Database analysis of a French type 2 diabetic population shows a specific age pattern of tooth extractions and correlates health care utilization.

AIMS: To assess the relationship between type 2 diabetes and tooth loss and the predictive value of health behavior and routine dental care in regard to both dental and medical follow-ups. METHODS: Cross-sectional study from a national database of a French population of railways transport workers was conducted with a descriptive analysis between registered diabetic patients and non-diabetic subjects. The relationship between oral health and diabetes was measured by tooth extraction prevalence in regard to the frequency of scaling-prophylaxis sessions and the number of medical and dental appointments. RESULTS: The prevalence of tooth extractions in the type 2 diabetic population is 1.88 higher than the non-diabetic population. Diabetic patients tend to undergo dental extractions earlier and more often than non-diabetic individuals. They also have more medical appointments and less dental check-ups and scaling sessions than the non-diabetic population. CONCLUSION: Measured by tooth loss, type 2 diabetic patients have a significantly earlier detrimental oral status when compared to the non-diabetic population. They exhibit a different pattern in health care utilization of outpatient medical resources. Oral health surveillance is not correctly addressed by the medical and dental coverage of these diabetic patients. Emphasis should be directed on specific dental care programs aimed at preventing tooth loss.

Complications following oral piercing. A study among 201 young adults in Strasbourg, France.

OBJECTIVE: This study was designed to identify and quantify the number and type of complications relating to the oral environment following piercing of tissue in the oral sphere. METHODS: The epidemiological survey included patients attending the University of Strasbourg Dental Hospital, students frequenting the University of Strasbourg canteen, and members of the public attending piercing conferences in Strasbourg, France between the months of February and June 2005. No dental examination was performed as part of this survey. RESULTS; 201 people were interviewed in this study. The average subject age was 22.7 years and 73.6% were smokers. Women comprised 72.6% of the sample population. Post-piercing complications occurred in 23.4%, but frequency depended on piercing location in relation to the oral sphere. Gingival recession occurred in 8.5%, and chipped teeth in 6.9% of the group who were aware of complications. Titanium, stainless steel and Teflon were associated with recession in 52.9%, 23.5% and 9%, and chipped teeth in 35.7%, 42.9% and 14.3% of this group respectively. CONCLUSION: The occurrence of complications was high. There is a need for public education and a further study with a dental examination.

Use of the generalised linear model with Poisson distribution to compare caries indices.

In dental epidemiological studies, an analysis of variance assuming a normal distribution is commonly used to compare caries indices, which are often not normally distributed. As these indices represent discontinuous data, it would be preferable to use the negative binomial or the Poisson distribution. In this study, in order to compare the DMFS indices of adults working in the confectionery manufacturing industry in France, the results of the generalised linear model obtained using the normal and the Poisson distribution with identity or log built-in link function were compared. The negative binomial distribution was not used because it is very often unavailable in the most used statistical software. Analysis of the caries indices showed that the use of the normal distribution could lead to an incorrect interpretation of the data. Therefore it is concluded that the generalised linear model with Poisson distribution and over dispersion is to be preferred when comparing caries levels.

[Epidemiology of dental caries in children]. / Epidémiologie de la carie dentaire chez l'enfant.

Epidemiological surveys showed a marked decrease of caries prevalence in French children during the last 20 years. One of the main factor of this improvement appears to be the extension of the prevention based on fluoride use. Nevertheless, the prevalence in caries in children remains higher in France than in many other countries. At the same time, no severe cases of dental fluorosis were observed, recent surveys showing that 97% of children had no sign of dental fluorosis, and 3% mild, very mild or doubtful fluorosis without esthetic consequences. In order to improve the dental status of French children, caries prevention by fluoride must therefore be reinforced and extended to all infants and children. However, medical fluoride prescriptions must take into account the possible other sources of fluoride resulting from salt fluoridation and water with high fluoride content, in order to prevent dental fluorosis.

Caries prevalence and salt fluoridation among 9-year-old schoolchildren in Strasbourg, France.

