Experiences in a dental emergency clinic

This report provides descriptive information on the Dental Emergency Clinic at the Royal London Dental Hospital. General information was recorded over 6 months (January-July 2001) regarding total number of patients presenting for treatment, number of patients turned away, sex, age, and ethnic origin of the patient. Demographic information was recorded as well as reason for attendance source of referral and treatment carried out. This data was statistically analysed. Between January and July 2001 6299 patients presented to the Royal London Dental Hospital for treatment on the Dental Emergency Clinic. 73% of patients were seen on the Dental Emergency Clinic, whilst 27% were turned away. The mean daily attendance on the clinic was 31 patients. The majority of patients who attended this clinic were white (English, Scottish and Welsh, 39.1%). The next largest ethnic group were Bangladeshi (8.2%). The highest rate of attendance was in the 20-39 year old age band. The majority of patients attended from the surrounding health authority region (East London and City). The majority of patients attended without referral (78.9%), nearly a quarter were referred by their general dental practitioner (21%). Dental pain was the main reason for attendance (73%). 4054 patients were seen and treated with 4325 items of treatment carried out. There was an 8.4% increase in items of treatment between January-March 2001 and May-July 2001. April was excluded to avoid bias due to re-organisation of the clinic. This increase did not show statistical significance (p > 0.05). Most of the patients attending the Dental Emergency Clinic are aged between 20 to 39 years and from the surrounding health authority region. The majority of the patients are from the indigenous population, even though the clinic is situated in a culturally diverse part of London. Since April 2001 there was a reorganisation of the Dental Emergency Clinic. Although the mean number of patients attending the clinic did not increase, the number of items of treatment increased by 8.4%. This reflects the trend of increase in items of treatment being provided for the patients on the day of presentation.

Impact of socio-demographic variables, oral hygiene practices, oral habits and diet on dental caries experience of Indian elderly: a community-based study

A number of factors influence the caries experience and the pattern of restorative care especially in the older age group.

OBJECTIVE

To evaluate the dental caries experience and restorative treatment needs of an elderly Indian population and to study the impact of socio-demographic variables, oral hygiene practices, oral habits and dietary practices on them.

DESIGN

A community-based study.

SETTING

An urban area in the south zone of Delhi and a cluster of four villages in its neighbourhood.

SUBJECTS

A total of 1240 elderly subjects, 716 urban and 524 rural, were included in the study.

RESULTS

Of the 1052 dentate elderly subjects, 676 (64.2%) had decayed teeth (66.7% root caries and 33.3% coronal caries), 69 (6.6%) had filled teeth and 17 (1.6%) had recurrent decay. Restorations were indicated in 233 (22.2%) subjects, endodontic treatment in 51 (4.8%) and extractions in 424 (40.3%). Urban-rural differences in caries experience were statistically significant. Multivariate regression analysis showed that dental caries was associated with literacy level, oral hygiene practices, oral health perception and diet, while previous restorative treatment was correlated only with location (urban-rural) and presence or absence of systemic diseases.

CONCLUSION

Dental caries prevalence was high amongst the studied elderly population and significant differences were observed in those living in a rural compared with an urban setting. Only a small percentage of elderly had evidence of previous restorative treatment whereas their unmet treatment need was significant.

Analysis of paediatric dental care provided under general anaesthesia and levels of dental disease in two hospitals

OBJECTIVE

To compare the level of dental disease and the pattern of dental treatment under controlled airway general anaesthesia for ASA I and II children and ASA III and IV children in two hospitals.

DESIGN

Prospective analysis.

SETTING

Hospital and postgraduate dental teaching institution, UK 1996 - 2000.

SUBJECTS AND METHODS

During a four-year period (1996-2000), data were collected on children aged 1 to 16 years who were admitted for treatment of dental caries under general anaesthesia. Outcome measures Levels of dental disease (dmft/DMFT), treatment provided.

