Does treating proximal cavities in primary molars non-restoratively affect intra-arch space and alignment of successor teeth negatively? A 4-year longitudinal study.

Background: Removing plaque with toothbrush and toothpaste from proximal cavities in primary molars without restoring them follows sound cariological principles. But does this treatment affect space for and alignment of their permanent successors negatively? Hypothesis: There is no difference in impaction and displacement of the premolars, as well as in the D+E space in quadrants with three different statuses of the proximal surface of primary molars over a 4-year period. Methods: A total of 936 quadrants (466 maxillary and 470 mandibular quadrants) in 233 children were assessed. Treatment of cavities in the proximal surfaces of the primary molars consisted of amalgam and ART restorations using high-viscosity glass-ionomer cement, and cleaning of open large- and medium-sized cavities with toothbrush and toothpaste (UCT) under supervision for 220 days per year over 3 years. Dental casts were made at baseline, and after two, three, and 4 years. The D+E spaces were measured digitally. Status of the proximal surface of the primary molars was assessed by two calibrated examiners, and quadrants were grouped into normal anatomy, defective restoration, and proximal cavity. ANCOVA, ANOVA and LSD tests were applied. Results: There was a statistically significant difference between groups (p <= 0.001) and between evaluation times (p < 0.001), for the D+E space in both the maxilla and mandible. A sex difference related to the D+E space in the maxilla was found (p = 0.007). For boys, quadrants in the maxilla of the group 'proximal cavity' showed a significant shorter D+E space when compared to quadrants of the group 'normal anatomy' at the 3- and 4-year evaluation time. For girls the difference between the two groups was only present at the 3-year evaluation time. There was no significant difference between the D+E space in quadrants with defective restorations and those with normal anatomy in the mandible and in the maxilla. Displacement and impaction of the premolars showed no significant difference between groups. Conclusion: Primary molars with open proximal cavities that are cleaned with toothbrush and toothpaste do not result in displacement and impaction of the successor teeth, neither do primary molars with defective restorations in proximal tooth surfaces.

Dental caries in three-year-old preschool children in Lima, Peru assessed according to the CAST instrument.

The aim of this study was to determine the caries situation of three-year-old preschool children residing in low socioeconomic status districts in Lima, Peru. The study is a crosssectional analysis of the caries situation of suburban areas of Lima. A stratified sampling procedure by geographical distribution, considering healthcare centers with a motherand- child health clinic and surrounding preschools as factors, identified 45 randomly selected preschools, of which 17 accepted to participate. Children from 3-year-old classrooms were examined by two independent calibrated dentists using the Caries Assessment Spectrum and Treatment (CAST) instrument at their premises using artificial light, sterile examination mirrors and gauze for drying each tooth before evaluation. ANOVA and the Tamhane method were used to analyze the data. 308 children, mean age 3.4 years (min: 3 years; max: 3 years, 7 months), were examined. The sample prevalence of enamel and dentine carious lesions (CAST code 3-7) was 91.2% while the prevalence of dentine carious lesions (CAST code 4-7) was 58.8%. The mean number of teeth with cavities that had reached the pulp and those that had an abscess or fistula were 2.0% and 0.5% respectively. The majority of enamel and dentine carious lesions were observed in molars. The CAST severity score was 7.0. Mean examination time was 57 seconds. The burden of dental caries of the children at this young age was high.

