Prevalence of self-assessed tooth discolouration in the United Kingdom

AIMS

To determine the prevalence of perceived tooth discolouration in the United Kingdom and to investigate socio-demographic variations and satisfaction with own tooth colour.

METHODS

A national cross-sectional questionnaire study was carried out using a multistage random probability sample. Assessment of people's perceptions of their own tooth colour was conducted by asking study participants to match colour to the closest of a set of photocards demonstrating different levels of tooth discolouration. A separate question asked how satisfied they were with their tooth colour. Information on socio-demographic characteristics of the population were gathered at the same time.

ANALYSIS

Data was coded and entered into SPSS software. Descriptive statistics were used to determine the prevalence of perceived discolouration and satisfaction with own tooth colour. Bivariate and regression analyses were performed to explore the effect of socio-demographic variations.

RESULTS

The self-assessment exercise was completed for 3215 subjects. Half of the study population perceived their tooth colour to be normal and 6% perceived that they had severe discolouration, the remainder reported themselves to have levels of tooth discolouration between these two extremes. Satisfaction with tooth colour decreased with increased discolouration. Sex, age, income and smoking, had statistically significant effects on the prevalence of perceived discolouration (P< 0.01).

CONCLUSIONS

Half of the people in this study perceived themselves to have tooth discolouration. Results suggest that the general public is concerned about dental appearance in terms of tooth colour, indicated by public dissatisfaction with relatively mildly discoloured teeth. Findings may suggest that a further increase in the demand of tooth whitening services and cosmetic dentistry in general is likely. The changing emphasis and level of perceived dissatisfaction need to be taken into account in planning dental services. Evidence based approaches are needed for the appropriate management of patients who demand treatment of mild discolouration.

Early quality of life benefits of icodextrin in peritoneal dialysis

Early quality of life benefits of icodextrin in peritoneal dialysis.

BACKGROUND

The impact of new therapies on patient quality of life (QOL) is emerging as an important indicator of the value of these therapies. In patients on dialysis, previous QOL evaluations have focused mainly on comparative approaches between modalities, or on longitudinal trends within a modality, but few have evaluated technical innovations or introduction of new therapies. The aim of the present study was to assess the early effects of a new dialysis solution (icodextrin) on the QOL of peritoneal dialysis patients. The QOL is compared with that of patients on dextrose, and the impact of demographic, and clinical characteristics on patients' QOL is examined.

METHODS

The kidney disease quality of life questionnaire (KDQOL) was administered to patients who participated in a phase III double-blind, parallel group, active-controlled trial to evaluate the efficacy and safety of a peritoneal dialysis (PD) solution containing icodextrin in comparison with dextrose PD solution. A total of 93 patients (58 icodextrin, and 35 dextrose) completed the questionnaire at both baseline and after 13 weeks. In addition to patients QOL, patients' demographic and clinical characteristics were recorded at both baseline and 13 weeks.

RESULTS

Mean change scores from baseline to 13 weeks of icodextrin patients were substantially higher (> or =5) than dextrose, particularly with respect to general health perception, physical functioning, role-physical, and many KDQOL symptom items such as lack of strength, washed out or drained, lack of appetite, faintness or dizziness, dry skin, cramps after an exchange or treatment, cramps during an exchange or treatment, and muscle spasms or twitching. At 13 weeks, icodextrin patients had significantly improved symptoms, and rated their health in general higher than those patients in the dextrose group. Upon multivariate analysis, icodextrin contributed significantly to the improvement of patients' mental health, general health, and symptoms such as muscle spasms or twitching, cramps during an exchange or treatment, cramps after an exchange or treatment, itchy skin, and faintness or dizziness.

CONCLUSIONS

Peritoneal dialysis patients treated with icodextrin experienced substantial quality of life improvement at 13 weeks after the start of treatment when compared to dextrose patients. Further research is necessary to determine patients' quality of life over time in a longitudinal study setting.

Enzyme-catalysed oxygenation and deoxygenation routes to chiral thiosulfinates

Enantioenriched thiosulfinates have been obtained by dioxygenase- and chloroperoxidase-catalysed oxidation of 1,2-disulfides and dimethyl sulfoxide reductase-catalysed deoxygenation.

Dopamine receptor subtype density as a function of age in Aplysia californica

The age-associated changes in dopamine subtype receptors were examined in Aplysia californica. The density of the subtype receptors D1, D2, D3 and D4 was examined in the ganglia from 4.5-, 6-, 8-, 9- and 12-month animals. Receptor analysis was performed by examining the binding of radiolabeled ligands to the individual subtypes. [3H]SCH23390 and [3H]Clozapine were used to analyze D1 and D4 specific binding. [3H]Quinpirole was used for determining D2 and D3 specific binding. Specific binding was found to be present for all four receptor subtypes. All receptor subtypes showed an increase in density from 4.5 to 6 months. From 6 to 8 months D2 and D3 decreased, while D1 and D4 increased. D4 showed the strongest increase. All four subtypes examined showed decreases from 8 to 12 months. ANOVA results indicated age was a significant factor in the subtype receptor density for all receptor types.