RESULTS

A total of 515 ASA I and II and 430 ASA III and IV children were treated. The dmft and DMFT values of the ASA I and II children were significantly higher than those of the ASA III and IV children (p = 0.03). A significantly greater number of restorations and fissure sealants were carried out for permanent teeth in ASA III and IV children (p < 0.001). The number of extractions for both primary and permanent teeth was significantly greater in the ASA I and II group (p < 0.05).

CONCLUSIONS

The ASA III and IV children had significantly lower levels of dental caries than the ASA I and II children and received a higher level of preventive and restorative care.

Clinical outcome of third molars in adults followed during 18 years

PURPOSE

The aim of the present study was to follow the clinical changes in third molar status during an 18-year period in patients aged 20 to 38 years.

PATIENTS AND METHODS

The series consisted of 118 subjects (37 men and 81 women). In the beginning of the study, the mean age was 20.2 years (SD, +/-0.6 year), and at the end, it was 38.6 years (SD, +/-0.6 year). Panoramic radiographs were taken at baseline and at age 38. All of the subjects were clinically examined at baseline and at the end of the study. A portion of the subjects (n = 69) were also examined at age 32.

RESULTS

Most of the initially unerupted third molars were removed during the follow-up period (73%, maxilla and mandible together). More than half of the initially partially erupted third molars were removed during the follow-up period (64%, maxilla and mandible together). The percentage of erupted third molars found in the mouth at age 38 increased significantly depending on the initial status. Of the initially unerupted, partially erupted, or erupted third molars, 10%, 33%, and 50%, respectively, were erupted at age 38 (maxilla and mandible together). Changes in the status of third molars continued from age 32 to age 38, although to a lesser extent (8%). The 3 third molars with advanced eruption were all maxillary teeth in men.

CONCLUSION

Third molars undergo continuous clinical change on a reduced scale at least up to the age of 38 years.

Risk of osteoradionecrosis after extraction of impacted third molars in irradiated head and neck cancer patients

PURPOSE

This study was performed to compare the risk of osteoradionecrosis (ORN) in head and neck cancer patients in whom 1 or more impacted third molars were extracted before radiotherapy with patients whose impacted third molars were left intact.

PATIENTS AND METHODS

Eighty-one patients were selected from the medical records from 1989 to 1998. Patients had at least 1 impacted third molar and received radiotherapy for a head and neck cancer. These patients were divided into 2 groups on the basis of preirradiation extraction: group 1, patients who had impacted third molars extracted before radiotherapy (n = 55), and group 2, patients whose impacted third molars were left intact before radiotherapy (n = 38). In 12 patients of combined groups 1 and 2, at least 1 but not all of the impacted third molars were extracted before radiotherapy.

RESULTS

Before radiotherapy, a total of 99 impacted third molars were extracted from the 55 patients in group 1 and a total of 55 impacted third molars were left intact in the 38 patients in group 2. After radiotherapy, a total of 7 impacted third molars were removed from 5 patients as treatment for infection (5 lower molars) or discomfort (2 upper molars). A total of 4 patients (2 from group 1 and 2 from group 2) developed ORN in the mandible. Of these 4 cases of ORN, 1 from group 1 appeared to be related to a dry socket that developed after preirradiation extraction of a lower impacted third molar, 1 from group 2 seemed to be related to infection of a lower impacted third molar after radiotherapy, and the remaining 2 cases appeared to be unrelated to an impacted third molar.

CONCLUSION

Because few patients in this study developed ORN, the study failed to demonstrate whether preirradiation extraction versus retention of impacted third molars affects the risk for ORN.

Dental treatment needs of children in a rural subcounty of Uganda

OBJECTIVES

To describe normative dental treatment needs of 5-7 and 12-year-olds in a rural sub county of Uganda and devise a strategy to improve oral health.

DESIGN

Clinical survey.

SETTING

Primary schools in the subcounty.