El objetivo del presente estudio fue determinar la prevalencia de caries dental en niños en edad preescolar de 3 años residentes en áreas suburbanas de Lima, Perú. Se trata de un análisis transversal de la situación de caries de áreas periféricas de Lima. Un procedimiento de muestreo estratificado por distribución geográfica consideraba a los centros de salud materno-infantiles y centros educativos preescolares de la jurisdicción como factores, identificando 45 centros prescolares aleatoriamente, de los cuales 17 aceptaron la invitación para participar del presente estudio. Dos odontólogas independientes, calibradas examinaron a los niños de las aulas de 3 años utilizando el instrumento Caries Assessment Spectrum and Treatment (CAST) en las instalaciones de cada jardín de infancia, utilizando luz artificial, instrumental estéril y gasas para el secado de las superficies a evaluar. Los datos fueron analizados utilizando ANOVA y el método Tamhane. Se evaluaron 308 niños, quienes tenían una edad media de 3.4 años (min: 3 años; max: 3 años, 7 meses). La prevalencia de lesiones de caries de esmalte y dentina (código CAST 3-7) fue del 91,2%, mientras que la prevalencia de lesiones de caries en dentina (código CAST 4-7) fue de 58,8%. El número promedio de dientes afectados por caries dental con compromiso pulpar y que tenían un absceso o fístula fue de 2.0% y 0.5% respectivamente. La mayoría de las lesiones de caries en esmalte y dentina se observaron en los molares. La valoración de severidad CAST fue 7.0. El tiempo promedio de examinación fue de 57 segundos. La carga de la enfermedad caries dental a estas edades tan tempranas ya es alta en la infancia suburbana de Lima.

Dental caries in three-year-old preschool children in Lima, Peru assessed according to the CAST instrument / Caries dental en niños prescolares de 3 años en Lima-Perú evaluados con el instrumento CAST

ABSTRACT The aim of this study was to determine the caries situation of three-year-old preschool children residing in low socioeconomic status districts in Lima, Peru. The study is a crosssectional analysis of the caries situation of suburban areas of Lima. A stratified sampling procedure by geographical distribution, considering healthcare centers with a motherand- child health clinic and surrounding preschools as factors, identified 45 randomly selected preschools, of which 17 accepted to participate. Children from 3-year-old classrooms were examined by two independent calibrated dentists using the Caries Assessment Spectrum and Treatment (CAST) instrument at their premises using artificial light, sterile examination mirrors and gauze for drying each tooth before evaluation. ANOVA and the Tamhane method were used to analyze the data. 308 children, mean age 3.4 years (min: 3 years; max: 3 years, 7 months), were examined. The sample prevalence of enamel and dentine carious lesions (CAST code 3-7) was 91.2% while the prevalence of dentine carious lesions (CAST code 4-7) was 58.8%. The mean number of teeth with cavities that had reached the pulp and those that had an abscess or fistula were 2.0% and 0.5% respectively. The majority of enamel and dentine carious lesions were observed in molars. The CAST severity score was 7.0. Mean examination time was 57 seconds. The burden of dental caries of the children at this young age was high.

RESUMEN El objetivo del presente estudio fue determinar la prevalencia de caries dental en niños en edad preescolar de 3 años residentes en áreas suburbanas de Lima, Perú. Se trata de un análisis transversal de la situación de caries de áreas periféricas de Lima. Un procedimiento de muestreo estratificado por distribución geográfica consideraba a los centros de salud materno-infantiles y centros educativos preescolares de la jurisdicción como factores, identificando 45 centros prescolares aleatoriamente, de los cuales 17 aceptaron la invitación para participar del presente estudio. Dos odontólogas independientes, calibradas examinaron a los niños de las aulas de 3 años utilizando el instrumento Caries Assessment Spectrum and Treatment (CAST) en las instalaciones de cada jardín de infancia, utilizando luz artificial, instrumental estéril y gasas para el secado de las superficies a evaluar. Los datos fueron analizados utilizando ANOVA y el método Tamhane. Se evaluaron 308 niños, quienes tenían una edad media de 3.4 años (min: 3 años; max: 3 años, 7 meses). La prevalencia de lesiones de caries de esmalte y dentina (código CAST 3-7) fue del 91,2%, mientras que la prevalencia de lesiones de caries en dentina (código CAST 4-7) fue de 58,8%. El número promedio de dientes afectados por caries dental con compromiso pulpar y que tenían un absceso o fístula fue de 2.0% y 0.5% respectivamente. La mayoría de las lesiones de caries en esmalte y dentina se observaron en los molares. La valoración de severidad CAST fue 7.0. El tiempo promedio de examinación fue de 57 segundos. La carga de la enfermedad caries dental a estas edades tan tempranas ya es alta en la infancia suburbana de Lima.

