Occurrence of plaque, gingivitis and caries as related to self reported frequency of toothbrushing in fluoride areas in Finland

Abstract Toothbrushing is generally recommended as one of the main means of preventing dental caries and periodontal problems. The present study was an attempt to evaluate the validity of such a claim. In three Finnish towns with low (0.2 part/10⁶), optimal (1.0 part/10⁶) and high (2.5 parts/10⁶) fluoride content in their drinking water, about 40 schoolchildren were examined in each age group of 13, 14 and 15 years. A total of 365 children were first interviewed about their oral health habits, including frequency of toothbrushing. Their teeth were then scored for visible plaque (VPI), gingival bleeding (GBI) and past caries experience (DFS). The total mean scores for the children were VPI = 43 %, GBI = 40 %, and DFS = 14.5. Girls were found to brush more often than boys. About 50 % of the girls and only 10 % of the boys reported brushing their teeth more often than once daily. Among the girls the frequency of toothbrushing significantly increased from age 13 to 15. In all groups high frequencies of toothbrushing were associated with low VPI and GBI scores. No correlation was found between the frequency of toothbrushing and the DFS scores of the children. This lack of correlation persisted also after the total material was grouped according to sex, age, and fluoride content of drinking water. The results indicate that uncontrolled toothbrushing helps to prevent periodontal disorders but has no measureable effect on dental caries.     

Relationship of oral hygiene and sugar consumption to risk of caries in children

Abstract The associations of denial caries with poor oral hygiene and high sugar consumption were analyzed taking into account possible confounding and factor interaction. The series consisted of 543 children from low-fluoride areas (0.10–0.46 parts/10⁶), aged 5, 9 and 13 years Plaque accumulation and sugar consumption were slightly confounded throughout the observations. Effect-modification appeared to exist, since the effect of one factor was greater at higher levels of the other. The association between the amount of plaque and dental caries was statistically significant at all levels of sugar consumption. With increasing total sugar consumption the risk of caries increased significantly only when oral hygiene was simultaneously poor. Effect estimates (E) and attributable risk estimates (AR) were calculated for increased plaque accumulation and sugar consumption. For the total sets of tooth surfaces in the various age groups the proportions of the total caries load associated with increased plaque accumulation were 35.2–63.0%, and those associated with higher total sugar consumption 0.7–5.4%. The fractions varied greatly with the tooth group. The effect estimates for the two factors in combination were always greater than the sums of the separate effects, indicating synergistic interaction between the two caries determinants.     

Relationship between reported toothbrushing and dental caries in adults

The relationship of toothbrushing to dental decay has remained unclear. In the present study an effort was made to throw more light on this problem. Clinical and interview data were obtained from 212 males. Potential confounding risk indicators were controlled by a multivariate confounder summarizing score. In general it was found that the values of caries prevalence indicator were consistently higher for sporadic toothbrushers. It was concluded that the current study provides evidence in favor of a positive association between toothbrushing and low caries prevalence.     

Social factors and oral hygiene habits among caries free children in a low fluoride area in Sri Lanka

The relationship of toothcleaning habits and caries free status of a group of 13-16-yr-old children who were not subjected to any caries preventive measures in Sri Lanka were studied. Despite lack of prevention, 31% of the subjects were caries free, and a higher proportion of these were boys. All subjects reported brushing their teeth at least once a day. The study failed to show any relationship between either brushing frequency or the use of brush or finger for toothcleaning, and caries. Although social status by father's employment was not related to the caries status, it was seen that a higher proportion of children of employed mothers' were caries free. Significant differences in oral hygiene habits except brushing frequency were noted among different social groups.     

Caries in permanent dentition and social class of children participating in public dental care in fluoridated and nonfluoridated areas

Abstract A random sample of 7-16-year-old children (n= 2778) who visited municipal dental clinics in fluoridated and nonfluoridated areas was studied. Structured questionnaires were used to collect data on social class and fluoride exposure; caries diagnoses were made by local dentists in municipal dental clinics. Children from the highest social class had the lowest caries frequency in both fluoridated and nonfluoridated areas. Differences between middle and lower class children were small. Water fluoridation had a similar effect in all social classes.     