SAMPLE AND METHODS

School-based random cluster sample of 236 5-7-year-olds and 202 12-year-olds. Dental status and treatment need data were collected according to WHO Oral Health Surveys Basic Methods. Additional data for 12-year-olds included dental fluorosis using the Thylstrup and Fejerskov index (TFI), oral hygiene procedures and experience of oral pain in the previous month.

RESULTS

In the 5-7-year-olds, mean dmft was 1.47 (50.8% dmft = 0). A total of 52.5% needed fillings and almost one third needed a tooth extracted. Among the 12-year-olds, mean DMFT was 0.64 (65.8% DMFT = 0), 28.5% had dental fluorosis and 6.7% had TFI > 2. Toothache in the previous four weeks was reported by 36.5%, 30.2% needed a filling and 6.4% needed one or more teeth extracted.

CONCLUSIONS

Dental disease is a significant public health problem in this population. An efficient way to meet the needs of the children would be to increase the availability of fluoride toothpaste and to develop a service to provide treatment using Atraumatic Restorative Technique.

Types, frequencies, and risk factors for complications after third molar extraction

OBJECTIVES

The study objective was to identify the types, frequency, and risk factors for complications after third molar (M3) extractions.

STUDY DESIGN

This retrospective cohort study consisted of patients who had 1 or more M3s removed between 1996 and 2001. Risk factors were grouped into demographic, general health, anatomic, and operative. Outcome variables were operative or inflammatory complications. Data were analyzed using descriptive, bivariate, and multivariate statistics.

RESULTS

The study sample was composed of 583 patients (57.0% male) with a mean age of 26.4 +/- 8.4 years. The overall complication rate was 4.6%. Increasing age, a positive medical history, and the position of the M3 relative to the inferior alveolar nerve were associated with an increased risk for complications.

CONCLUSION

While age, medical history, and M3 anatomy cannot be altered directly, these factors may be modified indirectly, resulting in a potential decrease for postoperative complications.

Effect of clinical guidelines on practice for extraction of lower third molars: study of referrals in 1997 and 2000

We made a retrospective study of patient records for 3-month periods during 1997 and 2000 to assess changes in referral patterns and decision-making for extraction of lower third molars after publication of national guidelines. A total of 277 patients were referred to the department for extraction of lower third molars in 1997 and 234 in 2000 while overall referrals increased from 884 to 979. The number having extractions dropped from 243/277 (88%) to 190/234 (81%) of those referred (P=0.05) and of those operated on, bilateral removal dropped from 120/243 (49%) to 65/190 (34%) (P=0.002). The number of patients operated on under general anaesthesia reduced from 161/243 (66%) to 103/190 (54%) (P=0.01). However, women remained more likely to get treatment under general anaesthesia than men. In conclusion, there was a reduction in referrals for extraction of third molars, the proportion of referred patients having extractions, the number of bilateral operations, and changes in the choice of anaesthesia over the period of introduction of national guidelines on operations for third molars.

Dental caries experience in northern Manhattan adolescents

OBJECTIVE

The study sought to document dental caries among adolescents residing in northern Manhattan, New York, by race, sex, and community.

METHODS

Clinical and demographic data were collected from children aged 12-17 years at five school-based dental clinics in northern Manhattan. Data on dental caries were collected by calibrated examiners using the National Institute of Dental and Craniofacial Research criteria for oral examinations.

RESULTS

A total of 566 children participated in the study. They were predominantly Hispanic (64%) or African American (28%). Compared to data from the National Health and Nutrition Examination Survey III, mean DMFT (3.36 vs 2.53; P<.01) and the prevalence of untreated disease (36% vs 16%; P<.01) were significantly higher for northern Manhattan adolescents. Of the adolescents evaluated, 13 percent had at least one severely carious tooth with pulpal involvement that required either extraction or endodontic therapy.

