Disability days in Canada associated with dental problems: a pilot study.

OBJECTIVE: The aim of this study was to explore disability days, or bed days and cut-down days, associated with dental problems in Canada. METHODS: Data were collected through a national telephone interview survey of 1005 Canadians aged 18 years and over using random digit dialling. Participants were asked to enumerate the number of disability days associated with dental problems in the previous 2-week period. Descriptive and bivariate logistic regression analyses were undertaken. RESULTS: In the previous 2-week period, 33 people, or 3.3% of the sample, reported spending a day in bed because of a dental problem. Of these, 22 people also reported having to cut down on their normal activity because of the dental problem. It appears that younger age groups, those with the lowest incomes, college educations, no dental insurance, oral pain and a history of visiting a hospital emergency room for a dental problem, were all more likely to report a dental disability day. CONCLUSIONS: These data demonstrate the potential economic impacts of dental problems in Canada, yet they must be interpreted with caution because of the very low prevalence of the main outcome measure, the potential for selection bias and the relative inconsistency with existing historical estimates.

Rm62, a DEAD-box RNA helicase, complexes with DSP1 in Drosophila embryos.

Two main classes of proteins, Polycomb group (PcG) and Trithorax group (TrxG), play a key role in the regulation of homeotic genes. These proteins act in multimeric complexes to remodel chromatin. A third class of proteins named Enhancers of Trithorax and Polycomb (ETP) modulates the activity of TrxG and PcG, but their role remains largely unknown. We previously identified an HMGB-like protein, DSP1 (Dorsal Switch Protein 1), which was classified as an ETP. Preliminary studies have revealed that DSP1 is involved in multimeric complexes. Here we identify a DEAD-box RNA helicase, Rm62, as partner of DSP1 in a 250-kDa complex. Coimmunoprecipitation assays performed on embryo extracts indicate that DSP1 and Rm62 are associated in 3- to 12-h embryos. Furthermore, DSP1 and Rm62 colocalize on polytene chromosomes. Consistent with these results, a mutation in Rm62 enhances a null mutation of dsp1 and also mutations of trxG or PcG, suggesting that Rm62 has characteristics of an ETP. We show here for the first time that an RNA helicase is involved in the maintenance of homeotic genes.

Long-term dental visiting patterns and adult oral health.

To date, the evidence supporting the benefits of dental visiting comes from cross-sectional studies. We investigated whether long-term routine dental visiting was associated with lower experience of dental caries and missing teeth, and better self-rated oral health, by age 32. A prospective cohort study in New Zealand examined 932 participants' use of dentistry at ages 15, 18, 26, and 32. At each age, routine attenders (RAs) were identified as those who (a) usually visited for a check-up, and (b) had made a dental visit during the previous 12 months. Routine attending prevalence fell from 82% at age 15 to 28% by 32. At any given age, routine attenders had better-than-average oral health, fewer had teeth missing due to caries, and they had lower mean DS and DMFS scores. By age 32, routine attenders had better self-reported oral health and less tooth loss and caries. The longer routine attendance was maintained, the stronger the effect. Routine dental attendance is associated with better oral health.

Dental health state utility values associated with tooth loss in two contrasting cultures.

The study aimed to assess the value placed on oral health states by measuring the utility of mouths in which teeth had been lost and to explore variations in utility values within and between two contrasting cultures, UK and Iran. One hundred and fifty eight patients, 84 from UK and 74 from Iran, were recruited from clinics at University-based faculties of dentistry. All had experienced tooth loss and had restored or unrestored dental spaces. They were presented with 19 different scenarios of mouths with missing teeth. Fourteen involved the loss of one tooth and five involved shortened dental arches (SDAs) with varying numbers of missing posterior teeth. Each written description was accompanied by a verbal explanation and digital pictures of mouth models. Participants were asked to indicate on a standardized Visual Analogue Scale how they would value the health of their mouth if they had lost the tooth/teeth described and the resulting space was left unrestored. With a utility value of 0.0 representing the worst possible health state for a mouth and 1.0 representing the best, the mouth with the upper central incisor missing attracted the lowest utility value in both samples (UK = 0.16; Iran = 0.06), while the one with a missing upper second molar the highest utility values (0.42, 0.39 respectively). In both countries the utility value increased as the tooth in the scenario moved from the anterior towards the posterior aspect of the mouth. There were significant differences in utility values between UK and Iranian samples for four scenarios all involving the loss of anterior teeth. These differences remained after controlling for gender, age and the state of the dentition. With respect to the SDA scenarios, a mouth with a SDA with only the second molar teeth missing in all quadrants attracted the highest utility values, while a mouth with an extreme SDA with both missing molar and premolar teeth in all quadrants attracted the lowest utility values. The study provided further evidence of the validity of the scaling approach to utility measurement in mouths with missing teeth. Some cross-cultural variations in values were observed but these should be viewed with due caution because the magnitude of the differences was small.

