The condition of teeth in the UK in 1998 and implications for the future

Dental caries in a Norwegian adult population, the HUNT4 oral health study; prevalence, distribution and 45-year trends

OBJECTIVE

To investigate dental caries prevalence amongst adults in Central Norway and assess changes over the last 45 years.

MATERIALS AND METHODS

The cross-sectional HUNT4 Oral Health Study was conducted in 2017-2019. A random sample of 4913 participants aged ≥19 years answered questionnaires and underwent clinical and radiographic examinations. Data were compared to findings from previous studies in the same region conducted from 1973 to 2006.

RESULTS

Mean number of decayed, missing and filled teeth (D_3-5MFT) was 14.9 (95% CI 14.7, 15.1), 56% of adults had one or more carious teeth (D_3-5T) and 11.8% had ≥4 D_3-5T, with the mean number of 1.4 (95% CI 1.32, 1.42). For initial caries, mean D_1-2S was 3.8 (95% CI 3.7, 3.9), being the highest for 19-24-year-olds at 8.6 (95% CI 7.9, 9.3). Comparisons with earlier studies showed a decline in mean D_3-5MFT for 35-44-year-olds from 26.5 in 1973 to 10.8 in 2019. In 1973, 4.8% of 35-44-year-olds were edentulous, while in present study edentulousness was found only in individuals >65 years.

CONCLUSIONS

Despite a substantial reduction in caries experience over the last 45 years, untreated dentine caries was common, evenly distributed across all age groups. Initial caries particularly affected younger individuals, indicating a need to evaluate prevention strategies and access to dental services.

The frequency of enamel and dentin caries lesions among elderly Norwegians

Aim: To describe the distribution of enamel-, dentin-, root- and secondary caries within an elderly population in Northern-Norway.Material and methods: A study population (n = 1 173) was divided into age groups: 65-69 (seniors), 70-74 (young elderly), 75-79 (elderly) and 80-94 (old elderly). Seven examiners registered presence, location and severity of caries lesions on x-rays and intra-oral photos. Severity of approximal, occlusal, secondary and root caries was graded (D_1-2: into enamel; D_3-5: into dentin, root caries)_, and decayed missing filled surfaces/teeth (DMFS/DMFT) were calculated. T-test, ANOVA and a Bonferroni correction were used.Results: The seniors had more primary caries (DS_1-5) compared to the oldest age groups, while the old elderly had significantly more secondary caries than the other groups (p < .05). Of those ≥65 years 13.8% were affected with root caries, 21% among the oldest. About 48% of the old elderly had one or more surfaces with untreated caries lesions into dentin, while for the other groups the number was 35% (p < 0.05).Conclusion: Individuals seem to maintain good oral health up to at least 80 years of age. Those older than 80 years have more root caries needing more intensified caries-controlling measures and a higher prevalence of untreated dentin lesions often in need of operative treatment.

Tooth wear in Swedish adults-A cross-sectional study

BACKGROUND

Tooth wear has been recognised as a growing oral health problem in children and adolescents, with erosion often cited as the main cause of the tooth wear. Most studies on tooth wear have been conducted on children and adolescents, and only few studies focus on adults. Our aim was to study the prevalence of different types of tooth wear in an adult population and investigate related factors to tooth wear.

METHODS

A total of 831 adults in Sweden participated in the study by completing a questionnaire about oral health, a clinical examination, saliva sample and intraoral photographs. Tooth wear was estimated according to the Basic Erosive Wear Examination index, and the aetiology was determined based on the clinical appearance.

RESULTS

Almost 80% of the individuals had signs of erosion, and over 90% had signs of attrition. A high level of tooth wear was found in 4.6% of the individuals, few of who reported having received information about both attrition and erosion. Significantly, more men had tooth wear. Daily consumption of fruit had a stronger correlation to tooth wear than acidic drinks.

DISCUSSION & CONCLUSION

A high level of tooth wear was found in 4.6% of the individuals, and it was more common in men than women. Aside from attrition, tooth wear due to erosion was a frequent finding in adults. Only a few of the individuals with a high level of tooth wear reported to have received information about tooth wear from their dentist or dental hygienist.

