Trends of caries prevalence and experience in children in Chengdu City, West China, 1982-1990

Can school-based oral health education and a sugar-free chewing gum program improve oral health? Results from a two-year study in PR China

The purpose of the study was to assess the outcome of school-based oral health education (OHE) and a sugar-free chewing gum program on the oral health status of children in terms of reduced caries increment and gingival bleeding over a period of 2 years. Nine primary schools randomly chosen from one district were divided into three groups: OHE group (Group E), sugar-free chewing gum in addition to OHE group (Group G), and the control group (Group C). All children of grade 1 (aged 6-7 years) were recruited (n = 1342). After 2 years, 1143 children remained in the study group at follow-up. The overall drop-out rate was about 15%. Data on dental caries and gingival bleeding were collected by clinical examination. The results showed that the mean increment of DMFS in Group G was 42% lower than in groups E and C (P < 0.05). The mean increments in F-S were higher in Groups G and E than in Group C (P < 0.01). The gingival bleeding scores were statistically significant among the three groups. Compared to Group C, the mean increment in bleeding scores of Group G was 71% lower (P < 0.01) and in Group E 42% lower (P < 0.05). The school-based OHE programs had some positive effect improving children's oral hygiene; in certain circumstances children may benefit from using polyol-containing chewing gum in terms of reduced dental caries.

Effect of a school-based oral health education programme in Wuhan City, Peoples Republic of China

OBJECTIVES

To assess oral health outcomes of a school-based oral health education (OHE) programme on children, mothers and schoolteachers in China, and to evaluate the methods applied and materials used.

DESIGN

The WHO Health Promoting Schools Project applied to primary schoolchildren in 3 experimental and 3 control schools in Hongshan District, Wuhan City, Central China, with a 3-year follow-up. Data on dental caries, gingival bleeding and behaviour were collected.

PARTICIPANTS

803 children and their mothers, and 369 teachers were included at baseline in 1998. After three years, 666 children and their mothers (response rate 83%), and 347 teachers (response rate 94%) remained.

RESULTS

DMFT/DMFS increments were comparable but the f/F components were higher among children in experimental schools than in control schools and the gingival bleeding score was, similarly, significantly lower. More children in experimental schools adopted regular oral health behaviour such as toothbrushing, recent dental visits, use of fluoride toothpaste, with less frequent consumption of cakes/biscuits compared to controls. In experimental schools, mothers showed significant beneficial oral health developments, while teachers showed higher oral health knowledge and more positive attitudes, also being satisfied with training workshops, methods applied, materials used and involvement with children in OHE.

CONCLUSIONS

The programme had positive effects on gingival bleeding score and oral health behaviour of children, and on oral health knowledge and attitudes of mothers and teachers. No positive effect on dental caries incidence rate was demonstrated by the OHE programme.

Dental caries and periodontal status of 12-year-old school children in rural Qinghai, China

OBJECTIVES

To describe the dental caries and periodontal status of 12-year-old children in rural Qinghai and to compare the oral health status between the Han and ethnic minority children.

METHOD

Children aged 12-years in three primary schools in Hexi Townships, Guide County, Hainan Tibetan Autonomous State, Qinghai Province, China, were invited to participate in the survey conducted during July 2001. Each child was interviewed and clinically examined in the schools, using portable equipment. World Health Organization (WHO) examination procedures and diagnostic criteria were used. SPSS 11.0 was used for data compilation and statistical analysis.

RESULTS

All 196 12-year-olds (118 Han and 78 from ethnic minorities, i.e. Muslims and Tibetans) were surveyed. 48% of the children reported never brushing their teeth, while 12% brushed only every 2-3 days. Over ninety per cent (n=182) of the children had never visited a dentist. The DMFT scores in Han and in minority groups were found to be 0.12 and 0.23 respectively. A larger proportion of children in Han group (94%) had no caries experience (DMFT = 0) than that of Muslim and Tibetan (82%) groups (p<0.01). None of the children had healthy gingiva (i.e. highest CPI score=0) and 85% had calculus.

CONCLUSION

The prevalence of caries experience in Han children is significantly lower than that in Muslim and Tibetan children in rural Qinghai. Dental caries and caries treatment needs of Han and minority rural schoolchildren in Qinghai are low but their periodontal health status is unsatisfactory. Basic dental health care and preventive education for the children in this part of China is needed.