Effect on caries of daily supervised toothbrushing with sodium monofluorophosphate and sodium fluoride dentifrices after 3 years

abstract – In a 3-year clinical trial the effect of daily supervised toothbrushing with a dentifrice containing sodium fluoride/ silicon dioxide and a dentifrice containing sodium monofluorophosphateo/calcium phosphate and calcium carbonate was investigated. Initially about 400 children aged 9–11 years from one school in Malmö took part in the study. They were randomly divided into two groups. Each group brushed their teeth daily in school under the supervision of a dental hygienist. The children and their families were given the corresponding dentifrices for home use. The children were examined for caries at the start of the study and again alter an interval of 1 year by the same dentist and according to the stated criteria. A comparison of the caries increments in the two dentifrice groups revealed a statistically. Significantly lower caries increment during the 2nd and 3rd experimental years in the sodium fluoride dentifrice group compared with the sodium monofluorophosphate dentifrice group.     

Three-year report on caries prevention using fluoride varnishes for caries risk children in a community with fluoridated water

Abstract – The Benifit of seminnual application of the sodium fluoride varnish Duraphat^(R) and the silane fluoride varnish Fluor Protector^(R) was studied in 11–13-year-old children with high caries activity and lifelong exposure to fluoridated drinking water (1–1.2 parts/10⁶). Annual clinical and radiographic examinations were made of 62 children in the Duraphat group and 70 children in the Fluor Protector group. Fluoride varnish was applied semiannually using the half-moth technique. After 3 years, for the Duraphat group mean total DMES increments on the control side were 6.2 and on the test side 4.3 ( P <0.001); for the Fluor Protector group the DMES increments were 4.9 and 4.4, respectively (NS). The caries reductions were 30% and 11%. Since ther were no differences between initial mean DMES scores of the groups, it is possible that the lower increment in the Fluor Protector control side compatred to the Duraphat control side was due to fluoride ions from Fluor Protector crossing the midline and providing protection on the control side as well. Therefore, we conclude that Duraphat proved effective, but definite conslusion of the effect of Fluor Protector cannot be made. Children with the highest DMES increment on the control side (duraphat) gained most from the applications.     

Effect of toothbrushing with chlorhexidine gel on salivary microflora, oral hygiene, and caries

abstract – The effect of daily toothbrushing with 0.5 % chlorhexidine-containing gel for 12 months was evaluated in a double-blind study in 37 dental students. The active gel did not markedly influence plaque formation, gingival conditions, or caries as compared with placebo gel treatment. Salivary bacterial counts were performed on subgroups of six subjects using chlorhexidine gel and on six using placebo gel. No differences in the effect of treatment on the microorganisms studied in the two subgroups could be detected except for S. sanguis . The percentage of this species decreased in the placebo group and increased in the chlorhexidine group. The difference became significant after 2 weeks. A tendency to a greater reduction of S. mutans noted in the chlorhexidine group was most marked in individuals who had high initial counts of this species. The proportion of S. sanguis , which could grow on chlorhexidine-containing mitis salivarius medium, increased and after 12 months of chlorhexidine treatment averaged 34 % of cultivable S. sanguis compared with 0.002 % prior to treatment. The number of less sensitive S. sanguis decreased in the 12 months following termination of treatment. There was no observed tendency for the selection or proliferation of other streptococci, gram-negative rods, yeasts, or staphylococci.     

Comparisons of caries prevalence of children with different daily toothbrushing frequencies.

Clinical caries examinations, supplemented by bite-wing radiographs, were conducted on 290 schoolchildren. The children ranged from 12 to 15 years of age and were residents of a fluoride-deficient community in New York State. The children were divided into two groups based upon their stated daily toothbrushing frequency, namely, those brushing once or less/day and those brushing twice or more/day. Mean DMFS and DMFT scores were recorded for children in both categories. A trend was noted that more frequent brushing was associated with less caries activity. For females and male-females combined the differences in mean DMFS and DMFT scores between those children brushing once a day or less. The caries scores for males in these two brushing groups were marginally significant (P less than .05). Ninety percent of the children used fluoride-containing dentifrices. The inverse relationship between brushing frequency and caries activity may be related to the more frequent fluoride contact when the children brush.     