The views and experiences of general dental practitioners (GDP's) in West Yorkshire who used the International Caries Detection and Assessment System (ICDAS) in research

Objective

To explore, through face to face interviews with a selection of General Dental Practitioners (GDPs), their views and experiences of having used the International Caries Detection and Assessment System (ICDAS) within primary care research studies for recording caries.

Methods

This qualitative study involved one on one interviews with eight GDP’s who had previously used ICDAS on patients in their dental practices as part of a research study. The participants were selected from among those who had taken part in two clinical studies in the UK using convenient, but purposive sampling. The interviews were tape-recorded and transcribed; the data analysis was conducted by thematic analysis.

Results

GDP’s indicated their beliefs that ICDAS had an important role in caries prevention but reported four main barriers while using the full (6 caries stages) ICDAS coding system in their practices: lack of simplicity of coding, financial implications and time consumption (in both training and use of ICDAS) and inadequate undergraduate training. An overarching theme identified from the GDPS was the willingness to offer potential solutions to their barriers which might improve the utilisation of the system in primary care.

Conclusion

The GDPs experienced common obstacles in using ICDAS in the primary care setting, many of which have relatively straight-forward solutions which they put forward themselves such as: incentivisation, undergraduate-level training in ICDAS for both dentists and nurses and computerized data entry. Further qualitative and quantitative research is needed on how to facilitate the utilisation of the system in dental practice. It is also recommended to explore the influences of wider agencies on influencing primary dental care professionals’ caries management, including appropriate recording of diagnosis and risk assessment.

Is caries equally distributed in adults? A population-based cross-sectional study in Norway - the TOHNN-study

OBJECTIVES

The aim of the study was to examine the prevalence and distribution of dental caries in an adult population and identify factors associated with being caries free.

MATERIAL AND METHODS

Data were collected from a randomized population sample in Northern Norway (N = 1932; 988 women; mean age 47.0 years, SD 15.3). The study included a structured questionnaire and a clinical examination. The sum of enamel and dentine caries, DS_1-5, formed the main outcome measures for caries prevalence.

RESULTS

Mean DMFT was 15.1 (95% CI 14.8, 15.4), mean DFT was 12.0 (CI 11.7, 12.2), and mean DT was 1.1 (CI 1.0, 1.2). The mean value for dentine caries (DS_3-5) was 0.8 (CI 0.7, 0.9), and mean DS_1-5 was 3.8 (CI 3.6, 4.1). Mean DS_1-5 was highest in the youngest age group (mean 6.9, 95% CI 6.3, 7.6) and in rural areas (mean 5.0, CI 4.4, 5.6). The most caries-prone 20% in the youngest age group had 52% of the total number of carious lesions compared with 80% in the two oldest age groups. Tooth brushing twice daily (p = .005), drinking sugar containing soft drink (p =.029), and attending dental services every year (p < .001), were associated with being caries free.

CONCLUSION

Dental caries is still a common condition, particularly in the youngest age group. Living in a rural area, low socioeconomic status, less frequent tooth cleaning and sugar containing soft drinks were associated with a higher prevalence of dental caries. The different caries distribution among adults calls for different preventive strategies at both population and individual levels.

The Role of Nutrition in Periodontal Health: An Update

Periodontal health is influenced by a number of factors such as oral hygiene, genetic and epigenetic factors, systemic health, and nutrition. Many studies have observed that a balanced diet has an essential role in maintaining periodontal health. Additionally, the influences of nutritional supplements and dietary components have been known to affect healing after periodontal surgery. Studies have attempted to find a correlation between tooth loss, periodontal health, and nutrition. Moreover, bone formation and periodontal regeneration are also affected by numerous vitamins, minerals, and trace elements. The aim of this review is to critically appraise the currently available data on diet and maintenance of periodontal health and periodontal healing. The effects of nutritional intervention studies to improve the quality of life and well-being of patients with periodontal disease have been discussed.

