Biannual fluoride varnish applications and caries incidence in preschoolers: a 24-month follow-up randomized placebo-controlled clinical trial.

UNLABELLED: Sound evidence on the effectiveness of fluoride varnishes (FV) to reduce caries incidence in preschool children is lacking. OBJECTIVE: To assess whether the application of FV in preschool children at 6-month intervals decreases the incidence of caries and produces any adverse effects. METHODS: A randomized, examiner- and patient-blind, placebo-controlled, parallel-group design, clinical trial, comprising 1- to 4-year-old children, 100 in each group (FV or placebo varnish, PV), was conducted in Rio de Janeiro, Brazil. Two trained pediatric dentists performed the clinical examinations (kappa = 0.85). Dental caries was recorded at the d2 (cavitated enamel) and d3 (dentine) levels using the International Caries Diagnosis and Assessment System. RESULTS: At baseline, the mean age of the participants was 2.4 years (SD 0.9) and the mean d3mfs was 0.8 (SD 1.9). Most of the children brushed their teeth with fluoride toothpaste and consumed fluoridated tap water. After 24 months, 89 and 92 children of the test and the control groups were analyzed, respectively. A total of 32 (35.9%) children in the FV group and 43 (46.7%) in the PV group presented new dentine caries lesions (χ(2) test; p = 0.14), showing relative and absolute risk reductions of 23% (95% CI: -9.5 to 45.9) and 11% (95% CI: -3.5 to 25.0). The mean caries increment differences between the test and control groups were -0.8 (95% CI: -2.0 to 0.4) at the d2 level and -0.7 (95% CI: -1.9 to 0.4) at the d3 level. Only 2 minor complaints regarding the intervention were reported. CONCLUSION: Although safe and well accepted, twice-yearly professional FV application, during 2 years, did not result in a significant decrease in caries incidence.

Effects of low and standard fluoride toothpastes on caries and fluorosis: systematic review and meta-analysis.

Although the anti-caries effects of standard fluoride (F) toothpastes are well established, their use by preschoolers (2- to 5-year-olds) has given rise to concerns regarding the development of dental fluorosis. Thus, a widespread support of low F toothpastes has been observed. The aim of this study was to assess the effects of low (<600 ppm) and standard (1,000-1,500 ppm) F toothpastes on the prevention of caries in the primary dentition and aesthetically objectionable (moderate to severe) fluorosis in the permanent dentition. A systematic review of clinical trials and meta-analyses were carried out. Two examiners independently screened 1,932 records and read 159 potentially eligible full-text articles. Data regarding characteristics of participants, interventions, outcomes, length of follow-up and potential of bias were independently extracted by two examiners and disagreements were solved by consensus after consulting a third examiner. In order to assess the effects of low and standard F toothpastes on the proportion of children developing caries and fluorosis, pooled relative risks (RR) and associated 95% confidence intervals were estimated using a fixed and a random-effects model, respectively. Five clinical trials fulfilled the inclusion criteria. Low F toothpastes significantly increased the risk of caries in primary teeth [RR = 1.13 (1.07-1.20); 4,634 participants in three studies] and did not significantly decrease the risk of aesthetically objectionable fluorosis in the upper anterior permanent teeth [RR = 0.32 (0.03-2.97); 1,968 participants in two studies]. There is no evidence to support the use of low F toothpastes by preschoolers regarding caries and fluorosis prevention.

Disparity between dental needs and dental treatment provided.

We hypothesized that more teeth would be treated by fee-for-service dentists than predicted by salaried dentists. In a cohort of 3818 participants, the number of teeth treated was related to the number of teeth with treatment needs by means of a zero-inflated negative binomial model. Among those obtaining dental care within 6 months (study population, n = 1239), the adjusted predicted number of teeth treated was 2 (95%CI = 1.7;2.3) for patients with no treatment needs. The sum of teeth treated by fee-for-service dentists (4374 when considering the whole cohort and 3550 when considering the study population) was much higher than that predicted by salaried dentists (4220 when considering the whole cohort and 1770 when considering the study population). Our findings demonstrate a disparity between dental needs assessment and the dental treatment actually provided.

