Judgement criteria for molar incisor hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003.

AIM: This paper reviews the proceedings and conclusions of a meeting of experts concerned with the problem of hypomineralised incisors and molars (MIH). The aims of this meeting were to establish criteria for the judgement of MIH, to select representative cases and to discuss how the name of the condition was best described as hypomineralised, or hypomaturated, first permanent molars. CONCLUSION: There was not complete agreement as to the correct diagnosis and aetiology of the condition. A suggested list of definitions of the judgement criteria to be used in diagnosing Molar Incisor Hypomineralisation (MIH) for prevalence studies was agreed upon.

Early dental caries risk assessment and prevention in pre-school children: evaluation of a new strategy for dental care in a field study.

The aim of the present field study was to evaluate a new strategy for the dental care of pre-school children which includes an early caries risk assessment and early preventive care. One hundred and sixty-seven children were studied from 1 to 6 years of age (intervention group). A group of 125 children from the same clinic (historical control) was used as a comparison group. On the basis of the clinical examinations of the children and the interviews with the parents when the children were 3 years of age, the children in the intervention group were divided into four different risk groups: no (n = 95), low (n = 33), moderate (n = 30), and high caries risk (n = 9). Only 8 of the 95 children who had been placed in the no caries risk group at 3 years of age developed manifest carious lesions in their primary cuspids and molars by 6 years of age. At 6 years of age 81% in the intervention group were free of manifest carious lesions, compared with 55% in the comparison group (P < 0.001). Furthermore, the mean numbers of defs were 0.6 for children in the intervention group and 2.7 in the comparison group. Thus, this field study indicates that early primary prevention (before the onset of caries attack) and a structured and systematic approach to dental care for pre-school children result in good oral health for the children and may be economically profitable for a society with organized public dental service for pre-school children.

Restorative treatment decisions on occlusal caries in Scandinavia.

In order to map variations in the operative treatment threshold for occlusal caries, a pre-coded questionnaire was sent to a random sample of 759 dentists in Norway, 923 in Sweden, and 173 in the Danish Public Dental Health Service inquiring about caries and treatment strategies. A further intention was to explore the type of operative treatment and filling material dentists in Scandinavia would use given an occlusal lesion in the lower 2nd molar in a 20-year-old. It is found that close to 70% of dentists in the 3 countries would put off carrying out operative treatment of occlusal caries until they registered a moderately sized cavity and/or any radiolucency in dentin. In Sweden, 26.7% of dentists and in Denmark 24.3% would postpone operative treatment until the lesion had a large cavity and/or until radiolucency could be observed in the middle third of the dentin; in Norway, only 11.5% of dentists indicated this. The majority of dentists in all 3 countries preferred to drill only the carious part of the fissure, though in Norway more dentists (30.9%) would tend to drill the whole fissure compared to their Swedish (23.4%) and Danish (9.5%) colleagues. The majority of Danish dentists (52.4%) suggested amalgam for restoring the occlusal surface, while 19.9% of Norwegian and 2.9% of Swedish dentists would use amalgam. Composite was the first material of choice for 71.5% of the Swedish dentists, the remaining 25.6% suggesting conventional glass ionomer cement, light-cured 'glass ionomer cement', or a combination of glass ionomer cement and composite. The corresponding values for the Norwegian dentists were 39.1% and 41.0%, respectively, and for the Danish dentists 29.2% and 18.4%. In Scandinavia, the leading strategy for occlusal caries seems to be to postpone operative treatment until a definite cavity or radiolucency in the outer third of dentin can be observed, and to carry out operative treatment only of the part of the fissure that is carious. Composite resin is the predominant material of choice in Sweden, while in Denmark the majority of dentists preferred amalgam. Composite, or composite in combination with glass ionomer cement material, was the choice of almost 80% of Norwegian dentists.

Caries prevalence and distribution in 3-20-year-olds in Jönköping, Sweden, in 1973, 1978, 1983, and 1993.