Periodontitis and Cognitive Decline in Alzheimer's Disease

Periodontitis is common in the elderly and may become more common in Alzheimer's disease because of a reduced ability to take care of oral hygiene as the disease progresses. Elevated antibodies to periodontal bacteria are associated with an increased systemic pro-inflammatory state. Elsewhere raised serum pro-inflammatory cytokines have been associated with an increased rate of cognitive decline in Alzheimer's disease. We hypothesized that periodontitis would be associated with increased dementia severity and a more rapid cognitive decline in Alzheimer's disease. We aimed to determine if periodontitis in Alzheimer's disease is associated with both increased dementia severity and cognitive decline, and an increased systemic pro inflammatory state. In a six month observational cohort study 60 community dwelling participants with mild to moderate Alzheimer's Disease were cognitively assessed and a blood sample taken for systemic inflammatory markers. Dental health was assessed by a dental hygienist, blind to cognitive outcomes. All assessments were repeated at six months. The presence of periodontitis at baseline was not related to baseline cognitive state but was associated with a six fold increase in the rate of cognitive decline as assessed by the ADAS-cog over a six month follow up period. Periodontitis at baseline was associated with a relative increase in the pro-inflammatory state over the six month follow up period. Our data showed that periodontitis is associated with an increase in cognitive decline in Alzheimer's Disease, independent to baseline cognitive state, which may be mediated through effects on systemic inflammation.

Survival rates of anterior composites in managing tooth wear: systematic review

The use of composite restorations for patients with tooth wear is considered as a more conservative treatment option. The aim of this study was to systematically review the literature investigating the survival rates of anterior composite restorations when used in managing tooth wear in patients. PubMed and MEDLINE (Ovid) databases were screened for studies from 1995 to 2015. Cross-referencing was used to further identify articles. Article selection and data extraction were performed in duplication. Languages were restricted to English. A quality appraisal of included studies was carried out using the Strength of Recommendation Taxonomy system. Six hundred and sixty-six articles were initially identified from which eight articles were full-text reviewed. Six articles involving five studies were selected for inclusion. Three studies were prospective and two retrospective. Included studies involved placement of 772 direct and indirect anterior composite restorations in 100 patients with follow-up periods between 5 months and 10 years. The survival rates of anterior composites were >90% and 50% at 2.5 and 5 years, respectively. Posterior occlusion was re-established in 91% of patients within 18 months. Meta-analysis could not be performed due to the heterogeneity of included studies. The systematic review's overall strength of recommendation was graded B. There is evidence to support the use of anterior composite restorations at an increased vertical dimension of occlusion in the short/medium-term management of tooth wear. Long-term reporting of outcomes remains limited. Further research is needed with standardised study design, detailed reporting of outcomes and long-term review.

Interactive treatment planning in toothwear: are we doing it right?

Toothwear is now common, especially in younger patients, with high demand for the restoration of the damaged teeth which is likely to increase further over time. Fixed prosthodontic options range from direct composite resin to conventional tooth preparation and cemented indirect restorations. This paper summarizes the views of a variety of clinicians on a plan delivered to a patient with toothwear in secondary care and explores the possible reasons for the variation in decision-making in the treatment of toothwear.

CLINICAL RELEVANCE

With levels of toothwear increasing, the clinician needs to be aware of the different treatment modalities which are appropriate.

Factors associated with tooth loss and prosthodontic status among Sudanese adults

A study was conducted to determine the degree of tooth loss, factors influencing tooth loss, and the extent of prosthodontic rehabilitation in Sudanese adults (≥ 16 years old) attending outpatient clinics in Khartoum State. Pearson and multivariate analyses were used to examine the relationships between tooth loss and specific characteristics determined through interviews and clinical examinations. The mean number of missing teeth was 3.6 (SD, 4.9) and the prevalence of edentulism was 0.1%. The prevalence of tooth loss (missing at least one tooth) was 78%; 66.9% of tooth loss was due to caries, and 11.2% was attributable to other reasons. Prosthetic replacement of missing teeth was evident in 3%, whereas a need for prosthetic replacement was evident in 57%. Having < 20 teeth was associated with age, gender, and socioeconomic status; tooth loss due to caries was associated with age, tribe, frequency of tooth-brushing, and a low rate of dental consultation. Tooth loss due to other reasons was associated with age, tribe, education, periodontal pocketing, tobacco use, tooth wear, and prosthetic status. The results of the present study indicated that the major cause of tooth loss was dental caries, thus emphasizing the importance of a public prevention-based healthcare program. Replacement of missing teeth was uncommon in the study subjects, which may reflect lack of access to this type of oral healthcare.