Impact of proximal cavities and primary molar absence on space in the dental arches.

BACKGROUND: A recently proposed treatment protocol for dental caries in primary teeth, called Ultra Conservative Treatment (UCT), keeps medium to large cavities open so that children can keep them clean with tooth brushing and fluoride toothpaste. However, carious lesions have been related to malocclusion and decrease of space for the eruption of the permanent successor. METHODS: This cross-sectional study evaluated dental casts of 235 schoolchildren, aged 6-7 years old of six public schools in deprived suburban areas, and with at least two cavitated dentin carious lesions. The casts were grouped according to the location of cavitated dentin lesions into non-proximal cavity (NPC), proximal cavity with buccal or lingual surface contact point to adjacent tooth (PCCP) and proximal cavity without contact to adjacent tooth (PCWC), as well as the absence of primary molars due carious lesions (PMA). The relationship between location of cavitated dentin lesions or absence of primary molars with C+D+E and D+E space was analyzed. RESULTS: Children with absence of primary molars exhibited the smallest C+D+E and D+E space in the maxilla (P < 0.001) and mandible (P < 0.001), followed by proximal cavity without buccal or lingual surface contact. No significant difference was observed between NPC and PCCP groups in upper and lower arches. DISCUSSION: PCWC are associated with minor (less than the leeway space) C+D+E and D+E space loss in both arches, and additional space loss is noted when primary molars are prematurely lost. These results may have implications for orthodontic and restorative dental care decisions in children.

Cavity treatment in primary molars and malocclusion: quasi-randomised clinical trial.

BACKGROUND: An innovative caries treatment protocol for primary teeth, termed Ultra-Conservative Treatment (UCT), restores small cavities through the Atraumatic Restorative Treatment (ART) protocol and cleans medium to large open cavities with toothbrush and fluoride toothpaste. However, UCT-treated primary molars were found to exfoliate earlier than amalgam (CRT) and ART-restored cavities, which may lead to unacceptable loss of space for normal eruption of permanent successors. The null-hypothesis tested was that there is no difference between the three treatment protocols and the intra-arch distances, and index of orthodontic treatment need (IOTN) after 4 years. METHODS: Dental casts were taken at baseline (T0) and four (T4) years. The space of the premolars (D + E space), arch perimeter, anterior and total arch depth were measured using a morphometric computer programme. The presence and level of malocclusion were assessed according to the IOTN index. Dependent variables were all intra-arch distances and the IOTN while the independent variable was treatment protocol (CRT, ART and UCT). Data were analysed using linear and logistic regression. RESULTS: The sample consisted of 867 pairs of casts of 272 initial 6-7-year-olds. No difference was observed between the UCT protocol and the two restorative protocols for the intra-arch variables in both maxilla and mandible over the 4 year period. There was no difference between the UCT and the CRT and ART protocols regarding the occurrence of orthodontic treatment need (malocclusion). In conclusion, the UCT treatment protocol does not differ significantly from the traditional amalgam (CRT) and ART restorative protocols with respect to intra-arch distances and malocclusion. The earlier exfoliation of UCT-treated primary molars does not lead to a worsening of the eruption pattern of permanent successors.

Dental caries and oral health-related quality of life of 3-year-olds living in Lima, Peru.