The 9-year-old group (236 children) of an epidemiological study carried out in 1991 in Strasbourg on children aged 6 to 15 years was selected with the aim of determining if the caries prevalence reduction observed could be related to the use of salt fluoridation (FS) introduced in France in 1987. From these 236 children, 143 answered a questionnaire which showed that 36 of them were fluoridated salt users and 107 were not. The dft index was significantly lower in the FS consumers which showed 35.5% dft reduction compared to the non-FS-consuming children. When using the Generalized Linear Model, this reduction was significant (P = 0.03). Although lower in the FS group, the DMFT and DMFS indices showed no statistical significant difference. It appeared that 72.2% of the users took simultaneously fluoride tablets but no dental fluorosis was observed. The use of fluoride tablets had a significant effect on the DMFS (P = 10(-2)). The children who consumed FS used more frequently fluoridated mouthrinses (P = 10(-3)) and had more frequent professional application of fluoridated gel and varnishes than non-consumers (P = 0.02). The DMFS index increased with the number of meals (P = 10(-6)), which was the most significant variable entered into the Generalized Linear Model. The children who brushed their teeth once a day had a DMFS value 2.6 times higher than those who brushed regularly three times a day (P = 10(-3)). The DMFS value was 4.4 times higher among the children who brushed their teeth irregularly when compared with those who brushed three times a day (P = 10(-2)).

Dental status and fluoride consumption among five-year-old schoolchildren in Strasbourg, France.

An epidemiological survey of the caries prevalence in 1743 five-year-old children was conducted in Strasbourg in 1991 and compared with a similar study performed in 1973 (Jung et al, 1975). In 1991, 44.2 percent of the children were caries-free and 3 percent of the sample had experienced extractions of carious primary molars. The average values of the dfs and dft indices were 2.93 and 6.10, respectively, with a caries reduction of 35 percent when compared to the 1973 data. The majority of children (87.96 percent) used fluoridated dentifrices and 49.5 percent of them benefited from at least another combined fluoride supplementation. The latter showed lower caries indices than the unsupplemented ones. The average plaque index and gingival index values were 0.62 and 0.1, respectively: 46.4 percent of the children had a plaque index of 0.

Caries prevalence in 6- to 15-year-old French children based on the 1987 and 1991 national surveys.

The caries prevalence in a multi-stage probability sample of 18,786 children representative of all French children 6-15 years of age was studied in 1991 and compared with the results of a similar survey made in 1987. A significant decline in dental caries in France became evident. This decline, observed in primary as well as in permanent teeth, was of variable magnitude among the different age groups. At the age of 6, 48.6% of the children were totally caries-free in 1991. At the age of 12, the DMFT and DMFS indices were 2.59 and 4.72, respectively, representing a corresponding decrease of 38% and 37%. In 1991, more caries-affected teeth or surfaces were filled, whereas fewer caries-affected teeth or surfaces were untreated. Females and children living in rural areas had a higher caries prevalence in both surveys. Pit-and-fissure lesions were the predominant caries types. Dental fluorosis was very uncommon; 96.1% of the 18,786 children examined in 1991 were totally free of any such lesions. Average plaque and calculus indices were similar in 1987 and in 1991, but a decrease of 25% was observed in the average gingival indices. Although the relative contributions of various preventive factors leading to this caries reduction are not clear, it should be noted that use of fluoridated salt (250 mg/kg KF) started in January, 1987. The sale of fluoridated dentifrices and the use of fluoride tablets and sugar substitutes increased during the period from 1987 to 1991.

Urinary fluoride excretion in children using potassium fluoride containing salt or sodium fluoride supplements.

With the introduction of fluoridated domestic salt in France in 1986, questions have arisen with respect to its efficacy in caries prevention. It has been of interest to compare the urinary excretion of fluoride in children who consume fluoridated salt to that in children who take fluoride tablets. Ninety-three schoolchildren, 10-14 years of age, participated in the study and were divided into four groups: group I consumed fluoridated salt with every meal; group II ate at a school restaurant once a day and consequently consumed fluoridated salt at only their evening meal, as fluoridated salt is not authorized for use in collective restaurants; group III consisted of children taking fluoride tablets (1.0 mg F/day) exclusively, and group IV did not receive any systemic administration of fluoride for prevention and constituted a low-fluoride control group. Total 24-hour urine samples were collected from all subjects. The average daily urinary flow rates varied from 0.51 to 0.68 ml/min, but showed no statistically significant differences among the groups. The average urinary fluoride concentrations were 0.60, 0.30, 0.99, and 0.28 mg/l, respectively, for groups I-IV. The mean 24-hour urinary fluoride concentrations and excretion rates for children who consumed fluoridated salt at all meals (group I) were not statistically different from those using tables (group III). There were also no statistically significant differences between groups II and IV. The differences between urinary fluoride concentrations and excretion rates of groups I and III, as compared with group IV, were statistically significant.

[The orodental status of the French population 6-15 years of age]. / Etat bucco-dentaire de la population française âgée de 6 à 15 ans.

