Dental caries and treatment needs in street children in Toluca, Mexico

OBJECTIVE: To assess dental caries (deft and DMFT) and treatment needs, in street children from the city of Toluca in Mexico. METHODS: After informed consent from their parents, guardian or legal representative, 310 street children, 0 to 17 years of age, from Toluca in the state of Mexico, were evaluated. Caries and treatment needs were recorded according to 1997 WHO criteria. The oral examination was carried out on site in daylight. RESULTS: For the population from which the sample was derived, the caries prevalence was 94.96%, the mean DMFT was 6.0 +/- 4.6 (5.8 decayed), while deft was 3.5 +/- 3.7 (3.4 decayed). Treatment needs in the deciduous dentition revealed that 43.9% of teeth did not require any treatment, 20% needed fissure sealants, 19% required one surface restoration and 13.19% needed restoration in two or more surfaces. In the permanent dentition, the treatment needs were as follows: 51.2% teeth did not need any treatment, 22.9% needed fissure sealants, 18.4% required one surface restoration and 5.3% needed restoration in two or more surfaces. CONCLUSIONS: These findings illustrate the high prevalence of caries in street children in the city of Toluca. There is an enormous need for dental treatment; sealant applications were the treatment most in need. The data can serve as a platform to implement preventive and restorative dental health programmes that meet the needs of Mexican street children,     

An audit of the caries status of patients about to start orthodontic treatment

STATEMENT OF THE PROBLEM: All dental caries needs must be addressed before orthodontic treatment in those deemed eligible for orthodontic treatment under HSE (Health Services Executive) guidelines.1 PURPOSE OF THE STUDY: To evaluate the prevalence of carious lesions in permanent teeth requiring restoration in patients from the North Cork area of HSE South taken off the Cork University Dental School and Hospital postqraduate orthodontic treatment waiting list. MATERIALS AND METHODS: A data collection form was designed and applied to 100 consecutive patients taken off the postgraduate orthodontic treatment waiting list from October 2009, A gold standard based on a similar audit carried out in the UK2 was adopted. Results: Carious lesions in permanent teeth requiring restorative intervention were found in 42% of patients (48.9% of males and 35.3% of females). Sixty carious lesions requiring restorations were detected on posterior bitewings and 34 on DPTs, in patients where both forms of radiograph were used. Caries were detected in one-third of the 6% of patients who had attended a primary care dentist in the previous six months. Conclusions: A total of 42% of this patient cohort failed the adopted gold standard by exhibiting caries requiring restoration in permanent teeth, with males showing a higher prevalence. A total of 43% of carious lesions detected by posterior bitewing radiographs were not detected on DPTs of the same patients. Six patients had attended a primary care dentist in the six months before being taken off the orthodontic treatment waiting list and two patients were diagnosed with carious lesions that required restoration.     

儿童乳磨牙金属预成冠的修复治疗

乳牙龋病是儿童常见的口腔疾病之一.第三次全国口腔健康流行病学调查结果显示,中国儿童乳牙存在患龋率高、就诊率低下的现状.由于儿童乳牙解剖形态及组织结构特点、儿童饮食特点等原因,导致儿童乳牙龋具有区别于恒牙龋的特殊临床表现,且可对继承恒牙、儿童生长发育及心理等产生不良影响.目前,针对乳牙龋的治疗主要采用药物治疗和修复治疗,修复治疗是最重要的治疗方法,其中对于较大面积的乳磨牙龋损,临床上多选择金属预成冠的修复治疗.本文从金属预成冠的背景、适应证、临床操作步骤及相关研究等方面,就儿童乳磨牙的金属预成冠修复治疗进行阐述.     

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.     

Longitudinal evaluation of caries patterns form the primary to the mixed dentition

The purpose of this study was to develop a model describing the sites and patterns of dental caries in the mixed dentition for children with one of five caries experiences in the primary dentition. Dental records were used from 317 children followed an average of 7.8 years in private pediatric dental offices to assess specific caries experiences in children from early primary dentition to middle or late mixed dentition. Eighty-four per cent of the children who were caries-free in the primary dentition remained so in the mixed dentition. Children with the pit and fissure caries pattern in the primary dentition were more likely to develop smooth surface caries of primary teeth in the mixed dentition (32%) than caries-free children (14%, X2 = 5.6;P less than 0.05). For children with molar-approximal lesions in the primary dentition, 57% developed lesions on additional molar-approximal surfaces in the primary teeth in the mixed dentition. Children with the faciolingual pattern (baby bottle tooth decay) were at the highest risk of any group for developing additional carious lesions. The model could serve as a basis for a prospective study.     