Do patients with osteoporosis have an increased prevalence of periodontal disease? A cross-sectional study

The study examined if women with osteoporosis were at increased risk of periodontal disease. Three hundred eighty females aged 45-65 years with recent dual-energy X-ray absorptiometry (DXA) scans of the spine and proximal femur agreed to a dental examination. No association was established between the presence of severe periodontal disease and osteoporosis.

INTRODUCTION

The purpose of this study is to determine whether patients with osteoporosis have an increased severity and extent of periodontal disease, taking full account of confounding factors.

METHODS

Volunteer dentate women (45-65 years), who had undergone recent DXA of the femur and lumbar spine, received a clinical examination of their periodontal tissues by a single trained operator who was blind to the subject's osteoporosis status. Clinical examinations were performed within 6 months of the DXA. Basic Periodontal Examination score, gingival bleeding score, periodontal pocket depth, recession and calculus were the periodontal outcome measures. Potential confounding factors were recorded. Logistic regression was performed for the dichotomous outcome measure of severe periodontal disease (present or absent) with osteoporotic status, adjusting for confounding factors.

RESULTS

There were 380 dentate participants for whom DXA data were available. Of these, 98 had osteoporosis. When compared with osteoporotic subjects, those with normal bone mineral density were significantly younger (p = 0.01), had a higher body mass index (p = 0.03) and had more teeth (p = 0.01). The prevalence of severe periodontal disease in the sample was 39 %. The unadjusted odds ratio for the association between osteoporosis and severe periodontal disease was 1.21 (0.76 to 1.93). The adjusted odds ratio analysis including other covariates (age, smoking, hormone replacement therapy, alcohol) was 0.99 (0.61 to 1.61).

CONCLUSION

No association was established between the presence of severe periodontal disease and osteoporosis.

The management of anterior tooth wear using gold palatal veneers in canine guidance

Localised anterior tooth wear can be managed using minimally invasive techniques with conservation of tooth structure and preservation of pulp vitality. This article describes and illustrates with two clinical cases, the management of localised tooth wear, with the restoration of canine guidance by a combination of gold palatal veneers and direct composite restorations.

Evaluation of the basic erosive wear examination (BEWE) for use in general dental practice

OBJECTIVE

The basic erosive wear examination (BEWE) is a relatively new index proposed for the screening and recording of tooth wear in adults. The aim of this study was to test the validity and reliability of the BEWE.

DESIGN

Cross sectional study of a sample of 164 adult patients.

SETTING

General dental practice in East Lancashire, UK in 2010.

SUBJECTS

Patients attending for routine examination or treatment.

MAIN OUTCOME MEASURES

By screening patients with the BEWE and comparing the results to the established tooth wear index (TWI) the sensitivity and specificity of the BEWE was established.Results The BEWE predicted moderate to severe wear (BEWE grade 3) with a sensitivity of 48.6% and a specificity of 96.1%, and predicted severe wear with a sensitivity of 90.9% and a specificity of 91.5% (also BEWE score 3). Inter- and intra-examiner reliability for the BEWE were both moderate (κ(w) = 0.43 and 0.57 respectively).

CONCLUSION(S)

BEWE scores show a similar distribution to TWI scores and the examination is an effective screening test for severe tooth wear. The moderate levels of examiner reliability suggests the BEWE scores should be interpreted with some caution.

Dental erosion and its growing importance in clinical practice: from past to present

Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.

A survey of oral health in a Sudanese population

Background

We aimed to assess the oral health status and risk factors for dental caries and periodontal disease among Sudanese adults resident in Khartoum State. To date, this information was not available to health policy planners in Sudan.