Predictors of dental care utilization among working poor Canadians.

OBJECTIVE: This study used the Gelberg-Andersen Behavioral Model for Vulnerable Populations to identify predictors of dental care utilization by working poor Canadians. METHODS: A cross-sectional stratified sampling study design and telephone survey methodology was used to collect data from a nationally representative sample of 1049 working poor individuals aged 18 to 64 years. Working poor persons worked > or = 20 h a week, were not full-time students and had annual family incomes <$34,300. A pretested questionnaire included sociodemographic items, self-reported oral health measures and two dental care utilization outcomes: time since their last dental visit and the usual reason for dental visits. RESULTS: Hierarchical stepwise logistic analyses identified independent predictors associated with visiting the dentist >1 year ago: male gender (OR = 1.63; P = 0.005), aged 25-34 years (OR = 2.05; P = 0.02), paying for dental care with cash or credit (OR = 2.31; P < 0.001), past welfare recipients (OR = 1.65; P = 0.03), <21 teeth (OR = 4.23; P < 0.001) and having a perceived need for dental treatment (OR=2.78; P < 0.001). Sacrificing goods or services to pay for dental treatment was associated with visiting the dentist within the past year. The predictors of visiting the dentist only when in pain/trouble were lone parent status (OR = 4.04; P < 0.001), immigrant status (OR = 1.72; P = 0.006), paying for dental care with cash or credit (OR = 2.71; P < 0.001), a history of an inability to afford dental care (OR = 1.62; P = 0.01), a satisfactory/poor/very poor self-rated oral health (OR = 2.10; P < 0.001), number of teeth <21 (OR = 2.58; P < 0.001) and having a perceived need for dental treatment (OR = 2.99; P < 0.001). CONCLUSIONS: This study identified predisposing and enabling vulnerabilities that jeopardize the dental care-seeking practices of working poor persons. Dental care utilization was associated with relinquishing spending on other goods and services, which suggests that dental care utilization is a competing financial demand for economically constrained adults.

Trajectories of dental anxiety in a birth cohort.

OBJECTIVE: To examine predictors of dental anxiety trajectories in a longitudinal study of New Zealanders. METHODS: Prospective study of a complete birth cohort born in 1972/73 in Dunedin, New Zealand, with dental anxiety scale (DAS) scores and dental utilization determined at ages 15, 18, 26 and 32 years. Personality traits were assessed at a superfactor and (more fine-grained) subscale level via the Multidimensional Personality Questionnaire at age 18 years. Group-based trajectory analysis was used to identify dental anxiety trajectories. RESULTS: DAS scores from at least three assessments were available for 828 participants. Six dental anxiety trajectories were observed: stable nonanxious low (39.6%); stable nonanxious medium (37.9%); recovery (1.6%); adult-onset anxious (7.7%); stable anxious (7.2%) and adolescent-onset anxious (5.9%). Multivariate analysis showed that males and those with higher DMFS at age 15 years were more likely to be in the stable nonanxious low trajectory group. Membership of the stable nonanxious medium group was predicted by the dental caries experience at age 15 years. Participants who had lost one or more teeth between ages 26 and 32 years had almost twice the relative risk for membership of the adult-onset anxious group. Personality traits predicted group membership. Specifically, high scorers (via median split) on the 'stress reaction' subscale had over twice the risk of being in the stable anxious group; low scorers on the traditionalism subscale were more likely to be members of the recovery trajectory group; and high scorers on the 'social closeness' subscale had half the risk of being in the stable anxious group. Dental caries experience at age 5 years was also a predictor for the stable anxious group. Membership of the late-adolescent-onset anxious group was predicted by higher dental caries experience by age 15 years, but none of the other predictors was significant. CONCLUSION: Six discrete trajectories of dental anxiety have been observed. Some trajectories (totalling more than 90% of the cohort) had clear associations with external influences, but others were more strongly associated with characteristics such as personality traits. A mix of both influences was observed with only the stable anxious dental anxiety trajectory.

