Risk factors for and prevention of caries and dental erosion in children and adolescents with asthma.

There are many studies and reviews of the relationship between the asthma disease in young individuals on the one hand and caries and dental erosion on the other. The causes of caries and dental erosion might be related to the asthmatic drugs, low pH and the sweeteners that the inhaled drug contains and perhaps even the lifestyle of children and adolescents with asthma. The main focus of this review is therefore to describe various preventive strategies, based on long experience of preventive dental care in Sweden. Two fact boxes are presented, one on fluoride toothpaste as a population-based intervention for different ages and one on diet counselling in children and adolescents with asthma. The most important thing is to introduce fluoride toothpaste early in the child's life and that the parents brush the child's teeth twice a day, in the morning after breakfast and at night before bedtime, up to the age of 10. Moreover, a high-risk approach with an additional fluoride supply at home is presented, together with the application of fluoride varnish at the clinic. Regarding diet counselling, it is important to make sure that the child has regular meals during the day, maximum five to six times a day, to allow the teeth to rest between meals and restrict sweets and soft drinks to once a week. It is important to identify children and adolescents with asthma as early as possible and to refer them to a dental team for preventive treatment.

Dental nurses' experiences of performing a school-based fluoride varnish programme for children and adolescents in Sweden.

In many parts of Sweden today, school-based fluoride varnish programmes (FVP) are perfor- med by dental nurses. Studies have shown that the dental personnel are largely responsible for creating the atmosphere related to children's and adolescents'experiences of the program- mes. Knowledge of dental nurses'experiences of performing FVP is therefore crucial in order to develop and improve these programmes and the dental health of children and adolescents.The aim of this study was to describe dental nurses'experiences of performing FVP for children and adolescents in Sweden. Fifteen female dental nurses, strategically chosen, aged 40-63, from the Public Dental Service in the Vistra Gtaland Region, Sweden, were individually interviewed.The interviews were transcribed verbatim and analysed according to the phenomenographic ap- proach.Three themes with a total of 11 categories, all describing the dental nurses' conceptions of performing FVP, emerged in the analysis. The main conclusions were that in overall terms, performing an FVP was found to be a positive experience for the dental nurses, as it meant mee- ting children and adolescents in a context in which the children and adolescents are comforta- ble and relaxed.The opportunity to identify children and adolescents with poor dental health or poor health and to be able to offer them assistance was regarded as a major advantage. In addition,the participants described a feeling of professional development originatingfrom the challenges associated with working in an arena outside the dental clinic.

Approximal caries increment in adolescents in a low caries prevalence area in Sweden after a 3.5-year school-based fluoride varnish programme with Bifluorid 12 and Duraphat.

OBJECTIVES: To evaluate approximal caries increment among 12- to 16-year-olds in a low caries prevalence area in Sweden after a 3.5-year school-based fluoride (F) varnish programme with Bifluorid 12 and Duraphat. METHODS: The design was a RCT study with 1365 adolescents, divided into following four groups: Group 1 Bifluorid 12 two applications/year; Group 2 Duraphat two applications/year; Group 3 Bifluorid 12 four applications/year and Group 4 no F varnish at school. 1143 children (84%) completed the study. Approximal caries was registered on bitewing radiographs. RESULTS: There were no statistically significant differences in caries prevalence among the groups either at baseline or after 3.5 years . The caries increment for Group 1 was 1.34 ± 2.99 (mean ± SD), 1.24 ± 2.84 for Group 2, 1.07 ± 2.66 for Group 3 and 1.25 ± 2.75 for Group 4, with no statically significant differences either between Bifluorid 12 and Duraphat with the same frequency of F varnish applications or between the F groups and the control group. CONCLUSIONS: In an area with low caries prevalence in Sweden, the supplementary caries-preventive effect of school-based F varnish applications, to regular use of F toothpaste at home and to regular caries prevention given at the Public Dental Clinics, appears to be nonsignificant regarding approximal caries increment.

Effect of post-brushing mouthwash solutions on salivary fluoride retention--study 1.

