Direct restorations and enhanced caries prevention among 20- to 60-year-olds attending Helsinki City Public Dental Service - a register-based observation

OBJECTIVE

Our retrospective register-based observational study evaluated age-specific aspects and changes in volume and content of direct restorative procedures, pulp cappings and enhanced caries prevention measures given to adults.

METHODS

Data included all treatments provided for 20- to 60-year-olds visiting the Helsinki City Public Dental Service (PDS) in 2012 and 2017. For both years, the data were aggregated into 5-year age groups. Data included means of DMFT indices, number and size of direct restorations, number of specific codes for pulp cappings and enhanced prevention.

RESULTS

Around half of all patients received restorations, 39,820 (50.9%) in 2012 and 43,392 (45.9%) in 2017. The greatest increase in DMFT means by age cohort was found for the 2012 age cohort of 25- to 29-year-olds and the smallest for the 2012 age cohort of 45- to 49-year-olds. In each same-age group and each age cohort, the enhanced prevention in 2017 was less frequent than in 2012. The proportion of two-surface restorations accounted for 44.7% of procedures in 2012 and 45.9% in 2017, followed by an increasing proportion of one-surface restorations, from 28.3% in 2012 to 32.9% in 2017. Associations between restoration size and age group were highly significant (p < .001).

CONCLUSIONS

The volume of direct restorative procedures and enhanced prevention measures were strongly age-dependent. Restorative treatment procedures were more frequent in older age groups than in younger age groups, and vice versa for enhanced prevention and pulp cappings. The magnitude of restorative treatment decreased slowly from 2012 to 2017, and overall enhanced preventive treatment was limited.

Surface-specific Correlation Between Extrinsic Stains and Early Childhood Caries

PURPOSE

This study was designed to assess (i) the prevalence of extrinsic stains in preschool children (ii) the correlation between extrinsic stains and the occurrence of early childhood caries (ECC) (iii) to compare the distribution of caries in pits and fissures, smooth surfaces or both among children with and without extrinsic stains.

METHODS

A cross-sectional study was carried out among 1,486 children aged 0-3 years. Extrinsic stain and ECC were scored by two calibrated examiners. Correlation between ECC pattern and extrinsic stains was analysed by logistic regression. Caries distribution in fissures, smooth surfaces or both were analysed using Mann Whitney test and Pearson chi-squared test.

RESULTS

The prevalence of extrinsic stains among 0-3 years children was 6.2%. Children with extrinsic stain had a 1.13-fold greater chance of exhibiting ECC (OR = 1.132, 95% CI: 0.739-1.733). Statistically significant differences were found for fissure caries (p < 0.0002) and both smooth surface and fissure caries (p < 0.0328) among children in both groups.

CONCLUSIONS

Occurrence of ECC appears to have surface-specific variations in children with and without extrinsic stains. However, the interaction of these individual factors and their impact on oral health outcomes needs to be identified through further research.

Survival analysis of caries incidence in African-American school-aged children

OBJECTIVES

To conduct an assessment of time-dependent covariates related to dental caries of the permanent dentition among a low socioeconomic status, understudied cohort of children, incorporating time-dependent covariates through the application of extended Cox proportional hazards modeling.

METHODS

This study modeled the time to first cavitated dental caries in permanent teeth among school-aged children and assessed factors associated with this event. A cohort of 98 low socioeconomic status African-American children with mean age of 5.85 years at baseline was recruited in Uniontown, Alabama and followed prospectively for 6 years. None of these children had dental caries on permanent teeth at baseline, and oral examinations were performed annually. Caries-free survival curves were generated to describe time to event (having first decayed, filled, or missing permanent surface). Bivariate and multivariable extended Cox hazards modeling was used to assess the relationships between time-dependent and time-independent covariates and time to event.

RESULTS

Twenty-eight children (28.6 percent) had their first permanent tooth caries event during the 6-year follow-up. Multivariable results showed that greater consumption of water was associated with lower dental caries hazard, while previous primary tooth caries experience was associated with greater dental caries hazard after adjustment for frequency of consumptions of milk, added-sugar beverages, and 100 percent juice.

CONCLUSIONS

There was a global/overall significant caries protective effect of water consumption during the school-age period of child development.