The second national survey of oral health status of children and adults in China

OBJECTIVES

To describe the oral health status of Chinese children and adults at national level in relation to location and province and to highlight changes in dental caries experience.

DESIGN

Cross-sectional study, oral epidemiological survey based on WHO methodology, clinical examinations.

SETTING

National survey by National Committee for Oral Health.

SUBJECTS

Representative samples of provinces, districts, townships; cluster sampling including subjects aged 5,12,15,18, 35-44 and 65-74. Each age group consisted of 23,452 participants, i.e. total of 140,712 individuals.

RESULTS

At age 5, 76.6% were affected by dental caries and mean dmft was 4.5. Mean DMFT varied from 1.0 in 12-year-olds, 1.4 in 15-year-olds, 1.6 in 18-year-olds, 2.1 in 35-44-year-olds to 12.4 in 65-74-year-olds. In adults, caries experience was higher in females than in males. The effect of urbanisation on caries prevalence in children varied by province and age. Among adolescents and young adults caries levels were high in urban areas while caries experience was high for old-age people of rural areas. At national level, changes in dental caries prevalence of 12- and 15-year-olds were small. However, some provinces with extensive oral health programmes (e.g. Love Teeth Day) showed declining caries experience whereas provinces with limited preventive activities had increasing levels of caries. For all age groups, gingival bleeding and calculus were most frequent. Severe periodontal conditions were relatively rare.

CONCLUSION

The systematic implementation of preventive oral care and community-oriented health programmes are needed for the continuous promotion of oral health in China.

Experiences from a school-based oral health promotion programme in Wuhan City, PR China

OBJECTIVES

To evaluate the effect of a six-year oral health promotion programme for school children of Wuhan City, PR China.

METHODS

The programme group (P-group) comprised 233 children who had just entered grade 1 (1989). The programme provided an oral health promotion programme, and 215 12-year-old children from three schools participated as a control group (C-group). After the 6-year period of the programme (1995), all of the children had a clinical examination according to the criteria of the WHO and responded to a structured questionnaire on dental health behaviour.

RESULTS

The results showed that attitudes to dental care, regular tooth brushing habits, use of fluoridated toothpaste, gingival health and dental visits, frequencies of consuming sugary drinks/foods were improved in the p-group when compared with the C-group.

CONCLUSION

The school-based oral health promotion programme should be expanded.

Oral health status and oral health behaviors in Chinese Children

The objectives of the study were to describe the oral health status and treatment needs of the 5- to 6-year-old and 12-year-old children in Southern China; to describe the patterns of oral health behaviors, knowledge, and attitudes among the 12-year-olds; and to assess the effects of socio-behavioral factors on the 12-year-old children's dental caries experiences. The study sample was comprised of 1,587 5- to 6-year-old and 1,576 12-year-old urban and rural schoolchildren living in Guangdong Province. Three calibrated dentists clinically examined the children, and trained interviewers interviewed the 12-year-olds. Caries prevalence of the 5- to 6-year-old children was high (urban 78% vs. rural 86%); the mean dmft of the urban and rural children was 4.8 and 7.0, respectively. The caries prevalence and mean DMFT score of the 12-year-olds were 41% and 0.9 (urban) and 42% and 0.9 (rural). Only 2% of the 12-year-olds exhibited no calculus or gingival bleeding, while more than 70% had calculus. In conclusion, there is an urgent need for establishing caries-preventive activities for preschool children. The prevalence of caries among the 12-year-olds was not high, but their periodontal condition was unsatisfactory. Knowledge about gum bleeding and the use of fluoride was low. More oral health education activities should be organized, especially for the rural children.

Oral health status and oral health behaviour of urban and rural schoolchildren in Southern Thailand

AIM

To describe the level of oral disease in urban and rural schoolchildren in Southern Thailand; to analyse self-care practices and dental visiting habits of 12-year-olds, and to assess the effect of socio-behavioural factors on dental caries experience.

DESIGN

A cross sectional study of 6- and 12-year-old children, urban and rural schools chosen at random from 19 districts of one province.

SETTING

Suratthani Province, Southern Thailand.

PARTICIPANTS

A total of 1,156 children of grade 1 (6 yrs) and 1,116 children of grade 6 (12yrs).

METHODS

Clinical recordings of dental caries and periodontal CPI scores 0, 1 or 2 according to WHO; structured interviews of 12-year-olds (n=1,084) concerning oral health behaviour and attitudes.

