Oral Health and Preventive Dentistry, 01/2005

Purpose: The aim of this study was to evaluate the effect of daily intake of LongoVital (LV) (herbal vitamin tablets) in the prevention of RAS. Materials and Methods: A group of 78 consecutively referred patients was enrolled to a three-months pretreatment period. Fifty subjects were then randomly allocated to an LV-group (n = 25) or a placebo group (N = 25). A double blind, stratified-randomised clinical case-control study was performed during six months. Number and size of the ulcers were registered by the patients using a standardized chart. The degree of discomfort was recorded on a 100 mm horizontal visual analogue scale (VAS-scale). Results: The three-months pretreatment period revealed that the most dominant symptoms were pain (78%) followed by burning sensation (18%). No significant differences between the two groups were found during this period when a comparison was made at the end of the study. After the intervention period the number of aphthous ulcers/month decreased significantly in the LV-group (p = 0,02). The number of days in pain/month were also reduced (p < 0,001). If a 50% reduction of number of aphthous ulcers and days in pain were considered as clinically relevant, no statistical significant differences were found between the groups. Conclusion: Thus, no strong evidence was found that justified a recommendation of LV as a general drug for treatment of RAS. Keywords: recurrent aphthous stomatits, LongoVital, immunostimulation

The purpose of the present paper is: 1) to review recent concepts of the causes of caries; 2) to illustrate parameters of causes of cases and of incidence; and 3) to outline the consequences for caries prevention and oral health promotion. The paper is divided in three sections. Section 1 reviews recent theories of the causes of caries and summarizes that it is necessary to make a clear distinction between the causes of a case of caries and causes of occurrence of caries in populations. Cases relate to the reasons why individuals get sick, while incidence relates to why so many (or so few) within a population get sick. In section 2 the difference between the causes of a case and of the occurrence in a population is illustrated. A new social epidemiology moves beyond the focus on individual level risk factors to a multi-level perspective. Applied to oral diseases the paradigm of social epidemiology bridges our understanding of the biological determinants of caries with an understanding of the societal determinants of caries. Social epidemiology is the branch of epidemiology that studies the social distribution and social determinants of states of health. Individuals are embedded in societies and populations. In section 3 the insight acquired above is applied to the choice of disease-preventive and oral health-promotive strategies. Prevention of caries and promotion of oral health must be rooted in the understanding of caries as it occurs in populations. Keywords: dental caries, causes, cases, incidence, prevention, promotion

Purpose: To analyse caries risk factors of 12-13-year-old children living in Laos, using the computer program Cariogram to illustrate the caries risk profile. In addition, to compare the results with a study performed in Sweden. Materials and Methods: One hundred Laotian and 392 Swedish children were included. Interviews were performed to obtain information on diet intake and fluoride use. Saliva was analysed for mutans streptococci, lactobacilli and secretion rate/buffering capacity. Oral hygiene was assessed using the Silness and Löe criteria. Caries prevalence was recorded according to WHO. The data were entered into the Cariogram to determine each child's caries risk, expressed as 'the chance of avoiding caries'. The children were divided into five risk groups. Results: Mean DMFT level of the Laotian children was 4.61 ± 2.95 and 1.38 ± 1.97 in the Swedish group. For the risk factors plaque amount, frequency of food intake, saliva secretion rate, buffering capacity and fluoride, the Laotian children had significantly less favourable values compared to the Swedes. Only 6% of Laotian children belonged to the Cariogram low risk group versus 40% of the Swedish children. The mean DMFT for the five Cariogram groups was (from low to high risk) 0.00, 3.00, 3.56, 5.66, 6.11 for the Lao children and 0.31, 1.39, 2.56, 3.03, 2.91 for the Swedish ones. The mean chance of avoiding caries was 37.3% for the Laotians and 69.2% for the Swedish children (p < 0.001). Conclusion: According to the 'opinion' of the Cariogram, the Laotian children demonstrated significantly higher caries risk than Swedish children. Keywords: cariogram, caries risk factors, Mutans streptococci, lactobacilli, salivary secretion rate, buffering capacity, Lao PDR