Methods

A descriptive population-based survey of Sudanese adults aged ≥ 16 years was conducted. After stratified sampling, 1,888 adult patients from public dental hospitals and dental health centres scattered across Khartoum State, including different ethnic groups present in Sudan, were examined in 2009-10. Data were collected using patient interviews and clinical examinations. Dental status was recorded using the DMFT index, community periodontal index (CPI), and a validated tooth wear index.

Results

Caries prevalence was high, with 87.7% of teeth examined having untreated decay. Periodontal disease increased in extent and severity with age. For 25.8% of adults, tooth wear was mild; 8.7% had moderate and 1% severe toothwear. Multivariate analysis revealed that decay was less prevalent in older age groups but more prevalent in southern tribes and frequent problem based attenders; western tribes and people with dry mouths who presented with less than18 sound, untreated natural teeth (SUNT). Older age groups were more likely to present with tooth wear; increasing age and gender were associated with having periodontal pocketing ≥ 4 mm.

Conclusions

The prevalence of untreated caries and periodontal disease was high in this population. There appear to be some barriers to restorative dental care, with frequent use of dental extractions to treat caries and limited use of restorative dentistry. Implementation of population-based strategies tailored to the circumstances of Sudanese population is important to improve oral health status in Sudan.

Does oral health matter in people's daily life? Oral health-related quality of life in adults 35-47 years of age in Norway

OBJECTIVE

The aim of this study was to assess the effect of oral health on aspects of daily life measured by the Dental Impact Profile (DIP) in 35- to 47-year-old individuals in Norway, and to study associations between reported effects and demographic variables, subjectively assessed oral health, general health, oral health behaviour and clinical oral health.

MATERIAL AND METHODS

A stratified randomized sample of 249 individuals received a questionnaire regarding demographic questions, dental visits, oral hygiene behaviour, self-rated oral health and general health and satisfaction with oral health. The DIP measured the effects of oral health on daily life. Teeth present and caries experience were registered by clinical examination. Bi- and multivariate analyses and factor analysis were used.

RESULTS

Items most frequently reported to be positively or negatively influenced by oral health were chewing and biting, eating, smiling and laughing, feeling comfortable and appearance. Only 1% reported no effects of oral health. Individuals with fewer than two decayed teeth, individuals who rated their oral health as good or practised good oral health habits reported more positive effects than others on oral quality of life (P ≤ 0.05). When the variables were included in multivariate analysis, none was statistically significant. The subscales of the DIP were somewhat different from the originally suggested subscales.

CONCLUSIONS

This study showed that most adults reported oral health to be important for masticatory functions and confirmed that oral health also had impacts on other aspects of life.

The Influence of a Short Training Program on the Clinical Examination of Dental Restorations

Training in restoration assessment and the evaluation of such in the clinical environment is shown to produce positive benefits that include improved reliability and agreement with the set standard.

Periodontal health in Europe: future trends based on treatment needs and the provision of periodontal services--position paper 1

This review gives an update on recent epidemiologic data on periodontal diseases and a description of current periodontal services in Europe. A Medline search of articles published within the last decade with the keywords epidemiology, prevalence, periodontitis, tooth loss, and Europe was performed. Data on provision of dental services originated from international databases. Epidemiologic data on the prevalence of edentulism, the number of missing teeth, the prevalence of probing depth (Community Periodontal Index - CPI >or= 3 or Pocket Depth - PD >or= 4 mm), and clinical attachment loss (CAL >or= 4 mm) displayed a fragmentary picture within Europe. With respect to the limited data on periodontal health, Spain, Sweden, and Switzerland ranked as the healthiest among European countries in contrast to Germany where increased tooth loss and the highest prevalence of CAL >or= 4 mm were reported. The role of dental auxiliaries especially of dental hygienists and/or the medico-legal framework in which they work, appears to be an important factor in provision of effective periodontal care. Actual epidemiologic data on periodontal diseases are non-homogeneous and absent from several European countries. This emphasises the need for more national representative epidemiological studies with a uniform design to permit comparability between different nations. Merging actual epidemiologic data with former data on provision of periodontal care may help to explain differences in periodontal parameters on a population basis and to define future provision of dental care.

