Clinical visual caries detection.

The reliable and reproducible detection of dental caries by clinical examination has been recognized as a problem for decades with very variable approaches being taken to recognize and stage lesions along the continuum of caries--from very small initial lesions, just visible to the human eye, through more established white- and brown-spot lesions, to shadowing beneath the enamel and different extents of cavitation. Clinical caries lesion detection implies some objective method of determining whether or not disease is present, and many systems have been developed to improve the objectivity of examiners. The existence of a large number of different systems, using different definitions of caries detection thresholds, lesion staging and examination conditions has led to problems in comparing between studies and communicating across different dental domains. The International Caries Detection and Assessment System (ICDAS) has been developed from the best elements of previously published systems and is based upon the most robust evidence currently available to address the incompatibility of the systems currently used across the full breadth of cariology. The inherently visual ICDAS lesion detection codes are outlined for use with primary coronal caries, caries adjacent to restorations and sealants and for root surface caries. The ICDAS detection codes for primary coronal caries have been demonstrated to have the capability to record both enamel and dentinal caries in a reliable, valid and reproducible manner in both permanent and deciduous teeth and are being adopted increasingly in the domains of research, epidemiology, clinical practice and education.

Differences in methodologies of measuring the prevalence of oral mucosal lesions in children and adolescents.

AIM: This review offers a brief summary of three of the more commonly surveyed and reported oral mucosal conditions found in children, and an appraisal of the variation between selected elements of prevalence study methodologies. DESIGN: Searches of electronic databases (i.e. MEDLINE, CINAHL, EMBASE and EBM Reviews) were conducted to find publications related to oral mucosal conditions in children. Studies were included and reviewed if they contained data on the prevalence of any of the following oral mucosal conditions: geographical tongue, oral ulceration and herpes labialis in children or adolescents (up to the age of 19 years). RESULTS: A total of 29 articles out of 333 met the inclusion criteria and were reviewed. Of these 29 reports, 18 considered geographical tongue, 12 herpes labialis and 10 oral ulceration, although a number of the surveys reported on more than one condition. The approaches used in these studies varied on a number of the potentially important areas associated with validity, comparability, and whether or not the findings may be extrapolated beyond the study population, such as the sampling frame, diagnostic criteria, training and calibration, and examination features. CONCLUSION: Although there were a number of surveys relating to the prevalence of geographical tongue, herpes labialis and oral ulcers in children and adolescents, reported prevalences varied and few studies were directly comparable in terms of the methodology applied. In particular, there was substantial variation between surveys in terms of the diagnostic criteria and method of detection employed although, in many instances, there was inadequate detail to allow full appraisal of the methodology. There is a need for more good-quality epidemiological studies in this area.

Out-of-hours emergency dental services--evaluation of the first year of a pilot project in Fife.

The Scottish Executive Health Department approved funding in 2001 for Fife NHS Board to pilot an integrated model of out-of-hours dental services based upon a dental nurse-led triage system during the evenings, weekends and some public holidays. After one year of the pilot project the activity was evaluated by analysing the triage database. Nearly 4,000 calls were received--Fridays and Saturdays were the most popular days to telephone which resulted in nearly half of all callers being referred to an emergency weekend clinic. Thirty-nine percent of callers received advice only or were advised to contact their own dentist during working hours. A further 12% who were not registered with a dentist (n=479) were offered a next-day appointment with a dentist in their area--around half of these callers subsequently attended for an appointment. Only two out of every 100 callers were deemed to require emergency out-of-hours attention and were referred to oral surgery staff in a local hospital.

Fluoride supplements and changes in tooth decay on the Island of Tristan da Cunha: 1966-1996.