Results of 10 years of supervised fluoride toothbrushing in Rygge, Norway

At the annual examination in 1978 of 141 patients born in 1962, DMFS, sound teeth and the number of erupted permanent teeth were registered. The number of filled tooth surfaces per child per year was compared for the period 1967--78. The average number of erupted teeth in 1978 was 27.3 of which 69 were sound (mean = 18.9). The average DMFS score was 14.3 and decayed surfaces equaled 2.0. The mean number of filled tooth surfaces per year dropped from 6.1 in 1968 to 1.2 in 1978. The need for annual recall and examination routines at the dental clinics are questioned. More attention should be paid to preventive care.     

Short intensive topical APF applications and dental caries in a fluoridated area

Three groups of approximately 200 children, consuming fluoridated water since birth, were given either 5, 10 or 25 consecutive topical applications with an APF gel (1.2% F, pH 3.2) in mouthpieces. After 1 year, mean DMFS increments were 7.2%, 30.4% and 35.3% less respectively for the three groups as compared with untreated control groups. Although enamel fluoride levels remained high after the 1st year, differences in dental caries increments between treated and control groups were too small to show group differences. The results suggest that in a fluoridated area, when caries activity is low, it would be difficult to show a long-term anticaries effect by increasing the fluoride concentration in sound enamel by a short series of self-applied topical fluoride applications.     

Occurrence of dental caries and gingivitis in low, medium and high fluoride areas in Finland

ABSTRACT The study was performed on a material of 365 Finnish schoolchildren aged 13–15 years. One-third of the children were from Jyväskylä, with 0.2 parts/10⁶ fluoride in the drinking water, one-third from Kuopio, with an artificially corrected 1.0 parts/10⁶ fluoride content since 1959, and one-third from Hamina, where the natural fluoride content of the drinking water varies between 2.5 and 5.0 parts/10⁶. All the children were scored for the Visible Plaque Index (VPI), the Gingival Bleeding Index (GBI) and for past caries experience (DPS). With increasing fluoride content of the drinking water the DFS scores were found to decrease significantly. No such difference was observed with regard to the VPI scores. The prevalence of gingival bleeding was found to be highest in Hamina (2.5 parts/ 10⁶). A highly significant positive correlation was found between individual VPI and GBI scores in all three towns. No corresponding correlations were found between the individual VPI and DFS scores. The latter finding is in disagreement with the generally accepted view that oral hygiene is an efficient caries-preventive measure.     

Fluoride exposure combinations and caries in permanent dentition among Finnish children

Abstract A representative sample (2865 persons, 7–16 years old) of children visiting municipal denial clinics was studied. Caries diagnoses were made by local dentists; structured questionnaires were used to collect data on fluoride and sugar exposures. Fluoridated pipe water was used by 26% of the children, 63% had supervised fluoride rinses and/or paintings, and 69% used fluoridated dentifrice. Water fluoridation prevented caries best. No major differences were observed between single and combined applications of different topical fluoride preventive measures as they are applied in everyday practice.     

Impact of oral hygiene and use of fluorides on caries increment in children during one year

The aim of this study was to assess the modifying effect of oral hygiene, and the use of fluorides on caries increment in children when frequency of meals, intake of sugars and prevalence of lactobacilli and S. mutans in the saliva were known. In 8- and 13-yr-olds it was possible to show that children with a low caries increment (0-2 surfaces) had lower mean values for frequency of meals, daily sucrose consumption and prevalence of lactobacilli and S. mutans in the saliva than children with a high caries increment (greater than or equal to 3 surfaces). There were higher mean values in the low caries-increment groups for toothbrushing frequency, use of fluoridated toothpaste and NaF-mouthrinse. Gingival bleeding index (GBI %) was used as an objective measure of oral hygiene and revealed statistically significant differences between the two groups in both age groups (P less than 0.05, P less than 0.01) with the highest scores recorded in the high caries-increment groups. Using as discriminating variables number of meals/day, daily consumption of sucrose and other sugars and number of lactobacilli and S. mutans in the saliva, 77% of the 8-yr-olds and 70% of the 13-yr-olds were correctly classified with regard to net caries increment. If GBJ %, tooth-brushing frequency, use of fluoridated toothpaste and NaF-mouthrinse were included in the analysis another 4% of the 8-yr-olds and 11% of the 13-yr-olds could be correctly classified.     

