Rural and urban disparities in caries prevalence in children with unmet dental needs: the New England Children's Amalgam Trial

OBJECTIVES: To compare the prevalence of caries between rural and urban children with unmet dental health needs who participated in the New England Children's Amalgam Trial. METHODS: Baseline tooth and surface caries were clinically assessed in children from rural Maine (n = 243) and urban Boston (n = 291), who were aged 6 to 10 years, with two or more posterior carious teeth and no previous amalgam restorations. Statistical analyses used negative binomial models for primary dentition caries and zero-inflated models for permanent dentition caries. RESULTS: Urban children had a higher mean number of carious primary surfaces (8.5 versus 7.4) and teeth (4.5 versus 3.9) than rural children. The difference remained statistically significant after adjusting for sociodemographic factors and toothbrushing frequency. In permanent dentition, urban children were approximately three times as likely to have any carious surfaces or teeth. However, rural/urban dwelling was not statistically significant in the linear analysis of caries prevalence among children with any permanent dentition caries. Covariates that were statistically significant in all models were age and number of teeth. Toothbrushing frequency was also important for permanent teeth. Conclusions: Within this population of New England children with unmet oral health needs, significant differences were apparent between rural and urban children in the extent of untreated dental decay. Results indicate that families who agree to participate in programs offering reduced cost or free dental care may present with varying amounts of dental need based on geographic location.     

Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial

We hypothesized that the six-monthly application of silver diamine fluoride (SDF) can arrest the development of caries in the deciduous dentition of six-year-old schoolchildren and prevent caries in their first permanent molars. A prospective controlled clinical trial was conducted on the efficacy of a 38% SDF solution for caries reduction. Four hundred and twenty-five six-year-old children were divided into two groups: One group received SDF solution in primary canines and molars and first permanent molars every 6 mos for 36 mos. The second group served as controls. The 36-month follow-up was completed by 373 children. The mean number of new decayed surfaces appearing in primary teeth during the study was 0.29 in the SDF group vs. 1.43 in controls. The mean of new decayed surfaces in first permanent molars was 0.37 in the SDF group vs. 1.06 in controls. The SDF solution was found to be effective for caries reduction in primary teeth and first permanent molars in schoolchildren.     

Changing Inequalities in the Distribution of Caries Associated with Improving Child Oral Health in Australia

Objectives: This study aimed to document the changing distribution of and inequalities in dental caries in Australian children across the 25-year period from 1977 to 2002. Methods: Oral health data were obtained from Australia's national Child Dental Health Survey. Measures of caries distribution included the Significant Caries Index and the proportions of children with high caries experience [decayed, missing and filled teeth (DMFT) ≥ 4], while inequality was assessed by using Gini coefficients calculated from Lorenz curves. Changes in caries distribution were compared with changes in child dmft/DMFT. Results: While appreciable reductions occurred in child caries experience, in terms of both mean dmft/DMFT and for those children with the poorest oral health, inequalities in the distribution of caries experience increased across the 25-year period. Inequalities in the distribution of decayed and filled teeth differed for the deciduous and permanent dentition and, in the permanent dentition, became increasingly similar in the 1990s. Conclusions: Increasing inequalities in child dental caries in Australia must be interpreted in the context of declines in both mean caries experience and in the caries experience of those children with the poorest oral health. The Gini coefficient documents that the majority of the caries experience is increasingly being confined to a smaller percentage of the child population; however, this is a consequence of population-wide child oral health improvements.     

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

A bstract — This report describes the intra-oral distribution of caries and frequency of reported toothache using data from 9690 South Australian children aged 5–15 years. School dental therapists and dentists recorded dmfs and DMFS data and a questionnaire to parents sought information about toothache and its impact. There were higher levels of cartes experience in deciduous teeth (mean 6-year-old dmfs=2.61) compared with permanent teeth (mean 12-year-old DMFS=1.15). In the deciduous dentition: between 11.4 per cent (9-year-olds) and 37.7 per cent (5-year-olds) of total dmfs was present as untreated decay; between 39.1 per cent (7-year-olds) and 42.8 per cent (10-year-olds) occurred on interproximal surfaces; and between 2.0 per cent (10-year-olds) and 27.8 per cent (5-year-olds) occurred in anterior teeth. In the permanent dentition, the majority of permanent caries experience occurred as fillings in pits and fissures of first molars and involved a single surface. Between 11.8 per cent (5-year-olds) and 31.8 per cent (12-year-olds) of children had a reported history of toothache, although the figure exceeded 50 per cent among children with all three forms of pit/fissure, interproximal and smooth-surface caries experience. The observed pattern of caries provides the basis for continued use of fissure sealants as a preventive measure among school children.     