Association between routine visits for dental checkup and self-perceived oral health in an adult population in Rio de Janeiro: the Pró-Saúde Study.

OBJECTIVE: To investigate the association between routine visits for dental checkup and self-perceived oral health. METHODS: Cross-sectional data from a study of university employees in Rio de Janeiro - The Pró-Saúde Study. Self-perceived oral health and the reported pattern and frequency of visits to the dentist were obtained through a multidimensional self-administered questionnaire. RESULTS: Data were obtained from 3252 participants. When compared with individuals who reported self-perceived oral health as good ('very good', 'good' or 'fair') individuals who reported self-perceived oral health as bad ('bad' or 'very bad') were significantly more likely to be older, male, less educated, poorer; they also reported more frequently to have lost more teeth and not visiting the dentist for routine dental 'checkup'. Among those who reported visiting for dental checks at least annually, 3% reported bad oral health, as opposed to 15% among those who reported visiting the dentist only when in trouble. Compared with those who reported visiting the dentist at least annually, odds ratio of bad oral health was 3.9 (95% CI, 2.68-5.67) for subjects who reported visiting only when in trouble, 2.6 (95% CI, 1.51-4.62) who reported visiting for dental checks less frequently than once every 2 years, and 1.4 (95% CI, 0.77-2.52) for subjects who reported visiting for dental checks once every 2 years, after controlling for sex, age, education, income and tooth loss. CONCLUSIONS: Not visiting the dentist for a routine dental check increased the chance of reporting one's own oral health as bad. In any case, the habit of visiting for dental 'checkup, once per year or once every 2 years was associated with nearly all the individuals perceiving his/her oral health positively. However, in order to gather more solid scientific data to guide public policies it is necessary to perform longitudinal studies, especially experiments in different populations focused mainly on the socioeconomic characteristics and dental clinical conditions.

Secular trends in socio-economic disparities in edentulism: USA, 1972-2001.

For health care planning and policy, it is important to determine whether socio-economic disparities in edentulism, an ultimate marker of oral health, have improved over time. The aim of this study was to investigate the socio-economic disparities in edentulism between 1972 and 2001. Representative samples of the United States population, 25-74 years old, were obtained from NHANES I (1972), III (1991), and 1999-2002. Differences in the edentulism prevalence between high and low socio-economic positions (SEP) were compared. Differences in edentulism prevalence remained stable over approximately three decades (p = 0.480), being 10.6 percentage points in 1972, 12.1 percentage points in 1991, and 11.3 percentage points in 2001. Exploratory subgroup analyses suggested that disparities decreased for those individuals reporting a dental visit in the prior year and those reporting never having smoked. In conclusion, the absolute prevalence difference in edentulism between low and high socio-economic positions has remained unchanged over the last three decades.

Oral malodour and its association with age and sex in a general population in Brazil.

AIM: To assess the prevalence of persistent oral malodour in a general population in Rio de Janeiro and to find out whether sex and age are risk factors for this condition. METHODS: This was a cross-sectional survey in which university students (informants) were interviewed regarding the prevalence of persistent oral malodour in their households. To estimate the effects of sex and age logistic regression models with and without random effects for the informant were applied. RESULTS: The prevalence of persistent oral malodour was 15% (95% confidence interval: 11-19). The risk of persistent malodour was nearly three times higher in men than in women, regardless of age. The risk was slightly more than three times higher in people over 20 years of age compared with those aged 20 years or under, controlling for sex. CONCLUSIONS: Oral malodour is common in Rio de Janeiro, more prevalent in men and in those over 20 years of age, in both sexes. CLINICAL RELEVANCE OF THE FINDINGS: Freedom from disabling oral malodour is an outcome indicator of social well-being. Health professionals in general, and dentists in particular, should be trained to appropriately manage and treat people who suffer from persistent oral malodour.

