Need of non-operative caries treatment in 16-year-olds from Northern Norway.

AIM: To assess the prevalence of proximal enamel lesions, the need for non-operative caries treatment and the quality of dental restorations in 869 students aged 16 years from Northern Norway. METHODS: All first year upper secondary school students in Tromsø and Balsfjord municipalities were invited to participate in an oral- and general health project (Fit Futures). The attendance rate was 90%, and all subjects born in 1994 (449 males and 420 females) were included in the present study. Dental caries was registered according to a 5-graded scale (1-2 = enamel lesions; 3-5 = dentinal lesions). Scores from 1 to 4 were used to register the quality of restorations (1 = good; 2 = acceptable; 3 = poor; 4 = unacceptable). RESULTS: Only 6% of the 16-year-olds were completely caries-free. There were 84% of the participants with proximal enamel lesions. A majority of them had either previously restored teeth (35%) or both restored teeth and untreated dentinal caries lesions (34%). When using the D-value of the DMFS-index as a diagnostic criterion, 39% of the participants were in need of restorative treatment. When proximal enamel lesions were included in the diagnosis, the number of participants in need of restorative and/or non-operative caries treatment was 85%. Over 1/3 of the participants presented with at least one restoration below an acceptable quality level. CONCLUSIONS: Dental caries is still a major health problem affecting the total teenage population. A non-operative treatment strategy should be considered relevant in order to reduce the need for restorative treatment.

Dental erosion: Prevalence and severity among 16-year-old adolescents in Troms, Norway.

AIM: To study the prevalence, distribution and severity of dental erosion among 16-year-old adolescents in the Troms region of Norway. MATERIALS AND METHODS: Study design: The participants were recruited through the Tromsø-study ("Fit Futures"), and 392 16-year-olds were examined for dental erosion using clinical intraoral photographs. Three calibrated clinicians used the Visual Erosion Dental Examination (VEDE) system to register and grade the dental erosive wear. RESULTS: More than one third (38%) of the participants showed dental erosion on at least one tooth surface, 18% were limited to the enamel, while 20% of the adolescents showed erosive wear extending into the dentine. The occlusal surfaces of the lower first molars, and the palatal surfaces of the maxillary incisors were the most often and most severely affected. Of the participants showing dental erosion, 93% exhibited "cuppings" on the molars, with 48% limited to the enamel and 52% extending into the dentine. The highest prevalence of "cuppings" (73%) was found on the first lower molars, especially the mesiobuccal cusp of the teeth. The prevalence and severity of dental erosion was found to be higher in male than in female participants (p < 0.0001). CONCLUSION: The results from this study indicate a high prevalence and severity of dental erosion among adolescents in Troms and stress the importance of information, early and effective diagnostics and implementation of prevention strategies.

Canines are affected in 16-year-olds with molar-incisor hypomineralisation (MIH): an epidemiological study based on the Tromsø study: "Fit Futures".

AIM: This was to determine the prevalence, distribution of affected teeth and severity of MIH in adolescents from Northern Norway. METHODS: It was part of a cross-sectional health survey Fit Futures including 16-year-olds from two neighbouring municipalities, Tromsø and Balsfjord. RESULTS: The prevalence of MIH was 13.9% (110 of 794). The maxillary first permanent molars (FPMs) were 1.6 times more frequently affected than in the mandible (P < 0.001). The FPMs on the right side were 1.2 times more often affected than the FPMs on the left side (P = 0.038). The maxillary incisors were 2.5 times more often affected than the incisors in the mandible (P < 0.001). The proportions of participants whose canines and incisors were involved were 22.8 and 41.8%, respectively. Altogether 201 FPMs were affected; 54.0% of these had opacities only, 24.3% had posteruptive breakdown (PEB), 18.8% had atypical restorations, and 3.0% had been extracted due to MIH. The buccal surfaces were most often affected in FPMs. More severe lesions were found in the mandibular FPMs compared with the maxillary FPMs (P = 0.002). In the lower canines, only opacities were recorded, while in the upper jaw 13.0% of the affected canines showed PEBs. The distribution of MIH in the dentition was not symmetrical. CONCLUSION: The prevalence of MIH (13.9%) in the study population of 16-year-olds from Northern Norway is consistent with previous Scandinavian reports. The distribution pattern shows that one participant in four with MIH had at least one affected canine. Further studies are needed to describe the localisation of defects on the enamel surface and to relate these findings to enamel thickness and the duration of amelogenesis.

Evaluation of a dental outreach teaching programme.