Caries experience and oral health behavior in Chinese children with cleft lip and/or palate

PURPOSE

The aims of this study were to investigate whether there were different caries levels in 3- to 6-year-old Chinese children who had a cleft lip compared to those with a cleft lip/palate. The goal also was to evaluate parental attitudes toward the feeding habits and oral health care for their children.

METHODS

A cross-sectional study was carried out through a dental examination of a sample of children and a questionnaire to their parents. A sample of 104 3- to 6-year-old children (66 boys and 38 girls) with cleft lip, cleft palate or both were selected from those receiving pre-surgical treatment. Each child was examined and a short questionnaire was given to parents of the children. The form included questions about infant feeding practices, frequency consumption of specific drinks and, children's toothbrushing frequency.

RESULTS

One hundred and four children were examined. Seventy-five percent had some caries experience and rampant caries was present in 26%. Children with cleft palate had a higher prevalence of rampant caries (30%) compared to those with cleft lip (12%). A multivariate analysis yielded feeding practices and mother's education as the variables significantly associated with caries and rampant caries.

CONCLUSIONS

The results of this study show that: 1. Children with a cleft lip/palate have higher levels of dental caries compared to those with a cleft lip alone; 2. The two most important factors for dental caries were: a. whether the child had been bottle-fed and; b. the educational attainment level of the mother.

Effect of early exposure on the integration of dental implants: Part 2--Clinical findings at 6 months postloading

Implant exposure during initial healing after placement has been considered important in both implant integration and postloading effects. This study evaluated the effect of early implant exposure on the clinical findings prerestoration and 6 months postrestoration. Forty-eight implants (24 CPTi and 24 Ti-13-13) were placed in maxillary and mandibular posterior sites in six baboons. Implant exposure was evaluated for 24 of the submerged implants at placement and at each weekly visit for 3 weeks after implant placement. The crestal bone level at maxillary posterior sites was measured at 6-month uncovering, and mandibular sites were measured at 3-month uncovering. All sites were again measured 6 months after restoration placement. Periotest readings were recorded at implant uncovering and again 6 months postloading. Arbitrary groupings of the Periotest values were assigned as good = -7 to -1; guarded = 0 to +2; and poor = +3 to +27. At 6 months postloading, there were no statistical differences between CPTi and Ti-13-13 for change in crestal bone height in either arch. The mean change in maxillary crestal bone height varied from a 0.59- to 1.35-mm loss. The differences between the mean exposed and nonexposed changes were not statistically significant The mean change in mandibular crestal bone height varied from a 0.25- to 0.88-mm loss. Changes in crestal bone height for nonexposed sites from 3-month implant uncovering to 6 months postloading were statistically significant at the mesial, buccal, and lingual aspects. The mean change for the nonexposed distal aspect approached significance. The differences between the mean exposed and nonexposed changes were not statistically significant. The overall percentage of maxillary implants in the good category for nonexposed sites decreased by 41% from uncovering to 6 months after loading, while no change occurred for exposed sites; the percentage of implants in the good category was comparable for early exposed and nonexposed sites (57% and 59%, respectively). At 6 months after loading, the percentage of implants in the good category was more favorable for early exposed (88%) than nonexposed sites (50%). A one-stage implant approach should provide similar postloading clinical results as the two-stage surgical approach.

Oral health status of heroin users in a rehabilitation centre in Hubei province, China

OBJECTIVE

To report on the oral health of heroin users and to determine risk factors for oral health status.

DESIGN

All heroin users at one rehabilitation camp received an interview using a pre-tested questionnaire from one of three trained interviewers and a dental examination using World Health Organization recommended procedures from one of three calibrated dentists.

SETTING

Interviews and examinations were carried out at Hubei Province camp.

PARTICIPANTS

All 520 resident heroin users at the camp participated in the study.

OUTCOME MEASURES

Oral hygiene expressed using the Debris Index; caries status by DMFT; periodontal status by percentage with bleeding, pocketing and calculus; mucosal status using standard World Health Organization criteria.

RESULTS

One hundred (19%) of the heroin users were caries free; their mean DMFT was 4.2. The majority (92%) of the DMFT was decay and only a small proportion (8%) was treatment related. The proportion of heroin users with bleeding, calculus, shallow pocketing and deep pocketing was 42%, 95%, 42% and 8% respectively. The mean Debris Index score was 3.2. Mucosal lesions were present in 31 subjects (6%). Using multivariate analysis, duration of heroin use and education were risk factors for DMFT, route of drug administration was a risk factor for calculus and gender was a risk factor for deep pocketing.