BACKGROUND: Untreated dental caries negatively impacts children and their families; the implication of which is best measured through assessing quality of life. Information related to Oral Health-Related Quality of Life (OHRQoL) in Peruvian pre-school children is scarce. AIM: To investigate the relationship between dental caries and the OHRQoL of 3-year-old children. DESIGN: Randomly selected government pre-schools (n = 17), situated in three low socio-economic status districts in Lima, participated. The OHRQoL data were obtained using the Peruvian (P) ECOHIS questionnaire. Clinical examinations using the Caries Assessment Spectrum and Treatment (CAST) instrument were performed on 308 children. From which, 213 parents returned the P-ECOHIS form. ANOVA, Tamhane, and Tukey methods were used to analyse the data. RESULTS: The mean age of the children was 3.04 years. The two highest mean P-ECOHIS scores in the child section were 'child symptoms' and 'child psychology' while 'parent distress' scored highest in the parent section. The prevalence of dental caries was 64.3% (CAST scores 4-7). Including CASTcode 3 (enamel carious lesion), the dental caries prevalence was 93.4%. The mean P-ECOHIS scores for 'child symptoms', 'child functions', 'child impact', 'parent distress', and 'the sample' were statistically significantly higher for children with MaxCASTcodes 5 and 6 (dentine and pulpally involved cavities, respectively) than for those with MaxCASTcode 3. CONCLUSION: The presence of cavitated teeth with and without pulpal involvement impacts negatively on the OHRQoL of 3-year-old children.

Children's Oral Health-related Quality of Life (OHRQoL) Three Years after Implementation of Treatment Protocols for Managing Cavitated Carious Dentine Lesions.

PURPOSE: To assess children's oral health-related quality of life (OHRQoL) three years after implementation of three treatment protocols for managing cavitated carious dentine lesions in primary molars by parent proxy report with the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) and to assess the level of agreement between the children's self-reporting and the parents' reporting of the children's OHRQoL. MATERIALS AND METHODS: Schoolchildren aged 6 to 7 were included in a clinical trial that compared three treatment protocols for managing cavitated carious dentine lesions: CRT (Conventional Treatment); ART (Atraumatic Restorative Treatment) and UCT (Ultraconservative Treatment). Before treatment (baseline), the OHRQoL of 273 children was assessed by B-ECOHIS using the parents'/caregivers' proxy report. Three years later, 147 parents/caregivers filled in the questionnaire while the children, ages 9 to 10, were interviewed. The t-test and one-way ANOVA were used for statistical analysis. RESULTS: No difference was observed between treatment protocols in regard to the children's OHRQoL (p = 0.41). A significant reduction in the parent distress domain was observed when baseline and parents'/caretakers' responses after three years (p = 0.01) were compared. The level of agreement between the parents'/caregivers' and children's scores was low. Children scored lower on the impact of oral health on their quality of life than their parents/caregivers did (p < 0.0001). CONCLUSION: The use of UCT, a largely non-restorative protocol, leads to a perception of OHRQoL by parents/caregivers that is similar to the ART and CRT protocols after three years. Parent distress decreased over time. Children and parents/caregivers disagreed about children's OHRQoL.

Caries assessment spectrum treatment: the severity score.

OBJECTIVES: To appraise the feasibility of the caries assessment spectrum and treatment (CAST) severity score according to the formula (F) recommended in the CAST manual. METHODS: Data from an epidemiological survey of 680 schoolchildren (mean age ± standard deviation: 7.45 ± 0.91 years), living in a low-income area in Brasília, were used. The CAST instrument was used for assessing enamel carious lesions (CAST code = 3), dentine carious lesions (CAST codes = 4-7) and tooth loss from caries (CAST code = 8). RESULTS: The prevalence of carious lesions including enamel and dentine in both deciduous and permanent dentitions was 49.41% and 69.12%, respectively. Calculating the CAST severity score per child using F was unsatisfactory because of the undiscriminating weight given for each CAST code. Modification of weights according to the accepted levels of disease severity for individual CAST codes resulted in a new formula (F1), in which the weight given to cavitated dentine lesions was quadrupled in relation to that given to enamel carious lesions; this was different from F, in which the weight given to such lesions was twofold. F1 was able to categorise satisfactorily the study children into one of three levels of dental caries severity: mild (34.1%); moderate (29.5%); or severe (36.4%). CONCLUSION: According to the outcomes of the present appraisal, it was concluded that the numerical score provided by the CAST severity scores allows an overview of the severity of caries disease and the classification of individuals into mild, moderate or severe levels of dental caries when the new formula (F1) is used.