A representative sample of 19,366 schoolchildren of France, aged 6 to 15 years, was randomly selected. Examiner teams from each of the 16 Faculties of Dental Surgery of France were trained together to be well calibrated. The dental caries prevalence was determined in each age group using the dft, dfs, DMFT and DMFS indices. The periodontal conditions were measured using the plaque index (Silness and Löe, 1964), the calculus index (Marthaler, 1966) and the gingival index (Löe and Silness, 1963). The mean DMFT index increased from 0.5 at age 6 to 6.9 at age 15 years. This index increased by 0.5 from one age group to the next until age 10, and from 1.0 from age 11 to age 15. The DMFS index increased from 0.8 to 13.0 between 6 and 15 years of age. In each age group, the numbers of carious and untreated surfaces were very similar to the number of filled surfaces. The percentage of children with caries-free permanent teeth decreased from 78.5% to 8.2% between 6 and 15 years of age. A direct relation was observed between the caries indices and the socio-economic category of the parents. The senior management and private professions presented the lowest indices.

National survey of caries prevalence in 6-15-year-old children in France.

The prevalence of dental caries in France is not known on a nationwide basis, despite the fact that a number of epidemiological studies have been conducted in various parts of the country. The aim of the present study was to provide a national baseline examination of the dental health of children in 1987 since, beginning in November, 1986, the sale of fluoridated salt began in France. A multi-stage probability sample of 19,366 children was selected as representative of the 6-to-15-year-old population. The sample covered all the 95 departments of France. Teams of well-calibrated examiners were constituted in each of the sixteen Faculties of Dental Surgery of France. The prevalence of caries for each age group was determined by means of DMFT, DMFS, dft, and dfs indices. Periodontal conditions were assessed by means of the Plaque Index (Silness and Löe, 1964), the Calculus Index (Marthaler, 1966), and the Gingival Index (Löe and Silness, 1963). Calculation of the mean DMFT index showed, respectively, 0.5 and 1.0 new carious teeth per year under and over the age of 11. The mean values of the DMFT index at ages 6, 12, and 15 were, respectively, 0.5, 4.2, and 6.9. Under the age of 11, the mean DMFS index increased by one between each successive age group and by nearly two over the age of 11. The mean values of the DMFS index at ages 6, 12, and 15 were, respectively, 0.8, 7.6, and 13.0. The percentage of caries-free children decreased from 32.2% at age 6 to 7.9% at age 15.

[Epidemiological study of the oro-dental status of the children of the Alsace and the Franche-Comté]. / Etude épidémiologique de l'état bucco-dentaire des enfants d'Alsace et de Franche-Comté.

Within a national epidemiological study conducted in France by the 16 Faculties of Dentistry, 946 school-children aged 6 to 15 years were randomly selected and examined in East of France. The Dental Faculty of Strasbourg studied the following departments: Doubs, Jura, Bas-Rhin, Haut-Rhin and Territoire de Belfort. Twenty per cent of the 12 year old children had a DMFT of 0, whereas by the age of 15 this percentage felt to 7%. The mean DMFT and DMFS of the 12 year old children were respectively of 4.6 and 8.7. The mean plaque index varied from 1.2 to 1.5 for all age groups. The mean calculus index increased progressively with age from 0.1 to 0.6. The mean gingival index was almost constant until the age of 8 (0.6 to 0.8). It reached 1.2 at 9 and remained unchanged until 15.

Approximal caries diagnosis in epidemiological studies: transillumination or bitewing radiographs?

The aim of this study was to compare the results obtained by transillumination and bitewing radiography in the diagnosis of caries affecting approximal surfaces of molar and premolar teeth for epidemiological surveys. 3960 posterior approximal surfaces on the right side of 330 patients aged 5 to 35 years were examined using a transillumination probe with a 1.5 mm diameters light source (Oralum, Rocky Mountain, Denver, Colorado) and bitewing radiographs using a portable dental apparatus (Elin, Wien, 60kV, 15mA. Transillumination detected 89% of the carious lesions reaching dentine diagnosed on radiographs and no statistically significant differences were observed in the diagnosis yield of the two systems. However, transillumination detected only 45% of these lesions diagnosed from bitewings as being confined to the enamel. Transillumination also made it possible to detect approximal caries into dentine in teeth covered by orthodontic bands. Thus comparative study gives experimental support to the use of transillumination in large epidemiological studies. The transillumination method is however not suitable for epidemiological trials including caries confined to the enamel.