BACKGROUND: The island of Tristan Da Cunha is one of the few examples in the world of a remote enclosed community. The inhabitants of the island were transported to England in 1961 as a result of a volcanic eruption and during their time in England they received a detailed dental health examination. They were later examined back on the island in 1966 by Dr John Fisher and in 1982 a school fluoride supplementation programme was introduced. AIM: The present paper reports the results of the first dental health survey to be carried out on the island since the introduction of a regular school fluoride supplementation programme in 1982. SUBJECTS AND METHODS: A cohort of 6-19-year-old subjects on the island were examined in 1996 using a similar protocol to that which was used by Fisher in the 1966 examination. RESULTS: Comparing the 6-12-year-olds who were caries free in 1966 with those caries free in 1996 using the Chi-squared statistic reveals a statistically significant greater number caries free in the more recent cohort (X2 - 6.0, P- 0.014). For the older age group (13-19 years), a similar comparison reveals a highly statistically significant difference(Z2 - 12.26, P 0.005). CONCLUSIONS: A significant increase in the number of caries free 6-19-year-old children in Tristan Da Cunha between 1966 and 1996 was noted: 1) This is a significant finding in the light of the school fluoride supplementation programme that was introduced on the island in 1982; and 2) Appropriate fluoride supplementation regimes may have conferred a protective effect in a group of children with a cariogenic diet. The paper discusses the significance of this study in the support of fluoridation as a method of reducing the prevalence of dental caries a nd also discusses possibilities for future research on the island of Tristan Da Cunha.

The influence of inputs to the Firth of Forth on the concentrations of trace metals in coastal waters.

The distribution of copper, lead and cadmium in dissolved and particulate phases has been investigated in the Firth of Forth, Scotland, an embayment of the North Sea. The effect of riverine and anthropogenic trace metal inputs on concentrations in the Firth of Forth and adjacent North Sea is examined. For the dissolved phase the effect of such inputs is confined to the immediate area of discharge. Concentrations in the outer Firth are indistinguishable from those in coastal waters of the North Sea, ca. Cu, 0.2 microgdm(-3) (3.1nm); Pb, 0.025 microgdm(-3) (0.12nm) and Cd, 0.020 microgdm(-3) (0.18nm). There is evidence that particulates enhanced in trace metals, relative to bottom sediments, are leaving the Forth and entering the North Sea. Predictions of the total metal concentrations in the waters of the inner Firth, based on riverine, industrial and sewage associated inputs, show reasonable agreement with observed values.

Cadmium in edible crabs (Cancer pagurus L.) from Scottish coastal waters.

Concentrations of cadmium in the hepatopancreas (0.1-61.3 mg kg-1), gonad (0.15-11.0 mg kg-1) and gills (0.2-10.7 mg kg-1) of the edible crab Cancer pagurus L. from 16 sampling sites round the Scottish coast are reported, and compared with published elevated concentrations in crabs from the Orkney Islands. Geographical variations in the distribution of cadmium between organs indicate that the dietary uptake of cadmium is predominant in northern mainland and Orkney crabs, but that uptake from the water is more important in the south of Scotland. Mean dissolved cadmium concentrations in eastern coastal water increase from approximately 10 ng dm-3 in northern waters to approximately 25 ng dm-3 in the south. It seems likely that a regional contamination of the environment by cadium of geological origin occurs in the extreme north coast of Scotland, and in the Orkney and Shetland areas.

Effects of stimulus level on vocal suppression in neonates.

In 4 separate 4-min sessions, the crying behavior was recorded in msec of 45 normal neonates in either a calm or a crying state. In the sessions a random noise (RN) was or was not presented at 60, 70, or 80 db SPL. In the crying state, all Ss cried significantly less during RN than in quiet. The 15 Ss in Grp III cried significantly less to RN at 80 db than the 15 in Grp I at 60 db, while the 15 in Grp II at 70 db was not significantly different from either of the other 2 groups. Thus, vocal suppression occurred even for relatively low-level stimuli and there appears to be a linear relationship between stimulus strength and response strength. In the calm state, All Ss tended to remain calm regardless of stimulus presentation and there were no significant differences across groups. Similar test procedures may improve response reliability and validity in behavioral observation audiometry.

Elevation of mercury in human blood from controlled chronic ingestion of methylmercury in fish.

The relationship between the intake of methylmercury in fish and mercury in blood has been investigated in man. The intakes of methylmercury were carefully controlled and lay in the range 40-230 micrograms/day, the Provisional Tolerable Weekly Intake is equivalent to about 30 micrograms/day. The results indicate that a daily intake of 1 microgram methylmercury would, at equilibrium, produce a blood mercury concentration of 0.8 micrograms/kg. There is a good close-to-linear correlation between methylmercury intake and blood mercury concentrations within the wide range of intakes employed.