Intra-oral distribution and impact of caries experience among South Australian school children

Morphology of the occlusal surface of primary molars as a risk factor for caries

Aims

Impact of primary molars is a significant problem for children with early caries, as they are the ones that predominate in the structure of damage to primary teeth. The goal of our study was to investigate the peculiarities of the primary molars occlusal surfaces with the study of their types and possibilities of caries occurrence in them.

Methods

To study the odontoglyphics of primary molars, a clinical preventive dental examination of 335 children of preschool institutions in the city of Poltava and Poltava region was conducted with the written consent of their parents. As a part of this examination, the occlusal surface of primary molars was studied according to the classic dental examination method with the examination card of each examined child being filled in. After a detailed study of odontoglyphic patterns of occlusal surfaces, photoprotocoling was carried out. A total of 2484 primary molars were examined: 622 maxillary first molars, 634 maxillary second molars, 608 mandibular first molars, and 620 mandibular second molars.

Results

We found that both maxillary and mandibular primary molars which have a complex relief of the occlusal surface are most often affected by caries.

Conclusions

The obtained data indicate that the primary molars of the upper and lower jaw, which have a complex pattern of the chewing surface, are most often affected. However, there is a need for preventive measures in children with such types of structure of the chewing surface.

Global and regional estimates of dental pain among children and adolescents-systematic review and meta-analysis

AIM

We aimed to evaluate the pooled prevalence of dental pain amongst children and adolescents.

METHODS

Studies conducted in children and adolescents up to18 years of age and where prevalence of dental is reported or calculated were included. Search was performed in four major databases from inception to June 1st, 2019. Prevalence estimate at the maximal recall for the dental pain for the individual study was used to calculate the overall pooled estimate.

RESULTS

The prevalence of dental pain ranged from 1.33 to 87.8% in the included publications for quantitative synthesis (n = 97). More than half of the publications reported the lifetime prevalence of dental pain (n = 51) while few studies reported the current prevalence of dental pain (n = 3) and only one study evaluated the dental pain in the past one week. Heterogeneity was high among the included publications (Q = 49,063.12; P < 0.001; df = 96 and I² = 99.8; P < 0.001). Overall pooled prevalence of dental pain was 32.7 (CI = 29.6-35.9). No difference was seen with respect to the trends in prevalence of dental pain (Coefficient: 0.005; 95% CI - 0.001-0.011; P-value: 0.101).

CONCLUSION

Two out of ten children below five years, four out of ten children between 6 and 12 years and three out of ten adolescents between 13 and 18 years would have experienced pain in the past. Overall, three out of ten children or adolescents might have experienced dental pain in the past. There was no difference in the pain prevalence between male and females. Studies from Africa reported highest pooled prevalence (50.1%) with least being from Australia (20.7%). Studies from India (40.4%), China (41.3%) and Iran (42.6%) reported high pooled prevalence estimates of dental pain.

Oral health care: The experience of Australian paediatricians

AIM

Many Australian children have dental decay in their deciduous teeth. Poor oral health can negatively impact a child's ability to eat, speak, sleep and socialise, with adverse impacts later in life. Paediatricians are well placed to examine children's teeth and to provide advice and education about oral health. Using a sample of Australian paediatricians, we aimed to determine: (i) self-reported oral health knowledge and skills, (ii) frequency of office-based oral health-related discussions, (iii) perceived role of paediatricians and (iv) barriers to oral health-related discussions.

METHODS

Members of a national network of paediatricians - the Australian Paediatric Research Network - completed a multi-topic survey, which included questions designed to assess oral health knowledge, current practice and barriers to oral health-related discussions.

RESULTS

Of 430 active members, 178 (41%) completed the survey. Few paediatricians reported very good/excellent ability to assess plaque build-up (8%) and dental caries (17%). Only 10% reported broaching the issue of oral health with all patients. Significant barriers included lack of professional training (52%) and other more pressing issues needing to be addressed (67%).

