Prevalence of dental caries among 16-year-olds in Troms County, Northern Norway.

The investigation documents caries prevalence and associated factors in a sample of16-year- olds from Troms County, Northern Norway. DMFT/S-values were 4.2/6.1, indicating dental health being similar to the south of Norway and the rest of Scandinavia. No ethnic differences were recorded. Out of a total of 22 tested variables, the following nine showed an independent strong association (p=0,001) with prevalence of dental caries: parental education, tooth brushing frequency, parental control of oral hygiene in young age, dental fear, self-rated dental health, BMI, self-rated general health, use of smokeless tobacco, and initial approximal caries. The final multivariate regression analysis indicated that use of smokeless tobacco, dental fear, self-rated dental health and initial approximal caries showed a strong independent association with prevalence of manifest dental caries. In addition, parental education and sugar consumption appeared to be of importance. Sedentary lifestyle with low level of physical activity or hours spent in front of a TV/computer screen did not show any correlation with prevalence of dental caries. Tooth brushing frequency, gingival bleeding, obesity and aspects of general health showed a strong bi-variate association that disappeared when controlling for other variables in a multivariate regression model.The results highlight the importance of including attitude and lifestyle modifiable factors in oral and general health education approaches. Additionally, focus should be set on the management of dental fear in the context of targeted oral health strategies. Fi- nally, it would be beneficial to include initial approximal caries, life style factors, and perception and attitudes to general as well as dental health in caries prediction models.

Deep carious lesions and other consequences of caries among 18-year-olds at Public Dental Health Service in Northern Norway: A cross-sectional age cohort study.

OBJECTIVES: To document deep carious lesions and other consequences of caries (DCL-CC) in molars of 18-year olds leaving the free-of-charge Public Dental Health Service (PDHS). To explore the association between background factors and DCL-CC. MATERIALS AND METHODS: The final study sample (n=1876) comprised 95% of individuals born in 1993 and registered in the PDHS in Troms County, Northern Norway. The most recent digital bitewing radiographs of each subject were examined for DCL-CC (deep untreated carious lesions, deep restorations, root canal obturations or extractions due to caries). Inter- and intra-observer kappa scores were 0.62 and 0.87, respectively. Information on background factors (gender, clinic location, history of medical problems, bitewing examination interval, DMFT score and planned recalls) were retrieved from dental records. RESULTS: About one-quarter of subjects (488) had at least one molar with DCL-CC. There were 848 molars in total with DCL-CC; the majority were deep restorations (70%), but 4% were deep untreated carious lesions. More than a quarter of DCL-CC were either root canal obturations (14%) or extractions (12%). Multivariable logistic regression analyses showed that a 1-unit increase in DMFT score was associated with deep untreated carious lesions and extractions due to caries. There was no association between urban/rural clinic location, which indicated socio-economic status, and either DMFT score or DCL-CC. CONCLUSIONS: Despite the existence of a free-of-charge dental service, more than one-quarter of the subjects in the present study had at least one molar with DCL-CC.

Caries prevalence and determinants among 12-year-olds in North-West Russia and Northern Norway.

OBJECTIVES: To assess oral health and oral health associated factors in 12-year-olds and to establish determinants explaining variation in oral health among children representing two areas in the Barents region - Arkhangelsk in North-West Russia and Tromsø in Northern Norway. METHODS: The samples consisted of Russian (N=590) and Norwegian (N=264) 12-year-olds and their parents selected according to stratified one-stage cluster design. The study included clinical examination (children) and self-reports (children and parents). The child's oral health was recorded under field conditions. Statistical analyses were conducted on pooled samples of subjects. RESULTS: The mean DMFT/S-scores were 3.0/4.4 for the Russian and 1.2/1.5 for the Norwegian children (p<0.001). In multiple logistic regressions, country of origin (OR=3.8) and filling obtained during last dental visit (OR=5.0) were showing the strongest association with child's dental caries (χ(2)=87; p<0.001). Among parent's variables showing the strongest association with child's dental caries were country of origin (OR=2.4) and oral health problems during the past two years (OR=1.8) (χ(2)=60; p<0.001). CONCLUSIONS: Dental caries prevalence was higher among the Russian than the Norwegian children. The overall regression models were significant for both the child and parental variables. The results indicate different impact on child's oral health from children and parental determinants.