Four cross-sectional studies were carried out in 1973, 1978, 1983, and 1993 to collect clinical and radiographic epidemiological data on the dental health status of the inhabitants of Jönköping, Sweden. The aim of the present paper was to use these data to analyze trends in the development of caries among children and adolescents between 1973 and 1993. Approximately 500 randomly selected individuals evenly distributed among the age groups 3, 5, 10, 15, and 20 years participated in each study. The main results show that the numbers of caries-free individuals increased in all age groups. In 1993, the mean number of decayed and filled tooth surfaces in the primary (dfs) and the permanent (DFS) dentition in all age groups was less than half of that found in 1973. Most of this decrease took place during the first 5 years, i.e., between 1973 and 1978. Between 1978 and 1983, only minor changes were observed. There was a further reduction of approximately 30%-50% in dfs/DFS between 1983 and 1993 in 3-, 5-, 10-, and 20-year-olds. The frequency distributions of dfs/DFS for 5- and 15-year-olds revealed an increasing skewness over time: in 1993, a large majority of the children and adolescents had a low or moderate caries severity while only a small group had high scores of dfs/DFS.

Oral health in pre-school children living in Sweden. Part III--A longitudinal study. Risk analyses based on caries prevalence at 3 years of age and immigrant status.

A decreasing proportion of children require operative treatment each year and an increasing proportion of children will at recall require no operative care. This would provide resources to give individualised prevention to children at risk for developing new carious lesions. From 3 years of age, however, the prevalence of caries increases up to the age when the primary dentition exfoliates, even though the children attend regular dental service programmes yearly, and for some children dental caries remains a significant problem. The purpose of the present study was to describe the dental health of a group of 6-year-old children living in Sweden, with special reference to caries prevalence at 3 years of age and to immigrant status. At 6 years of age, 45% of the children were free of initial and manifest carious lesions in the primary cuspids and molars. The mean caries increment between 3 and 6 years was 0.9 tooth surfaces for children who were caries free at 3 years of age compared to 4.5 tooth surfaces for children with manifest carious lesions at the same age. The mean caries increment from 3 to 6 years was 1.3 in the non-immigrant group and 3.6 in the immigrant group. For the majority of the children in this study, current preventive dental care seems sufficient. However, for about one-third of the children (children with carious lesions at 3 years of age and/or immigrant status), current caries preventive programme used in the Public Dental Service are inadequate.

Attractive magnets for orthodontic extrusion of crown-root fractured teeth.

A subgingival crown-root fracture presents the clinician with a difficult restorative problem, including reaching the fracture line, and is complicated by the need to maintain the periodontal tissues in good health. The treatment options up to now have usually been limited to extrusion of the remaining root with a conventional orthodontic appliance, surgical intraalveolar transplantation of the root or extraction with bridge replacement. In this report, a new method of orthodontic extrusion with attractive magnets is presented. One or two neodymium-iron-boron magnets were attached to the remaining root and a second, larger neodymium-iron-boron magnet was incorporated in a removable appliance. The roots were extruded 2 to 3 mm with a force range from 50 to 240 cN during a treatment period of 9 to 11 weeks. Good force control at short distances, no friction, and no material fatigue of permanent rare earth magnets resulted in successful rapid extrusion. No evidence of soft tissue dehiscences, aberrant tooth mobility, or root resorption was found.

Incisal and occlusal tooth wear in children and adolescents in a Swedish population.

The material consisted of 527 randomly selected children and adolescents from the community of Jönköping, Sweden, who in 1983 reached the age of 3, 5, 10, 15, or 20 years. The degree of incisal or occlusal tooth wear was evaluated for each single tooth in accordance with the following criteria: score 0 = no wear or negligible wear of enamel; score 1 = obvious wear of enamel or wear through the enamel to the dentin in single spots; score 2 = wear of the dentin up to one-third of the crown height; and score 3 = wear of the dentin more than one-third of the crown height. In the age groups 3 and 5 years the primary dentition was studied, and in the age groups 10, 15, and 20 years the permanent dentition. In the 3-year-old children 63% and in the 5-year-olds 19% had no or slight incisal or occlusal wear in the primary dentition. In the permanent dentition the corresponding figures for the 10-, 15-, and 20-year-olds were 78%, 51%, and 35%, respectively. The 5-year-olds had the highest percentage of primary teeth with incisal or occlusal wear related to existing teeth in accordance with criteria 1-3 (32.2%), and the 10-year-olds had the lowest score for permanent teeth (2.5%). There were small or no differences in tooth wear between the sexes in these age groups. Eighteen children (17%) among the 5-year-olds had one or more teeth with wear scored 2 in the primary dentition, and one individual had 4 primary teeth scored 3. The corresponding figures for the 3-, 10-, 15-, and 20 year-olds were 2%, 1%, 7% and 6%, respectively. No permanent teeth with wear scored 3 were found in these age groups. The number of teeth with incisal or occlusal wear increased with age both in the primary and in the permanent dentition.

