Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN)

OBJECTIVES

This cross-sectional study aimed to assess dental health and odontogenic infections in students with special health care needs (SHCN) in the Free State of Thuringia, Germany.

METHODS

From 1283 students with SHCN aged 6-16 years, 66.0 % (n = 848 of whom are 35.7 % females and 64.3 % males) with intellectual/learning disabilities (ID/LD), physical disabilities (PD), and sensory disorders (SD) participated after informed consent in oral examinations according to WHO standards. Dental caries was assessed by dmft/DMFT, odontogenic infections by pufa/PUFA. Fissure sealants (FS) were scored in permanent molars. Data were compared to regional and national reference data and analysed by t test and age-adjusted logistic regression models.

RESULTS

Students with SHCN revealed 41.2 % caries prevalence in permanent and 31.7 % in primary teeth. Highest prevalence/experience of caries and odontogenic infections in primary teeth was recorded in 6-11-year-olds with PD (65.1 %/2.3 dmft; 14.0 %/0.3 pufa). Most affected permanent teeth were observed in students with ID/LD (12-16-year-olds 59.6 %/2.4 DMFT; 6-11-year-olds 2.8 %/0.03 PUFA). All odontogenic infections in 12-16-year-olds occurred in males; n = 9 students revealed n = 9 teeth with pufa/PUFA. Students with ID/LD aged 6-11 years exhibited lowest prevalence of FS (29.0 %) and mean of 0.8 FS. Students with SHCN suffered more than twice as frequent from untreated dental caries and benefited up to 29.0 % less from FS than peers without disabilities.

CONCLUSION

This first study investigating odontogenic infections of German students with SHCN revealed highest prevalence in primary teeth and in males. Oral health among students with SHCN is reduced, and FS are underutilized compared to German students without disabilities.

CLINICAL RELEVANCE

Reinforcing the application of FS in students with SHCN might contribute to reducing disparities in oral health.

[Influence of Fissure Sealants on Dental Health of Elementary School Children in Weimar - A Longitudinal Observational Study under Real-life Conditions]

The aim of the present observational study was to assess the effect of the number and timing of placing fissure sealants (FS) on caries prevalence in elementary school children under real-life conditions. Methods: Oral health data from 7- to 10-year-old elementary school children (n=505) attending 4 consecutive annual checkups between 2004 and 2009 was extracted from the public health service database. The number of intact FS and the number of teeth affected by caries was scored according to WHO standard (1997). Results: 34.9% pupils had at least one, 10% 4 FS. Children without FS had a higher dental caries rate compared to peers with FS (0.2 DT/0.4 DMFT vs. 0.1 DT/0.2 DMFT). Pupils with 4 FS showed the lowest number of teeth with caries (0 DT/0 DMFT). Children with an early application of FS had a lower D-component than children with a later or missing application (0.1 DT vs. 0.2 DT). Pupils with less than 4 FS had a higher risk of developing caries in their permanent dentition compared to peers with 4 FS (OR 4.36). Conclusion: FS is an effective caries preventive measure under real-life conditions. Early application and sealing of all 4 molars can optimize the prevention of caries in the permanent dentition.

Comparison of visual inspection and different radiographic methods for dentin caries detection on occlusal surfaces

OBJECTIVES

The aim of the present study was to assess the validity of the digital phosphor plate radiographic technique (Gendex Dental Systems) on occlusal surfaces in comparison with visual examination and conventional E- and F-speed films.

METHODS

The study material consisted of 54 non-cavitated third molars with a range of appearances, including apparently sound surfaces. Each surface was visually examined (VI) according to the criteria established by Ekstrand et al. Three radiographic images (E-speed, F-speed, digital phosphor plate film) were taken of each molar. The standardized radiograph technique used an alignment fixture to reproduce the focus-to-object distance as well as the object-to-film distance. Afterwards each tooth was cut into sections in the buccolingual direction with a microtome saw, and caries extension was assessed using light microscopy (LM) and microradiography (MR). The statistical analysis included the calculation of sensitivity (SE), specificity (SP) and A(z) values.

RESULTS

The following validity parameters were found for the tested diagnostic methods on the dentin caries level: VI/LM, 68.0 SE/93.1 SP/0.698 A(z); VI/MR, 68.2/87.5/0.751; E-speed/LM, 76.0/78.6/0.637; E-speed/MR, 77.3/74.2/0.681; F-speed/LM, 64.0/67.9/0.507; F-speed/MR, 68.2/67.7/0.594; Gendex/LM, 60.0/85.7/0.629; and Gendex/MR, 59.1/80.6/0.586.

CONCLUSION

The methods used showed different levels of validity: E- and F-speed films were linked to higher sensitivity values, whereas a higher specificity was recorded for the tested imaging plate system. In accordance with the diagnostic performance, the digital system can be recommended for practical use and potentially help prevent overtreatment thanks to its high SP.