Epidemiological evaluation of short-form versions of the Child Perception Questionnaire.

The objective of the study was to compare the performance of four short-form versions of the Child Perceptions Questionnaire (CPQ(11-14)) with that of the long-form version in a random population sample of 12- and 13-yr-old children from New Zealand in order to determine which short-form version was the most valid. Children (n = 430, participation rate 74.1%) completed the 37-item CPQ(11-14). Two separate 8- and 16-item short-form versions were previously developed using (a) item impact and (b) regression methods. The four different short-form scales were compared with the full CPQ(11-14) on their construct validity. The children were examined for malocclusion (using the Dental Aesthetic Index) and for dental caries by a single examiner (L.F.P.). All short-form versions revealed substantial variability in overall oral health-related quality of life (OHRQoL). Cronbach's alpha ranged from 0.73 (Regression Short Form [RSF]-8) to 0.86 (RSF-16). For all short-form versions, mean scores were positively associated with self-rated oral health and overall wellbeing; associations with the latter were stronger. All short-form versions detected OHRQoL gradients, as hypothesized, across ascending categories of caries and malocclusion. These findings suggest that the short-form versions of the CPQ(11-14) all show acceptable properties, but that the 16-item versions perform better (and are essentially equivalent); however, the stronger theoretical underpinning of the item-impact-derived 16-item short-form version suggests that it shows the most promise.

Comparison of two methods in deriving a short version of oral health-related quality of life measure.

OBJECTIVE: To compare two methods of developing short forms of the Malaysian Oral Health Impact Profile (OHIP-M) measure. METHOD: Cross sectional data obtained using the long form of the OHIP-M was used to produce two types of OHIP-M short forms, derived using two different methods; namely regression and item frequency methods. The short version derived using a regression method is known as Reg-SOHIP(M) and that derived using a frequency method is known as Freq-SOHIP(M). Both short forms contained 14 items. These two forms were then compared in terms of their content, scores, reliability, validity and the ability to distinguish between groups. RESULTS: Out of 14 items, only four were in common. The form derived from the frequency method contained more high prevalence items and higher scores than the form derived from the regression method. Both methods produced a reliable and valid measure. However, the frequency method produced a measure, which was slightly better in terms of distinguishing between groups. CONCLUSION: Regardless of the method used to produce the measures, both forms performed equally well when tested for their cross-sectional psychometric properties.

Is the oral health impact profile measuring up? Investigating the scale's construct validity using structural equation modelling.

OBJECTIVES: The aim of the study was to provide an empirical test of the construct validity of the Oral Health Impact Profile as a measure of Locker's conceptual model of oral health. METHODS: A secondary analysis of data from the Ontario Study of Older Adults was carried out using structural equation modelling to assess the degree to which scale items measured the construct they were supposed to measure (within-construct validity) and whether relations between constructs were as hypothesized by Locker's model (between-construct validity). RESULTS: The findings indicated that the Oral Health Impact Profile as currently conceived does not have adequate within-construct validity. Scale items did not always measure the construct they were supposed to measure, some items within a construct were redundant, many measured more than one construct, and the scale did not represent seven separate constructs of oral health as originally devised. Following reconceptualization of the scale, the revised six-factor 22 item version was a better fit to the data. However, the scale did not have adequate between-construct validity. CONCLUSION: The present findings do not provide support for the conceptual basis of the Oral Health Impact Profile as a measure of Locker's model of oral health. The need for further conceptual development of the scale, and Locker's model, are discussed.

