Unstimulated whole saliva flow rate in relation to sicca symptoms in Hungary.

OBJECTIVE: To assess the prevalence of xerostomia and the related oral and extraoral dryness symptoms in Hungary, to evaluate the association of those symptoms with the unstimulated whole saliva (UWS) flow rate, and to find correlation between the level of UWS flow rate and the oral health status of the questioned patients. SUBJECTS AND METHODS: A total of 600 patients between the age of 18 and 92 years, 265 male, 335 female, were selected in accordance with the current regional age and residence distribution scheme of the Hungarian Statistical Office. A questionnaire was designed to determine the subjective presence or absence of the sicca symptoms. UWS flow rate and the dental and periodontal status were determined. RESULTS: The percentages of subjective symptoms in the questioned subjects were oral dryness, 34%; reduced salivation, 11%; mucous saliva, 15%; dysphagia, 13%; glossopyrosis, 7%; dysphonia, 31%; dysgeusia, 9%; nasal dryness, 32%; ocular dryness, 21%; itching, 40% and xeroderma, 60%. Vaginal dryness was 14%, vaginal itching was 16% in the interviewed women. The grade of xerostomia, dysphagia, tiredness, and additionally the gingival bleeding index showed a negative correlation with the UWS flow rate. After all decayed, missing and filled teeth (DMF-T) mean values, gingival bleeding index and plaque index were significantly higher in hyposalivators, compared with those who had normal flow rates CONCLUSION: This cross sectional study, representative of the Hungarian population, clearly shows that one-third of the adult population suffers from xerostomia. The clinical severity of the xerostomia demonstrated a strong relationship with the lower levels of UWS flow rate. Reduced levels of UWS flow rate in this study were also shown to be associated with dysphagia, fatigue, and increased DMF-T numbers. The data show that oral dryness, its associated desiccation symptoms and its clinical manifestations are significant health problems in Hungary.

A comparison of two methods for the evaluation of the daily urinary fluoride excretion in Romanian pre-school children.

OBJECTIVE: To compare two different methods of estimating daily fluoride urinary excretion in pre-school children under stable fluoride intake conditions. DESIGN: Thirty-five healthy kindergarten children, permanent residents of Targu-Mures, Romania, where the average drinking water fluoride concentration is 0.12 mg F/L, participated on two separate occasions, when they were aged 4-6 and 5-7 years, respectively in the collection of a) a mid-morning spot urine sample and b) a 16-h time-controlled urine sampling. In case a), the ratio of concentrations of fluoride and creatinine were measured, while in case b) the rates of fluoride excretion in two separate 8-hour periods were used to estimate the 24-hour fluoride urinary excretion. RESULTS: The estimated average daily fluoride urinary excretion values (S.D.) were 0.318 (0.182) mg F/day for method a) and 0.341 (0.193) mg F/day for method b). These values were not significantly different (Mann-Whitney U test; p = 0.49). The estimated daily fluoride doses were 0.040 (0.021) and 0.043 (0.022) mg F/kg body weight/day, respectively. The latter values were not significantly different (Mann Whitney U test; p = 0.38). CONCLUSIONS: Results obtained suggest that under stable F-intake conditions the estimation of the daily fluoride urinary excretion by means of a mid-morning spot urine sample yields comparable results to those obtained with the more involved method of separate, two 8 h (16 h) time-controlled urine sampling recommended by the WHO. Use of spot urine sampling appears to be particularly useful for epidemiological studies.

Effect of after-meal sucrose-free gum-chewing on clinical caries.

Previous in situ and in vitro studies have demonstrated that the chewing of sucrose-free gum after eating reduces the development of dental caries. To investigate the extrapolation of these findings to the clinical setting, we conducted a two-year study on 547 schoolchildren in Budapest, Hungary. Subjects in the "Gum" group were instructed to chew one stick of a commercially available sorbitol-sweetened chewing gum for 20 minutes after meals, three times daily. The "Control" group was not provided with chewing gum. After two years, the "Gum" group exhibited a 38.7% reduction in incremental caries, excluding white spots, compared with the "Control" group. Including white spots, a corresponding 33.1% reduction was indicated. These results clearly suggest that even in a moderate caries population practicing normal oral hygiene, including the use of fluoride dentifrices, an after-meal gum-chewing regimen can significantly reduce the rate of caries development.

Effect of amine fluoride/stannous fluoride toothpaste and mouthrinse on dental plaque accumulation and gingival health.