Dental health care is largely based on primary care. It is therefore logical to train students in external dental clinics in addition to university facilities. Consequently, the new dental curriculum at The University of Tromsø in Northern Norway has implemented outreach teaching and training as an extensive part of their curriculum. The overall opinion is that the external training has been very valuable both regarding volume and diversity of treatment experiences and has contributed substantially to the clinical maturity of the students. Educating the tutors is considered to be an essential part of the programme.

Osseointegrated implants in a patient with Papillon-Lefèvre syndrome. A 4 1/2-year follow up.

BACKGROUND: The Saudi female reported in this study was diagnosed with Papillon-Lefèvre syndrome. She had lost all her teeth, including third molars, at the age of 18 years. METHOD: She was wearing full dentures for 7 years, before 5 titanium implants were installed in the mandible. RESULTS: 4 1/2 years after the implant installation, the treatment was clinically and radiographically successful. Neither A. actinomycetemcomitans nor P. gingivalis were detected at any of the implants. This very encouraging result does not differ from what is generally reported in edentulous medically healthy patients. CONCLUSION: The use of implants could considerably enhance future therapeutic options for the severely dentally compromised patients with Papillon-Lefèvre syndrome.

Saliva composition in children and young adults with Papillon-Lefèvre syndrome.

The aim of the present study was to evaluate the salivary secretion rate and composition in a group of 16 children and young adults (6-27 years) with Papillon-Lefèvre Syndrome (PLS), and to compare the findings with a group (n = 16) of healthy controls. Unstimulated and stimulated whole saliva was collected at least 2 h after meals and the secretion rate determined. The stimulated saliva was assessed for buffer capacity, total protein, peroxidase and hexosamine, while the unstimulated samples were evaluated for total protein, lysozyme, thiocyanate, lactoferrin and salivary IgA. Both the unstimulated (p < 0.01) and stimulated (p < 0.05) saliva secretion rates were significantly lower among the PLS patients compared with the controls. Furthermore salivary buffer capacity was significantly (p < 0.01) lower in the PLS patients. The total protein content in saliva was comparatively high in the study group, while the concentrations of immunoglobulins and non-immunoglobulins were within normal ranges. When calculating the output of the assessed antimicrobial factors, the mean peroxidase level in stimulated whole saliva was found to be significantly (p < 0.01) lower in the PLS patients than in the healthy controls. In conclusion, the present study indicates an impaired water secretion and a somewhat altered saliva gland function in children and young adults with PLS.

Accuracy of dental hygienists in diagnosing dental decay.

During recent decades, the duties and care rendered by Swedish dental hygienists have continuously expanded, and since 1991 they are licensed to practice dental hygiene independently. The aim of the present study was to investigate the accuracy of dental hygienists in examining and recording dental caries in comparison with dentists performing identical examinations. The study included two parts: A) Registration of carious lesions from radiographs of 100 extracted teeth, where the correct diagnosis could be verified, and B) clinical examination and registration of carious lesions in 213 patients. No statistically significant differences could be found between the dental hygienists' and their control dentists' accuracy to diagnose and record dental decay, with the exception of the number of initial lesions (white spot lesions) registered clinically, where the dental hygienists recorded more buccal and lingual lesions. Irrespective of the group of examiners (dental hygienists or dentists), however, the inter-examiner variation was wide. The variation decreased with the size of the lesion and increased with the age of the patient. This study suggests that no patient with a restorative treatment need would have been neglected if the dental hygienists had performed the examination, and, possibly, a more accurate non-restorative treatment need would have been addressed.

Systemic retinoid medication and periodontal health in patients with Papillon-Lefèvre syndrome.

Periodontal health in relation to systemic retinoid medication was evaluated retrospectively in patients with Papillon-Lefèvre Syndrome (PLS). The material consisted of 18 children/young adults ranging from 8 to 28 years of age, all with a confirmed diagnosis of PLS. 9 participants, comprising a medication group, had been on long-term (range 1.5-9 years) retinoid medication for their cutaneous lesions. The remaining 9 served as controls. Regardless of whether or not retinoid medication was received, every patient experienced an early and devastating periodontitis, with atypical edematous and erythematous gingiva, suppuration from deep gingival pockets and premature loss of teeth. No correlation could be found between the severity of skin involvement and the severity of periodontal involvement. An improvement with age could be seen for the cutaneous lesions but not for the periodontal condition. Systemic medication with retinoids had a favorable therapeutic effect on cutaneous lesions, and no severe complication/side effect could be seen after several years of continuous use. However, from the results of this study it can be concluded that, at least in a situation with poor compliance of daily oral home-care, no positive effect on the periodontal health in patients with PLS could be seen by the retinoid medication.

A longitudinal study of dental health in a group of Swedish teenagers/young adults from the age of 14 to 25.