Sugar consumption and dental caries experience in Kenya

Introduction: There have been claims that dental caries experience and prevalence in Kenya has been increasing as a result of increased sugar consumption. A review of the literature in 1986 failed to link dental caries experience with an increase in gross national sugar consumption. Subsequently, a number of studies were conducted, necessitating further review to examine trends in dental caries experience and to relate this to changes in per capita sugar consumption. Methods: Studies conducted since 1980 for children 3–15 years of age were examined. Dental caries prevalence and experience for 3–5 years’ (deciduous teeth) and 12 years’ (permanent teeth) age groups were analysed. Calculation of per capita sugar consumption was performed using gross national annual sugar consumption for 1969–2009 national population census years. Results: There was a gradual increase in per capita sugar consumption, from 35.5 g/day in 1969 to 60.8 g/day in 2009. Dental caries experience in deciduous teeth for children 3–5 years of age increased from a decayed, missing and filled teeth/decayed and filled teeth (dmft/dft) index of 1.5 in the 1980s to 2.95 in the 2000s. At 12 years of age, caries experience for permanent teeth increased from a DMFT of 0.2 to a DMFT of 0.92 over the same period. Dental caries prevalence for both deciduous and permanent teeth also increased with time. Conclusion: These observations suggest that dental caries prevalence and experience increased with time, in parallel to an increase in per capita sugar consumption. However, a clearer understanding can be derived from longitudinal studies, based on actual household age-specific sugar consumption and dental caries incidence.Key words: Sugar, caries experience, socio-economic development     

The prevalence and distribution of dental caries in four early medieval non-adult populations of different socioeconomic status from Central Europe

Objectives

The aim of the study was to map the dental health status in non-adult individuals and to verify whether and how the existence of caries in the non-adult age group is associated with the different socio-economic status of early medieval populations.

Material and methods

We studied the dental remains from the acropolis of the Mikul?ice settlement agglomeration, where members of the higher social classes were buried, and from the Mikul?ice hinterland. Overall, we evaluated 2544 teeth/3714 alveoli of deciduous dentition and 1938 teeth/2128 alveoli of permanent dentition. We determined the number of individuals with dental caries (i.e., caries frequency index, F-CE) and the proportion of teeth/alveoli with caries/ante-mortem tooth loss (i.e., caries intensity index, I-CE).

Results

We found no statistical significant difference in the F-CE values between the Mikul?ice hinterland and the acropolis. In addition, we found no statistically significant difference in the proportion of teeth with carious lesions (I-CE) either in the case of deciduous dentition or in the case of permanent dentition between the hinterland and the acropolis. In the case of permanent dentition, the statistically significant highest proportion of carious lesions (I-CE) was found in Mikul?ice I (p ≤ 0.05). We confirmed an increase in the rate of caries with age.

Conclusions

The level of caries at all of the studied medieval locations was very low. We presume that lifestyle and the associated dietary habits and hygienic practices of the individuals or population groups had a greater influence on dental caries than did the socio-economic status of these individuals.     

First permanent molar: first indicator of dental caries activity in initial mixed dentition

The objective of the present study was to investigate among children in the initial mixed dentition phase the presence of clinical signs that might eventually function as more sensitive indicators of the development of caries disease, denoted here as caries activity. On this basis, we investigated the relationship between salivary levels of mutans streptococci (MS) and decayed, missing and filled permanent and deciduous tooth surfaces (DMFS and dmfs) using microbiological, clinical and radiographic examinations in 81 schoolchildren aged 7-8 years. Whereas dmfs did not present a positive correlation, DMFS was significantly correlated with salivary MS levels. The first permanent molars of the schoolchildren studied comprised 87.3% of the affected surfaces recorded in the DMFS, suggesting that the development of new lesions was preferentially located on the surfaces of the first permanent molars. These results permit us to conclude that the first permanent molars function as first indicators of dental caries activity in the schoolchildren examined.     