CONCLUSIONS

The increasing (and inequitable) rates of dental decay in Australian children mean that paediatricians should play a key role in the management of children's oral health. Many paediatricians reported a lack of specific training in oral health and limited ability to assess children and educate families. Despite the traditional divide between medicine and oral health, this study highlights the opportunity for Australian paediatricians to improve oral health through early intervention in the consultation room and beyond.

Dental pain among 10-15 year old children attending oral health promoting schools: A cross-sectional study

Introduction:

Dental pain is a major public health problem and one of the consequences of oral diseases which requires significant adjustments in life management leading to decreased quality of life.

Objective:

To assess prevalence of dental pain and its impact on daily life and to explore its relationship with oral health behavior and clinical oral status among 10-15 year old school children attending oral health promoting schools.

Method:

This cross sectional study was conducted in 6 schools serving low -middle socio economic strata in Bangalore, India. A total of 1237 children were surveyed for history of dental pain during past 3 month. Participants who reported dental pain completed self-reported oral health behaviour and Child dental pain questionnaire. Clinical oral examination included assessment of dental caries, periodontal status. Data was analyzed using t - test, Chi-square test, ANOVA and Regression Analysis.

Results:

Prevalence of dental pain was 15.6% (n = 194). Among children with pain, 17%, 43% and 40% reported mild, moderate and severe pain. Impact on daily activities was reported by 66%. Mean DMFT and DMFS was 1.80 and 2.11 Mean deft and defs was 2.47 and 3.41. Multiple logistic regression revealed that severity and impact of dental pain was associated with gender, frequency of tooth brushing, consumption of sweets and deciduous dental caries experience.

Conclusion:

Prevalence of Dental pain is associated with brushing behavior, consumption of sweets and deciduous dental caries experience, showing need for further attention to these conditions and a need to strengthen preventive and therapeutic dental services.

A qualitative study of the factors that influence mothers when choosing drinks for their young children

Background

The consumption of sweetened beverages is a known common risk factor for the development of obesity and dental caries in children and children consume sweet drinks frequently and in large volumes from an early age. The aim of this study was to examine factors that influence mothers when choosing drinks for their children.

Method

Semi-structured interviews (n = 32) were conducted with a purposive sample of mothers of young children from Victoria’s Barwon South Western Region (selected from a larger cohort study to include families consuming different types of water, and different socioeconomic status and size). Inductive thematic analysis was conducted on transcribed interviews.

Results

Several themes emerged as influencing child drink choice. Child age: Water was the main beverage for the youngest child however it was seen as more acceptable to give older children sweetened beverages. Child preference and temperament: influencing when and if sweet drinks were given; Family influences such as grandparents increased children’s consumption of sweet drinks, often providing children drinks such as fruit juice and soft drinks regardless of maternal disapproval. The Setting: children were more likely to be offered sweetened drinks either as a reward or treat for good behaviour or when out shopping, out for dinner or at parties.

Conclusions

Limiting intake of sweet drinks is considered an important step for child general and oral health. However, the choice of drinks for children has influences from social, environmental and behavioural domains, indicating that a multi-strategy approach is required to bring about this change.

Splash!: a prospective birth cohort study of the impact of environmental, social and family-level influences on child oral health and obesity related risk factors and outcomes

BACKGROUND

Dental caries (decay) is the most prevalent disease of childhood. It is often left untreated and can impact negatively on general health, and physical, developmental, social and learning outcomes. Similar to other health issues, the greatest burden of dental caries is seen in those of low socio-economic position. In addition, a number of diet-related risk factors for dental caries are shared risk factors for the development of childhood obesity. These include high and frequent consumption of refined carbohydrates (predominately sugars), and soft drinks and other sweetened beverages, and low intake of (fluoridated) water. The prevalence of childhood obesity is also at a concerning level in most countries and there is an opportunity to determine interventions for addressing both of these largely preventable conditions through sustainable and equitable solutions. This study aims to prospectively examine the impact of drink choices on child obesity risk and oral health status.