The post-amalgam era: a selection of materials and their longevity in the primary and young permanent dentitions

Summary. Objectives. During the last decade there has been a rapid change in the selection of dental restorative materials as the use of amalgam has decreased. The aim of this study was to obtain information on children's restorative dental care in Finland and to analyse the longevity of failed restorations. Design. A random sample of public dental health care centres was drawn from the registers and the dentists working there were asked to record information for each restoration they placed during a three‐day period. The survey data comprised a total of 2186 restorations in patients younger than 17 years. Results. Of the children in need of restorative treatment, only a few had previous amalgam restorations. Primary caries was the main reason for restorative treatment in both primary and permanent dentitions (80% and 83%, respectively). In primary teeth, the most common restorative material was resin‐modified glass ionomer cement (57·4%), whereas in permanent teeth, composite resin dominated (58·7%). Amalgam was not used at all in the primary dentition and in only 0·6% of permanent teeth. Eighteen per cent of treatments in primary and 12% in permanent teeth were replacements of previous fillings. The mean age of failed glass ionomer restorations was 2·8 years (n = 101) in the primary dentition, and 3·5 years (n = 54) in the permanent dentition. Conclusions. Until better restorative materials are developed, more attention should be paid to the prevention of dental caries as well as to the proper handling of alternative materials.     

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。     

Evaluation of Atraumatic Restorative Treatment restorations and sealants under field conditions.

Conventional restorative procedures require the use of dental materials, expensive equipment, instruments and electricity. This makes dental restorations costly and limits the availability and accessibility of the service to areas where these facilities are available. The new philosophy of restorative care requires minimal intervention and advocates early interception of the caries process through the use of glass-ionomers as sealants and as restorations. This new approach makes dental care accessible to all members of society in developing countries. The aim of this study was to evaluate the use of Atraumatic Restorative Treatment (ART) restorations and sealants under field conditions. Both were assessed for their retentive properties and the development of secondary caries adjacent to the procedures. A longitudinal study design was followed. ART restorations and sealants were assessed at intervals of 6 and 12 months. After 12 months 56.5% of ART restorations were still present in the primary dentition and 84% in the permanent dentition. Of these 85.1% had no defects in the primary and 78.6% no defects in the permanent teeth. 72.3% of primary and 92% of permanent teeth on which ART restorations were placed had no caries after 1 year. Even though most of the sealants were absent due to poor retention after 12 months (89.6%), 98.9% of the teeth where the sealant was initially placed had no caries. Only 6.3% of sealants present had marginal defects. The ART technique is strongly recommended for the management of small, occlusal carious lesions in primary and permanent teeth.     

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。     

A cohort study on prevalence of dental caries concerning primary schoolchildren in one village of Niigata Prefecture

To review the previous preventive measures against the incidence of dental caries in children, we started to examine the state of dental health in children at the age of 18 months. The annual dental examination continued up to 12 years of age (sixgraders). Enrolled in this study were a total of 225 children living in a Town T and born between 1980 and 1982. Meanwhile, we made surveys in order to gauge the degree to which the subjects and their parents have concern for oral health. The findings and their relationships to the caries incidence were analyzed using an epidemiological technique. The annual dental examinations revealed that in primary dentition the incidence of caries tends to increase in 3-year-olds while in permanent dentition the carious process extends in 4–6 graders. By kind of teeth, primary molars accounted for 52% of the affected deciduous teeth. First molars made up 72% of all the decayed permanent teeth. Using the two caries cumulative indexes developed by our department for recording the prevalence and severity of tooth decay in the deciduous dentition and in the permanent dentition, respectively, we found that there is a correlation between the incidence of caries in the deciduous dentition and that in the permanent teeth. The two formulae are based on the cumulative number of decayed teeth that appeared in the deciduous dentition and permanent dentition for a given period of time. In order to find whether there is any correlation between caries attack and attention paid to the risk factors, we divided the subjects into two groups by the number of decayed teeth per person. In the group made up of those with many carious teeth, it was noted that between-meal snacks are most likely to produce caries in deciduous teeth, while lifestyle affects permanentteth.

     

Caries prevalence and treatment needs of 7- to 10-year-old schoolchildren in southwestern Germany

Abstract The caries status of 1784 children aged 7 to 10 years was examined in a cross-sectional, epidemiological study in the Rhine-Neckar-District. Results showed that 30.5% of the children had caries-free primary and 65.2% had caries-free permanent teeth. The d(m)ft index was 2.68, and the D(M)FT averaged 0.76. As in previous studies, a high risk caries group was found, with 10% of all children showing more than 50% of all carious and filled teeth in the permanent dentition. Overall, 45.6% of the children's primary teeth and 16.3% of their permanent teeth needed treatment. As indicated by higher DT:F T (DT:FT) ratios in younger age groups, dentists preferred treating older children. Apart from a higher caries prevalence in primary teeth in males, no significant sex differences were found. Children of rural origin had a higher caries experience. The results confirm previous data showing considerable improvements with a declining caries experience in the young population. But the caries status of German pre-teenage children is still moderately high according to WHO criteria. For further improvements, considerable efforts have to be made with special emphasis on prevention in high risk caries groups.     