87 participants were followed from the ages of 14 to 25. Data concerning dental caries, gingival status, pocket depth, subgingival calculus, loss of attachment, and regularity of dental care were recorded. During the 11-yr-study-period 16% of the participants did not develop any carious lesions at all, and the average increase in DMFS-value was 0.6 per year. At age 25, about 75% of the subjects had never experienced any manifest carious lesions in incisors or cuspids or on any buccal and lingual surfaces, and 30% had never needed any proximal restorations. Over the study period, gingival inflammation changed from being merely a result of poor oral hygiene to being an indication of initial periodontal disease, and at age 25, 11% showed evidence of loss of marginal bone. The Dental Health was better in females than in males. In general, this sex differences increased in age, and at the age of 19 it had become clinically significant. The good habit of regular dental care reinforced during these 19 years of life was continued by 91% at 25, and no difference could be seen between the care rendered by the Public Dental Health Care system and by Private General Practitioners.

Oral sugar clearance in children compared with adults.

The aim of the present investigation was to study oral sugar clearance of various types of foodstuffs in children of different ages in comparison with adults. Thirty children and 20 adults were selected constituting five groups, each containing 10 individuals: 3-, 7-, 15-years-olds and adults, all with normal salivary secretion rate, and adults with low salivary secretion rate (dry mouth patients). Oral sugar clearance was studied using three glucose-containing products: solution, tablet and biscuit. Repeated saliva samples were collected every other minute, between 1 and 11 min after the intake, with a convenient method suitable for very young children. For that purpose, a small circular paper disc, absorbing approximately 20 microliters of saliva, was placed under the tongue for 10 s. The glucose concentration of the samples was then analyzed enzymatically. The results showed that, in children, the oral sugar clearance became faster with increasing age. The adults and the 15-year-olds had similar patterns of clearance, while the dry mouth patients had the slowest oral clearance of all groups. The 3- and 7-year-olds showed the greatest variation in oral clearance between the various foodstuffs; the solution had faster clearance than both the biscuit and the tablet. The main conclusion from this study is that young children (3- and 7-year-olds) have both slower salivary sugar clearance and larger variation in clearance among various foodstuffs than older children and adults.

Periodontitis in the primary dentition associated with Actinobacillus actinomycetemcomitans infection and leukocyte dysfunction. A 3 1/2 year follow-up.

2 siblings, aged 5 years (girl) and 7 years (boy), with periodontitis in the primary dentition were studied. Actinobacillus actinomycetemcomitans was isolated from the gingival pockets of both children. The titers of IgG antibodies against A. actinomycetemcomitans were elevated, and the polymorphonuclear leukocytes had a decreased capacity to ingest IgG-coated latex particles. Other functions of the polymorphonuclear leukocytes were normal. After antibiotic therapy and for the 7-year-old boy, debridement of the gingival pockets A. actinomycetemcomitans was no longer detectable in the gingival pockets, and the phagocytic capacity of the polymorphonuclear leukocytes was normalized. After 2 1/2 years, A. actinomycetemcomitans was found again in the gingival pockets of the boy, and once more his polymorphonuclear leukocytes had a decreased capacity to ingest IgG-coated latex particles. The antibiotic therapy was repeated and 6 months later, the number of A. actinomycetemcomitans was very low and the phagocytic capacity of the polymorphonuclear leukocytes was back to normal. This case report suggests that A. actinomycetemcomitans may be involved in the etiology of periodontitis in the primary dentition, possibly by triggering a phagocytic dysfunction of polymorphonuclear leukocytes.

Caries prevalence after submandibular duct retroposition in drooling children with neurological disorders.

This study is a long-term follow up of 17 patients surgically treated for uncontrolled drooling, by retroposition of the ducts from the submandibular glands. Mean age was 16.8 years (range 7-31), with an average postoperation time of 9.2 years (range 1-18). Clinically, no subject revealed an impression of an extremely dry mouth, but most patients showed obvious permanent decrease in drooling after the surgical treatment. They had a highly significant increase in caries prevalence of the mandibular incisal and canine area, and this caries prevalence was related to the severity of cerebral palsy.

Presence of mutans streptococci and various types of lactobacilli in interdental spaces related to development of proximal carious lesions.

During a 2-yr study period samples from saliva, the tongue, and 276 interdental spaces were obtained from 23 7-yr-old children in order to (a) relate the presence of lactobacilli in various oral sites to the occurrence of lactobacilli in saliva, and (b) relate the presence of mutans streptococci and various types of lactobacilli interdentally to the development of proximal carious lesions. The results showed an increased number of interdental samples containing lactobacilli with an increasing number of salivary lactobacilli. Furthermore, lactobacilli were never found interdentally without the presence of mutans streptocci, lactobacilli proved to be the more suitable microorganism for prediction of proximal carious lesions. Neither the number nor the differentiation into different species of interdental lactobacilli seemed to be of importance, but simply whether they were present. The presence of lactobacilli probably reflects a caries-inducing environment (etiologic microflora + fermentable carbohydrates), thus explaining their high predictive ability compared to their rather limited etiologic importance in the initiation of decay.