METHODS/DESIGN

This is a two-stage study using a mixed methods research approach. The first stage involves qualitative interviews of a sub-sample of recruited parents to develop an understanding of the processes involved in drink choice, and inform the development of the Discrete Choice Experiment analysis and the measurement instruments to be used in the second stage. The second stage involves the establishment of a prospective birth cohort of 500 children from disadvantaged communities in rural and regional Victoria, Australia (with and without water fluoridation). This longitudinal design allows measurement of changes in the child's diet over time, exposure to fluoride sources including water, dental caries progression, and the risk of childhood obesity.

DISCUSSION

This research will provide a unique contribution to integrated health, education and social policy and program directions, by providing clearer policy relevant evidence on strategies to counter social and environmental factors which predispose infants and children to poor health, wellbeing and social outcomes; and evidence-based strategies to promote health and prevent disease through the adoption of healthier lifestyles and diet. Further, given the absence of evidence on the processes and effectiveness of contemporary policy implementation, such as community water fluoridation in rural and regional communities it's approach and findings will be extremely informative.

Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach

BACKGROUND

Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level.

OBJECTIVES

To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics.

METHODS

The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed.

RESULTS

Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics.

CONCLUSIONS

Girls, students whose parents have low schooling, those with low per capita income, those classified as having black skin color and those with dental treatment needs had higher dental pain prevalence than their counterparts. Students from areas with low Human Development Index had higher prevalence of dental pain than those from the more developed areas regardless of individual characteristics.

The relationship between dental anxiety and dental pain in children aged 18 to 59 months: a study in Recife, Pernambuco State, Brazil

The aim of this study was to evaluate anxiety and pain related to dental treatment in children under the age of five years. This cross sectional study was carried out with 2,735 children of both sexes. Socioeconomic data, dental anxiety and dental pain experience, as well as the assessment of the child's oral health status, were obtained through a questionnaire answered by the child's parent or guardian. Dental anxiety was measured using the Dental Anxiety Question (DAQ). The prevalence of dental anxiety was 34.7% and that of dental pain was 9.1%. There was an association between these two variables (p < 0.0001). There was also an association between dental pain, age, family income and assessment of oral health status. The poorest rating of the child's oral health and the lowest family income were correlated with the highest percentages of a history of dental pain. Dental anxiety was related to a history of dental pain in children under the age of five years.

Changing risk factors for fluorosis among South Australian children

BACKGROUND

Research in the last decade has shown changing exposure patterns to discretionary fluorides and declining prevalence of fluorosis among South Australian children, raising the question of how risk factors for fluorosis have changed.

OBJECTIVE

To examine and compare risk factors for fluorosis among representative samples of South Australian children in 1992/1993 and 2002/2003.

METHODS

Similar sampling strategies and data collection methods were employed in the Child Fluoride Study (CFS) Marks 1 (1992/1993) and 2 (2002/2003). Participants in each CFS round were examined for fluorosis using the Thylstrup and Fejerskov (TF) Index. Exposure history was collected for fluoride in water, toothpaste, fluoride supplements and infant formula, allowing for a fluorosis risk assessment analysis. Data were re-weighted to represent the child population at each time. Changes in prevalence of fluorosis, defined as having a TF score of 1+ on maxillary central incisors, fluoride exposure and risk factors between the two rounds were evaluated.

RESULT

A total of 375 and 677 children participated in the 1992/1993 and 2002/2003 rounds respectively. Prevalence of fluorosis declined significantly from 45.3% to 25.9%. Reduced use of fluoride supplements and increased use of 400-550-ppm children F toothpaste were the most substantial fluoride exposure changes. Early toothpaste use, residence in fluoridated areas and fluoride supplement use were the risk factors in 1992/1993. Early toothpaste use and fluoride supplement use were not risk factors, leaving fluoridated water as the only risk factor among the common variables in 2002/2003. In an analysis stratified by the type of fluoridated toothpaste in 2002/2003, the large amount of toothpaste used was a risk factor in those who used 1000-ppm fluoridated toothpaste, and eating/licking toothpaste when toothpaste use started was a risk factor among children who used either 1000-ppm or 400-550-ppm fluoridated toothpaste.