Canadian dental students' perceptions of stress and social support.

This study explored the relationship between dental school stress and social support reported by undergraduate students in a Canadian dental school. Students completed questionnaires comprised of Dental Environment Scale stress items, social support measures evaluating perceived contact and two proxy measures of social support (marital status and living arrangement). Sixty-two per cent of undergraduate students in all four academic years participated in the study conducted in March--April 2005. Second-year students living with parents had significantly higher adjusted total stress scores (P < 0.001), whilst fourth-year students living with roommates had significantly lower total adjusted stress scores (P = 0.008). Social support systems utilised by students included teacher, parental, student and relationship support. Students who received more support from teachers and from students inside and outside dental school had lower adjusted total stress scores. Multiple regression analysis assessing the effect of social support on total adjusted stress scores identified two significant variables after adjustment: second-year students living with parents (P < 0.001) and low teacher support (P = 0.032). This study identified social support and proxy measures as significant predictors of dental school stress in Canadian dental students. Further studies are needed to elucidate the role of social support and proxy measures as potential dental school stress alleviators.

Changes in parent-assessed oral health-related quality of life among young children following dental treatment under general anaesthetic.

OBJECTIVE: To estimate the nature and magnitude of changes in oral health-related quality of life (OHRQoL) among children having dental treatment under general anaesthetic (GA) and to examine the evaluative properties of the Child Oral Health-related Quality of Life Questionnaire (COHQOL). METHODS: Data from a consecutive clinical sample of the parents/caregivers of children receiving dental treatment under GA at Wellington and Kenepuru Hospitals were collected from parents using the Parental-Caregivers Perception Questionnaire (P-CPQ) and the Family Impact Scale (FIS), which both form part of the COHQOL Questionnaire. The first questionnaire was completed before treatment or while the participant's child was undergoing treatment. The follow-up questionnaire was completed 1-4 weeks afterward. Treatment-associated changes in OHRQoL were determined by comparing baseline and follow-up data for the mean scores and the prevalence of impacts. The discriminative properties of the instrument were confirmed and then its evaluative properties were assessed (by examining its test-retest reliability, responsiveness and longitudinal construct validity). The minimally important difference was determined for the overall scale and subscales. RESULTS: Complete baseline and follow-up data were obtained for 202 and 130 participants, respectively (64.4% follow-up rate). The evaluative properties of the P-CPQ and FIS were acceptable. There were substantial and highly statistically significant reductions in mean P-CPQ and FIS scores after treatment, with effect sizes ranging from moderate to large, depending on the subscale being examined. The minimally important difference was shown by almost two-thirds of the children treated. CONCLUSION: The provision of dental treatment under GA for young children with severe dental caries experience is associated with substantial and highly significant improvements in both their OHRQoL and in the impact on their families. The P-CPQ and the FIS show promise as evaluative measures for use in dental health services research.

Cross-cultural adaptation of the Oral Health Impact Profile (OHIP) for the Malaysian adult population.

OBJECTIVE: The aim of this project was to develop an oral health related-quality of life measure for the Malaysian adult population aged 18 and above by the cross-cultural adaption the Oral Health Impact Profile (OHIP). METHOD: The adaptation of the OHIP was based on the framework proposed by Herdman et al (1998). The OHIP was translated into the Malay language using a forward-backward translation technique. Thirty-six patients were interviewed to assess the conceptual equivalence and relevancy of each item. Based on the translation process and interview results a Malaysian version of the OHIP questionnaire was produced that contained 45 items. It was designated as the OHIP(M). This questionnaire was pre-tested on 20 patients to assess its face validity. A short 14-item version of the questionnaire was completed by 171 patients to assess the suitability of the Likert-type response format. Field-testing was conducted in order to assess the suitability of two modes of administration (mail and interview) and to establish the psychometric properties of the adapted measure. RESULTS: The pre-testing revealed that the OHIP(M) has good face validity. It was found that the five-point frequency Likert scale could be used for the Malaysian population. The OHIP(M) was reliable, where the scale Cronbach's alpha was 0.95 and the ICC value for test-retest reliability was 0.79. Three out four construct validity hypotheses tested were confirmed. OHIP(M) works equally well as the English version. CONCLUSION: OHIP(M) was found to be reliable and valid regardless of the mode of administration. However, this study only provides initial evidence for the reliability and validity of the measure. Further study is recommended to collect more evidence to support these results.

