High levels of periodontal disease among the older adult population in San Juan, Puerto Rico.

UNLABELLED: The Puerto Rican Elderly Dental Health Study is the first to evaluate the periodontal status of a representative sample in Puerto Rico. OBJECTIVE: To assess the periodontal status among the elderly population in San Juan. BASIC RESEARCH DESIGN: Three dentists were trained and standardised by the US National Health and Nutrition Examination Survey (NHANES) reference examiner. They examined elders aged 70-97 in the San Juan area from participants in a representative cohort of the Puerto Rican elderly. Probing depth (PD), attachment loss (AL), and tooth mobility were assessed among the dentate participants on 4 sites on all teeth excluding third molars. We used the CDC-AAP definitions for moderate periodontitis (> or = 2 teeth with AL > or = 4mm at interproximal sites or > or = 2 teeth with PD > or = 5mm at interproximal sites) and severe periodontitis (> or = 2 teeth with AL > or = 6mm at interproximal sites and > or = 1 teeth with PD > or = 5mm at interproximal sites). RESULTS: The participation rate was 47%, 183 individuals, mean age 77.9 (sd 5.9), and 67% were females. Mean number of teeth was 15.8 (sd 6.8), and tooth mobility was present in 18% of participants. Mean PD was 1.5 (sd 0.6) and mean AL was 2.8 mm (sd1.5). The prevalence of moderate and severe periodontitis (CDC-AAP) was 44.5% compared to 20.7% in the NHANES 1999-2004 survey among 75 years and older. CONCLUSIONS: Our study showed high levels of severe and moderate periodontal disease among Puerto Rican older adults. Further research is needed to understand the reasons for the high prevalence.

Relationship between dental caries experience (DMFS) and dental fluorosis in 12-year-old Puerto Ricans.

OBJECTIVES: Examine the relationship between (1) DMFS and community fluorosis index (CFI) scores, and (2) between individual DMFS and NIDR/Dean Index fluorosis scores. DESIGN: Population-based, cross-sectional study. SETTING: Public and private schools of Puerto Rico. SUBJECTS: 1435, 12-year old students. METHOD: A probabilistic stratified sample was selected from 11 regions of Puerto Rico, according to type of school (public and private), and setting (urban and rural). Children were examined using NIDR criteria for DMFS and fluorosis. Regressions examined the relationship between DMFS means and CFI scores. Individual level DMFS was regressed on NIDR/Dean Index scores to test for linear and deviation from linear trends. RESULTS: (1) There was no statistically significant relationship between regional DMFS and CFI scores, and (2) individual level fluorosis scores when dichotomized as 0-2 as the referent level to level 3-4 demonstrated a statistical significant higher DMFS with the higher fluorosis level. Gender and school setting were statistically significant in all models: females and public school attendance were associated with increased DMFS. CONCLUSION: No ecological relationship between CFI and DMFS scores was found in 12-year-old children in Puerto Rico. Moderate and severe fluorosis were associated with higher DMFS levels relative to lower fluorosis scores, though this finding may be associated with restorations placed for cosmetic reasons. While controlling severe fluorosis is desirable, this will have little impact on overall high caries in Puerto Rican children. These findings suggest caution when interpreting caries experience using the DMFS index in populations with differing fluorosis levels.

The prevalence of pit and fissure sealants among twelve year olds living in Puerto Rico during 1997

OBJECTIVE: to estimate the prevalence of pit and fissure sealants on first permanent molars in twelve year olds living in Puerto Rico and to further evaluate dental sealant prevalence by (1) urban/rural and public/private school status as well as (2) gender; DESIGN: population-based, cross-sectional study. SETTING: public and private schools encompassing the 11 health regions of Puerto Rico. Subjects: a probabilistic sample of 12-year old school attendees in Puerto Rico representing a population of approximately 70,000. METHOD: during April through December 1997, the first permanent molars of 1435 subjects were evaluated by visual and tactile methods for the presence of dental sealants. RESULTS: the data collected revealed that 4.3of 12 years olds presented at least one permanent first molar sealed. A statistically significant difference (p = 0.01) between urban-public (2.5), rural-public (3.39) and urban-private (11.0) schools was observed. The prevalence of sealants was higher in males (5.5) than females (2.9); (p = 0.02). CONCLUSIONS: the prevalence of dental sealants in the first permanent molars of 12-year olds living in Puerto Rico during 1997 (4.3) is lower than that reported in the United States (18.5). Sealant prevalence was higher in males and students attending (urban) private schools.