CONCLUSIONS

There are indications of poorer periodontal health as well as higher caries experience in this group when compared to provincial dental epidemiological data. Mucosal lesions were not widely prevalent. Both social factors and characteristics of drug use were related to oral health in this group.

Caries patterns and their relationship to infant feeding and socio-economic status in 2-4-year-old Chinese children

AIMS

To describe the prevalence, severity and patterns of caries in 2-4-year-old children and to evaluate the association between caries experience of the children and their feeding patterns and socio-economic background in terms of mothers' education and family income.

DESIGN

Cross-sectional survey.

SETTING

Suburban area of Hanchuan in Hubei province, China.

PARTICIPANTS

A sample of 426 children (250 boys and 176 girls).

METHODS

Dental-examinations were undertaken in kindergartens using World Health Organization diagnostic criteria for dental caries. Mothers completed a short questionnaire.

OUTCOME MEASURES

Prevalence of caries; rampant caries; caries in incisors; caries in incisors and/or canines and molars; mean number of decayed, missing and filled teeth/surfaces (dmft/s).

RESULTS

36% of the children had caries, 7% had rampant caries. The more extensive pattern of caries involving primary molars as well as incisors and/or canines was seen in 12% of children. Children who had been wholly bottle-fed had five times the risk of having rampant caries compared to children who were breast-fed.

CONCLUSIONS

The results indicated that infant feeding practice might be a key risk factor for the development of caries at an early age in this country as elsewhere.

The initial dental health status of British Army Gurkha recruits

AIM

To describe the initial dental health status of British Army Gurkhas who were recruited in 1999 and to compare the present caries data with previous unpublished data from before 1970 and 1983.

DESIGN AND SETTING

A clinical examination was conducted on the 228 Gurkhas, the entire UK intake for 1999, during their second week of military training. The focus of the examinations was on caries experience. A questionnaire was employed to collect demographic data as well as information on the recruits' reported dental behaviour and beliefs.

RESULTS

1999 recruits who reported a dental problem within the past year were significantly more likely to have visited a dentist before compared to those recruits who reported no dental problems. The frequency distributions of D3MFT for the 1983 and 1999 recruits were very similar.

CONCLUSIONS

Gurkha men are at relatively low risk of dental caries and predicted treatment time suggests a relatively small use of resources would be needed to make this group dentally fit. These recruits are an extremely homogeneous group who remain discernible from the general Nepalese population.

Dental care for children and young people who have a hearing impairment

AIM

The aim was to determine whether there are indications that hearing-impaired children experience difficulties in accessing dental care and/or in receiving dental treatment.

METHOD

The study was carried out by means of a questionnaire. Parents of 84 children contacted through the National Deaf Children's Society returned completed questionnaires.

RESULTS

Eighty-two children (98%) had visited a dentist. Nearly two-thirds (63%) were reported to have at least one problem in communication while receiving dental care, this increased significantly as the severity of the hearing impairment increased. Fifty-nine children (70%) reported having at least one problem in communication at the doctors'. Fifty-two (62%) reported that the dentist had worn a mask while communicating with the child and 48 (57%) that there had been background noise in the surgery during appointments.

CONCLUSIONS

Removing masks while talking, reducing background noise and learning to use simple signs may improve communication with hearing-impaired children.

Effect of unintentional exposure of 2-stage implants upon subsequent osseointegration: histologic findings 6 months postloading

The purpose of this study was to evaluate the effect of early spontaneous exposure of 2-stage implants upon subsequent histologic bone contact following occlusal loading. As part of a study comparing 2 types of metallic threaded implants, 48 implants (24 CPTi and 24 Ti-13Nb-13Zr) were placed in maxillary and mandibular posterior sites in 6 baboons. Implant exposure was evaluated at time of placement and at each weekly visit for the first 3 weeks, then at 1, 2, and 3 months, and also at 6 months for the maxilla. Block sections were removed 6 months after the implant restoration was placed into function. One third (33%) of the maxillary implants became exposed, while 66.5% of the mandibular implants became exposed, mostly at 1 to 3 weeks. For all maxillary implants, fibrous tissue contact in the unintentionally exposed group (20.0%) was significantly greater than in the group that remained submerged (7.7%). Maxillary implants remaining submerged exhibited more sinus contact. For all mandibular implants, bone contact in the exposed group (38.9%) was significantly greater than in the submerged group (24.3%). Similarly, exposed implants exhibited less fibrous tissue contact. All other parameters in both maxillary and mandibular arches were statistically similar when comparing unintentionally exposed implants to those that remained submerged. This study suggests that accidental exposure of 2-stage implants should result in overall similarities in postloading bone contact to 2-stage implants that remain submerged during the early postoperative healing period.