Analysis of caries-related factors in infants and toddlers living in Sweden.

The aims of this study were 1) to investigate whether oral hygiene and dietary habits established at 1 year of age are maintained at 2 years of age and 2) to analyze caries-related factors with regard to oral health between the age of 1 and 3 years by using the salutogenic theory-that is, focusing on behavioral factors that do not result in impairment of health. Altogether 289 children were examined at 1, 2, and 3 years of age, and their parents were interviewed about the children's oral hygiene and dietary habits at 1 and 2 years of age. The result shows that caries-related habits, such as oral hygiene and dietary habits, established during infancy are maintained throughout early childhood. The principles of the salutogenic theory were found to be applicable when studying caries-related habits and oral health. Thus, if a dietary risk behavior is established at 1 year of age, the chance of remaining caries-free until 3 years of age is highest if good oral hygiene habits, including the use of fluoride toothpaste, are present at 2 years of age. We therefore conclude that comprehensive knowledge of a child's future dental health can be obtained by using chairside information-that is, interview of the parents and clinical examination of the children.

A multidisciplinary approach to oral rehabilitation with osseointegrated implants in children and adolescents with multiple aplasia.

Oral rehabilitation of children with extensive aplasia includes a number of dental considerations as well as attention to psychological and physical development. The well-documented results of the use of implants in adults have raised the question of the use of implants and the timing of this procedure in children and adolescents with multiple aplasia. Eight-years' experience of a multidisciplinary approach to oral rehabilitation of children with extensive aplasia is described. Special emphasis is placed on early diagnosis, careful therapy planning, and co-ordination and timing of different parts of the therapy. The specific considerations from the point of view of paediatric dentists, orthodontists, oral surgeons, and prosthodontists are presented. A system for integrating all these aspects and knowledge will be a guarantee for high professional standards and a successful outcome. To exemplify the multidisciplinary approach, three treated cases are presented.

Parental awareness of dental caries in toddlers.

The purpose of the study was to investigate if parents of toddlers could be taught how to discover dental caries in their children and, if carious lesions were found, contact the the child's dentist. The study was designed as a prospective study, starting with 671 children aged one year. Children examined and caries-free at one year of age were divided into two groups, an experimental and a control group. In connection with the clinical examination, the parents of the children in the experimental group were trained using a colour photo to recognize the first sign of initial dental caries on buccal surfaces of upper incisors and encouraged to contact the dentist as soon as they discovered caries in the teeth of their children. Eighteen parents contacted the dentist when the children were between one and three years of age, but none due to carious lesions. The children in the control group were re-examined at two years of age. About eight per cent of the children in the control group had manifest or initial caries at that age, predominantely in the upper incisors. At three years of age 27 per cent of the children in both the experimental and control group had detectable caries. This study has clearly shown that parents are not able to diagnose caries in their toddlers-at least they are not able to seek advice or dental treatment.

Dental caries and prolonged breast-feeding in 18-month-old Swedish children.

Three thousand children aged 18 months were screened for dental caries and ongoing breast-feeding at 46 child welfare centres in different parts of Sweden. Of these, 200 children were selected for a more comprehensive examination, involving investigation of dietary, toothbrushing and sucking habits, use of fluoride, and determination of salivary levels of mutans streptococci and lactobacilli. The children were divided into four groups: group 1: children with caries not being breast-fed; group 2: children with caries being breast-fed; group 3: caries-free children being breast-fed; group 4: caries-free gender- and age-matched reference children not being breast-fed. The results showed that 63 of the children (2.1%) had caries and 61 (2.0%) were still being breast-fed. Twelve (19.7%) of the 61 children still being breast-fed had caries compared with 51 (1.7%) of the 2939 children not being breast-fed; the difference was statistically significant. Children with caries and still being breast-fed had a mean defs of 5.3, and those with caries not being breast-fed 4.9; the difference was not statistically significant. Children with caries, irrespective of whether they were being breast-fed or not, had significantly higher numbers of cariogenic food intakes per day than caries-free children. Mutans streptococci were detected in 67% of the children and lactobacilli in 13%. Children with detectable mutans streptococci and lactobacilli had significantly more caries than those without. The results indicate that Swedish children with prolonged breast-feeding have a tendency to establish unsuitable dietary habits which constitutes a risk situation for developing caries at an early age.