CONCLUSIONS

Adolescents in northern Manhattan have higher caries prevalence and higher levels of untreated caries than their national counterparts. Carious lesions progress to pulpal involvement in a high percentage of northern Manhattan children and require extraction or root canal therapy as treatment. There is an urgent need for affordable and available dental primary care services targeted to economically disadvantaged communities.

Reasons for repeat dental treatment under general anesthesia for the healthy child

PURPOSE

This study investigated reasons a healthy child may need repeat dental treatment under general anesthesia (GA).

METHODS

Experimental subjects were 23 healthy children who received dental treatment under GA twice; controls were 23 healthy children requiring a single dental treatment session under GA. Records review determined demographics, intraoperative information, diagnosis, and treatment provided. Parents of 11 subjects and 9 controls competed a questionnaire and were interviewed.

RESULTS

Many factors differed between subject and control children. Common characteristics of children requiring repeat care under GA (subjects) were: (1) 100% percent caries involvement of maxillary central incisors at time of initial treatment; (2) majority of central incisors were nonrestorable; (3) still using nursing bottle at the time of GA; (4) child responsible for brushing own teeth; (5) poor cooperation in the medical and dental setting; (6) difficult personality as described by parent; (7) dysfunctional social situation; and (8) lack of follow-up dental care. Stainless steel crowns were the most successful restoration placed.

CONCLUSIONS

A number of predictors were found to help identify high-risk children. Best outcomes following dental rehabilitation under GA may result from aggressive treatment of caries, active follow-up, and education of parents.

Ten-Year Incidence of Tooth Loss and Dental Caries in Elderly Swedish Individuals

There has been a significant reduction in edentulism and the elderly retain more teeth into old age. The 10-year incidence of tooth loss, coronal and root caries was studied in a random sample of inhabitants of Göteborg, who were 55, 65 and 75 years old at baseline. Of the 208 persons examined at baseline, 102 (49%) participated in the follow-up examination: 56, 37 and 9, respectively, in the different age groups of 65, 75 and 85 years. In addition, for the purpose of time-trend comparisons, a new random sample of 98 individuals aged 55 years was examined. The mean numbers of remaining teeth were 24, 23, 17 and 14, respectively, in the age groups of 55, 65, 75 and 85. The corresponding mean numbers at baseline were 23, 19 and 17, respectively, in those subjects who were then 55, 65 and 75 years old. Forty-eight percent had lost no teeth during the 10-year period, while 13% had lost more than 2 teeth. The major reason for tooth extraction was dental caries and it was found in 60% of all cases. The incidence of coronal caries decreased, while that of root caries increased with age (p < 0.01). Comparing the same age groups, the frequency of root caries had decreased during the 10-year period. It could be concluded from this study that elderly people were determined to retain their teeth for as long as possible, but dental caries may be a problem among the very old.

Dental treatment in the primary dentition of 7-12 year-old Swedish schoolchildren

In most Swedish counties, epidemiological data on the permanent dentition are collected on all patients aged 7-19 years. For the primary dentition, epidemiological data are only reported for the 3-6-year-old age groups. The purpose of the present study was to investigate what treatments had been made in the primary dentition during the period when the children were 7 to 12 years old. The sample size constituted 10% of all children born in 1987 and regularly treated at Public Dental Service clinics in Jönköping County between 7 and 12 years of age. Data were extracted from the dental records. The most common treatments--new restorations and replacements of restorations--comprised 72% of all treatment. Replacements of restorations constituted 31% of all restorations performed between 7 and 12 years of age, and a majority (81%) of these had been made when the children were 7-9 years old. The mean defs value at 6 years of age was 1.9. The mean number of treatments performed per child between 7 and 12 years of age was 2.5. The result of the present study indicates that more treatments in the primary dentition are performed after 6 years of age than before.

Tooth retention as an indicator of quality dental care: development of a risk adjustment model

BACKGROUND

Retaining teeth improves oral health and quality of life. Thus, receipt of a root canal (vs. a tooth extraction) is a useful indicator of the quality of dental care. However, use of this quality measure without adjusting for the severity of oral disease could lead to spurious conclusions.