The influence of toothbrushing frequency and post-brushing rinsing on caries experience in a caries clinical trial

Objectives : To examine the effect of reported toothbrushing frequency and method of rinsing after brushing on caries experience and increment. Methods: Data are presented from 2621 adolescents (mean age 12.5 years at outset) participating in a 3-year double-blind caries clinical trial. At baseline, examiners questioned each participant about their toothbrushing habits, and at subsequent examinations, this information was obtained using a self-administered computer-based questionnaire. Participants used a fluoride-containing dentifrice through-out and clinical examinations were conducted using a mirror, CPITN probe and fibre-optic transillumination. Results: The reported brushing frequency increased throughout the trial. Caries experience at baseline was inversely related to tooth-brushing frequency with mean DMFS=9.66, 8.12 and 7.63 respectively for < 1/day, 1/day and > 1/day brushers ( P < 0.001). Mean 3-year DMFS increments of 8.90, 6.63 and 5.48 ( P < 0.01) were observed in those reporting to brush < 1/day, 1/day or > 1/day, on not less than two of the three clinical examinations during the trial. Caries increment was also significantly related to the claimed method used to rinse post-brushing. Overall frequency of brushing and rinsing method accounted for over 50% of the explained variance in the ANOVA model used to analyse the DMFS increments. Conclusions: Stated toothbrushing frequency and rinsing method after brushing were found to be strongly correlated with caries experience and caries increment. These factors should be reflected in the design of oral health education material and taken into account in the design and analysis of caries clinical trials.     

Effect on caries in mentally handicapped children of addition of fluoride and bicarbonate-phosphate to dietary sugar products

Abstract— Mentally handicapped children, aged 5–15 years and living in institutions, received fluoride supplement in several sugar products of their diet; in candies, marmalades, jams, fruit juices and in sweet desserts corresponding to 10 mg F as NaF per kg of the sugar (sucrose or glucose) of each product. To two of the four daily candies was also added a NaHCO₃+KH₂PO₄ mixture (mole ratio 9.8/1, resp.) to substitute for 2.5% of the sugar of the candy. The control children received the respective products without the additives. After stepwise exclusions of subjects for various reasons, e.g. for the absence of permanent teeth, low initial caries activity, strong medication, Down's syndrome, etc, the mean DMFS-increment in the remaining 48 control subjects was 4.5 and in the 41 test subjects 2.6 lesions/100 surfaces at risk, i.e. 42% reduction. Caries arrestment had occurred in these test subjects after the first year, while in the respective controls it was cantinuously increasing. Among numerous oral and body parameters. studied, only surface enamel fluoride in primary teeth was increased by the fluoride supplements and urinary phosphate and calcium excretion decreased.     

Effect of mouth rinsing and toothbrushing with fluoride solutions on caries among Norwegian schoolchildren

ABSTRACT The caries experience and the plaque and gingival conditions of 14-year-old children participating in fortnightly fluoride (0.2% NaF) mouth rinsing (88 subjects) were compared with observations in children performing supervised toothbrushing with a fluoride (0.5% NaF) solution 4–5 times per year (n= 90). Most of the children, 84 and 90% respectively, had participated in these programs for the previous 6 years. Caries was assessed only on radiographs. The mean number of decayed surfaces was 5.8 (s.d. = 4.1, n= 88) and 5.4 (s.d. = 4.1, n= 90). The mean numbers of decayed and filled surfaces were 19.3 ± 9.2 and 27.9 ± 10.2 for subjects with rinsing or brushing. This significant difference could not be ascribed to sex, social class, years of residence in the towns, number of dentists performing the previous treatments, toothbrushing habits, use of fluorides at home, or amount of plaque. All children had gingivitis. There were no differences in the mean number of Plaque Index score 2 or the number of Gingival Index score 2 between the children with the different preventive programs. The girls ‘oral hygiene was better than the boys’, but the gingival conditions were the same. Sex, social class, and toothbrushing techniques tended to have a slight influence on the amount of plaque.     