Shortage of dentists in Outer Regional and Remote areas and long public dental waiting lists: Changes over the past decade

OBJECTIVE

The shortage of dentists in Outer Regional and Remote areas of Australia and long public dental waiting lists have been the subject of media attention over the last decade. A number of state and federal initiatives were introduced over the years to address these problems. This study aims to gauge whether the waiting lists and shortage of dentists in Outer Regional and Remote areas have seen a positive change over the last decade.

DESIGN

This evaluation study analysed and compared the number of dentists full-time equivalent per 100 000 population, eligible population and waiting list size (New South Wales and Queensland) at various points in time over the last decade.

SETTING

National.

PARTICIPANTS

Data were extracted from practitioner registry reports.

MAIN OUTCOME MEASURES

Number of dentists practising in Outer Regional and Remote areas of Australia and number of people on the public dental waiting list (New South Wales and Queensland).

RESULTS

There was a significant improvement in the number of dentists practising in Outer Regional and Remote areas of Australia. The public dental waiting lists in New South Wales and Queensland (as of September 2016) were found to have surpassed their pre National Partnership Agreement levels in 2012. The growth of public dental waiting lists exceeded the growth of the eligible population by a significant margin.

CONCLUSION

The dentist-to-population ratios in Outer Regional and Remote areas have seen a significant improvement. The reduction in the number of people on the public dental waiting list was significant, but brief.

The equity of access to primary dental care in São Paulo, Brazil: A geospatial analysis

OBJECTIVES

Brazil is one of the largest countries in the world, in terms of geography and population. Most Brazilians reside in the south and south-eastern regions, with notable numbers in the regions' megacities, such as São Paulo city. Healthcare provision in such a complex environment is difficult. Thus, a clear understanding of the distribution - or rather, the maldistribution - of these services is fundamental for optimising the allocation of human and financial resources to areas of greatest privation. The present study aimed to determine the distribution of primary dental clinics in São Paulo city.

METHODS

A total of 4,101 primary dental clinics in São Paulo city were identified and geocoded. Clinic locations were integrated with the city's 19,128 constituent census tracts - each containing sociodemographic data for the 11,252,204 residents - using Geographic Information Systems (GIS).

RESULTS

Approximately two-thirds (64.8%) of the population resided within 0.5 km of a primary dental clinic, and a further 23.9% were within 1 km. Populations more than 1 km out were typically characterised as sociodemographically disadvantaged. Primary dental clinics were also more sparsely distributed in the city's peripheral census tracts than central census tracts.

CONCLUSION

Primary dental clinics are maldistributed in São Paulo city, with disadvantaged populations having less spatial access than their advantaged counterparts.

Factors affecting dental fluorosis in low socioeconomic status children in Mexico

OBJECTIVE

To assess the association between dental fluorosis and maternal education in schoolchildren of medium and low socioeconomic status in a low income region of Mexico.

DESIGN

Cross-sectional study.

SETTINGS

Public schools in the south-central region of Oaxaca, Mexico where the mean fluoride water concentration was 1.01 mg/L (SD 0.21; range 0.71-1.40). Fluoridated salt (200mgF/kg) was available in the region.

PARTICIPANTS

794 schoolchildren.

METHODS

To identify the socioeconomic status of the participants, the Bronfman index was used. Dental fluorosis was assessed applying the Thysltrup-Fejerskov Index, (TF).

RESULTS

The children's mean age was 10.4 (SD1.2) years. The prevalence of dental fluorosis (TF⟩0) was high 95.7% and 45.2% of the children showed dental fluorosis of TF≥4. The percentage of children showing TF≥4 was 48.8% where their mothers' education was ⟨6 years of schooling compared to 36.7% among other children (p⟨0.001). The multinomial logistic regression model using as base outcome category TF≤2 showed that severe forms of fluorosis (TF≥4) were associated with the consumption of boiled water, (OR= 1.65, p=0.039) of fluoridated salt (OR= 2.61 p=0.001), high brushing frequency (OR=3.12, p=0.001) and lower maternal education (OR=1.71, p=0.007).

CONCLUSIONS

A high prevalence of dental fluorosis was observed in the study region. An unequal burden of fluorosis in aesthetically objectionable categories was found in children exposed to several sources of fluoride and whose mother had lower educational level.