Removal of caries using only hand instruments: a comparison of mechanical and chemo-mechanical methods.

The aim of this study was to evaluate the efficacy, comfort and efficiency of removing dentin caries using only hand instruments. The Carisolv system for caries removal consisting of a solvent gel and a set of specially designed hand instruments (chemo-mechanical) was compared to the use of conventional spoon excavators (mechanical). This was a clinical randomised controlled trial where the two techniques were compared in the same individual. The outcome variables were: complete caries removal; pain during caries removal; anaesthesia requested by the patient during caries removal; time taken to remove caries. Sixty-six individuals, each with a pair of similar cavities in permanent teeth were selected. After caries removal, a 'blinded' evaluator assessed the clinical status of the cavity, with the use of a probe. The times for caries removal of the chemo-mechanical and mechanical methods were respectively: 9.2+/-3.8 and 8.6+/-3.8 min (p>0.05). There were 4 cavities arguably presenting signs of caries after cavity preparation in the 66 cavities treated with the mechanical method and 7 in the 66 chemo-mechanical cavities (p>0,05). Some pain/discomfort was reported by 21 (32%) participants when the chemo-mechanical method was used, compared with 43 (65%) when the mechanical method was used (p<0.05). During the chemo-mechanical and the mechanical treatment, 2 (3%) and 5 (8%) patients, respectively, requested local anaesthesia (p>0.05). The chemo-mechanical method appeared to be more comfortable for most patients.

The prevalence and impact of dental pain in 8-year-old school children in Harrow, England.

OBJECTIVE: To assess the prevalence, severity and impact of dental pain. DESIGN: Cross-sectional survey. SETTING: Schools in the London Borough of Harrow, England, in the summer term of 1995. SUBJECTS AND METHODS: The base population were all 2,300 8-year-old school children in Harrow. A cluster sampling of schools based on quotas from all postcode areas in Harrow was used. Data were collected through interviews with the children. MAIN OUTCOME MEASURES: Prevalence of previous toothache; prevalence of toothache in the previous 4 weeks; prevalence of toothache in the previous 4 weeks which resulted in a visit to the dentist, in stopping playing, eating, sleeping, going to school and taking painkillers. RESULTS: Of the 664 sample of children in the participating schools, 589 were interviewed (88.7%). The frequency of previous toothache was 47.5% (95% CI, 44-52) and dental pain caused crying in 17.7% (95% CI, 15-21) of children. 7.6% (95% CI, 5-11) of children had pain in the previous 4 weeks (45 children). Among these 45 children, this recent pain resulted in a visit to the dentist in 41.9% (19 children, i.e. 3.2% of all children), in stopping playing in 26.7% (12 children, i.e. 2.0% of all children), eating in 73.3% (33 children, i.e. 5.6% of all children), sleeping in 31.1% (14 children, i.e. 2.4% of all children) and in going to school in 11.1% (5 children, i.e. 0.8% of all children). CONCLUSION: Toothache in children is a sizeable problem in Harrow and had substantial consequences for children and their guardians. Freedom from disabling dental pain/discomfort is an outcome indicator of oral health and could be used as an explicit goal by dental systems. It is important to note however, that the present study did not assess the extent to which the dental pain was associated with avoidable dental problems as opposed to normal physiological processes. It is important that future work try and separate the prevalence of dental pain caused by physiological from avoidable pathological factors. In addition, future work is needed to assess how effectively and efficiently dental services are responding to people suffering with dental pain.

[Taste preference for sweets and caries prevalence in preschool children]. / Preferências por alimentos doces e cárie dentária em pré-escolares.