OBJECTIVES

This paper describes the development of a dental severity adjustment methodology.

RESEARCH DESIGN

Retrospective study.

SUBJECTS

54,423 users of Department of Veterans Affairs (VA) dental care who had either root canal therapy or a tooth extraction at a VA facility in Fiscal year 1998.

MEASURES

International Classification of Disease Clinical Modification codes for dental diagnoses and comorbid medical conditions. We modeled the effects of dental disease severity in logistic regression models of the probability of receiving a root canal, using both conceptual and Modified Delphi-Panel derived models, adjusting for age, and medical comorbidities.

RESULTS

Conceptual and Modified Delphi models performed similarly. The dental disease severity adjustments increased the fit in models of the probability of receiving a root canal (C-statistic = 0.822 for the conceptual model and 0.804 for the Modified Delphi Panel model) compared with the model including comorbid medical conditions alone (C-statistic = 0.561).

CONCLUSIONS

Risk adjustment for dental disease severity improves the fit of models of the probability of receiving a root canal. Studies of the quality of dental care should consider employing risk-adjusted models.

Incidence and predictors of self-reported tooth loss in a representative sample of Norwegian adults

OBJECTIVES

The purpose of this study was to determine the self-reported 12-month incidence of tooth loss among Norwegian adults and to assess the association between tooth loss and some predictor variables.

METHODS

Of a two-stage nation-wide, representative random sample (n = 3958), information was obtained from 2682 subjects aged 20-79 years and the response rate was 68%. Telephone or face-to-face interviews by interviewers employed by the Central Bureau of Statistics (CBS) of Norway. Information was collected about demographic characteristics, the number of natural teeth present, the number of teeth lost during the last 12 months, and belief in keeping natural teeth for life. The present analyses are based on 2520 persons 20-79 years of age.

RESULTS

The proportion of respondents who reported losing one or more teeth was 6.45% (95% confidence limits (CL) = 5.49, 7.41). The participants who reported extractions had lost on average 1.54 (range 1-9) teeth. Multiple logistic regression analysis revealed a borderline significant effect of the level of education (OR = 0.68, 95% CL = 0.46, 1.00), i.e. the odds of losing one or more teeth during the last 12 months were lower among persons with more than 12 years of education than among persons with less education. The explained variance was 1.9%.

CONCLUSION

The annual incidence rate of tooth loss among Norwegian adults was found to lie within the range reported from other industrialized countries. After controlling for socio-demographic variables and the number of teeth present, the only borderline significant predictor of the incidence of tooth loss was the level of education.

A clinical evaluation of dry socket in a Nigerian teaching hospital

PURPOSE

We sought to determine the incidence of dry socket in a Nigerian teaching hospital and to evaluate the patients' demographic pattern, predisposing factors, the treatment given, and treatment outcome.

PATIENTS AND METHODS

A retrospective review of records of dental extractions complicated by dry socket in Obafemi Awolowo University Teaching Hospital, Ile-Ife, between January 1996 and December 2000 was undertaken. Information retrieved included patient sociodemographic data, indications for extraction, tooth extracted, status of attending surgeon, onset of symptoms, relevant findings of the examining clinician, interval before presentation, treatment given, and its outcome.

RESULTS

Of the 3,319 dental extractions performed in 3,008 patients, 136 (4.1%) were complicated by dry socket. The patients' mean age was 33.4 (15.4) years and a peak age incidence of 21 to 30 years was found. A slight female preponderance (1.4:1) was observed. The majority of patients were in the low-income group, and presentation in the hospital was prompt in the high-income group. Mandibular teeth were affected 3 times more than maxillary teeth (P =.00080). Most cases of dry socket resulted from extractions performed by undergraduates and house officers. Various underlying systemic conditions were found in 11.0% of cases, none of which included use of oral contraceptives. Treatment was usually the use of zinc oxide eugenol dressing in an irrigated socket, combined with antibiotic therapy in 45.3% of cases. No adverse reaction to zinc oxide eugenol was observed.