Strategies for addressing restorative challenges in HIV-infected children

The complete caries removal of deep/extensive dentin carious lesions with conventional procedures (high- and low-speed bur) may increase the risk of pulp exposure. In children with systemic diseases, such as HIV-infected children, the dental treatment proposed for the primary dentition with pulp involvement is tooth extraction once endodontic therapies cannot be guaranteed successfully. Therefore, the objective of this study was to describe 3 cases of alternative techniques for caries removal in extensive and/or deep dentin carious lesions in the primary dentition of HIV-infected children: (1) atraumatic restorative treatment (ART); (2) Carisolv; and (3) Papacarie.     

Placement and longevity of tooth-colored restorations in Denmark

A survey has been made of the use of materials and the reasons for placement of 2542 tooth-colored restorations in Denmark. In adults 38% of all the restorations were inserted because of primary caries, and 62% were replacements of failed restorations. In children primary caries was the reason for placing 68% of the restorations in deciduous teeth and 77% of those in permanent teeth. Resin-based materials were the most frequently used tooth-colored restorative, except in the treatment of deciduous teeth, for which glass ionomer cement was used preferentially. Silicate cement was used for less than 2% of the tooth-colored restorations, and the few old silicate cement restorations were most often replaced with resin materials. The reasons for replacement of resin restorations were dependent on dentition, age of the patient, and type of restoration. Secondary caries, fracture of restoration, and loss of fillings were the most frequently recorded failures. The age of the resin restorations replaced ranged from 0 to 19 years, and half of the failed restorations in adults were more than 6 years old. In permanent teeth in children half of the failed resin restorations were replaced within 2 years, whereas half of those in primary teeth were replaced within 1 year.     

The atraumatic restorative treatment (ART) approach for the management of dental caries.

There is worldwide interest in and increasing usage of the conservative atraumatic restorative treatment technique or approach for the restoration of primary and permanent teeth. However, most published data on the clinical performance of the newer, high-strength esthetic conventional glass-ionomer restorative cements marketed for the procedure have been derived from short-term studies. There have been very few reports comparing different types of restorative materials and methods of cavity preparation. In primary teeth, after 1 year, success rates have been approximately 80% to 95% for Class I and Class V single-surface restorations, 55% to 75% for Class II multisurface restorations, and 35% to 55% for Class III and Class IV restorations. In permanent teeth, after 2 to 3 years, success rates have been approximately 90% for Class I and Class V single-surface restorations, but little data have been reported for other restoration classes. Failures usually result from restoration losses, fractures, and wear. Further improvements in the design of hand instruments and in the mechanical properties of the newer glass-ionomer cements are required. Currently, use of the atraumatic restorative treatment approach should be restricted to restoration of single-surface caries lesions, especially in permanent teeth, and to sealing of occlusal fissures in selected teeth.     

Rationale for the partial removal of carious tissue in primary teeth

No consensus exists regarding the need for a second clinical session to remove carious dentin that remains in the pulp wall after partial caries removal. The purpose of the present article was to review studies that evaluated the effect of partial caries removal as provisional or definitive treatment on the dentinal microflora, the pulp response, or the progression of carious lesions in primary teeth. The results showed that partial caries removal performed in 1 session is more advantageous than removal in stages over 2 visits. This treatment, in addition to permitting the inactivation of caries lesions and reducing cariogenic micro-organisms in dentin, reduces the risk of pulp exposure caused by cavity reopening and excavation of remnant carious dentin. The favorable outcomes of partial caries removal in a single session support the indication of this modality as a definitive alternative restorative treatment for the primary dentition.     

Association between body mass index and dental health in 1,290 children of elementary schools in a German city

The aim of the present study was to investigate the association between caries frequency and body mass index (BMI) in German elementary school children. A total of 1,290 elementary school children (648 boys, 642 girls) were examined. The dental examination included the determination of caries frequency (DF-T/df-t values). The medical evaluation assessed the pupils’ general health and BMI. The study showed that 3.6% of the children were underweight, 74.8% had a normal weight, 11.9% were overweight, and 9.7% were obese. Underweight children showed natural healthy teeth in 44.7%, those with normal weight in 40.7%, whereas children with high weight and obese children showed natural healthy teeth in 30.5% and 31.7%, respectively. A significant association between high weight and caries frequency in the first dentition (p = 0.0067) and in the permanent dentition (p = 0.0002) could be observed. The association remains statistically significant after adjusting for age. The number of natural healthy teeth decreased with age (p = 0.001) and BMI (p = 0.0061) and was different between girls and boys (p = 0.0334). This study demonstrated a significant association between caries frequency and weight in school children. In future preventive programs, the importance of nutrition should not only be emphasized with respect to general diseases but also with regard to carious lesions.     