Treatment preferences of deep carious lesions in mature teeth: Questionnaire study among dentists in Northern Norway.

OBJECTIVE: To investigate preferred treatment methods of deep carious lesions in mature permanent teeth among dentists in Northern Norway. MATERIALS AND METHODS: The survey included all 437 general dental practitioners in Northern Norway working in the private or the public dental health service. The participants received an invitation with a radiograph and a clinical picture of a deep carious lesion in a mature permanent tooth and a questionnaire asking about demographic characteristics and their preferred treatment methods related to different clinical deep caries diagnoses. RESULTS: The response rate was 56%. There was an over-representation of publicly employed dentists among the respondents; otherwise no systematic bias related to non-responders was detected. In the absence of carious exposure and no symptoms, total caries excavation was the preferred treatment method (49%) followed by stepwise excavation (45%). In cases of deep caries and no exposure with symptoms, the preferences were equally distributed between root canal treatment (39%) and stepwise excavation (38%). In the presence of carious exposure but no symptoms, the preferred treatment method was direct pulp capping (51%) and in carious exposure with symptoms root canal treatment was the preferred treatment method (91%). CONCLUSIONS: There is no uniform treatment method of deep carious lesions among dentists in Northern Norway.

Oral health-related quality of life among 12-year-olds in Northern Norway and North-West Russia.

AIMS: To assess self-perceived oral health-related quality of life (OHRQoL) in 12-year-olds living in two areas in the Barents region: North-West Russia (Arkhangelsk) and Northern Norway (Tromsø). METHODS: Sampling was performed according to a stratified cluster design and consisted of 590 Russian and 264 Norwegian 12-year-olds and their parents. After written consent from their parents, 514 Russian (87% attendance) and 124 Norwegian (47% attendance) children entered the study. The study included clinical examination (children) and questionnaires (children and parents). Dental caries and the aesthetic dental appearance were recorded under field conditions. Self-reports on background variables and oral health-related quality of life questions (CPQ11-14) were completed in classroom settings by children and at home by parents. RESULTS: OHRQoL was found to vary depending on country of origin, with higher scores of CPQ11-14 domains among 12-year-olds from Russia. OHRQoL was found to be associated with dental caries, with higher scores among 12-year olds with caries. Inferior emotional and social well-being were established as having the strongest association with quality of life. Dental caries showed an independent effect on OHRQoL scores, but this effect disappeared when controlling for background variables, with country of origin, family economy, parental education and aesthetic appearance as the most influential (R²=0.14). CONCLUSIONS: Norwegian 12-year-olds had better oral health and OHRQoL than their Russian counterparts. The impact of dental caries on OHRQoL was weak and aesthetic dental appearance and socio-economic determinants were found to be more important, probably reflecting the great differences in the standards of living between Northern Norway and North-West Russia.

Oral health care and dental treatment needs in the Barents region.

OBJECTIVES: The first aim was to study how oral health care delivery was organized in member countries and to determine whether there were differences across the Barents region. The second aim was to assess the performance of the care provision systems. The Barents region is one of the largest hinterlands in northern Europe. STUDY DESIGN: Descriptions of the oral health care provision systems in Norway, Sweden, Finland and Russia were written. Performance of the care provision systems was assessed by evaluating access to and use of services in relation to oral health. METHODS: National statistics, governmental reports and scientific publications were used as data sources. Data were supplemented by sending questioning to national and local managers and experts. Inter- and intra-country comparisons included dental health status, service availability and restrictions, financial support for oral health care, availability of dental personnel and use of services. RESULTS: In the Barents region, oral health care provision systems, mainly operating via the public sector, were in place in all countries. However, in most countries, oral health was poorer, access to care more difficult and use of services lower, mainly because of a lack of dental personnel and economic constraints. Overall, there was a huge difference in the inhabitants to dentist ratios between the Nordic countries and Russia. CONCLUSIONS: Professional co-operation within dentistry should be integral to the Barents region in order to expand the number of dental personnel, improve oral health and increase access to dental care.