OBJECTIVE: The aim of the present study was to evaluate the effects on post-brushing salivary F retention of rinsing with mouthwashes containing either 500 or 225 ppm F compared to not rinsing. METHODS: The study was a randomized, investigator-blind, cross-over trial with three treatment arms. Thirty volunteers brushed with 0.5 g of 1450 ppm F paste for 40 seconds and then spat out the waste slurry. They then rinsed for one minute with 10 mL of their allocated mouthwash or they did not rinse after the brushing. Saliva samples were collected before brushing (0 minutes) and at one, three, five, 10, 20, 30, 45, and 60 minutes after brushing. The subjects were not allowed to speak, eat, or drink during these 60-minute test periods. The F levels in saliva were then calculated for each time point and the integrated area under the curve calculated (AUC0-60). RESULTS: The mean AUCs were 626, 380, and 237 for the 500 ppm F, 225 ppm F, and no rinse treatments, respectively, and all pair-wise comparisons were statistically significant (p < 0.01). CONCLUSION: It is concluded that rinsing with either 500 or 225 ppm F mouthwash significantly increases the level of F in saliva compared to not rinsing after brushing with 1450 ppm F toothpaste. The 500 ppm F mouthwash provided a significant increase in F retention compared to the 225 ppm F rinse (p = 0.001).

Adolescents' experiences of participating in a school-based fluoride varnish programme in Sweden.

Population-based health promotion with school-based fluoride varnish programmes is becoming more frequent, as these programmes have been implemented in many parts of Sweden during the last five years. The caries-prevention effect is well studied, but as yet there is no study aimed at adolescents'experiences of these programmes. The aim of this study was therefore to describe how a school-based fluoride varnish programme is experienced by participating adolescents. The study was performed as a qualitative study by conducting four focus-groups interviews. In all, 26 adolescents participated, all aged 15. All the participants had several years'experiences of a fluoride varnish programme at school. The participants were asked to describe their experience of participating in the programme.The analysis of the data from the interviews was carried out according to the principles of phenomenography.The three themes that emerged were"Conceptions in relation to the individual", "Conceptions in relation to the school dental nurse"and "Conceptions in relation to the group and school". The result showed that the adolescents experienced that it was positive to take part in a fluoride varnish programme at school and they regarded the school as an important health promotion arena. In spite of this, there were perceptions that were worth reflecting on for school dental nurses, such as feelings of exposure, peer pressure and a perceived lack of information. To further improve these programmes, and thereby increase population-based dental health promotion, it is important to highlight the role of dental personnel, as they are largely responsible for creating the atmosphere.

Fluoride toothpaste and toothbrushing; knowledge, attitudes and behaviour among Swedish adolescents and adults.

The most effective way to administer fluoride is through the regular use of fluoride toothpaste. Adolescents and adults seem to have low awareness of toothbrushing procedures and use of fluoride toothpaste despite frequent dental care. The aim of this study was to describe knowledge, attitudes and behaviour concerning toothbrushing and use of fluoride toothpaste in three age groups in a Swedish population. A qualitative study design was used with the purpose of achieving a deeper understanding of the issue. Data were collected through interviews. A manifest and latent analysis of the text was performed using qualitative content analysis (Grounded theory). The informants were selected strategically to obtain the greatest possible variation in the data. Three age strata representing different stages in life were chosen: 15-16, 30-35 and 60-65 years. Informants were interviewed with support from an interview guide. Open-ended questions were used to focus on the individual's knowledge, attitudes and behaviour concerning toothbrushing and fluoride toothpaste. Five people from each age group were interviewed in the study. The content areas were knowledge, attitudes and behaviour and the latent analysis identified the areas of empowerment, driving force and guidance as categories. Although the informants showed little knowledge about the reasons for and techniques of using fluoride toothpaste effectively, they described toothbrushing as important and the habit as a priority, giving the theme of this study: toothbrushing with fluoride toothpaste was a priority, despite the lack of knowledge about how to use toothpaste effectively and its positive effects on oral health. In conclusion the state of knowledge concerning toothbrushing and fluoride toothpaste needs to be improved. In addition, people's desire for a fresh-feeling mouth and to fit in socially must be affirmed and utilized by dental staff in health promotion.

Cost-analysis of school-based fluoride varnish and fluoride rinsing programs.

