National survey of caries prevalence in 6-15-year-old children in France

Evaluation of Gingival Health Status among 6- and 12-years-old Children in Dhamar City, Yemen: A Cross-sectional Study

INTRODUCTION

Epidemiological data on gingivitis in children are important for understanding the natural course of the disease, identifying its risk factors, and predicting its time trends. The objective of this study was to evaluate the prevalence and severity of gingivitis among 6- and 12-year-old school children in Dhamar city, Yemen.

MATERIALS AND METHODS

A total of 663 children (310 children of 6 years old and 353 children of 12 years old) were examined from 10 public primary schools. Gingival health status was assessed using the plaque index (PI), calculus index (CI), and gingival index (GI) on the six Ramfjord teeth. The latter index was used to categorize gingivitis severity at the subject level. Data were analyzed using independent f-test, chi-squared test, and Spearman's correlation. A p-value of < 0.05 was considered significant.

RESULTS

Both age groups had high mean of PI and GI with nonsignificant difference. The 12-year-old children had calculus deposits much higher than the 6-year-old group with significant difference. There was a significant correlation between age and gender of the whole sample with CI [(odds ratio, OR = 1.65, p = 0.003) and (OR = 0.74, p = 0.05) respectively]. Most of the participants presented with gingival inflammation, which was less in 12-year-old females.

CONCLUSION

Poor oral hygiene and mild gingivitis were highly prevalent among Yemeni school children.

CLINICAL SIGNIFICANCE

The early assessment and intervention of gingivitis and periodontitis will minimize the chance of tooth loss. It has been reported that marginal gingivitis begins early in childhood, increases in prevalence and severity at puberty, and then subsides slightly to the remainder of the second decade of life.

Caries experience in schoolchildren in Bucharest, Romania: the PAROGIM study

OBJECTIVE

This cross-sectional study aimed to investigate the prevalence and experience of dental caries among children from public middle schools in Bucharest in relation to socioeconomic status and access to school-based dental care.

METHODS

Clinical data were collected from 1,595 schoolchildren aged 10-17 years, randomly allocated by clusters into a stratified sample population. The dental caries were scored according to the World Health Organization (WHO) clinical criteria and expressed based on tooth and surface levels [Decayed-Missing-Filled Teeth/Surfaces indices (DMFT/DMFS)]. A questionnaire was administered to the children to determine the education level of their parents and their living standard.

RESULTS

The caries prevalence was 75 percent, and 64 percent had untreated caries. The mean DMFT value for the entire sample was 2.8, and its highest component was decayed teeth (mean DT 2). Parental education level had the strongest influence on the caries scores; 70 percent of children whose parents had not completed a university degree had untreated caries (%DT) compared to only 49 percent of children whose parents had a higher level of education (P < 0.05). Children with access to school-based dental care had significantly better dental health (P < 0.05).

CONCLUSION

Compared to previous national surveys, the caries rates among schoolchildren in Bucharest are slowly declining. However, there was still a high proportion of untreated caries with a clear socioeconomic gradient, and a change in the school-based oral preventive strategy is needed to meet the needs of the children.

Assessment of Gingival Health Status among 5- and 12-Year-Old Children in Yemen: A Cross-Sectional Study

Purpose. There are limited data about the gingival health status in Yemeni children. The aim, therefore, was to assess oral hygiene status and prevalence and severity of gingivitis among Yemeni preschool and school children. Materials and Methods. A total of 5396 children were included from 5 representative Yemeni governorates: Sana'a, Hajjah, Hodeida, Hadramaut, and Taiz. Five-year olds (1292) were recruited from private kindergartens while 12-year olds (4104) were selected from public primary schools. Gingival health status was assessed using the plaque index (PI), calculus index (CAI), and gingival index (GI) on the 6 Ramfjord teeth. The latter index was used to categorize gingivitis severity at the subject level. Data were analyzed using simple hypothesis testing, as well as ordinal regression. Results. The 12-year old children had significantly much higher mean PI, CAI, and GI (P < 0.001) with 78.6% presenting with gingivitis and 47.8% with moderate gingivitis. In contrast, the figures were 27.2% and 3.1% in the younger group (P < 0.001). There were significant variations according to gender, area of residence, and governorate. Regression analysis revealed that mean PI (OR = 35), mean CAI (OR = 7.7), male gender (OR = 1.6), living in rural areas (OR = 1.4), and being from Hajjah or Sana'a were independent risk factors of gingivitis severity in the older group. For the 5-year olds, the determinants were mean PI (OR = 122), male gender (OR = 1.4), and living in Sana'a or Taiz. Conclusions. Bad oral hygiene and moderate gingivitis are highly prevalent among Yemeni preschool and school children. Geographical location appeared as important independent risk factors of gingival inflammation.