武汉市6～8岁儿童龋病及第一恒磨牙窝沟形态调查研究

目的调查武汉市6～8岁儿童龋病和第一恒磨牙窝沟形态情况,为儿童患龋风险评估和龋病预防政策的制定提供理论依据。方法选取武汉市区5所小学二年级学生,共检查1043名儿童,平均年龄7.6岁。由两名口腔医师检查龋病和第一恒磨牙窝沟形态。其中,龋指数采用改良世界卫生组织标准,使用单因素方差分析和t检验进行统计学分析。结果恒牙D3水平的患龋率为8.7%,乳牙d3水平的患龋率为68.7%。恒牙龋均和龋面均分别为0.11和0.14,乳牙龋均和龋面均分别为2.8和5.0。其中乳牙龋指数d3占d3mft的73.6%,而乳牙早期釉质龋牙数占乳牙d2水平牙数的36.4%。中窝沟和深窝沟第一恒磨牙的儿童占总受检人数的84.6%。结论武汉市6～8岁儿童的乳牙患龋率高,第一恒磨牙中度和深度窝沟比例较高,因此应对高患龋风险的儿童进行窝沟封闭等预防措施。     

Caries experience of Native children of British Columbia, Canada, 1980-1988

Abstract – Surveys of the dental health of Native children in British Columbia, Canada, were conducted in 1980, 1984 and 1988 by Medical Services Branch, Health and Welfare Canada. Data were gathered on children turning 5, 7, 9, 11, 13, and 15 yr of age in each survey year. This paper analyzes the findings related to dental caries and the treatment of caries. Comparisons were made between the 1980 and 1988 surveys using Student's t -tests; data from the 1984 survey were included for comparison. Results of these surveys demonstrate a continuous improvement in the dental health of Native children between the years 1980 and 1988, but the improvement was limited to the permanent dentition. The deft for 5-yr-olds remained constant over the time interval. In contrast, the DMFT for each group significantly decreased from 1980 to 1988 ( P <0.05). The percentage of 5-yr-old children who were caries-free in the primary dentition remained constant, and primary tooth mortality (tooth abscessed or with crown destroyed) in 5-yr-olds did not change. However, the percentage of children surveyed with caries-free permanent teeth improved significantly at each survey year and permanent tooth mortality significantly declined ( P <0.05). The proportion of filled, compared with carious, primary and permanent teeth increased from 1980 to 1988. In contrast, the number of extracted primary teeth stayed relatively constant for 5-yr-olds, but the proportion of missing teeth declined significantly for all other age groups ( P <0.05). The caries experience of this population of Native children was high relative to that of children of comparable age residing in the same region and to that of children who live in other parts of the world.     

乳牙深龋的间接牙髓治疗

乳牙是人类的第一副牙齿,其正常萌出建并行使生理功能对儿童的身心发育具有重要意义。乳牙龋病是儿童慢性疾病之首,是儿童口腔医学临床最常见的疾病之一。根据世界卫生组织调查数据显示,世界范围内60%~90%的学龄儿童患有龋病。乳牙龋病在我国具有患龋率高,就诊率低下的特点,如不及时治疗,可导致牙体组织缺损、生理间隙丢失、牙髓和根尖周病变及颌面间隙感染,严重者可致乳牙早失并伴发牙列畸形及后续恒牙萌出障碍等不良结果,影响儿童口腔健康及身心发育。因此,对深龋乳牙采取积极有效的治疗措施对保存必要乳牙及其牙髓活力,恢复正常生理功能,维持牙列完整性,诱导后续恒牙正常萌出建具有重要意义。本文从目前深龋乳牙间接牙髓治疗的研究认识现状出发,通过文献资料收集整理,对间接牙髓治疗、间接盖髓术、暂时性保髓充填、部分去龋法、分步去龋法和非创伤性修复治疗等相关概念进行了对比分析,阐明了乳牙间接牙髓治疗的技术内涵和治疗意义,对乳牙深龋的临床治疗路径完善提供了理论依据。     

