Effectiveness of a personalised referral letter following orthodontic screening.

No data exist on the usefulness of orthodontic screening in guiding those children who need orthodontic treatment towards professional advice. This study evaluated the effectiveness of a personalised referral letter following an orthodontic screening programme employing an objective measure of treatment need, the Index of Orthodontic Treatment Need (IOTN). Out of a total sample of 924 children aged 11-12 yr, 201 were in need of orthodontic treatment and no orthodontic treatment was planned. From this subsample test and control groups matched for sex, socio-economic background, dental disease and aesthetic impairment were created. Following screening, the parents of the test group only were sent a specific orthodontic referral letter. The dental practitioners of the children in the test and control groups were contacted during a follow-up investigation carried out 8 months later, this revealed that significantly more children entered orthodontic treatment pathways from the test group. This study demonstrated that a screening programme, using IOTN as a screening test, and a referral procedure which provided parents with specific information were successful in guiding over one third of children with a need for orthodontic treatment towards orthodontic advice.

Residual orthodontic treatment need in a sample of 15- and 16-year-olds.

This study investigated the residual unmet orthodontic need, both normative and perceived, in young adults who had passed the age at which orthodontic treatment would have normally commenced. A total of 506 15- and 16-year-olds attending eight secondary schools were screened by a single trained examiner using the 'Index of Orthodontic Treatment Need' (IOTN). There were 154 (30.4%) subjects classified as being in need of orthodontic treatment using IOTN and 82 of these (16% of the sample) were found to be in need of orthodontic treatment but had no recollection of orthodontic treatment ever being discussed with them. Children with malocclusion, who had received no orthodontic advice, came from across the range of socio-economic groups, were more likely to be male, and were less likely to be happy with their appearance than their unaffected peers.

Validity and reproducibility of clinical examination, fibre-optic transillumination, and bite-wing radiology for the diagnosis of small approximal carious lesions: an in vitro study.

This study measured validity and reproducibility of unaided clinical diagnosis, fibre-optic transillumination (FOTI), and bite-wing radiology in the diagnosis of approximal caries. Sixty models were made using extracted premolars and molars, each containing four teeth with six contacting approximal surfaces. The teeth were examined first using unaided clinical examination and then using FOTI. Bite-wing radiographs were then taken of the teeth set in the models and examined. The three examinations were repeated after 1 week. Histological sections of the undecalcified teeth were prepared following their removal from the models, and those showing signs of caries were examined to give the valid state of disease in each surface. The diagnostic threshold was caries penetrating into dentine. The reproducibility of all three methods was acceptable with kappa values exceeding 0.6. All specificity values exceeded 0.95. Statistically significant differences were seen between sensitivities for clinical (0.38) and bite-wing (0.59) diagnosis and between clinical and FOTI (0.67) examination, but not between bite-wing and FOTI. It is concluded that the validity of FOTI is at least as high as that of bite-wing radiology, and both are superior to unaided clinical diagnosis.

A comparison between the dental health of 3-year-old children living in fluoridated Huddersfield and non-fluoridated Dewsbury in 1989.

A study was undertaken to compare the prevalence of dental caries and developmental defects of enamel between 3-year-old children who were lifelong residents of fluoridated areas of Huddersfield (1 ppm F) and non-fluoridated Dewsbury (less than 0.3 ppm F). An interview was also conducted with the parents of the children to provide information regarding previous dental experiences. The study populations were identified using the national child health system. The mean dmft was 0.30 in Huddersfield and 0.74 in Dewsbury. The percentage of children who had experienced dental caries and the percentage with carious teeth were significantly lower in the fluoridated area. The Dewsbury children had suffered more toothache. There was a significantly higher number of children in Huddersfield with diffuse enamel defects on their upper and lower first molars. This study has also demonstrated that the national child health system provides a method for obtaining a random sample of pre-school children from the general population, thus avoiding the problems associated with studies using selected populations. Fluoridation in Huddersfield ceased in October 1989 and it is hoped that this decision will be reversed as soon as possible.

A national calibration exercise for the British Association for the Study of Community Dentistry regional examiners.

Representative examiners from all regions in England and examiners from Wales and Scotland took part in a national calibration exercise conducted in Manchester for The British Association for the Study of Community Dentistry (BASCD). Each dentist examined the same group of thirty-three 5-year-old and thirty 14-year-old children independently, and they were asked to examine the children by the same method as that used within that Region when conducting the annual BASCD surveys. Comparisons of inter-examiner differences revealed that in the examination of 5-year-old children diagnoses were not significantly different for 14 out of the 16 Regional examiners. Differences in the conventions applied in the case of missing teeth and 'arrested caries' were found and are discussed. There were no significant differences in the diagnoses for the DMFT for the 14-year-old children amongst all 16 Regional examiners. The calibration exercise allowed a close examination of the application of the BASCD criteria in the field.

Enamel defects in 8-year-old children in fluoridated and non-fluoridated parts of Cheshire.

The aim of this study was to compare the prevalence of developmental defects of enamel in fluoridated (1 ppm F) and non-fluoridated (less than 0.2 ppm F) communities in Cheshire, England. Eight-year-old children were examined under blind conditions. Only lifetime residents were included and only children with no history of dietary fluoride supplements. Significantly more children living in the fluoridated community (60%) had enamel defects compared to those in the non-fluoridated community (44%). In the fluoridated community, significantly more children whose parents claimed to begin brushing at an early age exhibited enamel defects.

Changes in the caries prevalence of 11-12-year-old schoolchildren in the North-West of England from 1968 to 1981.

Since 1968, six caries clinical trials have been conducted in the North-West of England by different examiners using the same diagnostic system, and a steady reduction in caries prevalence in 11-12-yr-old schoolchildren has been recorded. In the present study, five of the examiners revisited some of the schools which participated in their original trials and each examined between 196 and 296 children. The time intervals between the original and repeat examinations were 12, 10, 8, 5 and 3 yr. Percent caries reductions (PCRs) ranged from 19 to 33 for DMFT and from 24 to 35 for DMFS but the PCRs did not relate to the time intervals between examinations. The PCRs were greater on free smooth and approximal surfaces than on fissure surfaces and for the anterior teeth than for the mouth as a whole, suggesting that fluoride may have played a role in the reductions.