Caries experience in the primary dentition among French 6-year-olds between 1991 and 2000

BACKGROUND

There are few national caries preventive policies for children in France. Various surveys suggest that in the late 1980s, oral health of the 6-year olds in France was poorer than in those of other European countries. In Val de Marne (a Department just east of Paris) a public dental service was established in 1991. A programme to inform preschool staff about dental diseases was commenced and volunteers brought oral health information to parents and health professionals. Periodical monitoring of primary tooth caries of 6-year olds was planned.

AIM

The aim of the study was to evaluate changes in primary tooth caries in 6-year olds over the 10 years of the programme.

METHODS

Participating 6-year olds, randomly selected, were examined in schools by dentists. Clinical data were collected (WHO criteria). Sociodemographic data were collected through questionnaire. Statistical analysis involved comparison of mean values, variance analysis and chi-square test for categorical variables.

RESULTS

The proportions of children with caries experience were, 38.9%, 30.6% and 22.2% in 1991, 1995 and 2000 respectively (P < 0.01). The dft index decreased from 1.74 to 1.39 and 1.05 respectively. About 75% of children with dental caries remained untreated. Children of non-European native parents or belonging to low socioeconomic families remained those most affected by dental caries in 2000.

CONCLUSION

Dental caries in 6-year olds improved between 1991 and 2000 in Val de Marne but caries remained a socially inequitable disease. Most children did not have access to dental care. The situation requires changes to the dental care provision system.

Oral health in 35-44 year old adults in France

In 1994, a national study was carried out in the Rhône-Alpes area of France, within the WHO International Collaborative Study on Oral Health Outcomes. One thousand, 35-44-year-old adults were examined in 35 geographical sites. WHO assessment forms were used for the survey. None of the 35-44 year olds were edentulous and 97 per cent of the sample had more than 20 natural teeth present. The mean number of teeth was 27.1. The DMFT index was 14.6. The DT component was 1.2 and MT was 3.0. FT (10.4) was the major component of the DMFT index. Of the 1000 adults, 90.9 per cent did not have bridges, 48.8 per cent needed conservative treatment and 51.9 per cent required crowns or bridges. Indications for fillings were frequent and concerned on average one tooth per subject. Disparities are brought to the fore between dental health and the required treatment, and the following variables: gender, location and socio-economic status.

How useful are cross-sectional data from surveys of dental caries?

Surveys are projects involving systematic data collection without a specific hypothesis to be tested and hence without a specific research design. This paper reviews their uses, and some of the issues involved with measuring dental caries in surveys. The principal benefits of surveys are in (a) monitoring trends in oral disease when the surveys are repeated periodically: and (b) giving dental health a visibility it might otherwise not get among policy-makers. On the other hand, they are of limited use in determining treatment needs for a population, evaluating treatment outcomes, and evaluating prevention programs. Some major issues in caries surveys today include difficulties with the DMF index; the use of exclusively visual versus visual-tactile criteria; "hidden" caries; and the appropriate role for early, non-cavitated carious lesions. The DMF index suffers from its mixing of disease and treatment, and more research is needed to determine the most appropriate role for exclusively visual criteria in surveys. Trade-offs, such as weighing the benefits of exclusively visual criteria against the probable greater difficulty in finding "hidden" caries, have not been determined. Inclusion of non-cavitated lesions in a survey will increase its cost. Organizers should therefore be clear before the survey on how this additional information will be used to justify the additional expense.