CONCLUSION

Introduction of the 400-550-ppm F toothpaste and use of smaller amount of toothpaste restricted risk associated with early toothpaste use. Less use and possibly a stricter fluoride supplements regimen also restricted fluorosis risk. Periodic monitoring of risk of fluorosis is required to adjust guidelines for fluoride use in caries prevention.

Impacts of dental pain on daily activities of adolescents aged 14-15 years and their families

OBJECTIVE

To assess the prevalence and severity of dental pain on the daily lives of adolescents and their families in Brazil, and, in terms of socio-economic status, whether there are differences in the prevalence of impacts.

MATERIAL AND METHODS

In a cross-sectional survey of a random sample of 14 to 15-year-olds in Brazil, the prevalence and severity of dental pain, and how dental pain affects daily functioning, were assessed using a child-related questionnaire. A family-related questionnaire included questions on a child pain inventory and the pain-related impacts on the daily lives of the child's family members.

RESULTS

14.5% of children reported high impact levels on their daily lives related to dental pain, the more so among girls than among boys, i.e. 16.7% compared to 11.6%. Significantly more impacts occurred in lower socio-economic class children than in higher, i.e. 19.7% versus 7.8%. The prevalence of impacts among children who reported dental pain (n=354) was high; 64.7% reporting that concentration at school was affected, 55.6% that home activities were affected, and 51.4% that leisure activities were affected. There was a significant relationship between impacts of dental pain on children and families. Overall prevalence of impacts on children's families was 15.2%. The most frequent family dimensions affected were: in carrying out normal household activities (19.7%) and in visiting friends and relatives (17.7%). Emotional stability was the most frequent psychological activity dimension affected (14.1%); 9.6% of parents were woken up as a result of their child's dental pain on an average of 3.7 nights per week.

CONCLUSIONS

Dental pain has considerable impact on the daily lives of adolescents and their families in Brazil. There are many more dental pain-related impacts in girls and in lower social class children.

Caries patterns in primary dentition in 3-, 5- and 7-year-old children: spatial correlation and preventive consequences

This study aimed to contribute to the descriptive information of oral health status in the primary dentition, especially concerning the distribution and spatial correlation of lesions. Data were obtained from two surveys. In the Signal-Tandmobiel project 4,468 7-year-old children in Flanders (Belgium) were selected by a stratified clustered random sample. In the Tandje de Voorste - Smile for Life (TDV) project, data were obtained from 1,291 3-year-old and 1,315 5-year-old children. The children were examined by trained dentists, using standardized and widely accepted criteria, based on the British Association for the Study of Community Dentistry criteria. At the population level, symmetry in the prevalence of caries experience across the midline was tested at the tooth and tooth surface levels using generalized estimating equations and alternating logistic regression (ALR) approaches. Individual symmetry was tested using an approach described by Hujoel et al. [J Dent Res 1994;73:1575-1580]. Descriptive observations suggested a symmetrical distribution of caries experience at the population level. The null hypothesis of symmetry could not be rejected at a 0.05 level, suggesting that caries experience might be symmetric in the deciduous dentition. Based on the ALR approach, 2 x 2 associations of caries experience at the tooth and surface levels, both in 5- and 7-year-olds, appeared to be strongest for the left-right pairs in the mandible, followed by the left-right pairs in the maxilla. At the individual level the hypothesis of random caries pattern was rejected (p < 0.0001). In conclusion, at the population level the null hypothesis of left-right symmetry could not be rejected, while at the individual level lesions tended to cluster on one side of the mouth.

Prevalence and impact of oral pain in 8-year-old children in Sri Lanka

OBJECTIVE

The present study aimed to determine the prevalence and impact of oral pain in 8-year-old Sri Lankan children and their parents.