CONCLUSION

The incidence of dry socket in our hospital is 4.1%. The mandible was involved 3 times more than the maxilla. With the use of zinc oxide eugenol dressing, 70.6% of patients completed treatment satisfactorily and 29.2% were lost to follow-up.

Service provision trends among Australian private general dental practitioners: 1983/84 to 1998/99

AIM

To investigate time trends in service provision.

DESIGN

Four cross-sectional surveys across a 15-year period.

SETTING

Australian private general practice.

PARTICIPANTS

A random sample of dentists.

METHODS

Dentists were surveyed by mailed questionnaire in 1983, 1988, 1993 and 1998 (response rates 71%-75%). Data were weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988, 1993 and 1998.

MAIN OUTCOME MEASURES

Services per visit, annual services per dentist, annual services per patient.

RESULTS

Total services per visit increased over the study period from 1.78 to 2.14 (Poisson regression; p < 0.05). However the annual number of services provided per dentist did not vary significantly, reflecting a trend among dentists to supply fewer patient visits per year. The annual number of services provided per patient increased over the period from 3.47 to 5.22 (OLS regression; p < 0.05), reflecting both the increased service rate per visit and increased numbers of visits by patients. Dentists provided less restorative, prosthodontic and extraction services per year, but more endodontic and crown and bridge services. The pattern of annual care received per patient also included more endodontic and crown and bridge services but differed from the dentist pattern through increased service rates over the study period in areas such as restorative, diagnostic and preventive.

CONCLUSIONS

While dentists are providing a similar number of services annually, the content of their workload has changed to include less emphasis on removal and replacement of teeth and more effort on maintenance and retention of natural dentitions.

Dental anxiety in patients seeking care at the University Dental Hospital in Sri Lanka

OBJECTIVE

The purpose of the study was to determine the prevalence and factors affecting dental anxiety in patients seeking dental care.

DESIGN

A cross sectional study.

PARTICIPANTS

503 first visit patients attending the University Dental Hospital in Peradeniya, Sri Lanka.

OUTCOME MEASURES

Corah's dental anxiety scale was used to assess the dental anxiety in these patients.

RESULTS

The prevalence of dental anxiety was 32% (DAS score > or = 12) while 12% were considered to be extremely anxious (DAS score > or = 15). Females were found to be more dentally anxious than males. Level of education was associated with dental anxiety. Problem oriented attenders had a significantly higher mean DAS score than regular attenders. Those who had an extraction at the last dental visit were significantly more dentally anxious than those who had a restoration/scaling. Negative dental experience was not associated with dental anxiety. The logistic regression model revealed that gender, level of education and 'fear' which was cited as the reason for the delay in seeking care for the presenting complaint were significant predictors of dental anxiety. However, only 4% of the variation in dental anxiety could be explained by these independent variables.

CONCLUSION

Socio-demographic factors and variables related to past dental experiences had a limited influence in explaining dental anxiety in this sample of dental patients.

Early childhood caries-related visits to hospitals for ambulatory surgery in New York State

OBJECTIVES

The objective of this study was to assess the utilization of ambulatory surgery at hospitals for the treatment of early childhood caries in New York State.

METHODS

Data for this study came from the Statewide Planning and Research Cooperative System in New York State. We analyzed 16,149 oral health-related ambulatory surgeries performed between 1996 and 1999 in children younger than 6 years of age.

RESULTS

Between 1996 and 1999, the rate of hospitalization for dental caries in children younger than 6 years of age ranged from 180 to 193 cases per 100,000. Approximately two-thirds of the visits by children younger than 6 years old were due to dental caries. The highest rate was observed in 3-year-old children (346.5). The most frequent type of procedure performed was placement of stainless steel crowns. Medicaid was the primary source of reimbursement.