Bridging a gap: the (lack of a) sociology of oral health and healthcare

This article provides an historical review of international research related to sociology and oral health and healthcare. I begin by considering the relevance of the mouth and oral health to social interactions and physical health, and outline existing inequalities in oral health and healthcare experiences. The paper examines critically some of the existing published research in the field - considering both what might be described as sociology of oral health and healthcare and sociology in oral healthcare - and demonstrates the dearth of sociological research related to this subject compared to other areas of interest within the field of sociology of health and illness. I conclude by suggesting some ways in which this area could be expanded and developed further. I suggest that sociological analyses of how individuals experience, understand and manage their mouth and oral health, can add to and enhance the broader field of the sociology of health and illness. Further, examining experiences and provision of oral healthcare may provide sociology with a new opportunity to explore the neglected field of private healthcare, but also to engage with health policy makers who seek to address oral healthcare needs.

Caries prevention for older people in residential care homes

When attempting to prevent dental caries in older people who live in residential care homes, what is the effectiveness and relative cost benefit of high concentration fluoride toothpaste compared with fluoride varnish application?

Removable Prostheses Revisited: Challenges for Primary Dental Care. 3. Overdentures

The overdenture is, perhaps, an under-used form of treatment in the primary dental care sector. In this, the final paper in a series of three, the reader will be reminded of the basic concepts concerning overdentures. The author will outline some of the important changes that are likely to influence overdenture provision in the United Kingdom, and describe clinical aspects of this form of treatment.

Removable prostheses revisited: challenges for primary dental care. 2. Partial dentures

This is the second in a series of three papers. Its topic, the provision of removable prostheses, remains a significant aspect of primary dental care. In the recent past and in the near future, there have been and will be significant influences on how removable prostheses are provided for patients in the United Kingdom (UK). In this paper, the trends in partial edentulousness in the UK will be summarised and the important changes that are likely to influence removable partial denture provision will be outlined. The paper will then provide an update of clinical procedures in the provision of removable partial dentures. A third paper will consider overdentures.

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

OBJECTIVE

The aims of the present study were to describe caries experience among 35-year-olds in Oslo in 2003 and to assess changes in caries experience during the past 30 years using data from cross-sectional studies performed in 1973, 1984, and 1993.

MATERIAL AND METHODS

The dental status of 149 randomly selected 35-year-olds in Oslo was examined in 2003 (response rate 64%) and the data were compared with available data from earlier studies. Dental caries was registered clinically and radiographically at the surface level, applying the same criteria as used in previous studies, and recorded as DMFS/T.

RESULTS

The results indicate a gradual decrease in the mean DMFS scores by 62% from 68.2 in 1973 to 26.1 in 2003. There was an 83% decrease in the mean number of DS, a 73% decrease in the mean number of MS, and a 56% decrease in the mean number of FS during this 30-year period. The proportion of individuals with DS = 0 gradually increased from 5% in 1973 to 54% in 2003. There was also a significant decrease in the prevalence of recurrent caries from 2.8% in 1984 to 1.2% in 2003. While a statistically significant reduction in the number of decayed, missing, and filled surfaces was observed during the period 1984-1993, in the past decade (1993-2003) a significant decrease appeared only in the case of the filled surfaces.

CONCLUSIONS

The results indicate that dental health among 35-year-olds in Oslo, measured as a reduction in caries experience, has improved substantially from 1973 to 2003.

Sucrose substitutes and their role in caries prevention

Many non- or low-cariogenic sucrose substitutes are currently available and are found as ingredients of a variety of candy, chewing gum, and drinks. Recently the role of sugar alcohols in promoting remineralisation of enamel has attracted much attention. Thus, the dental profession needs to understand the general characteristics and features of sugar substitutes to provide advice on oral health to patients as well as the general public. There are two critical requirements for sucrose substitutes, namely, being nutritionally appropriate and not being detrimental to the overall general health of the individual. The use of a greater variety of confectionary containing sucrose substitutes and the development of new substitutes with high nutritional value are essential in the battle against caries. In this paper we review in detail the characteristics of sucrose substitutes currently in use, their role in caries prevention and promotion of oral health.