OBJECTIVE: The aim was to investigate the influence of amine fluoride (AmF)/stannous fluoride (SnF2) containing toothpaste and mouthrinse on plaque accumulation and gingival health of young adults after 4 weeks use. SUBJECT AND METHODS: Forty-two young adults (mean age: 28.33 +/- 7.19 years) were examined for the Plaque Index (PI; Silness and Löe, 1964) and Gingival Index (GI; Löe and Silness, 1963) scores, and divided randomly into two groups. Both groups used AmF/SnF2 containing toothpaste twice a day for 3 min toothbrushing, and one group after toothbrushing rinsed with AmF/SnF2 containing mouthrinse for 30 s. After 4 weeks the probands were re-examined. RESULTS: Statistically significant decrease in dental plaque (PI) and gingival (GI) index values were found at the end of the study. The reduction of PI and GI values was significant in all groups but it was higher in the combined (toothpaste + mouthrinsing) group, than using toothpaste only. CONCLUSION: The regular combined use of AmF/SnF2 toothpaste and mouthrinse was more effective in the reduction of plaque accumulation and maintenance of gingival health than the toothpaste alone.

Smoking and disease.

Tobacco represents the single most preventable cause of disease and death in the world today. The countries of Central Europe bear a disproportionate burden of tobacco-related morbidity and mortality. For example, some of the highest rates worldwide of cigarette consumption and smoking prevalence are in the Czech Republic, Hungary and Romania. This chapter first describes the extent of tobacco use in five central European countries, the Czech Republic, Hungary, Poland, Romania and Slovakia and then considers mortality from tobacco related disease. Data from two diseases, lung cancer and oral cancer, which result almost exclusively from tobacco use are considered. Finally, the relationship between tobacco use and oral disease is discussed.

Prevalence of tongue lesions in Hungarian children.

OBJECTIVE: The aim of this study was to investigate the prevalence of tongue lesions in Hungarian children in relation to age, sex, systemic diseases and allergies. MATERIAL AND METHODS: A total of 1017 preschool and school children aged 1-14 years were examined. The age, sex and tongue lesions diagnosed were recorded together with any history of systemic diseases and allergies. RESULTS: Tongue lesions were found in 35.11% of all the children examined. Fissured tongue was the most frequent lesion (29.2%), apparently associated with age and sex. It occurred more commonly in boys, and in older children, than in girls and younger children. Geographic tongue was found in 5.7%, occurred more often in boys, and a relationship existed between fissured and geographic tongue. Among the children with geographic tongue 44.82% also had fissured tongue. These findings agree in general with the epidemiological data reported on population samples elsewhere in the world. Crenated tongue occurred in 0.68%, central papillary atrophy in 0.78%, and partial ankyloglossia in 0.88% of the children examined: confirming the rarity of these lesions. Although there was no obvious correlation with systemic diseases, geographic tongue appeared to be coincident with a history of allergic diathesis in some cases. CONCLUSION: In some cases early recognition of tongue lesions may provide useful diagnostic markers for some diseases.

Effect of fluoride on cariogenic oral microorganisms (an in vitro study).

The effect of sodium fluoride and sodium monofluorophosphate at concentrations of 1, 5, 10, 50, 100 and 1000 mg/l in phosphate buffer (pH 6.5) as well as in UHT milk were studied on cultures and suspensions of Streptococcus mutans, Lactobacillus acidophilus and Candida albicans. Using serial tenfold dilutions up to 10(-7) of 24-48 hour cultures, a subsequent 0, 60 and 120 min incubation caused no decrease in the number of CFUs. Growth kinetic studies in the Bioscreen biophotometer (Labsystem, Finland) revealed that sodium fluoride in different concentrations (from 0.875 mg/l up to 500 mg/l) influenced the growth dynamics of S. mutans and C. albicans: the exponential phase flattened out at the highest fluoride concentrations (500 mg/l) present in the growth media. The lag phase of C. albicans became longer. The results of these experiments indicate that sodium fluoride administered at higher concentrations than the usual caries preventive dosage made the generation time of cariogenic oral bacteria and fungi longer, slowing down their multiplication.

Effect of after-meal sucrose-free gum-chewing on clinical caries.

Previous in situ and in vitro studies have demonstrated that the chewing of sucrose-free gum after eating reduces the development of dental caries. To investigate the extrapolation of these findings to the clinical setting, we conducted a two-year study on 547 schoolchildren in Budapest, Hungary. Subjects in the "Gum" group were instructed to chew one stick of a commercially available sorbitol-sweetened chewing gum for 20 minutes after meals, three times daily. The "Control" group was not provided with chewing gum. After two years, the "Gum" group exhibited a 38.7% reduction in incremental caries, excluding white spots, compared with the "Control" group. Including white spots, a corresponding 33.1% reduction was indicated. These results clearly suggest that even in a moderate caries population practicing normal oral hygiene, including the use of fluoride dentifrices, an after-meal gum-chewing regimen can significantly reduce the rate of caries development.

