of control scales and considering the value dimension. Data were collected by means of a quantitative questionnaire, a clinical oral examination and patient records. The research population comprised 149 insulin-dependent diabetics who had teeth of their own. Variables were the frequencies of tooth brushing and dental visiting, oral indexes, diabetes adherence, and HbA1c level. Dental and diabetes locus of control beliefs correlated with each other. Dental locus of control associated with frequency of dental visiting, plaque index, decayed surfaces, and with root caries, but diabetes locus of control associated only weakly with adherence with diabetes self-care regimens and not at all with HbA1c level. Correlations between dental locus of control and oral indexes were stronger among those having high value for dental care. Although there were correlations between dental and diabetes locus of control beliefs, only dental locus of control beliefs are practicable for determining health behavior and health status. It is therefore concluded that locus of control beliefs are health behavior specific. <57> UI - 99365535 AU - Warren JJ AU - Levy SM IN - Department of Preventive & Community Dentistry, College of Dentistry, University of Iowa, USA. TI - A review of fluoride dentifrice related to dental fluorosis. [Review] [53 refs] SO - Pediatric Dentistry 1999 Jul-Aug;21(4):265-71 AB - Introduced to the commercial market 40 years ago, fluoride dentifrice now accounts for nearly all dentifrice purchased in the United States. During this same time, the prevalence and severity of dental caries has declined while dental fluorosis prevalence has increased. While the caries decline can be largely attributed to widespread fluoride dentifrice use, as well as many other sources of fluoride, several recent studies have attributed much of the increase in fluorosis prevalence to early use of fluoride dentifrice. This paper reviews these studies, as well as the efficacy of fluoride dentifrices with lower fluoride concentrations. Finally, recommendations regarding fluoride dentifrice to maintain caries prevention and reduce the risk of dental fluorosis are presented. [References: 53] <58> UI - 99391688 AU - Marks LA AU - Weerheijm KL AU - van Amerongen WE AU - Groen HJ AU - Martens LC IN - Cariology, Endodontology, Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands. Luc.Marks@rug.ac.be TI - Dyract versus Tytin Class II restorations in primary molars: 36 months evaluation. SO - Caries Research 1999 Sep-Oct;33(5):387-92 AB - Due to the changed treatment approach of proximal caries and the amalgam controversy, clinicians are in search for new materials. The aim of the present study was to compare amalgam with an adhesive material in deciduous molars in a clinical, split-mouth design study. At baseline 30 polyacid modified composite (Dyract) and 30 amalgam (Tytin) restorations were placed in primary molars, of which 24 and 17 could be evaluated after 24 and 36 months, respectively. Modified USPHS criteria were used for clinical evaluation every 6 months. Annual bite-wing radiographs were taken for evaluation of recurrent caries and cervical gap formation. In the present study, for Dyract as well as for Tytin restorations, low rates of recurrent caries were found, while Dyract restorations showed a better marginal adaptation and surface texture compared to Tytin restorations. In the Dyract group more radiolucencies were found at baseline. In both groups no patient complaint or pain was reported related to the radiolucencies. After 3 years the colour of Dyract was not comparable to the original. For Dyract no excessive wear was noticed compared to enamel. During the study one Dyract (recurrent caries: 18 months) and two Tytin (pulpal aetiology: 6 months, recurrent caries: 36 months) restorations had to be replaced. Even though the restorations were placed in caries risk children, at the 36 months' evaluation of this clinical study, the results indicate that Dyract can be an alternative for Tytin in the primary dentition. <59> UI - 99360011 AU - Holst A AU - Braune K AU - Kjellberg-Larsson M IN - Public Dental Service, County of Blekinge, Sweden. TI - Occurrence and distribution of caries in 6-year-old children in Blekinge, Sweden. SO - Swedish Dental Journal 1999;23(2-3):71-6 AB - Community dentistry in Blekinge aims at age-specific