Associations between xerostomia and health status indicators in the elderly.

AIMS: This study investigated the associations between xerostomia (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic and health status indicators). This paper aims to report on the severity of xerostomia in the elderly population and investigate the relationship with other aspects of perceived health. METHOD: Data were obtained from a cross-sectional survey of 225 elderly people from a large multilevel geriatric care centre. The centre consists of three levels of care: an apartment building in which residents live more or less independently, a home for the aged, and a chronic care hospital. Participants in the study were recruited when they attended the dental care facility. Data were collected by means of a personal interview conducted either at the dental care facility or the participant's residence. RESULTS: The mean age was 83 years. Most were females (72%) and almost all (99%) reported one or more chronic medical conditions; 88% had physical disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively Bivariate analysis showed no association between dry mouth and sex, age, general health change or life satisfaction. However, when the high xerostomia group was separated out and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a negative impact on health than the low group. Xerostomia did not have a significant impact on chewing capacity, morale or stress, although it contributed to the variability of the oral health-related quality of life measures. It was the only variable with a significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Self-reported xerostomia in the elderly population can be categorised into a severity scale. Those suffering most from xerostomia are more likely to experience a negative impact on general health. CONCLUSION: The key finding in this study is that xerostomia has a significant and negative impact on the quality of life of elderly individuals, though oral function may be less affected.

The impact of oral conditions on the quality of life of the Malaysian adult population: preliminary results.

The aim of this paper is to describe the impact of oral conditions on the quality of life of the adult population of Malaysia. The adapted Malaysian Oral Health Impact Profile (L-OHIP-M) questionnaire was used. A total of two hundred and twenty respondents completed the L-OHIP(M). Overall, slightly more than 50% of the sample had at least one impact reported as either "very often" or "often". The younger age group, Indian ethnic and those who had tertiary education reported more impacts. The preliminary results revealed that a substantial proportion of the sample included in this study experienced frequent psychosocial impacts associated with oral conditions.

An evaluation of the Child Perceptions Questionnaire in the UK.

OBJECTIVE: To assess the reliability and validity of the Child Perceptions Questionnaire (CPQ11-14), an oral health related quality of life measure for 11-14 year old children, for use in the UK. BASIC RESEARCH DESIGN: Cross-sectional questionnaire and clinical analytical study. CLINICAL SETTING: Orthodontic and paediatric dentistry clinics at a dental hospital and one general dental practice. PARTICIPANTS: Eighty-nine children between 11 and 14 years of age attending for an examination. MAIN OUTCOMES MEASURES: The children were invited to complete the CPQ11-14, global oral health and impact on life overall ratings. Clinical data on caries status, malocclusion and presence of dental opacities and gingivitis were collected. CPQ11-14 was summarised as the total score (sum of the item codes) and the number of impacts reported often or every day. RESULTS: The Cronbach's alpha for the total scale was 0.87 and ranged from 0.59 to 0.83 for the subscales indicating acceptable internal consistency. The intraclass correlation coefficient on repeated application of the measure was 0.83 (95% CI = 0.76-0.90) suggesting almost perfect agreement. Summary measures of CPQ11-14 correlated with the global oral health rating indicating acceptable criterion validity. Impact on life overall was related to all summary measures of CPQ11-14. Number of impacts correlated with the total number of missing teeth and missing teeth due to caries. No other relationships between clinical and CPQ11-14 data were apparent. CONCLUSION: The CPQ11-14 shows acceptable reliability, criterion and construct validity in relation to life overall. Relationships with clinical data were more tenuous. If this measure is to be used to compare the impacts of oral diseases in similar settings in the UK a large sample will be required.

Validation of the Child Perceptions Questionnaire (CPQ 11-14).