CONCLUSIONS

These data illustrate that, although dental caries is preventable, it continues to be a significant problem in young children and results in a large number of ambulatory surgery visits.

[25 years of INAMI data in dentistry]

The author presents 25 years of social security data about expenses and the number of medical acts in dentistry using lists and diagrams. By relating these expenses per year to the number of dentists per year, the average expenses per dentist are compared to the evolution of the index of consumption. In the same manner the average number of medical acts per dentist are calculated. By this method the author emphasizes the changes in average dental practice profile over 25 years.

Does oral contraceptive use affect the incidence of complications after extraction of a mandibular third molar?

OBJECTIVE

This study investigated whether oral contraceptive use affects the incidence of complications (pain, trismus, dry socket) in women undergoing removal of impacted mandibular third molars.

PATIENTS AND METHOD

Two hundred and sixty seven women, aged 17 - 45 years, underwent removal of an impacted mandibular third molar. Eighty seven of the women were regular users of oral contraceptives. All patients were evaluated for postoperative pain, trismus and dry socket (localized alveolar osteitis).

RESULTS

Mean trismus values (measured as maximum interincisal distance) were similar in the two groups of patients. Postoperative pain was significantly more frequent among women taking contraceptives, both on day 1 (30% of women taking contraceptives used analgesics, versus 11% of women not taking contraceptives, p < 0.001) and on day 5 (14% versus 5%, p = 0.024). Similarly, dry socket occurred more frequently among women taking contraceptives than among women not taking contraceptives (11% versus 4%, p = 0.017).

CONCLUSIONS

The results of this study support the view that oral contraceptive use favours the appearance of dry socket and postoperative pain after extraction, but has no effect on trismus.

Caries prevalence in 3-year-old children living in a low socio-economic multicultural urban area in southern Sweden

The aim of this study was to investigate the prevalence of dental caries in 3-year-old children living in a multi-cultural low socio-economic urban area of Malmö, Sweden, and to establish its relationship to some medical, oral and behavioural factors associated with caries risk. All 238 children that became 3 years of age between July and December 2000 were invited to participate and 94% showed up for examination. The parents completed a structured questionnaire concerning social and ethnic background, medical history and oral health behaviour and a clinical examination of the child was performed in optimal light with a mirror and probe. Visible plaque, gingival health and occurrence of initial and manifest caries lesions, extractions and fillings (defs) were scored. The prevalence of caries was 85% with a mean defs value of 4.4 +/- 4.3. Of those with caries, 55% had manifest lesions while 45% exhibited lesions that were limited within the enamel. The variables significantly associated with caries were frequent intake of meals (odds ratio, OR = 6.0), gingivitis (OR = 3.7), presence of visible plaque (OR = 3.2) and compromising medical conditions (OR = 2.7). Children without fluoride supplements or fluoridated toothpaste had significantly (p < 0.05) more caries that those with a daily intake of fluoride (mean defs 7.2 +/- 5.3 vs 4.0 +/- 4.0). In conclusion, a high prevalence of caries was found in a low socio-economic multi-cultural population in an urban area of Malmö, Sweden. Thus, early childhood caries may still be a public health problem in certain groups, which calls for collective preventive measures to be re-instituted.

The oral health of a group of prison inmates

The oral health of prison inmates in England has come under increased scrutiny with the arrival of joint responsibility between the Home Office and the NHS for prison healthcare. This brief study indicates very high levels of oral disease amongst a group of prisoners attending for treatment in an English prison. Further study of the oral health of prisoners seems timely, as does the exploration of effective oral health promotion for this group of people.

How dental utilisation in The Netherlands was affected by a radical reform of the dental insurance system

OBJECTIVES

To establish the effects of the 1995 insurance system reform on dental utilisation.