DESIGN

A cross-sectional study using a multistage cluster sampling technique was carried out in a sample of 614 children attending schools in the Education Division of Badulla, Uva province, Sri Lanka. Data were collected by means of a pre-tested questionnaire that was sent to each of the children and their parents. The children were also given an oral examination. Of the 614 questionnaires which were sent to parents, 30 were not returned and eight had to be excluded from the analysis because the respondents had answered only two questions. Therefore, the present analysis is limited to data from 576 children and their parents.

RESULTS

The lifetime prevalences of oral pain, as reported by the children and parents, were 49% and 53%, respectively. According to the children's report, 25% had experienced oral pain in the past 2 months while 31% of the parents reported that their child had experienced oral pain within the same period. Of those children who reported that they had experienced oral pain in the past 2 months, nearly 45% stated that the pain was severe. In 48%, the pain was triggered when biting. 'Presence of cavity/decayed tooth' was cited as the most common cause of oral pain (67%). Overall, 74% of children had experienced a negative impact as a result of the pain whilst 66% of the parents said that the child's pain had had an impact on them. Ethnic group, parental income and level of education, and the caries experience of the child were significantly associated with the reporting of oral pain in the past 2 months.

CONCLUSIONS

The prevalence of oral pain was high among these children, and had a considerable impact on both the children and their parents.

Dental pain prevalence and association with dental caries and socioeconomic status in schoolchildren, Southern Brazil, 2002

The objective of this study was to assess the relation between dental pain, dental caries and socioeconomic status among 12- and 13-year-old schoolchildren enrolled in a public school in Florianópolis, SC, Brazil in 2002. This study was a cross-sectional study involving 181 schoolchildren. Dental pain experience was the dependend variable analyzed. Socioeconomic data of the children's families were obtained through a questionnaire. Dental caries experience was registered according to the DMFT index (WHO, 1997). The field workteam consisted of an examiner and a recorder. The statistical analysis was performed using the chi-square test and the non-conditional multiple logistic regression. The response rate was 93.4%. The intraexaminer agreement measured on a tooth by tooth basis was high (kappa > 0.73). Dental pain prevalence was 33.7% (CI95% 26.0-42.0). The multiple regression analysis, adjusted by sex and other variables, showed that children with DMFT > 1 presented 2.9 (OR CI95% 1.4-6.1, p < 0.01) more chances of having dental pain when compared with those with DMFT < or = 1. Children whose mother's schooling level was equal or less than 4 years presented 2.5 (OR CI95% 1.2-5.6, p = 0.02) more chances of having dental pain when compared with others whose mothers had more than 5 years of schooling and, finally, children whose family income was up to U$ 67.00 showed 3.2 (OR CI95% 1.2-8.4, p = 0.02) more chances of having dental pain when compared with the ones whose families had higher income. High levels of caries attack, low mother schooling level and low family income were associated to dental pain.

A two-year longitudinal study of dental caries in permanent first molars of Korean elementary schoolchildren

OBJECTIVE

This longitudinal study investigated dental caries increment in permanent first molars of Korean elementary schoolchildren.

METHODS

A convenience sample of 722 children aged 7-9 years attending one urban elementary school was examined at baseline, with follow-up examinations at one and two years. Coronal surfaces of permanent first molars were scored with regard to caries experience and sealant status.

RESULTS

Among sound occlusal surfaces at baseline, 21 percent of upper and 25 percent of lower surfaces developed caries during the two-year interval. In teeth that erupted between baseline and the first follow-up exam, over 10 percent of occlusal surfaces developed caries. Pit and fissure caries accounted for 93 percent of all new carious surfaces, while sealants had been placed on 16 percent of occlusal surfaces during the study.

CONCLUSIONS

Recognizing the limitations of this convenience sample, dental sealants should be used more widely in this Korean population, and should be applied soon after tooth eruption.