Infants and toddlers with caries. Mental health, family interaction, and life events in infants and toddlers with caries.

A child is part of a larger family system and the family, in turn, is part of a broader neighbourhood or community system. Consequently, changes in the family may affect the child and changes in the child, the family. Thus the basic etiological factors for caries are influenced by a number of indirect factors. The aim of this descriptive study was to investigate some of these indirect factors in families of children who had developed carious lesions at one or two years of age. By using a combination of interviews, questionnaires and video recordings, it was possible to obtain information regarding mental health, psychosocial background, life events, and family interaction. The results show that in all the investigated families, life events had occurred, that had caused a great deal of stress. From a descriptive point of view there does not seem to be a typical family in which infants develop caries. However, certain psychosocial factors could be essential for the development of caries in infants. Since family function, family interaction and life events influence many aspects of children's life, dental personnel must be aware of the repercussions this may have upon oral health in infants and toddlers.

Oral health of individuals aged 3-80 years in Jönköping, Sweden in 1973, 1983, and 1993. I. Review of findings on dental care habits and knowledge of oral health.

The aim of the present study was to compare data on dental care habits and knowledge of oral health in three cross-sectional studies carried out in 1973, 1983, and 1993. The 1973 study constituted a random sample of 1000 individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. The same age groups with addition of a group of 80-year-olds were included in the 1983 and 1993 studies which comprised 1104 and 1078 individuals, respectively. A questionnaire (23-101 questions) about dental care habits and knowledge of oral health was used in connection with a clinical and radiographic examination. The same questions were used in all the three studies. An addition to the 1993 investigation was questions concerning ethnographic background. In 1993 approximately 95% of all individuals were visiting the dentist on a regular basis every or every second year. The 30-year-olds, however, did not visit a dentist as regularly in 1993 as in 1983. The 70- and 80-year-olds visited a dentist more regularly in 1993 than in 1983. An increased number of adults in all age groups, except for the 70-year-olds, received their dental care in the Public Dental Service in 1993 compared to 1983 and 1973. Most 40-year-olds and older, however, received their dental care by private practitioners. About 80% of all adults in 1993 were enrolled in a recall system on the dentist's initiative while in 1973 most appointments were based on the patient's own initiative. The number of individuals who felt discomfort at the prospect of an appointment with the dentist was more or less the same in 1973, 1983, and 1993. The knowledge of the etiology of dental diseases has not changed much between 1973 and 1993. The frequency of toothbrushing has increased since 1973 and in 1993 more than 95% of all individuals brushed their teeth daily. The use of dental floss and toothpicks as well as disclosing tablets decreased in 1993 compared to 1983. Almost all individuals in 1993 used fluoride toothpaste. The use of topical fluorides and fluoride tablets in children had decreased considerably in 1993 compared to 1983.

Oral health of individuals aged 3-80 years in Jönköping, Sweden in 1973, 1983, and 1993. II. Review of clinical and radiographic findings.