STUDY DESIGN

Four categories of patients experiencing homogeneous insurance changes - public/private insurance with and without additional private dental insurance--were analysed. The reform was hypothesised to increase dental expenditure for the Sickfund with (S+), and privately insured with (P+) and without (P-) additional dental insurance. Sickfund insured without additional dental insurance (S-) were not expected to change dental expenditure. Volume effects were also hypothesised per insurance group. These eight hypotheses were tested using longitudinal dental utilisation data of regularly attending adult dental patients: 91 general dental practitioners provided 803 utilisation records.

RESULTS

The expected increase by S+ of dental expenditure was corroborated by the results. The three other hypotheses regarding dental expenditure were not supported by the results. The hypotheses regarding volume of dental services were partially supported. The S+ significantly increased their uptake of crowns. The S- showed constant uptake of crowns, endodontics and extractions as expected. The results for P+ and P- showed the constant uptake of restorations. The P+ group also showed the hypothesised significant increase in endodontics.

CONCLUSIONS

Having additional dental insurance did not seem to influence the use of dental care in this population of regular attending adult patients. The basic health insurance (Sickfund or private) seemed to have an effect on dental utilisation. The results indicate an association of (expected) treatment need and the application for additional dental insurance.

Tooth brushing and utilization of dental services in Fiji (1998)

Utilization of services is considered the presence or absence of care received. The most common measure of utilization is the annual number of dental visits per person. This study aims to determine oral health practices, which were a measure of their oral hygiene status and the use of health care facilities. It also aims to investigate the major problems that exist within the health care system in 1998, which may explain the lack of use of dental services. Fijians and Indo-Fijians were two ethnic groups in the sample, selected by stratified multi-stage cluster sampling. Only two age categories, 15-19 and 35-44 year-olds were selected being the index age for World Health Organization in Oral Health Surveys. A total of 1,000 questionaires were distributed and the completed questionnaires (n = 619) were collected immediately. Thirty one percent of the respondents indicated that they learnt to care for their teeth from dental personnel. Of the individuals who brushed their teeth twice a day, 41% visited the dentist within the last 12 months. Majority of the individuals (65%) who brushed their teeth twice or more daily indicated that they needed dental treatment. Individuals who visited the dentist within the last 12 months reported having a tooth extracted (53%), check-up (29%), filling (8.9%), polishing of teeth (3.7%), gum problem (3.2%) and false teeth (1.8%). Individuals who brushed twice daily did not visit the dentist within the last 12 months because nothing was wrong (63.2%), too busy (9%) and afraid of the dentist (7%). More than 80% of the respondents were satisfied with the current services, but indicated improvement on the waiting time (31.2%), availability of more treatment options in dental clinics (27.5%), dental fees (15.4%), improvement on the facilities for dental care (10.1%), a customer-friendly dental personnel (9.4%) and considerations for infection control (6.4%).

Tooth-by-tooth survival analysis of the first caries attack in different age cohorts and health centers in Finland

The aims of this study were to test the hypothesis that existing patient records serve as a source of data for survival analysis of dental health and to develop a system for routinely conducted survival analysis of dental health from tooth eruption to first caries attack. Patient records for three cohorts were collected from four towns in Finland: Oulu, Turku, Kuopio, and Kemi. The study population comprised 2103 children born and living in these towns. The Kaplan-Meier curves for dental caries were drawn separately for each tooth and for the maxilla and mandible (for each age cohort). Placements of the first restoration of all teeth in each age cohort were investigated. The 1960 cohort had an extremely high post-eruptive morbidity in all teeth. The 1970 cohort had relatively high immediate post-eruptive morbidity in both molars, but much lower than that of the 1960 cohort. The filling increment rates for second molars were lower than those of the first molars in the 1970 cohort. Characteristic of the 1980 cohort was a rapid increase in the caries increment of the premolars and second molars 4 years after eruption. The results indicate a big difference in tooth-by-tooth dental health in Finland. A huge decline in caries attack was seen from the 1960 cohort to the 1980 cohort, but a deterioration of dental health in premolars and second molars is clearly seen in the 1980 cohort in the 1990s.