Caries prevalence and salt fluoridation among 9-year-old schoolchildren in Strasbourg, France

The 9-year-old group (236 children) of an epidemiological study carried out in 1991 in Strasbourg on children aged 6 to 15 years was selected with the aim of determining if the caries prevalence reduction observed could be related to the use of salt fluoridation (FS) introduced in France in 1987. From these 236 children, 143 answered a questionnaire which showed that 36 of them were fluoridated salt users and 107 were not. The dft index was significantly lower in the FS consumers which showed 35.5% dft reduction compared to the non-FS-consuming children. When using the Generalized Linear Model, this reduction was significant (P = 0.03). Although lower in the FS group, the DMFT and DMFS indices showed no statistical significant difference. It appeared that 72.2% of the users took simultaneously fluoride tablets but no dental fluorosis was observed. The use of fluoride tablets had a significant effect on the DMFS (P = 10(-2)). The children who consumed FS used more frequently fluoridated mouthrinses (P = 10(-3)) and had more frequent professional application of fluoridated gel and varnishes than non-consumers (P = 0.02). The DMFS index increased with the number of meals (P = 10(-6)), which was the most significant variable entered into the Generalized Linear Model. The children who brushed their teeth once a day had a DMFS value 2.6 times higher than those who brushed regularly three times a day (P = 10(-3)). The DMFS value was 4.4 times higher among the children who brushed their teeth irregularly when compared with those who brushed three times a day (P = 10(-2)).

Using the DMF gender difference to assess the "major" role of fluoride toothpastes in the caries decline in industrialized countries: a meta-analysis

The regular use of fluoridated toothpastes has been ascribed a major role in the observed decline in caries prevalence in industrialized countries during the last 20 to 25 years, but only indirect evidence supports this claim. The purpose of this study was to test the hypothesis that the more frequent use of fluoride toothpastes by girls than by boys has reduced the relative age-specific D(M)FT gender difference, and that this difference should decrease with increasing age and fluoride toothpaste exposure among adolescents. The material comprised 8,777 subjects 12 to 17 years of age from the pre-fluoride toothpaste era (1946-1959) and 39,903 from the period when use of fluoride toothpaste had become common (1983-1993) in industrialized countries. Meta-analyses were done using the relative age-specific mean D(M)FT difference between girls and boys. Separate analyses were carried out for subgroups of studies/countries to check for confounding. Regardless of analytical approach, no evidence was found to support the hypothesis. It is concluded that the gender difference in fluoride exposure due to tooth brushing frequency is too small to matter, that the study lacked power, or that the role of fluoride toothpastes in the caries decline has been overrated.

Cross-sectional comparisons of caries time trends in nursery school children in Sendai, Japan

The aim of this study was to clarify the trends in caries experience in the primary dentition of nursery school children in Sendai, Japan, over a period of 20 yr. An annual clinical dental examination of children aged 2-5 yr at 13 nursery schools in Sendai City was carried out in 1972, 1977, 1982, 1987 and 1992. Data obtained from all five surveys were compared in each age group respectively. The percentages of 2-, 3- and 4-yr-olds free from caries increased remarkably until 1977, while that in 5-yr-olds started increasing several years later. After such increments, percentages in all age groups except 3-yr-olds remained almost at the same level with slight fluctuations. The mean deft and defs values per child in 2-, 3- and 4-yr-olds decreased remarkably until 1977, but then remained almost at the same level thereafter. That in 5-yr-olds continued decreasing slightly during the 20-yr period. The marked reduction of caries experience in nursery school children shown during the 1970's did not continue through the 1980's or the beginning of the 1990's.

Oral health in adolescents from a small French town

In France, caries are more prevalent in rural areas than in large cities. This study analyzed the relationship between number of oral health indices and some known risk factors (toothbrushing, sugar consumption, saliva components) and sociodemographic factors in adolescents from a small town. The sample included 112 children aged 12-14 in the north-east of France. School marks was found to be better linked with dental caries indices than the socio-occupational category of parents: gingival index (GI), DMFS, DMFT and caries severity (CS) significantly increased with decreasing school marks; oral plaque was related to socio-occupational of parents. The analysis using the regression method showed that the variance explained by the various factors studied was modest (between 23 and 30%) for GI, initial caries sites (IS), DS, DMFS, DMFT and CS, and was small for plaque (5%) and calculus (3%). This would be due in part to the wide dispersion of these indices. The sex had a non-significant regression coefficient for all oral health indices investigated. For GI, only mutans streptococci (MS) and plaque had a significant regression coefficient. Calculus was explained by any factor considered. Only MS had a significant part in plaque. IS was explained by MS, toothbrushing and age. For DS, only toothbrushing, MS and sweet drinks during meals had a significant part. DMFS and DMFT were explained only by MS and age. CS was explained by MS, age, salivary buffer pH, salivary flow rate, and toothbrushing.