Three-year survival of ART high-viscosity glass-ionomer and resin composite restorations in people with disability.

OBJECTIVES: To assess the 3-year cumulative survival rate of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability. MATERIALS AND METHODS: Patients referred for restorative care to the Haemophilia Foundation special care service were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. Treatment was provided as selected unless this option proved clinically unfeasible when an alternative technique was proposed. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). After 6, 12, 24 and 36 months, two independent, trained and calibrated examiners evaluated restoration survival using established ART codes. The proportional hazard model with frailty corrections gave survival estimates over 3 years. RESULTS: Sixty-six patients (13.6 ± 7.8 years) with 16 different disability profiles participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). Altogether, 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). The 3-year cumulative survival rates and jackknife standard errors for the 182 ART and 116 CRT restorations were 94.8 ± 2.1 and 82.8 ± 5.3%, respectively (p = 0.01). CONCLUSIONS: The 3-year follow-up results confirm that ART is an effective treatment protocol. CLINICAL RELEVANCE: Patients with disability, many of whom have difficulty coping with CRT, may benefit from the ART approach.

Caries Assessment Spectrum and Treatment (CAST): A Novel Epidemiological Instrument.

Caries detection is fundamental to understanding the oral health status of a population and is the basis for caries diagnosis for individual patients. Although different caries detection/diagnosis criteria are available, none of them include the total spectrum of dental caries (which ranges from a sound tooth to a tooth lost due to caries) other than the Caries Assessment Spectrum and Treatment (CAST) instrument. The CAST codes and descriptions were submitted to experienced epidemiologists from across the world for obtaining face and content validity. Its construct validity and reproducibility under field conditions were tested in child and adult populations, and showed a high level of agreement between examiners. Compared to what is usually reported in the literature, CAST provides more relevant information on caries prevalence, experience, and severity. CAST is straightforward and easy to use. A manual with valuable information about how to apply CAST and report its results has been published in order to facilitate communication among researchers, oral health planners, and medical professionals. Feedback from researchers indicates that CAST is considered an asset and that reporting results after using CAST is uncomplicated. More research about the effects of CAST in different cultures and age groups is required.

Treating High-Caries Risk Occlusal Surfaces in First Permanent Molars through Sealants and Supervised Toothbrushing: A 3-Year Cost-Effective Analysis.

We conducted a 3-year cost-effectiveness analysis on the cavitated dentine carious lesion preventive capabilities of composite resin (CR) (reference group) and atraumatic restorative treatment (ART) high-viscosity glass-ionomer cement (HVGIC) sealants compared to supervised toothbrushing (STB) in high-risk first permanent molars. School children aged 6-7 years in 6 schools (2 per group) received CR and ART/HVGIC sealants or STB daily for 180 days each school year. Data were collected prospectively and cost estimates were made for sample data and a projection of 1,000 sealants/STB high-risk permanent molars. Although STB had the best outcome, its high implementation cost (95% of cost for supervisors visiting schools 180 days/school year) affected the results. ART/HVGIC was cost-effective compared to CR for the sample data (savings of USD 37 per cavitated dentine carious lesion prevented), while CR was cost-effective compared to ART/HVGIC for the projection (savings of USD 17 per cavitated dentine carious lesion prevented), and both were cost-saving compared to STB. Two STB scenarios were tested in sensitivity analyses with variations in caries incidence and number of supervision days; results showed STB had lower costs and higher savings per cavitated dentine carious lesion prevented than CR and ART/HVGIC. A major assumption is that both scenarios have the same high effectiveness rate experienced by STB under study conditions; however, they point to the value of further research on the benefits of adopting STB as a long-term venture in a general population of school children.