Oral health and quality of life in Norwegian and Russian school children: A pilot study.

OBJECTIVE: To document the oral health status, to study oral health determinants and oral health-related quality of life among 12-year-olds from the Barents Euro-Arctic Region. MATERIAL AND METHODS: The study was conducted in Severodvinsk (North-West Russia) and Tromsø (Northern Norway). Two schools representing each region were selected and all 12-year-old pupils having obtained their parents' written consent were included (Severodvinsk n=48, Tromsø n=36). Background factors were collected by questionnaires. Oral health conditions, i.e. caries (DMFT/S), oral hygiene (OHI-S) and satisfaction with their own dental appearance were recorded under field conditions and possible associations between background factors and the children's oral health status were studied. RESULTS: Oral health was better among Norwegian than Russian participants. The most important factors explaining variation in oral health were country of origin and treatment (filling/no filling) received at the last dental visit. Among parental factors, education and oral health status were of importance. Oral health related quality of life (OHRQoL) was found to be related to oral health conditions. CONCLUSIONS: Norwegian 12 year old pupils presented with better oral health than their Russian counterparts. Oral health is of importance for self-perceived quality of life.

Occurrence, population structure, and antimicrobial resistance of enterococci in marginal and apical periodontitis.

Subgingival plaque samples and root canal samples were collected from 2,839 marginal periodontitis (MP) patients and 21 apical periodontitis (AP) patients. Enterococcus species were identified by a series of phenotypic and genotypic tests. Antimicrobial susceptibility assays were performed by an agar disk diffusion test. Multilocus sequence typing (MLST), eBURST, and minimum spanning tree were used for enterococcal genetic clustering and population analysis. Enterococcus faecalis was recovered from 3.7% MP patients and 9.5% AP patients, and Enterococcus faecium was recovered from 0.04% MP patients. Enterococci were detected more often in older male patients. E. faecalis isolates of MP were found resistant to tetracycline (49.1%), erythromycin (8.5%), trimethoprim (2.8%), and gentamicin (1.9%), while one AP isolate was resistant to tetracycline. A total of 40 sequence types (STs) were resolved in 108 E. faecalis isolates. Comparison with E. faecalis international MLST database revealed that 27 STs were previously found, 13 STs were novel, and several major clonal complexes in the database were also found in MP isolates. The tetracycline-resistant isolates distributed mainly in the major clonal complexes and singletons, whereas the erythromycin-resistant isolates were more dispersed. Although the rate of occurrence of enterococci recovered in the MP and AP samples was low, 50% of these isolates are resistant to at least one antimicrobial agent, which is most often tetracycline. This implies that subgingival E. faecalis might represent a reservoir of resistance to tetracycline and erythromycin. The subgingival E. faecalis isolates show high genetic diversity but are grouped, in general, with the known isolates from the international database.

Dental health and disease determinants among 35-year-olds in Oslo, Norway.

OBJECTIVE: The aim of the present study was to identify non-biological determinants associated with the number of sound teeth (ST) and presence of decayed surfaces (DS) among 35-year-old Oslo citizens. MATERIAL AND METHODS: Randomly selected participants (n=149, response rate 64%) completed a self-administered questionnaire and were examined clinically and radiographically. Dental caries was registered clinically following World Health Organization (WHO) diagnostic criteria for caries registration, and the findings were combined with radiographic caries recordings. The number of sound teeth and the presence of two or more dentine caries lesions (D(3)S > or = 2) were selected as dependent variables. Associations between selected dependent variables and possible determinants were assessed by linear and logistic regression analyses, taking into account the hierarchical relationships between the independent variables. RESULTS: On average, 35-year-olds had 17.1 (SD=5.6) ST. Half of the participants had no DS and 26% had D(3)S > or = 2. Non-Western region of birth, being single, and having a university education were significantly associated with higher numbers of ST. Low family income, presently a smoker, and irregular dental visits were significantly associated with the presence of dentine caries. CONCLUSIONS: The results of this study indicate that several non-biological determinants operating at different levels are important for health and disease in this adult population.