The aim of this epidemiological study was to analyse various clinical and radiographic data on oral health and compare the results to those of two cross-sectional studies carried out in 1973 and 1983. In 1973, 1983, and 1993 a random sample of 1000, 1104, and 1078 individuals, respectively were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. In 1983 and 1993 80-year-olds were also included. All subjects were inhabitants of the community of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations and overhangs, oral hygiene, calculus, periodontal status, endodontic treatment, and periapical status. The number of edentulous individuals was reduced by half from 1973 to 1993 and is now 8% in the age groups 40-70 years. The mean number of teeth has increased and up to the age of 50 years the individuals had more or less complete dentitions. During the 20-year period there was generally decreasing number of carious lesions and restorations. In the 15- and 20-year-olds, however, there was an increasing number of decayed/filled tooth surfaces in 1993 compared to 1983. Furthermore, after the age of 50 there was an increase in number of restored tooth surfaces. As regards secondary caries there was an increase for the 10- and 15-year-olds between 1983 and 1993. For all other age groups there were only minor differences. Generally restorations exhibited a high quality and 85-90% had no proximal overhangs. In 1973 this figure was about 60%. Concerning the frequency of tooth surfaces exhibiting plaque and gingival inflammation there was a considerable decrease from 1973 to 1983, but during the period from 1983 to 1993 there seems to be no improvement. In some age groups there was even a significant increase in plaque (15-year-olds) and gingivitis (3-, 5-, 15-, 20-, and 60-year-olds). The frequency of individuals with one or more periodontal pockets (> 4 mm) increased with age. In 1993 the bone level at the age of 40 years corresponded to the bone level at the age of 20 years in 1973. The percentage of endodontically treated teeth was lower in 1993 in all age groups than in 1973 and 1983. The percentage of endodontically treated teeth with periapical or juxtaradicular destructions was unchanged in all three studies. The comparison of the three studies from 1973, 1983, and 1993 shows that there has been a great improvement in oral health over this 20-year period. In 1993, however, the increasing number of decayed/filled tooth surfaces in the 15- and 20-year-olds and an increase in plaque and gingivitis in some younger age groups calls for special attention.

Oral hygiene in relation to caries development and immigrant status in infants and toddlers.

The purpose of this study was to describe oral hygiene factors in infants and toddlers living in Sweden with special reference to caries prevalence at 2 and 3 yr of age and to immigrant status. The study was designed as a prospective, longitudinal study starting with 671 children aged 1 yr. At 3 yr, all the children were invited to a further examination. A total of 298 children, randomly selected from the original group, were also examined at 2 yr. The accompanying parent was interviewed about the child's oral health habits. Children who were free of caries at 3 yr had had their teeth brushed more frequently at 1 and 2 yr of age, had used fluoride (F)-toothpaste more often at 2 yr of age, and had a lower prevalence of visible plaque at 1 and 2 yr of age than children with caries. Immigrant children had had their teeth brushed less frequently, had used less F-toothpaste, and had a higher prevalence of visible plaque at 1 yr of age than nonimmigrant children. Early establishment of good oral hygiene habits and regular use of F-toothpaste seem to be important for achieving good oral health in pre-schoolchildren.

Prediction of behavior-management problems in 3-year-old children.

The aim was to determine power of nondental background factors to predict behavior-management problems at the first dental visits of 3-yr-old children. A total of 273 children from three kinds of residential area--city, town, and rural area--in Sweden took part. The parents were interviewed before the child's dental visit. The behavior of the child was rated by registering the degree of acceptance according to the method of HOLST & CROSSNER. The following steps were rated: entering the dental treatment room, mirror in mouth, probe on fingernail and tooth, air-blower on hand and in mouth, sitting in the dental chair, and examination. The behavior was then analyzed in relation to the answers of the interviews, and a logistic regression model was used to calculate the power of the variables, separately or combined, to predict behavior-management problems. Seventy-six percent of the children cooperated well at the dental examination; 13% reacted reluctantly, and 11% reacted negatively. Two interview variables had statistically significant predictive power: the parent's expectation of a negative reaction from the child in the dental situation and the child's anxiety when meeting unfamiliar people. Sixty-nine percent of child patients accepted the examination while sitting alone in the chair. Sitting alone used as a predictor for cooperation showed sensitivity 0.80, specificity 0.71, predictive value for positive test 0.44, and predictive value for negative test 0.94.

Oral health in preschool children living in Sweden. Part II--A longitudinal study. Findings at three years of age.