Trends in dental caries experience of school children in Australia - 1977 to 1993

Data on the dental health of Australian school children from 1977 to 1985 have previously been reported. Significant features included a secular decline in caries experience as defined by the number of decayed, missing and filled teeth in both the deciduous dentition (dmft index) and permanent dentition (DMFT index), and a change in the distribution of caries experience within the child population in Australia, indicated by increasingly smaller percentages of children accounting for greater proportions of total disease experience. The aim of the present paper was to extend the annual reporting on caries experience in Australia up to and including 1993, and to document the change in the distribution of caries within the child population since 1977. In addition, the data are compared with dental targets for children for the year 2000 in Australia and internationally. Caries data were obtained for the years 1977–1993 for children who were patients at School Dental Services in each State and Territory of Australia. Caries experience was recorded by uncalibrated dentists and dental therapists during routine dental examinations. From 1977-89 data were weighted by State and Territory estimated resident populations. From 1989, the data were stratified according to age, year, and State, and weighted to reflect proportions in the national estimated resident population for each State/age stratum. Between 1977 and 1993 there has been a decline in caries experience for 6 year old children from a dift? of 3.13 to a dmft of 1.90, and an increase in the per cent with dmft=0 from 33.1 per cent to 53.2 per cent with dmft=0 in 1993. Over the same time period the DMFT for 12 year olds reduced from 4.79 to 1.10 and the per cent while DMFT=0 increased from 10.5 per cent to 53.1 per cent. Projection of the decline in DMFT indicates the dental health target for 12 year old children of DMFT=1.0 by the year 2000 should have been achieved by the end of 1995     

Molar incisor hypomineralization in Hong Kong Chinese children

Background.   Most prevalence studies on molar incisor hypomineralization (MIH) were carried out in European countries, and data from the East-Asian populations were lacking.
Aim.   This study aimed to investigate the prevalence of MIH in Hong Kong Chinese children.
Design.   Since 2006, charting of teeth with MIH was included into the routine dental examination in a school dental clinic. The dental records of grade 6 primary school children who attended annual check-up in this clinic in 2006 were subsequently reviewed retrospectively. The records were selected for this study if the charting indicated that the children were affected by MIH.
Results.   A total of 2635 records were reviewed and 73 cases of MIH were identified. The prevalence of MIH in this group of children was 2.8%. Their mean age was 12, and the male-to-female ratio was 1 : 1.2. The mean decayed, missing, or filled permanent teeth value of those affected was 1.5, which was higher than that of the general Hong Kong Chinese children aged 12 years old (0.8). A total of 192 teeth were affected. The most commonly affected teeth were permanent maxillary first molars, followed by mandibular first molars and maxillary central incisors. Dental fillings and fissure sealants were found in 52 (38%) and 65 (47%) permanent first molars with hypomineralization, respectively. Medical histories were unremarkable in 60 children, whereas early childhood diseases were reported in 13 cases.
Conclusions.   The prevalence of MIH in the permanent dentition of Hong Kong Chinese children was 2.8%. Children with MIH showed higher caries experience in the permanent dentition than the general population of similar age.     

Comparison of the caries-preventive effect of a glass ionomer sealant and fluoride varnish on newly erupted first permanent molars of children with and without dental caries experience

Abstract

Purpose: This longitudinal clinic study evaluated the effect of a glass ionomer sealant (GIS) and a fluoride varnish (FV) in the prevention of dental decay on newly erupted permanent molars of children with and without caries experience. Materials and methods: Eighty children, aged 6–8 years, with all four newly erupted first permanent molars, were divided into two groups. Group 1 consisted of 53 children without caries experience and group 2 consisted of 27 children with dental caries experience. Permanent molars of the right side were sealed with GIS and the fluoride varnish was applied on the other two permanent first molars. Evaluation of GIS retention and the effectiveness of both materials in the prevention of dental caries were performed after 6, 12 and 18 months. Results: After 18 months, of the 299 teeth, 271 (91%) showed no caries lesions and 28 presented caries lesions (9%). Teeth sealed with GIS had more carious lesions (15) than teeth with fluoride varnish (13). Most of the teeth (70%) that presented carious lesions were in group 2. Of the 138 sealed teeth, only one showed GIS to be totally present, 95 were partially present and 42 teeth were absent. Conclusion: The caries-preventive effect was very similar between both treatments. The presence of dental caries prevailed in the children with caries experience.     