Purpose: To describe the caries status and oral health-related behaviors of three- to five-year-old Chinese children by their ethnic background, and to identify potential determinants of caries experience. Materials and Methods: A cross-sectional survey was undertaken in a multi-ethnic province (Guangxi) in Southern China. Representative samples of preschool children from two ethnic groups (Han and an ethnic minority Zhuang: 487 Han and 470 Zhuang children) were examined using decayed, missing, filled teeth/surface (dmft/dmfs) indices. The children's general information as well as their personal oral hygiene practices and dietary habits were collected based on a structured questionnaire. Results: Overall, 60% of children had caries with a mean dmft value of 3.01. Zhuang children had a significantly higher prevalence of rampant caries (13% vs. 9%), mean dmft (3.36 vs. 2.66) and mean dmfs (5.10 vs. 3.76) than the Han children. Decayed teeth/surfaces dominated the dmft/dmfs indices for both Han and Zhuang children. Multiple regression analysis showed that ethnicity and drinking fruit juice from feeding bottles during babyhood were significantly related to dmft. Conclusion: There was a higher level of caries experience in the Zhuang ethnic minority than in Han preschool children. Keywords: dental caries, ethnic groups, oral hygiene practice, dental behavior

Purpose: The aim of this paper was to describe the caries experience in four North Italian areas. The areas selected were four North Italian medium-sized cities: San Remo located in western Liguria, Ferrara in Emilia, and Varese and Melegnano (Milan suburbs). Materials and Methods: 1104 subjects (560 males and 544 females) were examined. Several dental outcomes were used: DMFT Index and SiCindex following WHO recommendations; and the caries experience ratio; the percentage of children with high caries disease and with rampant caries was calculated as the percentage of subjects with DMFT > 0, DMFT >= 4 and DMFT >= 7. Results: Mean DMFT ranged from 1.21 ± 1.65 in the Ferrara group to 1.83 ± 2.49 in San Remo. Among the groups, statistically significant differences were observed for DT and DMFT (p = 0.04 and p = 0.01 respectively). The SiC index was 3.75 ± 1.87, 3 (2-5) in all samples, with significant differences among the four areas (p = 0.04). No statistical differences were observed among the four areas regarding caries experience and the proportion of children with high and rampant caries. An elevated proportion of subjects with high caries (DMFT >= 4) was noted in the San Remo group (22.9%). The distribution of children by gender according to DMFT levels was not statistically significant either. The F/DMFT ratio was similar in the survey areas, from 0.30 in San Remo, 0.38 in Varese and Ferrara, to 0.40 in the Milan suburbs. Conclusion: Information drawn from this study can be helpful to describe and plan future dental prevention programmes aimed at reducing caries experience and promoting better oral health level. Keywords: caries epidemiology, DMFT index, SiC index, children, Italy