An in vitro comparison of the ability of fibre-optic transillumination, visual inspection and radiographs to detect occlusal caries and evaluate lesion depth.

The aim of this study was to compare the performance of fibre-optic transillumination (FOTI), visual inspection and bite-wing radiographs to detect occlusal caries and estimate the lesion depth. Fifty-nine extracted molars were assessed using FOTI and visual examination by 4 trained examiners and 1 examiner evaluated the bite-wing radiographs. Histological validation was performed using 250-microm sections examined with a stereomicroscope. For the three methods, the correlation between the lesion depth and the histological scores varied from 0.65 to 0.73. For dentinal caries detection, the areas under ROC curves ranged from 0.83 to 0.87. The radiographic method was poor at detecting lesions confined to enamel. FOTI, visual inspection and radiographs showed a good correlation with the histology but had difficulty in distinguishing lesions located deep in enamel or in the outer third of dentine. FOTI was shown to be as accurate as a detailed visual inspection in detecting occlusal caries.

Comparative anticaries efficacy of sodium fluoride and sodium monofluorophosphate dentifrices. A two-year caries clinical trial on children in New Jersey and Puerto Rico.

PURPOSE: To provide a head-to-head comparison of the anticaries efficacy associated with two commercially-available and American Dental Association-accepted dentifrices: Crest Cavity Fighting Toothpaste with Fluoristat, containing 0.243% sodium fluoride in a silica base, and Colgate Great Regular Flavor Fluoride Toothpaste, containing 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base. The study was conducted in harmony with the published 1988 American Dental Association guidelines for studies geared toward this purpose. MATERIALS AND METHODS: The study employed a double-blind, parallel-groups, multi-center two-treatment design, and involved third, fourth, and fifth grade schoolchildren from Newark, New Jersey, and from the Cidra and Lares areas of Puerto Rico. Qualifying subjects were stratified according to age and sex, and were randomly assigned to the two treatment groups, with multiple subjects in the same household all assigned to the dentifrice randomly allocated to the first among them. Caries examinations were conducted in accordance with U.S. Food and Drug Administration guidelines for the clinical evaluation of drugs to prevent dental caries. After treatment assignment, study participants were instructed to brush their teeth at home with their assigned dentifrice at least twice daily. Brushing instructions were reinforced by the presentation of educational films and lectures at school, by semi-annual mailings to parents, and through the periodic distribution of small novelty gifts along with the dentifrice deliveries, in order to enhance the interest and enthusiasm of study participants. Post-baseline examinations were performed after 1 and after 2 yrs of product use. Two thousand four hundred seventy-nine (2,479) subjects completed this 2-yr study. For these subjects, the mean (S.D.) DFS scores at baseline were 2.77 (3.35) for the Crest group, and 2.66 (3.18) for the Colgate group. For caries increment after 1 yr, the respective means were 1.68 (2.53) and 1.70 (2.57). After 2 yrs, the mean caries increments were 3.56 (4.11) for the Crest group, and 3.56 (4.05) for the Colgate group. RESULTS: The analysis of the 2-yr caries increment scores support the conclusion that the anticaries efficacy associated with Colgate Great Regular Flavor Fluoride Toothpaste is equivalent to that associated with Crest Cavity Fighting Toothpaste with Fluoristat, in accordance with the procedures and standards provided by the published guidelines of the American Dental Association. Further, consistent with those same standards, the results of this study serve to lend additional support to the conclusion that dentifrices formulated with sodium monofluorophosphate provide an equivalent level of anticaries efficacy as to those formulated with sodium fluoride.