Caries and restoration prevention.

BACKGROUND: The authors analyzed studies of decayed, missing and filled (DMF) rates for surfaces and teeth in Norway published during the last 30 years. The result of active fluoride therapy combined with a change in criteria for when to place restorations led to a marked reduction in the need for restorations. METHODS: The authors reviewed independent, cross-sectional DMF studies of representative samples of young adults performed every 10 years during the period 1973 through 2006. The clinicians involved in the studies used standardized and calibrated methods. The authors of this article also reviewed an additional series of studies collecting DMF data from representative samples of 15-year-old adolescents that also had been carried out independently from 1979 through 1996. In these studies, the investigators examined clinical records and bitewing radiographs with attention to progression of carious lesions and restorative treatments. RESULTS: The authors noted a marked reduction in the mean decayed, missing and filled surface (DMFS) scores from 1973 through 2006 in the two adult groups. They also found a significant decrease in treatment of caries. The reduction was most marked after the mid-1990s. They noted that the most dramatic change in the data from the 15-year-olds resulted from a change in the treatment criteria during the 1980s. Approximal lesions in enamel were monitored by the investigators of those studies in combination with the use of fluoride toothpaste. CONCLUSION AND CLINICAL IMPLICATIONS: A caries treatment approach based on active caries-preventive treatment and restrictive criteria for restoration placement are good bases for reducing the need for restorations as shown in cross-sectional studies reviewed.

Trends in periodontal health among 35-year-olds in Oslo, 1973-2003.

AIM: The aim of the present study was to describe trends in periodontal health and oral hygiene using data available from four epidemiological studies on 35-year-olds in Oslo performed from 1973 to 2003. MATERIAL AND METHODS: Periodontal status of randomly selected 35-year-olds was assessed clinically and radiographically. Clinical registrations were based on the Community Periodontal Index of Treatment Needs (CPITN) and the Simplified Oral Hygiene Index. In addition, the proportion of individuals with marginal bone loss was assessed using available orthopantomograms. RESULTS: The proportion of persons with CPITN score 4 (one or more pockets > or = 6 mm) decreased from 21.8% in 1984 to 8.1% in 2003. In addition, the mean number of sextants with deep pockets per person was considerably lower in 2003 than previously. The proportion of persons without recorded bone loss increased from 46% in 1973 to 76% in 2003. An improvement in oral hygiene scores was also observed during this period. CONCLUSIONS: The results suggest that periodontal health and oral hygiene have been improving among 35-year-olds in Oslo during the last 30 years.

Changes in caries experience among 35-year-old Oslo citizens, 1973-2003.

OBJECTIVE: The aims of the present study were to describe caries experience among 35-year-olds in Oslo in 2003 and to assess changes in caries experience during the past 30 years using data from cross-sectional studies performed in 1973, 1984, and 1993. MATERIAL AND METHODS: The dental status of 149 randomly selected 35-year-olds in Oslo was examined in 2003 (response rate 64%) and the data were compared with available data from earlier studies. Dental caries was registered clinically and radiographically at the surface level, applying the same criteria as used in previous studies, and recorded as DMFS/T. RESULTS: The results indicate a gradual decrease in the mean DMFS scores by 62% from 68.2 in 1973 to 26.1 in 2003. There was an 83% decrease in the mean number of DS, a 73% decrease in the mean number of MS, and a 56% decrease in the mean number of FS during this 30-year period. The proportion of individuals with DS = 0 gradually increased from 5% in 1973 to 54% in 2003. There was also a significant decrease in the prevalence of recurrent caries from 2.8% in 1984 to 1.2% in 2003. While a statistically significant reduction in the number of decayed, missing, and filled surfaces was observed during the period 1984-1993, in the past decade (1993-2003) a significant decrease appeared only in the case of the filled surfaces. CONCLUSIONS: The results indicate that dental health among 35-year-olds in Oslo, measured as a reduction in caries experience, has improved substantially from 1973 to 2003.