Trends in prosthodontics

Prosthodontics is concerned with the impact of tooth or tissue damage and partial or complete loss of teeth on oral function in its broadest sense. It deals with this largely through prosthetic replacement. The discipline occupies a major portion of a dental school curriculum, and dental practitioners usually devote much of their practice to prosthodontic services. With the rapid improvement in oral health and the reduction of edentulism in many countries, increasing numbers of people are retaining more teeth later in life.Gradually,the main focus in prosthodontics has shifted from removable dentures to fixed prostheses, while implant-supported restorations have attracted intense interest in the dental community. Another factor increasingly influencing prosthodontic practice is patients' awareness of newer technologies in aesthetic dentistry. Because prosthodontic interventions as well as maintenance and repair are by nature costly, the global development in the field manifests fundamental inequalities in the levels of service that patients can access. Diminishing resources for health care in general challenges educators and practitioners of prosthodontics alike. This review is an attempt to describe the recent developments in prosthodontics and its therapeutic areas, and the impact such developments may have on the theory and practice of the discipline.

Changes in caries experience among Australian public dental patients between 1995/96 and 2001/02

OBJECTIVE

Health Card holders are a financially disadvantaged group and are the target population eligible for public-funded dental care. The aims of this study were to describe the oral health status of public-funded dental patients by age, sex, type of care and geographic location, and to compare trends over time.

METHODS

Patients were sampled randomly by State/Territory dental services in 1995/ 96 and 2001/02. Dentists recorded oral health status at the initial visit of a course of care using written instructions. The samples were weighted in proportion to the numbers of public-funded dental patients for each State/Territory.

RESULTS

Multiple linear regression analysis indicated that caries experience measured by the DMFT index increased across older age groups (p<0.05). For male compared with female patients mean numbers of decayed teeth were higher (beta=0.74), and filled teeth lower (beta=-1.16). For emergency compared with general care, mean numbers of decayed and missing teeth were higher (beta=0.52 and beta=0.76), and filled teeth lower (beta=-1.08). For major city compared with regional/remote patients, mean numbers of decayed (beta=-0.35) and missing teeth were lower (beta=-0.34). Between 1995/96 and 2001/02 numbers of decayed teeth were higher (beta=0.81) while numbers of filled teeth were lower (beta=-0.55).

CONCLUSIONS

There was variation in oral health among public dental patients by sex, type of care and location, and there was a trend towards lower numbers of filled teeth but higher numbers of decayed teeth and higher overall caries experience over time.

IMPLICATIONS

Despite population trends towards improved oral health, levels of untreated decayed teeth have increased among public dental patients.

The rational use of oral care products in the elderly

This review examines the evidence of the effectiveness of oral care products in preventing and controlling dental caries and periodontal disease in the ageing population. The strength of evidence is indicated using the following hierarchy: Type 1 (systematic reviews), Type 2 (randomised controlled trials), Type 3 (observational studies) and Type 4 (traditional reviews). Most of the evidence to support the effectiveness of fluoride products is extrapolated from studies involving children and adolescents. The few studies that have been performed in older adults suggest that fluoride toothpaste and, in the case of high caries risk individuals, the adjunctive use of other fluoride delivery systems, may be effective in preventing coronal and root caries. Some dentifrices containing triclosan have been shown to improve plaque control and gingival health and one, which contains triclosan/copolymer, reduces the progression of periodontitis in adults and high-risk individuals. Powered toothbrushes with an oscillation-rotation action are more effective in reducing plaque and improving gingival health than manual toothbrushes.

Restorative management of the elderly patient

It is predicted that geriatric patients will dramatically increase in number within our working lives. Although they are considered to demand treatment less frequently than the younger age groups, there are specific issues that need to be considered when providing dental treatment for these patients. The term gerodontics has been coined to describe this subject. The need to consider family relationships and the role of carers may play a greater part in their dental management than that of the general population. As well as oral disease, the incidence of general disease is higher in this population, as is the amount of medication prescribed to treat it; these factors often complicate dental management. Special problems that will have a high dental impact on the geriatric patient may be lack of adaptive potential, poor plaque control, root caries, periodontal breakdown and levels of toothwear.

