Community fluoridation status and caries experience in children.

OBJECTIVE: This study compares dental caries experience in fluoridated and nonfluoridated communities. METHODS: A dental health survey designed to collect data on caries experience and treatment needs for community-specific public health planning purposes was conducted in public elementary schools during the 1996-97 school year. Oral examinations of 17,256 children were completed, representing 93 percent of children residing in 62 East Tennessee communities. RESULTS: The analysis showed that water fluoridation was significantly related to caries experience in the primary (dfs) and permanent (DMFS) dentitions and to the proportion of caries-free children in the primary and permanent dentitions. When the data were adjusted for socioeconomic status, race, and age, caries levels were 21 percent lower in the primary dentition and 25 percent lower in the permanent dentition in fluoridated communities than in nonfluoridated communities. In addition, the proportion of children who were caries free was larger in fluoridated as compared with nonfluoridated communities by 19 percent in the primary dentition and 6 percent in the permanent dentition. CONCLUSION: Although the design of the study prevented the collection of individual fluoride and residency histories, findings suggest there was substantially lower caries experience in fluoridated communities than in nonfluoridated communities.

Successful implementation of community water fluoridation via the community diagnosis process.

OBJECTIVES: This paper describes the community diagnosis process and how it was used to implement community water fluoridation in Tennessee. METHODS: Public health dental staff developed a survey instrument to collect community-specific data on the oral health status of schoolchildren. Key survey findings were presented to county health councils who were determining and prioritizing the health needs of their communities. RESULTS: Community-specific data showed higher caries levels in children without access to an optimally fluoridated community water supply. Presentation of local survey findings to county health councils resulted in fluoridation being a high-priority health issue in several counties. With health council support, opposition to fluoridation by utility district officials was overcome when decision makers were challenged with local survey findings. The community diagnosis process resulted in the successful fluoridation of six community water systems serving a total of 33,000 residents. CONCLUSIONS: The community diagnosis approach was successful in implementing community water fluoridation in geographic areas historically opposed to this public health measure. The success of these fluoridation initiatives was attributed to: (1) current, community-specific assessments of children's oral health; (2) identification of communities with disparate oral health needs, problems, and resources; and (3) effective presentation of community-specific oral health survey data to community leaders, stakeholders, and decision makers.

Community socioeconomic status and children's dental health.

BACKGROUND: Although a substantial decline in dental caries has occurred among U.S. children, not everyone has benefited equally. The first-ever surgeon general's report on oral health in America indicates that the burden of oral diseases is found in poor Americans. This study investigates the relationship between community socioeconomic status, or SES, and dental health of children. METHODS: An oral health survey of 17,256 children, representing 93 percent of children residing in 62 Tennessee communities, was conducted in public elementary schools during the 1996-1997 school year. Portable dental equipment was used for examinations, and data from each examination were entered directly into a laptop computer. The authors performed analyses of covariance to examine the relationship between community SES (low/medium/high) and dental health, controlling for community fluoridation. RESULTS: Community SES was significantly related to caries experience in the primary teeth, the proportion of untreated caries in the primary and permanent teeth, dental treatment needs, dental sealants and incisor trauma. Overall, dental health was significantly worse for low-SES communities than for medium- and high-SES communities. CONCLUSION: The authors conclude that all specific dental indexes used to measure children's dental health in this study, with the exceptions of caries experience in the permanent teeth and sealant presence, were inversely related to the communities' SES. The percentage of children with dental sealants was directly related to the community's SES. PRACTICE IMPLICATIONS: Further improvements in oral health will necessitate that community-based preventive programs and access to quality dental care be made available to children who are identified as being at highest risk of experiencing oral disease.

Hepatitis viruses A, B, C, D, E and G: implications for dental personnel.

BACKGROUND: This article provides dental personnel with a brief overview of the different types of viral hepatitis, including their epidemiology, clinical features, prevention and treatment. It also explores the ramifications of these diseases for the practice of dentistry. DESCRIPTION OF THE CONDITION: Viral hepatitis is an inflammation of the liver caused by one of at least six distinct viruses. The hepatitis A and E viruses, or HAV and HEV, are enterically transmitted viruses that produce acute disease only. The hepatitis B, C and D viruses, or HBV, HCV and HDV, are most efficiently transmitted by infected blood, but also can be transmitted by exposure to other infectious bodily fluids. These three viruses can cause acute or chronic hepatitis. People with chronic viral hepatitis can develop chronic liver disease, cirrhosis and hepatocellular carcinoma. The hepatitis G virus was recently identified, and its ability to cause clinically significant acute or chronic hepatitis is unknown. CONCLUSIONS: Dental health care workers, or DHCWs, should be concerned primarily with HBV, HCV and HDV, as occupational exposure to these pathogens places them at risk of developing acute or chronic infections. Vaccines and immune globulins are available and effective in protecting against infections with HAV, HBV and HDV, but not HCV. CLINICAL IMPLICATIONS: DHCWs should become knowledgeable about viral hepatitis. They should be vaccinated against hepatitis B. Adherence to infection control measures will help prevent occupational transmission of all bloodborne pathogens, including hepatitis viruses.

Clinical sealant retention following two different tooth-cleaning techniques.

OBJECTIVES: This study compared the effectiveness of two different tooth-cleaning techniques on clinical sealant retention. METHODS: Seventy-four children in second and third grades at an elementary school in the rural town of Waverly, Tennessee, had sealants applied to four, noncarious, fully erupted, first permanent molar teeth. The teeth had been cleaned using a brush attached to a rotary instrument with fluoridated prophy paste, versus a toothbrush without paste (dry brushing). A split-mouth design was used, whereby one side (upper and lower) of the mouth was subject to one tooth-cleaning technique while the opposite side received the other technique. RESULTS: Twelve months after a single application of pit and fissure sealant, 63 children were available for recall. Exactly 252 teeth were examined and overall retention was high, with approximately 98 percent of sealants retained. Although the greatest loss of sealant occurred with the rotary instrument technique, the difference in proportions of missing sealant between techniques was not statistically significant. CONCLUSIONS: In this study, the tooth-cleaning technique of dry brushing with a toothbrush as a preparatory step in the sealant procedure yielded high clinical sealant retention at 12 months. This retention was comparable to that observed with rotary instrumentation. This finding suggests that dry brushing by the operator may be an acceptable alternative to using a rotary instrument with brush and paste.

Dental caries and sealant prevalences in schoolchildren in Tennessee.

This article presents findings on the prevalence of dental caries and dental sealants from the 1988 oral health survey of schoolchildren in Tennessee. The purpose of the study was to describe the prevalence of dental caries, dental sealants, and periodontal disease, as well as the need for restorative, exodontia, and periodontal treatment among schoolchildren. A multistage probability sample was designed to represent 927,000 children enrolled in grades K-12 in public and private schools across the state. Analyses of the data collected from the examination of 2,588 children aged 5-17 revealed that 55 percent were caries free in their permanent dentition and that the mean DMFS score was 2.86. For those aged 5-9, the mean dfs score was estimated to be 5.52. Only 10 percent of schoolchildren in Tennessee had dental sealants on their teeth. Comparisons of the results of this survey with those reported from earlier state surveys indicated that caries levels have declined steadily. We assumed that the reduction in caries experience observed in Tennessee is the result of widespread exposure of children to systemic and topical fluorides. Further reduction in caries experience is possible with continued fluoridation of community water supplies, in conjunction with increased utilization of pit and fissure sealants.