Purpose: Dental care in Italy is carried out mainly by private professionals and therefore the collection of epidemiological data on dental health is not often possible. Thus, the aim of this study was to collect the DMFT and CPITN values in a population of young Italian male subjects, namely call-up soldiers and cadets, and relate them to the socio-economic status of the subjects. Material and Methods: The sample was made up of two groups from different Italian academies: call-up soldiers: 1184 male call-up soldiers aged from 19 to 25; cadets: 2477 cadets aged from 19 to 25. The level of education was evaluated by means of a questionnaire which the soldiers had to fill in before being examined. Two trained dentists carried out the epidemiological survey following WHO guidelines. Data elaboration was carried out at the 'WHO Collaboration Centre of Milan for Epidemiologist and Community Dentistry'. Data on DMFT were compared by ANOVA. A p value < 0.01 was considered as statistically significant. Results: The mean DMFT value observed was 3.69 ± 3.31. The differences between the two groups were statistically significant for D e F components (p < 0.05). The caries-free rate is lower in the call-up soldiers group (12.57%) than that reported for the cadets group (25.26%) and the difference was statistically significant (p < 0.01). Statistically significant differences were observed in DMFT values between the two groups stratified by educational level. A healthy periodontium was observed in more than 50% of the sample. In the call-up soldiers group, 40.95% had healthy periodontal conditions; 40.25% of the subjects showed bleeding on probing; 19.03% presented with calculus; and 2.77% presented periodontal pockets 4-5 mm deep. In the cadets group, 57.95% had healthy periodontal conditions; 38.18% of the subjects showed bleeding on probing; 3.52% presented with calculus; and 0.35% presented periodontal pockets 4-5 mm deep. The differences in proportion between the two groups were always statistically significant except for the bleeding score where an almost similar percentage for both groups was recorded. Conclusion: The results showed that call-up soldiers have a higher DMFT index and the D value is higher in less educated subjects. Bleeding on probing did not vary either between call-up soldiers and cadets or among socio-economic subgroups. Such results have underlined the need of a systematical information campaign on oral hygiene in Italian schools. Keywords: epidemiology, dental caries, DMFT, CPITN

Introduction: The prevalence of caries, and its preferential location, has changed in recent years. The percentage reduction in caries has been lower in pits and fissures than in other locations, making it necessary to use more sensitive diagnostic procedures than visual inspection for approximal lesions. Objectives: The objective of this study was to compare the amount of overlooked proximal caries by bitewing X-rays versus clinical in patients who were completing a public oral health program at the age of 14 years. Methods: 162 children aged 14 years were clinically examined by a dentist as part of the systematic six-monthly dental check-ups of the children. The survey was carried out on dried teeth using a light, plane mouth mirror and blunt probe. All molar and premolar surfaces were examined in order to determine the presence of caries or restorations. In addition, two bitewing radiographs of each patient were obtained using a Klauser plastic parallelizer. Results: Caries lesions were diagnosed better by the X-rays than clinically (Δ X-ray = 0.61), whereas clinical examination was better at diagnosing the presence of fillings (Δ X-ray = - 0.03). Clinical examination diagnosed all occlusal caries but underestimated the interproximal lesions by 86.84%. Conclusions: In the context of public oral health programs, the authors consider it necessary to obtain two bitewing X-rays of the children's teeth before discharging them, as otherwise they could be told that they are healthy whereas, in fact, they present interproximal caries that could be treated by remineralization or restorative methods. Keywords: bitewing radiography, approximal caries diagnosis, dental caries

Purpose: To investigate the pattern of decision-making by southern Brazilian dentists regarding the use of restorations in the treatment of dental caries. Materials and Methods: A cross-sectional survey involving 840 dentists, randomly selected in three southern Brazilian states, was performed. Telephone interviews were conducted by three previously trained dentists, in which clinical situations with different-depth radiolucencies, based upon bitewing radiographs, were described. Two other situations, including dark fissures and white spots, were also described. The main outcome measures were the tendency in clinical decision-making in comparison with the number of years elapsed since qualification and attendance on postgraduate courses. Results: The overall response rate was 89.4%: 31.5% of dentists would restore cavities in the outer half of the enamel; 54.5% when the cavity reached the inner half of the enamel, but not the enamel-dentine junction (EDJ); 79.0% when cavities reached the EDJ; and 96.9% when cavities reached the outer half of the dentine. Furthermore, 21.8% of dentists would restore dark fissures without signs of demineralization. Dentists qualified for less than 10 years and those who had attended postgraduate courses were less interventionist. Conclusion: It was concluded that dentists have an interventionist attitude in the making of treatment decisions for dental caries and may be over-treating in several situations. Keywords: diagnosis, dental caries, treatment decision, over-treatment