The trend and risk factors of perceived toothache among Finnish adolescents from 1977 to 1997

Toothache is a subjective oral health indicator that should become uncommon when oral health is improving. The aim of this study was to assess changes in perceived toothache between 1977 and 1997 among Finnish adolescents. In the Adolescent Health and Lifestyle Survey, a self-administered questionnaire was mailed to a representative sample of 12-, 14-, 16-, and 18-year-old Finns every second year. The sample sizes in the surveys varied from 2422 to 11,105, making a total of 35,349 subjects in the entire study. The incidence of toothache during the previous 2 years was requested in 1977, 1985, 1991, 1995, and 1997, and the prevalences were 31%, 25%, 28%, 29%, and 37%, respectively. The increase between 1995 and 1997 was highest among 16- and 18-year-olds. There was no tendency for perceived toothache to decline over the study period, despite the decrease in caries experience. Toothache varied by age, socioeconomic status (SES), place of residence, and toothbrushing frequency. The increase in the incidence of toothache reported after 1995 could be a warning signal that economic recession in Finland has caused changes in the dental care system.

Conference report. Direct adhesive materials: current perceptions and evidence--future solutions

This paper reports the proceedings, including the consensus views of an Australasian expert group convened to consider current perceptions, evidence and future solutions in the field of direct adhesive materials. This group, in anticipating a trend to preservative dentistry, formed the view that caries risk assessment should increasingly influence the selection of restorative materials. In low caries risk patients, aesthetic demands typically favour the use of resin-based composites. Interactive (biomimetic) materials based on glass-ionomer chemistry have particular application in high caries risk patients. Teaching in dental schools, continuing education programmes and research, both in the laboratory and in the clinical environment should be more attuned to the ever-increasing use of tooth-coloured restorative materials in everyday clinical practice. Linked to this trend are changes in patient--dentist relationships, whereby patients should be encouraged to become more involved in treatment decision-making. Expert group meetings are suggested to be of value in addressing some of the shortfall between the need for good evidence and the relentless challenge of the introduction of new products and concepts in the field of direct adhesive materials.

Caries experience and streptococci and lactobacilli salivary levels in 6-8-year-old Sardinians

OBJECTIVES

The aim of this investigation was to compare clinical data regarding oral status (DMFT/DMFS indices) and streptococci or lactobacilli counts in stimulated whole saliva in two groups of children, aged 6 and 8 years.

METHODS

Seventy-nine boys and 93 girls aged 6 (84 subjects) and 8 (88 subjects) years old were selected. DMFT/dmft, DMFS/dmfs and OHI-S indices were recorded. Mutans streptococci (Sm) and lactobacilli (Lb) salivary levels were assessed using commercially available strip tests and were rated from 0 to 3 and from 0 to 4 in the group as a whole.

RESULTS

Mean dmfs was 9.06 +/- 10.80, made up of ds = 7.28 +/- 9.54, fs = 1.19 +/- 3.64 and ms = 0.59 +/- 3.47. Mean DMFS was 0.73 +/- 1.91, made of DS = 0.54 +/- 1.29, FS = 0.08 +/- 0.56 and MS = 0.11 +/- 0.56. Statistically significant differences were found for both Sm and Lb scores between those with and without caries in the primary teeth (P < 0.05). The different Lb scores were also significant in relation to caries in permanent teeth in older children.

CONCLUSION

A high proportion of children had some caries experience, and were in need of treatment.

Utilization of day stay general anaesthesia for the provision of dental treatment to children in New South Wales, Australia

OBJECTIVES

To assess the demand for paediatric dental general anaesthetic services at a specialist paediatric dental unit in Australia and to evaluate the changing pattern of general anaesthetic use in children at this unit over the past decade.

METHODS

A retrospective review of hospital records of a random sample of children receiving dental treatment under general anaesthesia during the years 1984 and 1996. Demographic and clinical data was collated and analysed using SPSS for Windows.

RESULTS

The number of children managed under general anaesthesia increased from 189 in 1984 to 777 in 1996. This was accompanied by an increase in the time the patients waited for treatment. There was little difference in the mean age of the patients with over two-thirds of the children being under the age of 6 years. Whilst children of Anglo-Saxon origin accounted for the majority of patients across the 13-year period there was a significant increase in the number of children from Asian or Middle Eastern backgrounds. A disproportionate number of these children accessed the services as self-referrals. Caries remained the most common reason for referral, with trauma and dental anomalies accounting for less than 10%.