Caries prevalence in the deciduous dentition of a mediaeval population from the Southwest of Scotland

The prevalence, distribution and location of dental caries were studied in the deciduous dentition of 185 skeletons aged between 6 months and 13 years from a large, mostly mediaeval, cemetery, where successive phases of use could be distinguished. The main phases dated from 1240 to 1440 AD. During this period, no consistent trend or pattern of caries was identified, but there was a significantly higher caries prevalence in the age band 6–12.9 years than in the age band 0.1–5.9 years. The caries prevalence in the juveniles from the earlier Northumbrian, or Anglo-Saxon, phase of the cemetery was higher than in any mediaeval phase group, with mostly approximal surfaces affected. In the mediaeval population, first deciduous molars generally showed lower caries prevalence than second deciduous molars, significantly lower for the older age band, and maxillary molars consistently showed lower levels than mandibular molars. The highest caries rate, shown by mandibular second molars in the older age band, was 7.9%. In deciduous molars, the occlusal surface was most frequently affected by caries, whereas in the permanent molars of the same population the approximal surfaces had shown the highest level of attack. The overall caries prevalence in deciduous teeth in the mediaeval population of Whithorn was 2.3% of the teeth present, lower than the levels found in previous Scottish and English population groups, including a small assemblage of children from the Scottish sites of Elcho, Southwick and Kirkhill.     

Pain prediction for preventive non-operative management of dentinal caries in primary teeth in general dental practice

OBJECTIVES: To provide a pain-predictive model for the non-operative management of carious deciduous teeth from the analysis of data from a retrospective analysis of clinical case notes of children regularly attending two general dental practices and receiving preventive care. DESIGN: A clearly defined protocol was used to determine the fate of deciduous teeth diagnosed as carious into dentine but symptomless and left unrestored from the sequential examination of the clinical records of 480 children attending at least annually. RESULTS: The age of the children at the first visit when carious teeth were diagnosed ranged from 008 to 12.3 years, with the majority of children (243/480) presenting by 6 years of age. In all, 250 teeth from 162 children were extracted because of pain or became painful and were treated. The remaining 318 children did not report pain on subsequent visits. The strongest predictor of pain was age on diagnosis, the other factors being tooth type and extent of the cavity when first seen. Data from the present study provides a model that enables a child with deciduous caries to be placed into one of six pain-predictive groups associated with a risk of pain or infection if the teeth are not restored but provided with preventive care only. CONCLUSIONS: In these patients, the majority of unrestored carious deciduous teeth remain symptomless until shed. A higher risk of subsequent pain or infection was associated with the development of caries in younger patients, disease extending beyond single surfaces, and disease in lower deciduous molars. The results provide evidence to aid the treatment planning of carious deciduous teeth in children receiving regular preventive dental care.     

Dental caries status of young children in a suburban community of Mexico City

One hundred and thirty-four children, 6 to 7 yr of age from a public school in Tepepan, Mexico were examined for the prevalence and severity of dental caries. Average deft score was 6.08 and defs was 12.15. Average DMFT and DMFS scores were .57 and .99 respectively. It was observed that 66% of primary teeth with carious lesions required one surface restoration and 11% three or more surface restorations. In the permanent dentition 99% of the affected teeth required one surface restoration. A comparison of the results with those of the Mexico City public school children survey (1980) showed that the Tepepan children had a similar caries level in primary teeth and a lower caries level in permanent teeth. Although the Tepepan group showed fewer carious lesions, their caries index and unmet restorative index are still high, especially for primary dentition, so an intensive educational, preventive and restorative program is required.     