In vivo detection of non-cavitated caries lesions on occlusal surfaces by visual inspection and quantitative light-induced fluorescence

OBJECTIVE

The aim of this clinical caries detection study was to compare the outcome of quantitative light-induced fluorescence (QLF) and meticulous visual inspection (VI) in detecting non-cavitated caries lesions on occlusal surfaces in young adolescents. It was hypothesized that the respective diagnostic performances of meticulous VI and QLF are similar.

MATERIAL AND METHODS

The subjects were 34 fifteen-year-old students. Five-hundred-and-seventeen cleaned occlusal surfaces were air-dried and examined using VI. Fluorescence images were captured with QLF equipment and custom software was used to display, store and analyze the images. The area of the lesion (area; mm2), fluorescence loss (DeltaF;%) and DeltaQ (Area*DeltaF; mm2*%) were determined at a QLF threshold of -5%. The presence/absence of non-cavitated lesions was independently recorded with both methods.

RESULTS

78.8% of all untreated surfaces were classified as sound or as having a non-cavitated lesion with both methods uniformly (VI+QLF). On 7.1% of all surfaces a lesion was detected by VI only and on 14.1% by QLF only. All parameters (Area, DeltaF, DeltaQ) differed significantly between lesions registered with both methods (VI+QLF) and lesions recorded with QLF only.

CONCLUSIONS

It was concluded that our hypothesis cannot be confirmed. The study shows that QLF detects (1) more non-cavitated occlusal lesions and (2) smaller lesions compared to VI. However, taking into consideration time-consuming image capturing and analysis, QLF is not really practical for use in the dental office.

Establishing quantitative light-induced fluorescence cut-offs for the detection of occlusal dentine lesions

The aims of this in vitro study were, first, to define suitable cut-off values for the detection of occlusal dentine lesions by means of quantitative light-induced fluorescence (QLF), and, second, to compare the validity of light microscopy (LM) and microradiography (MR) as reference standards. Fifty-four third molar occlusal fissures with sound sites or non-cavitated lesions were examined. Standard QLF equipment was used to capture, display, store, and analyze fluorescence images. Each tooth was cut into sections in the bucco-lingual direction using a microtome saw, and the caries levels were subsequently assessed with the two reference methods. The histological examination with LM indicated that 46% of the specimens had carious lesions progressing into the dentine compared with 41% measured using MR (D3-4 level). Using optimal cut-off levels for the detection of dentine lesions, the sensitivity and specificity values were > 80%. The area under the receiver operating characteristic curve was slightly higher for MR (0.91-0.93) than for LM (0.88-0.89). The results of this study give a good idea of suitable cut-off points for the detection of occlusal dentine lesions using QLF. Owing to the small number of specimens in this study, further studies should be carried out before establishing definite cut-offs.

Detection of initial caries lesions on smooth surfaces by quantitative light-induced fluorescence and visual examination: anin vivocomparison

The aim of this clinical study was to compare the outcome of quantitative laser/light-induced fluorescence (QLF) and visual inspection (VI) for the detection of initial caries lesions on all maxillary and mandibular smooth surfaces in caries-risk adolescents. The subjects were 34 students, mean age 15 yr. A total of 879 buccal and 882 lingual surfaces were air-dried and visually examined at a magnification of x3.5. Fluorescence images of each smooth surface were captured with QLF\clin equipment, and QLF software 2.00 was used to display, store, and analyse the images. Fluorescence loss (deltaF; %) and area of the lesion (A; mm2), and fluorescence loss integrated over the lesion area (deltaQ; deltaF x A; % x mm2), were determined. The presence or absence of initial caries lesions was scored using both VI and QLF. A total of 87.2% of all smooth surfaces were scored as sound or initially carious when assessed by VI + QLF in combination: 4.9% were detected by VI alone and 7.9% by QLF alone. The parameters DeltaF, A, and DeltaQ differed significantly between lesions registered with VI + QLF and QLF alone. It was concluded that (i) QLF seems to be a sensitive method that is suitable for the detection of visually undetected initial caries lesions; and (ii) that the clinical use of QLF is limited by several confounding factors in caries-risk adolescents.

[Evaluation of the therapeutic performance of an integral program of neuroses as applied to an outpatient clinic]

1. During 1976, it was evaluated the treatment of 45 cases of neurosis, carried out by monitors (D4) of the External Consultation of Barros Luco-Trudeau Hospital. 2. It is emphasized that the cost of the program in terms of professional hours and economic resources is low. 3. From 156 patients referred to therapy, 88 deserted (56,4%); 23 attend without finishing therapy (14,7%), and 45 completed it (28,8%). 4. It seems important to carry out studies about the factors that influence the desertion to the psychotherapy offered by our psychiatric services. To establish comparisons between the attendance to the group therapy, and also between the attendance to the group therapy carried out by professionals and carried out by monitors. 5. In the patients that complete therapy (12 sessions of 1,5 hours, once a week) the total improvement is 79,1%, the partial, 11,3%, and there is no modification in 9,3%.