Reliability of radiographic observations recorded on a proforma measured using inter- and intra-observer variation: a preliminary study

AIM

The aim of this preliminary study was to test the reliability of radiographic evaluation of features of endodontic interest using a newly devised data collection system.

METHODOLOGY

Twelve endodontic MSc postgraduate students and one specialist endodontist examined sample radiographs derived from a random selection of 42 patients seen previously on an Endodontic New Patient Clinic (EDI). Each student examined a random selection of 8-9 roots on periapical radiographs of single- and multirooted teeth, with and without previous root canal therapy and 3-4 dental panoramic tomograms (DPTs). A total of 100 roots were examined. A proforma was used to record observations on 67 radiographic features using predefined criteria. Intra-observer agreement was tested by asking the students to re-examine the radiographs. The principle investigator and the specialist endodontist examined the same radiographs and devised a Gold Standard using the same criteria. This was compared with the student assessments to determine inter-observer variation. The postgraduates then attended a revision session on the use of the form. Each student subsequently examined 8-9 different roots from the pool of radiographs. A further assessment of inter-observer variation was made by comparing these observations with the Gold Standard.

RESULTS

Of the 67 radiographic features, only 25 had sufficient response to allow statistical analysis. Kappa values for intra- and inter-observer variation were estimated. These varied depending on the particular radiographic feature being assessed. Fifteen out of 25 intra-observer recordings showed 'good' or 'very good' Kappa agreement, but only three out of 25 inter-observer observations achieved 'good' or 'very good' values. Inter-observer variation was improved following the revision session with 16 out of 25 observations achieving 'good' or 'very good' Kappa agreement.

CONCLUSIONS

Modification to the proforma, the criteria used, and training for radiographic assessment were considered necessary to improve the accuracy and reproducibility of the observations entered.

Tropisetron plus dexamethasone is more effective than tropisetron alone for the prevention of postoperative nausea and vomiting in children undergoing tonsillectomy

The 5-HT3 antagonists are effective in reducing postoperative nausea and vomiting (PONV) associated with paediatric tonsillectomy. Although prophylactic tropisetron can reduce the incidence of PONV by half, the resulting level of over 40% is still unacceptably high. The aim of this study was to evaluate the effect of adding dexamethasone to tropisetron. In a blinded study, 59 children (mean age 6.1 years) were administered 0.1 mg.kg-1 up to 2 mg of tropisetron and 66 children (mean age 5.7 years) received the same dose of tropisetron plus 0.5 mg.kg-1 up to 8 mg of dexamethasone. Both drugs were given intravenously during induction of anaesthesia for tonsillectomy. During the inpatient stay of 24 h, the incidence of postoperative vomiting in the tropisetron alone group was 53% compared with 26% in the combination group (P=0.002, chi-squared). A significant reduction in nausea from 53% to 30% was also observed (P=0.02). Parents completed a daily diary for 5 days following discharge. Delayed vomiting occurred in 27% and 11% of the tropisetron and combination therapy groups, respectively (P=0.025) Sixteen percent and 9%, respectively, required medical attention (P=0.27). Tropisetron plus dexamethasone is more effective than tropisetron alone in reducing the incidence of PONV following paediatric tonsillectomy.

Effect of early exposure on the integration of dental implants in the baboon: Part 1--Clinical findings at uncovering

There has been increased discussion on the advantages of a one- versus a two-stage surgical approach in the placement of dental endosseous implants. This study evaluated the influence of early implant exposure on crestal bone height adjacent to the implant surface and Periotest values at uncovering in the baboon. Forty-eight implants (24 commercially pure titanium, 24 titanium alloy) were placed in maxillary and mandibular posterior sites in 6 baboons. Implant exposure was evaluated weekly for 3 weeks after implant placement. The level of bone adjacent to the dental implants was measured at placement from the top of the implant collar to the crest of the bone at the mesial, distal, buccal, and lingual surfaces. The maxillary sites were measured again at a 6-month uncovering, while the mandibular sites were measured at a 3-month uncovering. Periotest readings were also recorded at uncovering. Early implant exposure was more common in the mandible, with the majority occurring by the second week postplacement. There were no significant differences in the crestal bone height changes at uncovering between the pure titanium and alloy implants in either arch. In the maxilla, the changes in crestal bone height were not statistically different between exposed and nonexposed implants at any aspect. In the mandible, the difference in 3-month changes between exposed and nonexposed implants was significant for the distal, buccal, and lingual aspects. The overall percentage of implants with a Periotest reading in the "good" category was greater for the nonexposed sites as compared to exposed sites. The results of this study suggest that the two-stage surgical approach results in a better clinical outcome as compared to the one-stage approach in the baboon model.