Dental caries among urban schoolchildren in Madagascar

Abstract An epidemiological survey of prevalence and severity of dental caries was carried out in an urban population of children in Madagascar. The study population comprised 1257 children in the age groups 4–5 yr to 14–15 yr equally distributed by sex. The children were examined according to the recording system for the Danish Child Dental Services. The caries experience in the primary dentition as well as in the permanent dentition was high. For example, among 6-yr-olds a mean number of 11.8 defs and 5.2 deft was observed and 82% of the children were affected by caries in primary teeth. In particular, primary molars in the mandibular and incisors in the maxilla were affected and approximate caries was frequent. Among 12-yr-olds mean DMFS was 4.0 and DM FT 2.4 and 75% of the children had caries in permanent teeth. In permanent teeth caries was located predominantly to mandibular molars and occlusal surfaces. In both dentitions almost all decay was untreated, indicating lack of dental treatment available due to the shortage of dental manpower. The establishment of a child dental service system is a matter of urgency. Dental health education and primary health care should be organized.     

A simplified dental examination for detection of cavitated carious lesions in school setting

Objective:  The objective of the study was to compare a simplified dental examination involving the use of a wooden spatula and a toothpick (TS examination) with the conventional dental mirror and probe examination (MP examination) for detection of cavitated carious lesions in schoolchildren.
Methods:  The study involved three groups of caries-positive schoolchildren aged 4–5, 9–10 and 13–14 years with 179, 188 and 202 children, respectively. All children were examined by a trained and calibrated examiner using a wooden spatula and a toothpick under natural light. After a week the same examiner examined the three groups of children by a dental mirror and a Community Periodontal Index (CPI) probe. 'Teeth' were considered as units of measurement for data analysis. The WHO recommended criteria (2) for decayed, missing and filled teeth were followed for recording dental caries on a specially designed recording form. The sensitivity, specificity, positive predictive value, negative predictive value, false-positive rate and false-negative rate of TS examination were calculated using MP examination as the standard method.
Results:  The specificity of TS examination was well above 95% in three types of dentition. Although the sensitivity of this type of examination in deciduous and mixed dentitions was almost comparable with that of MP examination, it was the lowest for permanent dentition but still within the acceptable limits.
Conclusion:  The TS examination can provide an alternative to traditional MP examination to undertake regular check-ups of schoolchildren for dental caries.     

Progression of proximal caries in the mixed dentition: a 4-year prospective study

PURPOSE: The purpose of this study was to investigate the survival rate and median survival time of different stages of proximal caries in 196 children aged 6 to 8 years at baseline examination. METHODS: Proximal caries and its progression were diagnosed from bitewing radiographs taken at 1-year intervals over a period of 4 years. The mesial surface of the first permanent molars, the mesial and distal surfaces of the first and second primary molars, and the distal surface of the primary canine were examined. Sound surfaces, caries lesions in the external- and internal-half of the enamel and external-, middle-, and internal-third of the dentin, as well as filled, extracted, and exfoliated teeth were recorded. A life table analysis was performed to estimate the annual and cumulative survival rates and the median survival time of each state of proximal lesions. RESULTS: For the sound mesial surfaces of the first permanent molars, the cumulative survival rate was 76% and the median survival time was over 48 months. The corresponding values for the external-half of the enamel lesions were 41% and 45 months. Regarding the sound mesial and distal surfaces of the primary teeth, the cumulative survival rate was 92% and the median survival time was over 48 months. The corresponding values for the external and internal-half of the enamel lesions were 40% and 31 months, and 29% and 22 months, respectively. The value of the cumulative survival rate for the external-third of dentin lesions was 42%, with a median survival time of 34 months, and the value for the middle-third of the dentin was 38% with a median survival time of 17 months. CONCLUSIONS: The risk of developing carious lesions in the sound proximal surfaces of both primary teeth and first permanent molars is low during the mixed dentition period; the progression of the external-half of enamel lesions of the first permanent molars is low for the first 3 years and becomes faster thereafter; and as the time period that the tooth exposed to cariogenic factors increases, the progression of the proximal caries is faster for all stages of the lesion in the primary teeth.