OBJECTIVE: From a dental care perspective, we analyze whether the prevention of approximal caries by fluoride varnish treatment (FVT) or by fluoride mouth rinsing (FMR) could contain costs in an extended period of follow-up after the end of school-based prevention programs. MATERIAL AND METHODS: It is assumed in a model that, after 3 years of prevention with either FVT or FMR according to published studies, the "natural course" of approximal caries progression would follow for 5 consecutive years, as described in a Swedish longitudinal study. The outcome and costs of FVT, FMR and controls were modelled from years 4 to 8. RESULTS: The FVT program had a better outcome in reducing approximal caries than FMR, and costs were lower. The FVT was expected to result in cost containment compared to controls 3 years after the end of the preventive FVT program. The ratio benefits to costs were 1.8: 1 for FVT and 0.9: 1 for FMR. CONCLUSIONS: Prevention of approximal caries by FVT may result in cost containment, at a benefit cost ratio of 1.8: 1, given that the program can be administered at school.

On caries prevalence and school-based fluoride programmes in Swedish adolescents.

Dental caries on approximal tooth surfaces in adolescents is still a problem in Sweden, as well as in many other industrialised countries. The aims of the present thesis were therefore: 1) to study whether caries prevalence is underestimated, 2) to evaluate the effect of cessation of fluoride mouth rinse (FMR) programme in schoolchildren with low caries prevalence, and 3) to reconsider the school as an arena for population-based fluoride (F) varnish and FMR programmes in order to minimise caries development in 13-16-year-olds. Paper I and II showed that the adolescents' own dentists consistently registered less caries compared to the recordings made by calibrated dentists from outside. Based on 420 16-year-olds at 12 different dental clinics in two neighbouring counties in Sweden, the differences were statistically significant at 10 of the 12 clinics when caries prevalence both was high in 1984 (Paper I) and somewhat lower in 1987 and 1990 (Paper II). About 80% of all approximal caries lesions were enamel lesions and are therefore not reported to the Swedish authorities, as only dentin lesions and fillings are currently included in the official caries data. The basis for Paper III was that many counties in Sweden abandoned school-based FMR programmes in the mid-late 1980s, as the official caries data revealed low caries prevalence among children. The cessation of FMR for 3 years for a group of 13-16-year-old adolescents (n=60) with low caries prevalence did not reveal any statistically significant differences in new caries lesions and fillings or in the progression of existing enamel lesions compared to a group of 13-16-year-olds (n=60) who continued to rinse for 3 years. Nor did a supplementary cross-sectional study reveal any differences in caries prevalence among adolescents who had or had not taken part in FMR programmes for the last 3 years. In Papers IV and V, new models for school-based F treatment were evaluated in two 3-year randomised controlled trials (RCT studies). Fluoride varnish (Duraphat) treatment, carried out at school by specially trained dental nurses using a simple mobile unit, among 854 13-16-year-olds from low, medium and high caries risk areas showed that the control groups developed more caries than the varnish groups (Paper IV). The largest difference was found in the high-risk area. The prevented fraction (PF) with approximal enamel lesions as the diagnostic threshold was 69% in high, 66% in medium and 20% in low risk areas for F varnish applied twice a year at six-month intervals. Supervised school-based FMR among 788 13-16-year-olds with low to moderate caries risk (Paper V) showed that FMR on the first three and the last three school days during the school term, i.e. 12 rinses/year, had a PF of 59%. Enamel lesions constituted > 90% of the new approximal caries lesions in both Papers IV and V. The main conclusions from this thesis are: (1) that enamel caries lesions on approximal surfaces should be included in epidemiological caries data in order to show true caries prevalence, (2) that the cessation of weekly FMR for 3 years did not lead to a statistically significant increase in caries incidence in a relatively small group of adolescents with low caries prevalence, and (3) that the school should be reconsidered as an arena for new models for population-based F school programmes. Fluoride varnish treatment twice a year at six-month intervals in medium and high caries risk areas, as well as supervised FMR on the first and the last three school days during the school term in low and medium caries risk areas, are excellent caries prevention strategies for approximal surfaces in adolescents at the caries risk ages of 13-16 years, as a supplement to dental home care and preventive efforts at dental clinics.