Scientific epidemiological studies of dental health in children three years of age are relatively few in Sweden. The aim of this study was to describe the oral health of three-year-old children living in Sweden, with special reference to immigration and failure to attend health examinations. All of 671 children requested to take part in an earlier investigation (Wendt et al. 1991) were invited for a new dental examination at three years of age. A total of 632 children were examined. At the age of three years 71.7 per cent of the children were caries free. Of the children with caries, 33.5 per cent were immigrants and of the total number of immigrants, 50.5 per cent had caries compared to 21.9 per cent of the non-immigrant children. Among those children, who failed to attend the earlier investigations at one or two years of age, 61.5 per cent had caries at the age of three. Compared to studies on dental health in three-year-old children from the 70's and 80's (Hugoson et al. 1986), this study shows that dental health in three-year-old children has not improved significantly during the last decade. Furthermore, this study supports the suggestion that special preventive dental programmes should be developed for immigrant children and that extra attention should be paid to children who fail to attend health examinations and their families.

Osseointegrated implants in the oral habilitation of a boy with ectodermal dysplasia: a case report.

The most characteristic oral feature in ectodermal dysplasia is hypodontia. Children and adolescents suffering from ectodermal dysplasia often need extensive and complicated prosthetic treatment. The development of techniques for osseointegrated implants offers new possibilities for the oral habilitation of these children. This paper describes the oral habilitation of a boy with severe ectodermal dysplasia and where Brånemark osseointegrated implants have been used as part of the treatment. The patient was seen at the dental department at the age of 1.5 years. Two conically-shaped upper incisors were at that time the only teeth that had erupted. The treatment was planned in a multidisciplinary odontological group involving paediatric dentistry, orthodontics, prosthodontics, oral surgery and maxillofacial radiology. At the age of 3 years it was verified that the boy had four primary teeth (53, 51, 61, 63) and four permanent teeth (16, 11, 21, 26). There were no teeth in the lower jaw. The alveolar ridges in the edentulous areas were low or missing. During the period 3-6 years of age the boy used an upper partial denture adapted to allow the mesial drift of the 16 and 26 teeth. At the age of 6 years, two Brånemark implants were inserted in the lower front-cuspid region. A specially designed overdenture for the lower jaw was constructed. The overdenture was retained in contact with the male attachments by two cuffs of heat-polymerized resilient silicone. Over the next 4 years the dentures were modified due to the eruption of permanent teeth and growth. However, only minor corrections were necessary concerning the retention system of the lower denture. The implants are well osseointegrated and stable and allow the boy to use a lower denture without any complications.

Craniomandibular function in juvenile chronic arthritis. A clinical and radiographic study.

Craniomandibular function was studied in 70 subjects with juvenile chronic arthritis (JCA). The subjects represented the total group of children and adolescents with the diagnosis JCA in a Swedish county. At examination, the median age of the subjects was 11.9 years and the median duration of the disease was 2.6 years. The most important finding of the study was the high prevalence (41%) of radiographic signs of temporomandibular joint (TMJ) pathology. Few subjects showed the typical craniofacial abnormalities associated with JCA, like mandibular micrognathia, facial asymmetries and open bite. Subjective symptoms of dysfunction were almost absent in subjects younger than seven years but were reported by 56% of the older subjects. TMJ sounds and pain on jaw movements were the most frequent symptoms reported. At the clinical examination, TMJ crepitations and restricted horizontal jaw movements were noted in 26% and 32% respectively. The high prevalence of TMJ involvement found in this study underlines the importance that dentists become part of the medical team responsible for the treatment of children and adolescents with JCA.

Dental caries in one- and two-year-old children living in Sweden. Part I--A longitudinal study.

There are few epidemiological studies on caries prevalence in young children. The aim of this study was to describe the caries prevalence in 1- and 2-year-old children. All 1-year-old children, living within the area of four child welfare centres, were invited to participate. 632 children out of 671 invited were examined for dental caries. Among the children examined 120 (19%) were immigrants. One year later 326 of the 632 previous examined children were selected for a second examination of dental caries. Fifty-four children (18.1%) were immigrants. At the age of one and two years 0.5 and 7.7 per cent respectively of the children had caries. In 2-year-old children with caries the mean number of decayed tooth surfaces was 6.3. About fifty-two per cent of this group of children were immigrants. In 2-year-old immigrants 22.2 per cent had caries compared to 4.5 per cent in non-immigrant children (p less than 0.001). This study shows that, as early as at one and two year of age, a group of children have developed a number of carious lesions. Further studies in infants on predisposing factors related to early caries activity are urgent in order to find measures for effective preventive care.