Dental caries experience, rather than toothbrushing, influences the incidence of dental caries in young Japanese adults

A dose-response relationship between toothbrushing frequency and the incidence of dental caries has not been confirmed. Furthermore, no longitudinal study about this relationship has considered dental caries experience at baseline, which is an important factor influencing the frequency of future caries.

OBJECTIVE

To elucidate the association between the incidence of dental caries and toothbrushing frequency after adjusting for dental caries experience at baseline in a Japanese population.

BASIC RESEARCH DESIGN

The 92 recruits of the Japan Maritime Self-Defense Force in Kure, Japan, in 2011 were followed up for 3 years. They underwent oral examination at the annual checkups and answered questions about toothbrushing frequency.

MAIN OUTCOME MEASURES

The multiple logistic regression analysis was used to analyze the incidence of dental caries and to identify independent effects of toothbrushing frequency and dental caries experience at baseline. Furthermore, the relative importance of the incidence of dental caries was investigated among other independent variables using the partial adjusted R² score.

RESULTS

Logistic regression analysis showed that toothbrushing frequency alone did not influence the increment in decayed, missing, and filled teeth (DMFT). However, DMFT at baseline alone was associated with the increment in DMFT (crude odds ratio, OR, 1.20, 95% confidence interval, CI, 1.08,1.33). In the fully adjusted model, only DMFT at baseline was associated with the increment in DMFT (adjusted OR 1.23, 95%CI 1.09,1.38).

CONCLUSION

After three years, the incidence of dental caries in young adult Japanese males was influenced by DMFT at baseline, rather than toothbrushing frequency.

Factors underlying the polarization of early childhood caries within a high-risk population

BACKGROUND

Early childhood caries (ECC) are particularly prevalent in disadvantaged populations, and socioeconomic factors are associated with the polarization of disease. A previous study showed that even within a homogenous low-income population disease is polarized, indicating that other factors apart from income may contribute to disease susceptibility.

METHODS

This study used a hierarchical approach to identify factors associated with polarization of ECC in low-income subjects. This cross-sectional study was conducted retrospectively using a cohort of 244 children (aged 48-72 months) with family incomes not exceeding double the minimum wage (U.S. $8,208.00/year), living in neighborhoods on the outskirts of São Luís, Maranhão, Brazil. The sample was divided into three groups based on the Significant Caries (SiC) Index: no caries group, few caries group (mean 1.38 lesions), and a high caries group (mean 3.82 lesions). Hierarchical multinomial logistic regression analyses were performed based on a theoretical model.

RESULTS

Twenty-eight (11.5%) of the 244 children presented with high caries. Age (p = 0.026; prevalence ratio (PR) = 1.10; 95% confidence interval (CI) 1.01-1.20) and frequency of sucrose consumption - p = 0.001; PR 4.65 (95% CI 1.83-11.84) were associated with increased risk of ECC.

CONCLUSIONS

In the high caries group, greater consumption of sucrose between main meals may explain why, in a group of children with homogenous social and health conditions, some had more caries than others.

Development of gold standard ion-selective electrode-based methods for fluoride analysis

BACKGROUND/AIMS

Currently available techniques for fluoride analysis are not standardized. Therefore, this study was designed to develop standardized methods for analyzing fluoride in biological and nonbiological samples used for dental research.

METHODS

A group of nine laboratories analyzed a set of standardized samples for fluoride concentration using their own methods. The group then reviewed existing analytical techniques for fluoride analysis, identified inconsistencies in the use of these techniques and conducted testing to resolve differences. Based on the results of the testing undertaken to define the best approaches for the analysis, the group developed recommendations for direct and microdiffusion methods using the fluoride ion-selective electrode.

RESULTS

Initial results demonstrated that there was no consensus regarding the choice of analytical techniques for different types of samples. Although for several types of samples, the results of the fluoride analyses were similar among some laboratories, greater differences were observed for saliva, food and beverage samples. In spite of these initial differences, precise and true values of fluoride concentration, as well as smaller differences between laboratories, were obtained once the standardized methodologies were used. Intraclass correlation coefficients ranged from 0.90 to 0.93, for the analysis of a certified reference material, using the standardized methodologies.

CONCLUSION

The results of this study demonstrate that the development and use of standardized protocols for F analysis significantly decreased differences among laboratories and resulted in more precise and true values.