[Effect of smoking on the development of oral leukoplakia]. / A dohányzás hatása a szájüregi leukoplakia kialakulására.

The increase in cancer mortality throughout the world justifies the study of its causes and development. Oropharyngeal cancer is ranked on the sixth place, Hungary with the highest mortality among 46 countries. Tobacco use is implicated in the development of oral cancer, and oral leukoplakia as well. The aim of the study was to give an overview on the connection between tobacco use and oral leukoplakia. Summarizing the literary data strong evidence has been found on the role of smoking in the development both of oral cancer and oral leukoplakia. Epidemiologic patterns of cigarette-smoking show a steep increase in Central-European countries, especially in Hungary. Cross-sectional studies indicate higher prevalence rate of leukoplakia among smokers, with a dose-response relationship between tobacco use and oral leukoplakia, while intervention studies show a regression of the lesion after stopping the smoking habit.

Fluoride concentrations of unstimulated whole and labial gland saliva in young adults after fluoride intake with milk.

Following a fluoride depletion period 6 subjects repeatedly rinsed with 30-ml volumes of milk with or without added fluoride (5 ppm). Rinsing time was timed according to the measurements on how long it took to drink 200 or 500 ml milk. Rinsing with fluoridated milk for a total interval of 20 and 60 s, respectively, did not influence significantly the fluoride concentration of unstimulated centrifuged whole saliva 45 min later. Neither the urinary fluoride concentration nor the fluoride excretion were significantly affected by rinsing with fluoridated milk during the first hour. However, intake of 1 or 2.5 mg of fluoride with 200 and 500 ml milk, respectively, resulted in significant elevations in whole saliva fluoride levels 45 min later. In addition, the fluoride excretions into urine produced during 60 min after the fluoride intakes were significantly elevated and those reflected the ingested dose of fluoride. The intake of either 1 or 2.5mg fluoride with milk did not significantly influence the fluoride level of unstimulated labial gland saliva collected simultaneously with whole saliva.

Tobacco use and oral leukoplakia.

The increase in cancer mortality throughout the world justifies the study of its causes and development. Hungary has the highest mortality rate from oropharyngeal cancer out of forty-six countries. Tobacco use is implicated in the development of oral cancer, and oral leukoplakia as well. The aim of the study was to give an overview of the connection between tobacco use and oral leukoplakia, considering the epidemiologic patterns of tobacco habits, the prevalence of smoking in oral leukoplakia, and the effect of smoking on clinically healthy oral mucosa with special respect to central Europe and Hungary. In the data, strong evidence has been found for the role of smoking in the development of both oral cancer and oral leukoplakia. Epidemiologic patterns of cigarette smoking show a steep increase in central European countries. Cross-sectional studies show a higher prevalence rate of leukoplakia among smokers, with a dose-response relationship between tobacco use and oral leukoplakia, and intervention studies show a regression of the lesion after stopping the smoking habit.

[Comparative epidemiologic examination of caries in adolescents]. / Osszehasonlító caries epidemiológiai vizsgálatok serdülókorú fiatalokban.

The aim of the study was to assess the caries prevalence and oral hygiene in groups of adolescents living in two Hungarian towns and to establish correlations with socio-economical factors. Examinations of caries and oral hygiene were performed in 586 14-16-year-old children. The percentage of caries free children was 5.1%, the DMFT and DMFS values were 6.97 +/- 4.67 and 9.95 +/- 7.94 respectively. The VPI index was 41.6 +/- 32.7% (mean +/- S.D.), and showed positive correlation with the caries prevalence. The DMFT and DMFS values, as well as VPI decreased as the educational level of the father had increased. The number of siblings had a worsening effect on DMFT, DMFS and VPI values.

[Perspectives of dentistry in the 21st century]. / A fogászat perspektívái a 21. században.

The topics reviewed are based on those published in a recent USA journal, including the following: demographic trends of oral diseases, changes in the trends of oral diseases, minimally invasive dentistry, the development of bond-systems, endodontics in the 21st century, trends in surgical and non-surgical periodontal treatments, esthetic ceramics in the 21st century, total dentures: present trends. The author is attaching comments to each of the topics on the present situation in Hungary, hoping to challenge a debate in the following numbers of Fogorvosi Szemle.

Risk group assessment of oral precancer attached to X-ray lung-screening examinations.