3-year survival rates of retained composite resin and ART sealants using two assessment criteria.

The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin (CR) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment (ART) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years. This cluster-randomized controlled clinical trial consisted of 123 schoolchildren, 6-7-years-old. At baseline, high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants. Evaluations were performed after 0.5, 1, 2 and 3 years. Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided. The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material. Data were analysed according to the PHREG model with frailty correction, Wald-test, ANOVA and t-test, using the Jackknife procedure. The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years. A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations. Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional. The modified retention assessment criterion should be used in future sealant-retention studies.

3-year survival rates of retained composite resin and ART sealants using two assessment criteria

Abstract The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin (CR) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment (ART) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years. This cluster-randomized controlled clinical trial consisted of 123 schoolchildren, 6–7-years-old. At baseline, high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants. Evaluations were performed after 0.5, 1, 2 and 3 years. Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided. The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material. Data were analysed according to the PHREG model with frailty correction, Wald-test, ANOVA and t-test, using the Jackknife procedure. The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years. A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations. Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional. The modified retention assessment criterion should be used in future sealant-retention studies.

A study on the survival of primary molars with intact and with defective restorations.

BACKGROUND: Failed restorations in primary teeth are not always re-restored. Is re-restoration not required anymore? OBJECTIVE: To compare survival rates of primary molars with intact and defective amalgam and ART restorations. METHODS: A total of 649 restored primary molars, of which 162 were assessed with defective restorations for mechanical reasons, from a cluster-randomised controlled clinical trial, were followed up over a period of 3.5 years. Restored primary molars, extracted because of dental sepsis or toothache, were considered a failure. Primary molars with defective restorations were followed up from the time they were assessed defective. Data were analysed using PHREG model with frailty correction, Wald test, t-test, and jackknife procedure. RESULTS: The survival rate of primary molars with intact restorations (96.3%) was statistically significantly higher than that of primary molars with defective restorations (75.9%) over a 3-year period (P < 0.0001). Neither the effect of treatment protocol (amalgam or ART) (P = 0.05) nor the type of surface (single or multiple) (P = 0.73) was observed with respect to the survival rate of restored primary molars. CONCLUSIONS: Survival rates for primary molars with intact and defective amalgam and ART restorations were high. The 3-year survival rate of primary molars with intact restorations was significantly higher than that of primary molars with defective restorations.

Exfoliation rates of primary molars submitted to three treatment protocols after 3.5 years.

OBJECTIVE: The aim of the study was to evaluate the exfoliation pattern of primary molars treated according to three treatment protocols. The hypothesis tested was that there is no difference in the exfoliation pattern of primary molars treated according to conventional restorative treatment using amalgam (CRT), atraumatic restorative treatment using high­viscosity glass­ionomer (ART), and ultraconservative treatment (UCT). The latter consisted of restoring small cavities with ART and cleaning medium/large nonrestored cavities daily with toothpaste/toothbrush under supervision. METHODS: A sample of 302 children aged 6­7 years from a suburban area of Brasilia was followed up for 3.5 years. The numbers of treated molars were 341 (CRT), 244 (ART), and 275 (UCT). Exfoliation rates were obtained using the PHREG procedure. Differences between the three treatment protocol groups were tested using the Wald test. RESULTS: After 3.5 years, there was no difference over the exfoliation rates of all primary molars as 51.0% (CRT), 48.7% (ART), and 59.3% (UCT) had exfoliated at the overall period (P = 0.34). CONCLUSION: The three treatment protocols led to similar exfoliation patterns of all primary molars after 3.5 years.

Effectiveness of an oral health program for mothers and their infants.