Prevalence and severity of clinical consequences of untreated dentine carious lesions in children from a deprived area of Brazil

Disadvantaged children suffer because tooth cavities are not being treated and their clinical consequences not being surveyed. The present study aimed to assess the prevalence and severity of clinical consequences of untreated dentine carious lesions in schoolchildren from a deprived area of Brazil and to investigate the determinants of the pufa index. A sample of 835 children aged 6-7 years, from six public schools, was examined by 3 calibrated examiners. Clinical consequences of untreated dentine carious lesions in primary teeth were diagnosed using the four codes of the pufa index: 'p' (pulpal involvement), 'u' (ulceration), 'f' (fistulae), 'a' (abscess). Effects of gender, age, school, history of extraction, and toothache on the prevalence of pufa codes were tested. The prevalence of pufa codes was 23.7%. The mean pufa score was 0.4 ± 0.9. Code 'p' was the most prevalent (19.5%), whereas code 'u' was least prevalent (0.1%). Children with a history of extracted primary teeth due to caries had a 2.7 times higher chance to have a pufa code than children with no previous extraction. Children with toothache had a 5.6 times higher chance to have a pufa code than children without toothache. The prevalence of clinical consequences of untreated dentine carious lesions was moderate and the severity was low. The pufa index is an epidemiological tool complementary to existing caries indices aimed to assess dental caries. However, there appears to be no need to include code 'u' nor to score codes 'f' and 'a' separately.     

Prevalence of noncavitated and cavitated carious lesions in 5-year-old head start schoolchildren in Alachua County, Florida

PURPOSE: The diagnosis of early carious lesions is essential for nonsurgical management of dental caries. This report describes the prevalence of early noncavitated and cavitated carious lesions in the primary dentition of 5-year-old Head Start schoolchildren in Alachua, Fla. METHODS: As part of the Fluoride Varnish Study conducted at the University of Florida, modified caries diagnostic criteria-which differentiated caries lesion activity and severity-were developed for the primary teeth. Dental examinations were conducted on 221 children ages 5 years by 2 calibrated examiners. RESULTS: Overall, 86% of the children had experienced noncavitated or cavitated caries lesions in the primary dentition. Prevalence of cavitated dentinal lesions was 48%, and prevalence of active noncavitated enamel lesions was 71%. The mean number of active noncavitated enamel lesions (mean +/- SEM: 2.91 +/- 0.21) was slightly higher than the mean number of cavitated dentinal lesions (2.52 +/- 0.31). The mean number of restored surfaces was 1.24 (+/- 0.42), and only 8% of the children had 1 or more restored surfaces. Noncavitated lesions were most common on occlusal surfaces, especially in mandibular second molars. African-American children had a higher prevalence of noncavitated lesions (81%) than whites (69%) or others (33%; P<.0001). Prevalence of cavitated lesions was 49% for African Americans, 46% for whites, and 48% for others. CONCLUSIONS: This study shows that noncavitated enamel and cavitated dentinal lesions are common in this study population's primary dentition. There is a need for preventive measures and treatment of decay in these children living in low-income families.     

Common dental conditions associated with dental erosion in schoolchildren in Australia

PURPOSE: The purpose of the investigation was to determine factors associated with dental erosion in a group of schoolchildren in Queensland, Australia. METHODS: Dental examinations were carried out on 714 children aged 5.5 to 14.6 years from 8 randomly selected Australian schools. A total of 3,165 primary and 2,976 permanent teeth were scored for dental erosion using a modified erosion index. Dental caries experience was determined from clinical examination and bitewing radiographs. Enamel defects were recorded using the developmental defects of enamel index. RESULTS: There were 225 children (32%) who exhibited no erosion and 489 (68%) who had erosion of at least one tooth. Erosion was found in 78% of subjects with primary teeth and 25% of subjects with permanent teeth (P<.001). Children with erosion in the primary and permanent dentition were more likely to have: (1) a lower socioeconomic status (primary dentition, P<.001 and permanent dentition (P<.001); (2) enamel hypoplasia in permanent dentition (P=.001); (3) dental caries in the primary dentition (P=.001); and (4) permanent dentition (P=.002). CONCLUSIONS: In Australian schoolchildren, the prevalence of dental erosion in the primary dentition is approximately 3 times greater than in the permanent dentition. Dental erosion is strongly associated with caries experience and enamel hypoplasia.