RESULTS

At age 6, 96.3% of children had caries and mean dmft was 8.1. In 12-year-olds, 70% had caries in permanent teeth and the level of DMFT was 2.4. Experience of pain during the previous 12 months was reported by 53% of 12-year-olds, 66% saw a dentist within the previous year and 24% reported that visits were due to troubles in teeth. Toothbrushing at least once a day was claimed by 88%. Significant numbers of the children reported having hidden sugar every day: soft drinks (24%), milk with sugar (34%), and tea with sugar (26%). Important predictors of high caries experience were dental visits, consumption of sweets, ethnic group (Muslim) and sex (girls) whereas lower risk was observed in children with positive oral health attitudes.

CONCLUSIONS

Systematic health education may further improve the oral health of Thai children and the primary school provides a unique setting for such programmes.

Oral health services in PR China as evaluated by dentists and patients

OBJECTIVE

To describe the function of oral health services and the delivery of oral health care in PR China.

DESIGN

Cross-sectional surveys. Self-administered questionnaires gathered information on professional practices and attitudes of Chinese dentists. Patients were examined clinically for caries and services rendered. Patients were interviewed about oral health status, reason of dental visits and consumption of services, perceived need for care and self-care practices.

SETTING

Wuhan City of the Hubei Province of China.

SUBJECTS

Random samples of dentists (n = 250) working with child and adult patients in 1998 in Wuhan City. Each dentist had a representative sample of 20 patients attending consecutively for care enrolled in the study.

RESULTS

On average, the dentists saw 12 patients per day, with most time devoted to restorative treatment and extraction. The majority of dentists held the opinion that in China little attention is given to preventive care. Forty per cent of the patients were new to the dentists and more than half attended care because of pain or acute symptoms. The reported mean number of decayed, missing, and filled teeth varied from 2.6 for 12-year-old patients to 10.7 for patients aged 65-74. Daily toothbrushing was practised by more than 90% of the patients in all age groups, however, the tradition of regular dental visits was weak. Most patients (51-75 per cent) attended for care due to acute problems or pain.

CONCLUSION

The study indicated the need for reorientation of the Chinese oral health services towards prevention.

Arresting dentine caries in Chinese preschool children

OBJECTIVES

To investigate the incidence of rehardening of caries lesions in children in Southern China taking part in a preventive programme.

DESIGN

Longitudinal study.

SAMPLE AND METHODS

A prevention programme was established for 168 3-6-year-old children in a kindergarten (KG1), which included regular oral health education sessions and a daily toothbrushing exercise using fluoridated toothpaste (1000 ppm F). A group of 121 children studying in two other kindergartens without a preventive programme formed the controls. Due to lack of resources and dental personnel, restorative and other curative treatments were not provided.

RESULTS

Rehardening of dentine caries (arrested caries) was found in children in both test and control groups. At the third annual examination, 45% of the caries lesions on the proximal surfaces of primary anterior teeth in KG1 children found at the baseline and previous annual examinations had become arrested. A multiple linear regression analysis indicated that baseline ds score and its interactions with the prevention programme, gender and the child's oral hygiene all had significant effect on the number of tooth surfaces with arrested caries at the third annual examination.

CONCLUSION

Results from this study support the use of simple prevention programmes to stabilize the caries situation in communities where intensive use of trained dental personnel is not feasible.

Prevention of early childhood caries--results of a fluoride toothpaste demonstration trial on Chinese preschool children after three years

OBJECTIVES

This field demonstration trial evaluates the long-term effects of introducing daily toothbrushing with fluoride toothpaste in a Chinese kindergarten (test group) compared to caries development in children who had no organized preventive program (control group).

METHODS

In the test group teacher-supervised toothbrushing was initiated with 1,000 ppm MFP toothpaste in addition to oral health education activities. Test and control children were examined at baseline (n = 289, aged 3 years) and annually thereafter.

RESULTS

After three years, 251 children (87%) were still in the trial. Caries development (dmfs) calculation included only those children who were present at both baseline and subsequent annual examinations. At baseline the mean dmfs was 4.8 in the test group and 6.5 in the control group (NS). After three years the caries increment was 6.2 and 8.4 in the test group and the control group, respectively (P < .05). Adjusting for reversals, the net caries increment was 3.6 and 6.3, respectively (P < .01). Additionally, multiple linear regression analysis indicated that both baseline dmfs, the program and plaque level had a significant effect on the net caries increment. The use of hierarchical caries severity zones was useful for the identification of those children most at risk for further caries development.