Ecology of oral health: a complexity perspective.

Health and disease are determined by many interwoven factors. Complexity theory may facilitate an understanding of oral health and disease by studying their complex interplay, and not focusing only on the importance of each individual factor involved. This introduces a theoretical basis for a dynamic, holistic approach to oral health with possible far-reaching consequences for dental education and diagnosis, prevention and treatment of oral diseases.

The human mouth: oral functions in a social complexity perspective.

In the dental and medical literature, the mouth and oral functions are usually presented in a biomedical context. However, there may be a need for a broader perspective if we are to appreciate the importance of the human mouth as an organ with diverse functions. The paradigm of complexity appears to be of relevance in our understanding the social and psychological characteristics of the human mouth in addition to its biological functions. Examples such as the pleasures of taste, social aspects of eating, the importance of linguistics and communication are illustrations of some of the social and psychological aspects of oral functions. Professional knowledge related to such issues is important in our understanding the patient's priorities and in performing the relevant diagnosis and treatment planning.

Dental health patterns in young adults in Lithuania: an exploratory, analytical approach.

Patterns of variation in experience related to caries and treatment with regard to psychosocial, socio-economic, lifestyle, and oral healthcare-related characteristics were explored. A random sample of 382 (response rate 51%) subjects residing in 10 areas of Lithuania was examined (35 to 44-year-olds). Participants were given a dental examination and asked to complete a structured questionnaire. Experience related to caries and treatment differed with regard to residency and between genders. Analysis of self-reported data elucidated different aspects of psychosocial and socio-economic status and a variety of lifestyle factors. Interrelationships between the studied determinants were also analysed. Different patterns of dental health were revealed for men and women and for urban and rural participants. It can be concluded that factors influencing the dental status of Lithuanians are not only multiple, they seem also to influence dental health in complex ways. An exploratory approach should therefore be considered as a prerequisite to a causal approach of studying caries in populations.

Oral health of 12-year-old Bangladeshi children.

Previous dental caries studies in Bangladesh have been performed on non-randomized samples, using various clinical criteria. Estimates of dental caries prevalence in 12-year-olds are therefore uncertain. In the present study a clustered, stratified random sampling procedure was used. Dental caries was stored as DMFT in accordance with the WHO recommendations and related to oral hygiene and various behavioral and social variables. The caries experience was found to be low, with a mean DMFT score of experience was 0.97. Poor oral hygiene and bleeding gingiva were frequently detected. Dental caries associated with sex, oral hygiene (girls), and use of dental services (more caries among frequent users than non-users). A Correlation matrix analyzing the most influential independent variables indicated that sex and oral hygiene seemed to have an independent effect, whereas a web of social factors interfered with the use of dental services' variable.

Psychosocial stress, lifestyle and periodontal health.

BACKGROUND, AIMS: The hypothesis that psychosocial stress and lifestyle are related to periodontal status was tested. MATERIAL AND METHODS: The study was performed in 1997-98 in 10 areas in Lithuania (response rate 53%). Information comprised recordings of oral hygiene, calculated levels of remaining periodontal support and information about psychosocial and lifestyle factors. A hypothetical structure was tested in 2 age and gender subgroups by means of a structural equation model both for an overall fit and for the fit of individual parameters within the model. RESULTS: The hypothesised structure presented high confirmatory fit index values (CFI) in all subgroup models, i.e., CFI >0.94. However the probability value of 0.01 found in the older males model presented an unlikely event. When individual parameters within the models were tested, different misspecifications were found. Therefore the hypothesised structure needed to be revised and tested repeatedly. All revised models presented high CFI and probability values (p>0.35). The testing of individual parameters did not reveal any significantly misspecified parameters. CONCLUSIONS: The path between lifestyle and levels of remaining periodontal support was empirically supported in the present study. Although the pathway between psychosocial stress and remaining periodontal support was not empirically supported, there is reason to believe that such link is likely.