Comparison of caries prevalence 7 years after discontinuation of school-based fluoride rinsing or toothbrushing in Norway

The purpose of this study was to compare caries prevalence in two groups of 21-yr-olds 6-7 yr after discontinuation of school-based preventive programs consisting respectively of fortnightly rinsing or brushing 3-5 times per year with NaF solutions. Stratified random samples of 125 persons were drawn from appropriate population registers. Non-response was 30%. Blind clinical and radiographic examinations were carried out and the subjects were interviewed concerning their dental health related behavior. The results revealed significantly lower mean DMFS score in the rinsing than in the brushing group (P less than 0.001). Comparisons with results of other studies suggest persistence of benefits of school-based preventive programs after discontinuation.     

Dental caries in South African Black and White high school pupils in relation to sugar intake and snack habits

Abstract DMFT scores, total sugar intakes and snack habits were determined in 1918 South African Black pupils (923 rural, 995 urban) and 724 White pupils (English and Afrikaans speaking) aged 16–18 years inclusive. Mean DMFT scores of school groups of Black pupils (both sexes) ranged from 0.9 and 2.0 in rural areas, to 4.2–6.7 in urban areas (where data were far higher than such obtained 7 years ago), and were 9.2 and 10.2 for White pupils. Corresponding mean daily sugar intakes were - rural Blacks, 69 g and 97 g, urban Blacks 118–141 g, respectively (all slightly higher than previously); and Whites 102 g and 123 g. Mean DMFT scores of girls were higher than those of boys; yet while mean sugar intakes of Black girls and boys were somewhat similar, White girls' intakes were much lower than those of White boys. In the ethnic-sex groups studied, mean DMFT scores for pupils in upper, compared with lower, third of sugar intake, were higher in nine of the 14 sub-groups. Mean DMFT scores in upper, compared with lower, third of exposure to snack practices were higher in 11 of the 14 groups. However, most of the differences were slight. In further research, more intensive enquiries should be pursued on roles of ethnic and familial factors, as well as on roles of inter-acting dietary components additional to sugar and sugar-containing foods.     

Enamel defects and dental caries in 9-year-old children living in fluoridated and nonfluoridated areas of Auckland, New Zealand

Abstract – Objectives: This epidemiological study aims to investigate the developmental enamel defects and dental caries among 9‐year‐old children resident in fluoridated and nonfluoridated regions in Auckland, New Zealand. Methods: A stratified, two‐stage random selection design where strata were defined by fluoridation status, school size, and school decile. After informed consent was obtained, parents completed oral health questionnaires and children underwent dental examinations at school clinics. Results: 612 children from 38 schools participated in the study. Overall, 175 (29%) children had lived continuously in fluoridated areas, 149 (24%) had lived continuously in nonfluoridated areas, and 288 (47%) had resided intermittently in fluoridated areas. Diffuse opacities were present in 117 (19%) children and deciduous teeth dental caries was seen in 370 (60%) children. After adjustment for covariates, a strong dose–response relationship between diffuse opacity and fluoridation status was found, with children who lived continuously in fluoridated areas being 4.17 times as likely to have diffuse opacities as children who lived continuously in nonfluoridated areas (P < 0.001). Conversely, a strong protective dose–response relationship between caries experience and fluoridation status was seen, with children who lived continuously in fluoridated areas being 0.42 times as likely to have dental caries as children who lived continuously in nonfluoridated areas (P < 0.001). Conclusions: Reticulated water fluoridation in Auckland reduces the risk of dental caries but increases the risk of diffuse opacities in 9‐year‐old children. Guidelines and health‐promotion strategies that enable children to minimize their risk to diffuse opacities yet reduce their risk of dental caries should be reviewed.