levels of dental health. For 6-year-old children the goal is that > 65 percent will have dmft = 0 in the year 2000. At present there is no study on dental health in 6-year-olds in Blekinge. The aims of the present study are to establish baseline epidemiological data on dental caries in the county of Blekinge, expressed as dentin lesions and enamel lesions, to analyse these data and to formulate program oriented planning of dental care for pre-school children to achieve the dental health goal for the year 2000. The material comprised a random sample of 213 children. The sample was drawn from the population register for children living in the county of Blekinge. A clinical investigation was performed by one of the authors and was completed with bite-wing radiographs whenever the proximal surface could not be inspected clinically. In addition the parents were asked questions about tooth-brushing and use of fluoride tablets. Fifty-six percent of the children had filled lesions and manifest lesions (dfs), 65 percent had enamel caries lesions (dsi) and 42 percent had manifest lesions (ds). Fifty-three percent had dmft > 0. The finding of initial lesions in 65 percent of the children indicates that caries prevalence is greatly underestimated. Together with poor oral hygiene, this means an increase in the risk of caries progression. The pattern of dental health was very skewed among the children; 23 percent had between 5 and fourteen decayed or filled teeth and 11 percent had from 5 to 23 manifest lesions. Clinics in Blekinge have had different strategies for preventive dental care. In 1997, however, all the public dental service clinics in Blekinge, adopted a uniform program for child dental care, focusing on primary prevention and risk assessment for each individual. <60> UI - 99351665 AU - Splieth C AU - Bernhardt O IN - Department of Operative Dentistry, Periodontology and Pediatric Dentistry, Ernst Moritz Arndt University, Greifswald, Germany. splieth@rz.uni-greifswald.de TI - Prediction of caries development for molar fissures with semiquantitative mutans streptococci test. SO - European Journal of Oral Sciences 1999 Jun;107(3):164-9 AB - Risk-specific caries prevention requires validated and simple parameters for a caries risk assessment. The aim of the study was to evaluate the validity of a site-specific chair-side mutans streptococci (MS) test for the prediction of caries incidence in fissures. In 230 6- to 7-yr-old children, occlusal plaque samples of teeth 16 and 36 were cultured with Dentocult SM tests at 37 degrees C for 24 hr. Caries (DMFS), initial caries, sealants, and a plaque index (QHI) were recorded and oral hygiene habits were assessed. Not erupted, carious, filled and sealed teeth were excluded from the analysis (n = 154). After 2 yr, the status of the fissures was re-examined, and a fluoride history was recorded with a questionnaire filled out by the children's parents. Sealed teeth were excluded again (n = 54). With a classification of MS score 0 or 1 as low and MS score 2 or 3 as high caries risk, 92% agreement was reached by two independently working examiners. The MS scores and caries incidence correlated significantly. Seventy-eight % of the caries progression in fissures was prognosed correctly. Sensitivity was 50%, specificity 82%, positive predictive value 29%, and negative predictive value 92%. Children with caries progression tended to have lower fluoride scores. Low MS scores were most likely to be associated with low caries incidence, while high mutans streptococci scores seem to be partially compensated by other parameters. <61> UI - 99372539 AU - Gisselsson H AU - Birkhed D AU - Emilson CG IN - Department of Cariology, Faculty of Odontology, Goteborg University, Sweden. TI - Effect of professional flossing with NaF or SnF2 gel on approximal caries in 13-16-year-old schoolchildren. SO - Acta Odontologica Scandinavica 1999 Apr;57(2):121-5 AB - The aim of this study was to evaluate the effect of professional flossing with NaF and SnF2 gels on caries development on approximal tooth surfaces. Two-hundred-and-eighty 13-year-old schoolchildren were divided into 3 groups: (1) NaF (n = 97), (2) SnF2 (n = 85), and (3) placebo gel group (n = 98). The investigation was carried out double-blind. The children were treated 4 times a year for 3 years with 1% NaF gel, 1% SnF2 gel, or plac