OBJECTIVE: To assess the preference for sweetness among preschool children and differences between less and more deprived groups. In addition, to assess whether sweet taste preference was associated with presence of caries. METHODS: The sample was composed by 572 preschool children aged between 4 and 6, distributed in three day nurseries of varied socioeconomic background. Cross-sectional study developed in two steps. Preference for sweetness was assessed using a modified version of the Sweet Preference Inventory. The solutions varied in sugar concentration from 0 to 1,17 molar (0 to 400 g / litre). The presence of caries was assessed using the defs index. The socioeconomic status of the sample was classified according to the origin of domicile. RESULTS: The variation in preference for sweetness in our sample was too small. Most children preferred the sweetest juice. This reduced the ability of this variable to explain variation in caries prevalence. Despite this limitation, our results showed that socioeconomic level influenced preference for sweetness, which in turn was associated with caries prevalence. CONCLUSION: The socioeconomic status influence the sweetness preference and this, in turn, is associated with the dental caries prevalence.

Can questionnaires replace clinical surveys to assess dental treatment needs of adults?

OBJECTIVE: The purpose of this study was to ascertain whether questionnaires can be used to replace clinical surveys by comparing normative and perceived caries status and treatment needs in a sample of adults living in East London, UK. METHODS: A cross-sectional study was conducted in two stages: a structured interview inquired about perceived dental caries status and treatment needs, and dental examinations were performed to determine oral health status and normative treatment needs. Perceived and normative assessments were compared for overall proportions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), using the dental examination as a gold standard. RESULTS: Of 139 people examined, 122 were dentate. The PPVs for perceived caries and treatment need were 0.58 and 0.67, respectively. Overall agreement was 65.4 percent for the presence of caries and 64.7 percent for the presence of treatment need. However, no net error was found between the proportions of participants with decay, and a small net error (7.4%) was found between perceived and normative treatment need. CONCLUSIONS: Self-assessment is not useful to assess individual dental treatment need, but is of possible value in assessing the needs of adult communities.

Relative contribution of dental services to the changes in caries levels of 12-year-old children in 18 industrialized countries in the 1970s and early 1980s.

The contribution of health services to improvements in health is contentious. The main aim of the present study was to assess the relative contribution that dental services may have made to the changes in dental caries (decayed, missing or filled permanent teeth) level of 12-year-old children in some industrialized countries in the 1970s and early 1980s. A secondary aim was an analysis of the association of the changes in caries levels with broad socioeconomic factors. In this study aggregate (ecological) data from 18 industrialized countries were analyzed at a national level. Data were obtained from published papers and official publications and included 3 kinds of variables: caries, presence of dental service and broad socioeconomic factors (including fluoridated toothpastes). Dental services explained 3% of the variation in changes in 12-year-old caries levels in the 1970s and early 1980s period whereas broad socioeconomic factors (including or excluding fluoridated toothpastes) explained 65%. The findings suggest that dental services were relatively unimportant in explaining the differences in changes in 12 year-old caries levels in the 1970s and early 1980s in the 18 countries. The view that fluoride in toothpaste was the only important cause of the declines in decayed, missing or filled permanent teeth in industrialized countries was questioned. A possible important contribution of the dental services to the declines was a change in the diagnostic and treatment criteria of caries.

The relative contribution of dental services to the changes and geographical variations in caries status of 5- and 12-year-old children in England and Wales in the 1980s.

The aim of this study was to assess the relative contribution of dental services to the changes and geographical variations in caries status of 5- and 12-year-old children in England and Wales in the 1980s. A secondary aim was to assess the association between caries experience and social factors. An ecological study analysing data at a district health authority level in England and Wales was conducted. Twenty-eight, 43 and 34 per cent of the variations in 5-year-old dmft in 1985, 1987 and 1989 respectively were explained by dental service activity indicators and 53, 62 and 57 per cent by social factors. Twenty-nine per cent of the variation in 12-year-old DMFT in 1988 was explained by dental service activity indicators and 46 per cent by social factors.