CONCLUSIONS

Despite the general decline in dental caries there remain an important group of young children who have high treatment needs and for whom general anaesthesia provides a useful treatment option. Preventive strategies should be targeted towards these groups of children.

The prevalence and impact of dental pain in 8-year-old school children in Harrow, England

OBJECTIVE

To assess the prevalence, severity and impact of dental pain.

DESIGN

Cross-sectional survey.

SETTING

Schools in the London Borough of Harrow, England, in the summer term of 1995.

SUBJECTS AND METHODS

The base population were all 2,300 8-year-old school children in Harrow. A cluster sampling of schools based on quotas from all postcode areas in Harrow was used. Data were collected through interviews with the children.

MAIN OUTCOME MEASURES

Prevalence of previous toothache; prevalence of toothache in the previous 4 weeks; prevalence of toothache in the previous 4 weeks which resulted in a visit to the dentist, in stopping playing, eating, sleeping, going to school and taking painkillers.

RESULTS

Of the 664 sample of children in the participating schools, 589 were interviewed (88.7%). The frequency of previous toothache was 47.5% (95% CI, 44-52) and dental pain caused crying in 17.7% (95% CI, 15-21) of children. 7.6% (95% CI, 5-11) of children had pain in the previous 4 weeks (45 children). Among these 45 children, this recent pain resulted in a visit to the dentist in 41.9% (19 children, i.e. 3.2% of all children), in stopping playing in 26.7% (12 children, i.e. 2.0% of all children), eating in 73.3% (33 children, i.e. 5.6% of all children), sleeping in 31.1% (14 children, i.e. 2.4% of all children) and in going to school in 11.1% (5 children, i.e. 0.8% of all children).

CONCLUSION

Toothache in children is a sizeable problem in Harrow and had substantial consequences for children and their guardians. Freedom from disabling dental pain/discomfort is an outcome indicator of oral health and could be used as an explicit goal by dental systems. It is important to note however, that the present study did not assess the extent to which the dental pain was associated with avoidable dental problems as opposed to normal physiological processes. It is important that future work try and separate the prevalence of dental pain caused by physiological from avoidable pathological factors. In addition, future work is needed to assess how effectively and efficiently dental services are responding to people suffering with dental pain.

Oral health of children in South Australia by socio-demographic characteristics and choice of provider

Australia has a highly developed school dental program for providing dental care to schoolchildren which operates alongside well-established private practice delivery of dental care. While free school-based dental care has high utilisation where offered, little is known about the oral health outcomes of groups of children across different providers of dental care, or patterns of service use. This paper investigates the effects of socio-demographic characteristics and choice of dental provider on oral health amongst a random sample of secondary school students residing in Adelaide, South Australia.

OBJECTIVES

To describe the oral health of children by different dental provider groups, to describe the association of socio-demographic characteristics with oral health outcomes; and to describe the differences in oral health that remained after controlling for socio-demographic confounding, by dental provider group.

METHODS

The study included metropolitan Adelaide schoolchildren from Year 9 and 10 school grades (n = 373).

RESULTS

Children who received care from the School Dental Service (SDS) and from both the SDS and private dentists (Mixed) had significantly lower caries experience (DMFS) than children who received care from private dentists (Private) or who had not received any care for at least 2 years (No Recent Care). There were differences in the socio-demographic characteristics between children who used different dental providers, and these socio-demographic characteristics were significantly associated with levels of decayed, missing and filled surfaces and surfaces which had been fissure sealed. After controlling for socio-demographic characteristics using multiple regression, significant differences were seen in mean caries experience (DMFS) and mean numbers of decayed surfaces and filled surfaces.

CONCLUSION

Although from less advantaged backgrounds, children seen through the SDS had more favourable oral health outcomes than children seen by a private dentist.