Caries prevalence in 6- to 15-year-old French children based on the 1987 and 1991 national surveys

The caries prevalence in a multi-stage probability sample of 18,786 children representative of all French children 6-15 years of age was studied in 1991 and compared with the results of a similar survey made in 1987. A significant decline in dental caries in France became evident. This decline, observed in primary as well as in permanent teeth, was of variable magnitude among the different age groups. At the age of 6, 48.6% of the children were totally caries-free in 1991. At the age of 12, the DMFT and DMFS indices were 2.59 and 4.72, respectively, representing a corresponding decrease of 38% and 37%. In 1991, more caries-affected teeth or surfaces were filled, whereas fewer caries-affected teeth or surfaces were untreated. Females and children living in rural areas had a higher caries prevalence in both surveys. Pit-and-fissure lesions were the predominant caries types. Dental fluorosis was very uncommon; 96.1% of the 18,786 children examined in 1991 were totally free of any such lesions. Average plaque and calculus indices were similar in 1987 and in 1991, but a decrease of 25% was observed in the average gingival indices. Although the relative contributions of various preventive factors leading to this caries reduction are not clear, it should be noted that use of fluoridated salt (250 mg/kg KF) started in January, 1987. The sale of fluoridated dentifrices and the use of fluoride tablets and sugar substitutes increased during the period from 1987 to 1991.

Prevalence of dental caries and gingivitis in a population of Mexican schoolchildren

The prevalence of dental caries and gingivitis was assessed in schoolchildren of the Tlalpan region in Mexico City. A total of 700 children (age range: 11-17 yr) of both sexes were examined. The sample population included children attending the Middle-School System, where two shifts are run (A.M. and P.M.). Decayed, missing and filled surfaces (DMFS), and Gingival Index (GI) were recorded for all existing teeth. Analysis of the data showed that mean DMFS scores increased with chronological age in both genders, were higher in the P.M. session, and more elevated in females. Similarly the mean GI scores also increased with age, and were higher in the P.M. session. In contrast to the DMFS scores, males presented higher GI scores than females at all age intervals. The results of our study indicated a distinctively high prevalence of caries and gingivitis in Mexican schoolchildren.

Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The growth in the dental literature continues to escalate, as evidenced by the publication of at least 326 new books in 1988 and 1989 and more than 20 new journals in 1989. There still appears to be undue emphasis on quantity instead of quality of research. This proliferation in the literature poses ever increasing difficulties to this Committee in filtering out the articles that are of particular interest to the members of the Academy and identifying those that are most likely to have a major impact on dental practice and service. The subjects covered include periodontics, caries and preventive dentistry, craniomandibular disorders, occlusion, pulp biology, ceramics, and restorative dental materials.

The future of water fluoridation and other systemic fluorides

School and community water fluoridation, salt fluoridation, and use of dietary fluoride supplements have abundant scientific support as effective caries-preventive methods. Because caries has declined greatly in many developed countries from use of topical fluorides, the absolute caries reduction will be considerably smaller when systemic fluoride methods are implemented now than it was 20 to 40 years ago. For countries with most of the population living in cities with communal water supplies, community fluoridation is the most logical approach from the standpoints of cost-effectiveness and total caries-preventive impact. In countries with a mostly rural population without central water supplies, salt fluoridation is more practical. Dietary fluoride supplements can be recommended only for regions where neither water fluoridation nor salt fluoridation is possible, or as a temporary measure. Although divergent views exist concerning the relative caries-preventive effects of pre-eruptive and post-eruptive fluoride administration, the effectiveness of systemic fluoride methods for preventing dental caries remains unchallenged. Persuasive scientific and public health arguments exist to justify implementing and sustaining their use. The future of these methods will be influenced by the findings of new clinical and epidemiological research. Social, political, economic, and educational factors will be of equal, if not greater, importance. Perceptions of the current severity of dental caries as a health problem and of risks associated with preventing the problem may affect the future uses of systemic fluorides more than will recommendations of scientists.