A retrospective radiographic study of alveolar bone loss in the primary dentition in patients with localized juvenile periodontitis.

Lately, it has been questioned whether localized juvenile periodontitis (LJP) is restricted to the permanent dentition, or if it sometimes might have a prepubertal onset, involving the primary dentition. To clarify this question, 17 patients with LJP, together with 17 non-LJP matched controls, were retrospectively examined for radiographic signs of alveolar bone destruction in their primary dentitions. All LJP subjects but one showed localized marginal bone loss, whereas no bone loss was observed among the controls. The results suggest that at least some cases of LJP start in the primary dentition prior to the involvement of the permanent teeth.

Prediction of behavior management problems in children.

The aim of the present investigation was to study non-dental and dental background variables with a view to estimating their influence on behavior management problems by means of a structured interview and analyzing their separate and combined predictive power. The material consisted of a case group, 101 children aged 3-16 yr, referred for management problems to clinics of specialized pedodontics, and a control group, individually matched with the cases as regards age, sex, residential area, number of tooth surfaces restored, and dentist. The children or their parents were interviewed concerning background variables. Logistic regression was used for the analyses. Three non-dental variables turned out to be statistically significant as predictors (P less than 0.05): problems on visiting a medical doctor, dental fear in the mother or father, and anxiety when meeting unfamiliar people. Management problems might be expected if one of these attributes is found. Four dental variables had significant predictive power: earlier problems on seeing a dentist, dislike of the dentist, not enough time to adjust to the dental situation, and fear of injection. However, none of these dental variables was found to have predictive power in 3-6-yr-olds, and none of them improved the predictive power of the three main non-dental variables.

Direct ratings of acceptance of dental treatment in Swedish children.

The aim of the present study was to bring forward data of acceptance of dental treatment for 3-16-yr-old children in a population with good dental health and annual dental care, and to evaluate the influence on acceptance of age, sex, residential area, and previous experience and present need of dental treatment. The material consisted of 2773 children. Direct ratings of behavior were made at each of 10 different treatment steps passed during dental appointments. The majority of children needed no more than one dental visit and 79% showed positive acceptance at all steps of treatment passed during dental visits. Eight percent of all children sometimes reacted in such a way that treatment could not be carried out without restraint or undue delay. Dental fear was diagnosed in 3% of all children.

Salivary lactobacillus counts as a diagnostic and didactic tool in caries prevention.

The usefulness of salivary lactobacillus counts in regular dental care was investigated in 236 13 1/2-yr-old Swedish children for 2 1/2 yr. The average individual preventive care was at least as extensive as the restorative care and the dental health of these children must be considered good with a mean DFS-value of 6.8 at baseline. Nevertheless, it proved possible to reduce caries increment by more than 50%, simply by replacing one NaF-rinsing in school once every 6 months by a saliva sampling session together with subsequent presentation and information of an inoculated and incubated Dentocult dip-slide. The way of determining salivary lactobacillus counts in schoolchildren, as performed in this study, could easily be adopted as a routine part of general care. It proved to be useful for early diagnosis of caries and motivation to home care, and as a supplement to clinical examination it would be a valuable aid in the early selection of high-risk cases as well as identification of low-risk cases, who do not require extensive prevention.

A longitudinal study of dental health and treatment need in Swedish teenagers.

Ninety-seven teenagers were followed from the age of 14 1/2 to 19 yr. During that time they were given regular dental care by the Public Dental Service. Data concerning dental caries, gingival status, probing pocket depths, subgingival calculus, defective fillings, loss of attachment and additional preventive care were recorded. The prevalence and increment of caries were low and at 19 one-third of the subjects had still needed no proximal restorative care at all. However, in 26% of the 19-yr-olds subgingival calculus was diagnosed radiographically and during the study period gingival inflammation changed from being merely a result of poor oral hygiene to an indication of initial periodontal disease. There was a sex difference in dental health, which increased with age and was of clinical importance at 19. In spite of a good caries situation, most of the subjects were in need of individual care due to an initial periodontal problem. Furthermore, the change to a treatment strategy based on prevention requires regular check-ups, and an extension of intervals between dental examinations could not be justified in this study, especially as it seemed to be difficult for the regular dentist to predict future disease on a clinical basis.