General dental practitioners' knowledge of and attitudes towards the employment of dental therapists in general practice

OBJECTIVE

To investigate general dental practitioners' knowledge of and attitudes towards dental therapists, to ascertain the likelihood of their employment in general dental practice, what client groups they would be likely to treat, and to identify the main perceived barriers to their employment in general dental practice.

METHOD

Postal questionnaire.

SETTING

General dental practitioners in the county of West Sussex.

SAMPLING

All dentists holding a contract to provide general dental services in West Sussex were contacted. Final sample size was 200.

KEY FINDINGS

Thirty eight per cent of dentists said they would employ a therapist if legislation allowed. Main perceived barriers were cost, lack of knowledge and dentists' acceptance.

CONCLUSIONS

In general dentists had a favourable attitude towards dental therapists, although there was a real lack of knowledge about their permitted duties. Most dentists felt therapists should treat children and people with special needs.

The effects of the combination of chlorhexidine/thymol- and fluoride-containing varnishes on the severity of root caries lesions in frail institutionalised elderly people

OBJECTIVES

To compare the clinical effects of a fluoride-containing varnish (Fluor-Protector) in combination with a chlorhexidine-containing varnish (Cervitec) on existing root caries lesions in a group of frail elderly subjects.

METHODS

A randomised double blind longitudinal study was utilised. Subjects (n = 102) were randomly allocated to a Test or Placebo group. All leathery and soft root caries lesions in all subjects were coated with Fluor-Protector while the lesions in the Test group were also coated with Cervitec and the lesions in the Placebo group were coated with a Placebo varnish. Treatments were repeated five times in a 12-month period. Clinical parameters associated with root caries, measurements of individual lesions and salivary levels of caries associated bacteria were made at intervals.

RESULTS

The clinical severity of the lesions in the Test group did not change significantly during the 12-month study period. In the Placebo group the mean lesion width and lesion height and length of exposed root increased significantly and the lesions were significantly closer to the gingival margin. There were no significant changes in the salivary levels of caries-associated microorganisms after 12 months although, in both groups, there was initially a significant reduction in the salivary levels of mutans streptococci.

CONCLUSIONS

The combination of Fluor-Protector and Cervitec is a useful, simple, quick and non-invasive method for the control and management of existing root caries lesions. The procedure could be performed by a dental hygienist and may be usefully applied in other high-risk groups including persons with Parkinson's disease, debilitating neuromuscular conditions and dry mouth from whatever cause.

Trends in oral surgery in England and Wales 1991-2000

OBJECTIVE

To investigate trends in oral surgery in England and Wales 1991-2000.

METHODS

Oral surgery procedure data were derived from Dental Practice Board and Department of Health Hospital Episode Statistics.

RESULTS

There was a 6% increase in minor oral surgery (MOS) procedures, including ordinary extractions, extractions of special difficulty, apicectomies and third molar removals, carried out in the General Dental Services (GDS) but the number of third molars removed fell by 32% after 1997. General anaesthetics (GA) administered in the GDS fell by 77% and the number of sedations rose 54% after 1998. There was concentration of minor oral surgery in practices: in the year 2000, 88% of practitioners carried out less than five third molar removals. In the Hospital Dental Service (HDS) there was a 98% increase in day surgery, and a 53% decrease in ordinary admissions for minor oral surgery. HDS waiting times remained constant over the ten year period.

CONCLUSIONS

The principal trends were substantial decreases in apicectomies, third molar removals after 1997 and GAs after 1998; increases in extractions of special difficulty and concentration of MOS in the GODS. Numbers of ordinary extractions did not change. In the HDS there was a large shift from in-patient to daycase provision which has facilitated expansion of maxillofacial surgery. This is an important example of NHS reconfiguration. Perhaps the most important implication of these changes concerns the place of MOS in vocational training.