BACKGROUND: The baby oral health program (bOHP) provides pregnant women and their future babies with oral care. AIM: To assess the bOHP effectiveness by comparing caries prevalence in infants enrolled and not enrolled in the oral health program (OHP). DESIGN: Mothers who had been invited to participate in the bOHP from 2006 to 2009 were contacted. Two groups were formed: 87 pairs of mothers and infants who effectively participated in the OHP (G1) and 107 pairs who did not (G2). Mothers and infants were given a dental examination. Socio-economic status (SES) and education level (EL) questionnaires were completed. t-tests and multivariate logistic regression were used in analyzing data. RESULTS: Statistically significant differences were observed in the mean age of mothers (G1 = 33.8 years; G2 = 35.6 years; P = 0.015) and mean decayed, missed and filled surface (DMFS) score (G1 = 24.71; G2 = 32.58; P < 0.001), not in SES (P = 0.758) and EL (P = 0.109). Mean age and mean dmfs scores of G1 and G2 children were 4.2 and 4.4 years (P = 0.068), and 0.25 and 4.12 (P < 0.001), respectively. The odds ratio (OR) for children in G2 to develop dentine lesions, as opposed to those in G1, was 48.56. CONCLUSION: The bOHP was effective in preventing caries in infants enrolled in the program.

Assessing caries status according to the CAST instrument and WHO criterion in epidemiological studies.

BACKGROUND: The Caries Assessment Spectrum and Treatment (CAST) is a new epidemiological instrument for detection and treatment of dental caries. Worldwide, the WHO criterion constitutes the epidemiological tool most commonly used for caries detection. The objective of the present study is to determine the levels of similarity and difference between the CAST instrument and WHO criterion on the basis of caries prevalence, dmf/DMF counts, examination time and reporting of results. METHODS: An epidemiological survey was carried out in Brazil among 6-11-year-old schoolchildren. Time of examinations was recorded. dmft, dmfs, DMFT and DMFS counts and dental caries prevalence were obtained according to the WHO criterion and the CAST instrument, as well the correlation coefficient between the two instruments. RESULTS: Four hundred nineteen children were examined. dmft and dmfs counts were 1.92 and 5.31 (CAST), 1.99 and 5.34 (WHO) with correlation coefficients (r) of 0.95 and 0.93, respectively. DMFT and DMFS counts were 0.20 and 0.33 (CAST), 0.19 and 0.30 (WHO), with r = 0.78 and r = 0.72, respectively. Kappa coefficient values for intra-examiner consistency were CAST = 0.91-0.92; WHO = 0.95-0.96 and those for inter-examiner consistency were CAST = 0.90-0.96; WHO = 0.94-1.00. Mean time spent on applying CAST and WHO were 66.3 and 64.7 sec, respectively p = 0.26. The prevalence of dental caries using CAST (codes 2, 5-8) and the WHO criterion for the primary dentition were 63.0% and 65.9%, respectively, and for the permanent dentition they were 12.7% and 12.8%, respectively. CONCLUSIONS: The CAST instrument provided similar prevalence of dental caries values and dmf/DMF counts as the WHO criterion in this age group. Time spent on examining children was identical for both caries assessment methods. Presentation of results from use of the CAST instrument, in comparison to WHO criterion, allowed a more detailed reporting of stages of dental caries, which will be useful for oral health planners.

One year survival of ART and conventional restorations in patients with disability.