CONCLUSIONS

We conclude that a daily toothbrushing with limited involvement of professional staff was feasible in a Chinese kindergarten and that caries development was significantly slowed in the test children. Caries severity zones may possibly assist in determining levels of intervention.

Dental caries and oral health behaviour situation of children, mothers and schoolteachers in Wuhan, People's Republic of China

This study was undertaken in order to describe the occurrence of dental caries in Chinese schoolchildren and to highlight the oral health behaviour situation. Clinical examinations of grade 1 children (age 6, n = 381) and grade 6 children (age 12, n = 413) were performed. At age 6, 86 per cent of the children were affected by dental caries and at age 12 the mean DMFT index was 1.0. Personal interviews with the mothers (n = 691) showed that dental care habits of children were poor; 22 per cent of all children brushed their teeth twice a day and 20 per cent had seen the dentist within the past 12 months. Very few children (4 per cent) had practical support from their parents in daily toothcleaning. Self-administered questionnaires for schoolteachers (n = 138) revealed that most (85 per cent) are positive towards oral health education of children. Systematic school-based programmes should be implemented to promote oral health.

Changes in oral health knowledge and behaviour 1987-95 among inhabitants of Wuhan City, PR China

The purpose of this study was to evaluate the changes of oral health knowledge and behaviour among Wuhan citizens after six years of 'Love Teeth Day' campaigns. Representative samples of citizens aged 10-62 years were identified and interviewed in 1987 (n = 1180) and in 1995 (n = 1014). Data on oral health knowledge and practises were collected by structured questionnaires in both surveys and high response rates were obtained (87-94 per cent). In general, improvements in oral health knowledge and toothbrushing behaviour were observed in 1995 as compared with 1987. The younger age group (10-19-year-olds) showed significantly higher improvements of positive answers to knowledge items and toothbrushing behaviour. The findings also indicated that less than half of the interviewees were aware of the anti-caries effect of fluoride and about 30 per cent of the participants brushed their teeth performing the recommended method (vertical). In China, community based oral health education programmes should be implemented to further improve regular self-care practises, especially in relation to the adult population.

Description and epidemiology of nursing caries

Nursing caries is a virulent form of tooth decay that affects the primary dentition of infants and preschool children. The purpose of this paper is to review the scientific literature to describe the clinical characteristics of this disease and to report on its prevalence in various locations and populations around the world. A Medline search was completed using the key words below. All English-language articles that reported on the prevalence of caries involving the primary maxillary incisors in preschool children in association with feeding habits were included in the review. Nursing caries is associated with ad libitum bottle feeding, particularly at naptime or nighttime, and has been reported in children who engage in demand breastfeeding. A substantial body of literature from numerous countries now exists that documents the prevalence of nursing caries. In developed countries the prevalence is reported to vary between 1 percent and 12 percent. However, in developing countries and within disadvantaged populations in developed countries, the prevalence has been reported to be as high as 70 percent in the preschool population. A universally accepted definition for nursing caries does not exist and methods used to define the condition, establish study populations, and collect prevalence data vary widely among studies. This review provides a detailed clinical description of nursing caries, reviews the characteristics of children who may be at risk for nursing caries, and reviews the prevalence data for nursing caries for countries that have reported it, and suggests directions for research into nursing caries etiology and prevalence.

Caries prevalence and patterns in 3-6-year-old Beijing children

A total of 400 Beijing children, 3-6-yr-old, equally distributed by age and sex, were examined for dental cares. Results were analyzed with the traditional dmfs/t index and with the Caries Analysis System. The system differentiated between caries patterns and examined the percentage of affected children (Prevalence), the degree to which these children were affected (Severity), and the proportion of total caries each disease pattern represented (Distribution). Over 67% of the children experienced caries, a level comparable to other reports from China and other developing countries, but 50% greater than those seen in United States preschool children. Nearly all children with caries experienced fissure caries. In 3-yr-olds maxillary anterior caries was the next most prevalent pattern with 43% affected, whilst in the 6-yr-olds, posterior proximal caries was the second most prevalent pattern with 68% affected. Since maxillary anterior caries was so prevalent, and because the presence of this pattern has been shown to be a risk factor for future caries, preventing the maxillary anterior pattern may markedly reduce caries in this population.