The mortality rate of oral tumours in Hungary, as in some other countries, is increasing. In order to assess risk groups for oral cancer and precancer, oral examinations were carried out as part of the X-ray screenings for lung cancer in the 3rd district of Budapest, Hungary. There were 5,034 adults who participated voluntarily in these investigations. After completing a questionnaire with 23 questions, a short oral examination was performed. Males comprised 57.7% of the group, and the age-distribution among men and women was similar. Oral precancerous lesions were found in 3.7% of the whole group, in 3.3% of those with leukoplakia, and in 0.4% of those with oral lichen planus. The prevalence of leukoplakia in men was 5.8%, and in women 1.5%, with significantly higher prevalences in men and women over 40. Among the examined persons there were 31% who were smokers, and 6% reported that they were regular consumers of alcohol. Fifty-four percent of those examined reported that they did not visit the dentist regularly. Oral complaints came mostly from those with lichen planus. The described model, where the oral screening examinations are done in conjunction with other examinations, in a so-called multiphasic screening system, seems to be a worthwhile approach for early diagnosis of oral cancer and precancer.

[Stomato-oncological screening examinations: possibilities for early diagnosis] / Stomato-onkológiai szûrôvizsgálatok: a korai diagnosis lehetôségei.

The dramatic increase in the mortality of lip- and oral cancers in Hungary in the last decades points to the importance of primary and secondary prevention. Stomato-oncological screening examinations belong to the latter category, and might represent useful tools in the early diagnosis and treatment of oral carcinomas and precancerous lesions. The aim of the paper is to review the methods, results and effectivity of stomato-oncological screening examinations in Hungary. Between 1962 and 2000 nine screening examinations were performed: one on a population sample, one in an industrial setting, four connected to X-ray lung-screening examinations (one with the help of a mobile unit), one on voluntary persons, one on high risk people (homeless), one in general medical practice. Among these, in the last five years, in the course of the stomato-oncological examination of 17325 individuals, oral carcinoma has been found in 0.12%, and oral precanceroses in 2.63%. Although the general dentist is obliged by law to perform a stomato-oncological examination on the patients appearing in the practice, unfortunately, about 50-to-90% of the population does not visit a dentist regularly. The regular examination of these - high risk - groups by the help of the above methods, including the help of general medical practitioners is highly recommended.

[Comparative epidemiologic study of caries in German and Hungarian adolescents]. / Német és magyar serdülókorú fiatalok összehasonlító caries epidemiológiai vizsgálata.

The aim of the study was to assess the trend of caries prevalence in German and Hungarian population sample. The authors examined 15-16-year-old Hungarian adolescents in Debrecen and Budapest in 1997 (451 persons), then re-examined them in 1999 (377 persons). These data were compared to those of 15-16 and 17-18-year-old adolescents examined in the Eastern part of Germany (Plauen) in 1991 (668 persons) and in 1995 (586 persons). The results showed significant caries reduction in Germany. The DMFT values of 17-18-year-old adolescents were nearly half in Germany (x = 5.2) compared to those of Hungary (x = 9.0). This fact suggests the necessity of introduction of effective preventive programs including salt fluoridation in Hungary.

[The state of dentistry education in Europe]. / A fogászati szakképzés helyzete Európában.

In order to find out what branches of Dentistry are recognized in Europe as Dental specialties a questionnaire was designed and sent to various Associations and groups across Europe. It contained eight main questions covering the various specialties that were recognised or were to be recognised. Responses were obtained from 28 countries, 15 EU member states and 13 non member states. The results from the questionnaire indicated that there was a broad agreement on many of the questions but a considerable variety of opinions. There seems to be a desire to harmonize standards across Europe for the benefit of the profession and the public.

[Study of the permeability of oral leukoplakia]. / A szájüregi leukoplakia permeabilitásának vizsgálata.

The significant increase in the mortality rates of oral carcinoma speeded up the research on the mechanisms of tumor promoting and inhibiting factors. Results of previous studies in the USA showed different permeability between keratinized (hard palate, gingive) and non-keratinized (floor of the mouth) regions of the oral mucosa, and a corresponding difference in lipid composition. Aim of this study was, to compare the permeability and lipid composition of leukoplakia of the oral mucosa with healthy specimens from the same region, in order to assess a possible enhancement or inhibition in the barrier-function, in cases of pathological keratinization. Results of the measurements showed, that hyperplastic leukoplakia areas were more permeable for the NNN carcinogens contained in tobacco, and even clinically healthy sites showed a higher permeability, that oral mucosa of non-smokers. These data together with the results of lipid analysis, point to the possible generalized changes--caused by smoking--in the oral cavity, even before the appearance of clinical signs.