While the use of adult oral-health-related quality-of-life (OHRQoL) measures in supplementing clinical indicators has increased, that for children has lagged behind, because of the difficulties of developing and validating such measures for children. This study examined the construct validity of the Child Perceptions Questionnaire (CPQ(11-14)) in a random sample of 12- and 13-year-old New Zealanders. It was hypothesized that children with more severe malocclusions or greater caries experience would have higher overall (and subscale domain) CPQ(11-14) scores. Children (N = 430) completed the CPQ(11-14) and were examined for malocclusion (Dental Aesthetic Index) and dental caries. There was a distinct gradient in mean CPQ(11-14) scores by malocclusion severity, but there were differences across the four subscales. Children in the worst 25% of the DMFS distribution had higher CPQ(11-14) scores overall and for each of the 4 subscales. The construct validity of the CPQ(11-14) appears to be acceptable.

Need and demand for sedation or general anesthesia in dentistry: a national survey of the Canadian population.

The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population.

How well do parents know their children? Implications for proxy reporting of child health-related quality of life.

OBJECTIVES: This study examined parental knowledge of their children's oral-health-related quality of life (OHRQoL) (Objective 1), and the effects of different analytical techniques to manage 'Don't know' (DK) responses on the validity and reliability of the questionnaire (Objective 2) and the level of agreement between parental and child reports (Objective 3). METHODS: The parental (PPQ) and child (CPQ11-14) components of the Child Oral Health Quality of Life Questionnaire were used. Objectives 1 and 2 were addressed in the study that involved 221 parents and Objective 3 in the study that involved 63 pairs of parents and children. Four methods for treating DK responses in the PPQ were tested: listwise deletion, item mean imputation, imputation of the value zero and adjustment of scores to account for items with DK responses. RESULTS: Respectively, 26 and 11% of the parents gave > or = 3 and 6 > or = DK responses to 33 items comprising the PPQ. DK responses were associated with child's age and clinical condition, and parental gender. The methods of managing DK responses did not have differing effects on the measurement properties of the PPQ and the level of agreement between parents and children. CONCLUSION: Some parents have limited knowledge concerning their children's OHRQoL. However, given that parental and child reports are measuring different realities, information provided by parents is useful even if it is incomplete.

Questionnaire for measuring oral health-related quality of life in eight- to ten-year-old children.

PURPOSE: This study measured oral health-related quality of life for children, which involved the construction of child perceptions questionnaires (CPQs) for ages 6 to 7, 8 to 10, and 11 to 14. The purpose of this study was to present the development and evaluation of the CPQ for 8- to 10-year-olds (CPQ8-10). METHODS: Questions (N=25) were selected from the CPQ for 11- to 14-year-olds based on the child development literature and input from parents, child psychologist, and teacher of grades 3 and 4. Validity and reliability were evaluated on 68 and 33 children, respectively. RESULTS: There was a positive moderate correlation between the CPQ8-10 score and overall well-being rating (R=.45). The level of impact was slightly higher in the orofacial than in the pediatric dentistry group (mean score=19.1 vs 18.4, respectively). Hypotheses concerning the relationship between the CPQ8-10 score and number of decayed surfaces were confirmed with R=.29, and the mean score higher in caries-afflicted than caries-free children (21.1 vs 14.7). The Cronbach's alpha and intraclass correlation coefficients were 0.89 and 0.75, respectively. CONCLUSIONS: Results suggest good construct validity, internal consistency, reliability and test-retest reliability, but do not demonstrate discriminative validity. This is consistent, however, with theoretical models of oral disease and its consequences. Further research is required, as these are preliminary findings based on convenience sampling.

Prevention. Part 8: The use of pit and fissure sealants in preventing caries in the permanent dentition of children.

This paper reviews evidence concerning the use of pit and fissure sealants in preventing caries in the permanent dentition of children. While the evidence with respect to some sealant types and application techniques is incomplete, systematic reviews have clearly demonstrated that sealants are an effective preventive technology when used in high risk children, and that with proper application techniques long-term retention rates can be achieved. However, careful selection of patients and teeth for sealant placement is required to ensure cost-effectiveness.