BACKGROUND: Providing restorative treatment for persons with disability may be challenging and has been related to the patient's ability to cope with the anxiety engendered by treatment and to cooperate fully with the demands of the clinical situation. The aim of the present study was to assess the survival rate of ART restorations compared to conventional restorations in people with disability referred for special care dentistry. METHODS: Three treatment protocols were distinguished: ART (hand instruments/high-viscosity glass-ionomer); conventional restorative treatment (rotary instrumentation/resin composite) in the clinic (CRT/clinic) and under general anaesthesia (CRT/GA). Patients were referred for restorative care to a special care centre and treated by one of two specialists. Patients and/or their caregivers were provided with written and verbal information regarding the proposed techniques, and selected the type of treatment they were to receive. Treatment was provided as selected but if this option proved clinically unfeasible one of the alternative techniques was subsequently proposed. Evaluation of restoration survival was performed by two independent trained and calibrated examiners using established ART restoration assessment codes at 6 months and 12 months. The Proportional Hazard model with frailty corrections was applied to calculate survival estimates over a one year period. RESULTS: 66 patients (13.6 ± 7.8 years) with 16 different medical disorders participated. CRT/clinic proved feasible for 5 patients (7.5%), the ART approach for 47 patients (71.2%), and 14 patients received CRT/GA (21.2%). In all, 298 dentine carious lesions were restored in primary and permanent teeth, 182 (ART), 21 (CRT/clinic) and 95 (CRT/GA). The 1-year survival rates and jackknife standard error of ART and CRT restorations were 97.8 ± 1.0% and 90.5 ± 3.2%, respectively (p = 0.01). CONCLUSIONS: These short-term results indicate that ART appears to be an effective treatment protocol for treating patients with disability restoratively, many of whom have difficulty coping with the conventional restorative treatment. TRIAL REGISTRATION NUMBER: Netherlands Trial Registration: NTR 4400.

Barriers to adopting and implementing an oral health programme for managing early childhood caries through primary health care providers in Lima, Peru.

BACKGROUND: To identify barriers to participation in a primary oral health care programme aimed at preventing early childhood caries, as perceived by nurses. METHODS: Of a total of 140 randomly selected nurses employed in 40 government health centres in Lima, 123 completed a pre-tested questionnaire. Background variables were districts' 'socio-economic status' (SES) and 'years of experience'. Factor analysis was performed. ANOVA was applied for testing the influence of the background variables on the barrier factors. Chi-square test was applied to test for differences between single item barriers and the background variables. The Likert-scale (1-4) was used. RESULTS: There was no statistical significant effect of 'SES' or of 'years of experience' of nurses on any of the 7 barrier factors, nor on the 11 single item barrier factors. The highest mean score (3.81) was obtained for the barrier factor 'importance of oral health', followed by 'perceived responsibility' (3.44). The lowest mean score was (1.70) for 'knowledge on caries prevention'. CONCLUSIONS: Nurses consider oral health very important and are willing to participate actively in programmes aimed at reducing Early Childhood Caries, provided that they will be trained well and that the director and dentists of the health centre give their consent.

The caries assessment spectrum and treatment (CAST) instrument: its reproducibility in clinical studies.

A new caries assessment instrument, the Caries Assessment Spectrum and Treatment (CAST), was developed. It covers carious lesion progression from no lesion, sealants and restorations to lesions in enamel and dentine, advanced stages in pulpal and tooth-surrounding tissues, and tooth loss owing to dental caries, in nine codes. The objective of this study was to determine the reproducibility of the CAST instrument in primary and permanent dentitions, using three age groups. Two epidemiological surveys were conducted in Brazil, covering three age groups: 2-6-year-old and 6-9-year-old children and 19-30-year-old adults. Four trained and calibrated examiners performed the examinations. Reproducibility was calculated for intra- and inter-examiner at surface and tooth levels and expressed as unweighted kappa-coefficient value (κ) and percentage of agreement (Po) for CAST codes (0-7) and for the categories healthy (0-2) versus diseased (3-7), and non-cavitated (0-3) versus cavitated (4-7) teeth. Using CAST codes (0-7) for the 2-6-year-old age group in primary dentitions, inter-examiner consistency was κ = 0.74 and Po was 98.3%. In the 6-9-year-old age group in primary dentitions, inter-examiner consistency ranged from κ = 0.68 to κ = 0.86 and Po was ≥ 93.7%. In the 19-30-year-old age group inter-examiner consistency was κ = 0.87 and Po was 94.1%. The reproducibility of the CAST instrument for use in the primary dentition of 2-6-year olds and of 6-9-year olds was 'substantial' to 'almost perfect'. The reproducibility for its use in the permanent dentition of 19-30-year olds was 'almost perfect'. The CAST instrument can reliably be applied in epidemiological studies covering these ages.