Early developmental traits in class II malocclusion

The occlusal traits of Class II occlusion in the deciduous dentition include distal terminal plane of the second deciduous molars, distal canine relation, large overjet, and large overbite. Other findings are narrow upper dental arch and maxillary base and poor anterior spacing. Skeletally, Class II children differ less from normal children. The cranial base, including the base flexure, and the maxilla are normal. The mandibular corpus and lower facial height are short, the gonial angle is large, and the dentoalveolar position of the mandible is retruded. The height of the ramus is normal, as is the skeletal position of the mandible, with the exception of the chin, which becomes slightly retruded after 5 years of age. As most skeletal traits of Class II occlusion develop later than the occlusal characteristics, it is suggested that no evidence can be found for a skeletal Class II growth pattern in the deciduous dentition. The deficient transversal growth of the maxilla and the sagittal growth of the mandible seem to cause the typical Class II occlusion. Further skeletal changes are likely to develop as secondary adaptations.     

氟保护漆预防儿童乳牙龋齿的临床效果评价

目的对氟保护漆预防儿童乳牙龋齿的临床效果进行评价。方法将重庆市一所幼儿园的150名3岁儿童随机分为4组,0.5%氟保护漆组、0.1%氟保护漆组、0.5%氟化钠组和空白对照组,分别采用质量分数为0.5%氟保护漆、0.1%氟保护漆、0.5%氟化钠和去离子水作为涂擦药物,每6个月涂擦1次,为期2年,记录试验前后患龋情况,对4组药物的防龋效果进行比较分析。结果0.5%氟保护漆组的龋均和龋面均显著低于0.1%氟保护漆组、0.5%氟化钠组和空白对照组（P<0.05）。结论质量分数为0.5%的氟保护漆具有明显的预防乳牙龋齿的作用。     

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针对专业人员使用的氟防龋方法,包括水氟调节、食盐氟化、牛奶加氟、氟剂等全身应用方法以及含氟牙膏、氟涂漆、氟凝胶和氟泡沫、氟水漱口等局部应用方法,采纳权威的文献,客观报告其效果、应用优缺点、可行性。实施任何氟防龋项目,都要根据目标人群龋流行程度及氟摄入量去判断。实施项目过程中,必须监测效果、副反应,评价当前氟暴露状况,及时调整氟防龋措施。     

Effect of a fluoride varnish (Duraphat®) in preschool children

The caries-preventive effect of semiannual applications of a fluoride varnish (Duraphat) was tested for 2 years in 225 3-year-old children; 113 children served as a control group. At the baseline examination, 69% of the children in the test group and 75% in the control group were caries-free. The results after 2 years showed an average caries increment of 2.1 surfaces in the test group and 3.7 in the control group. The difference is statistically significant. Thirty-eight percent of the children in the test group and 27% in the control group were still caries-free. The caries reduction was 44%.     

Caries clinical trial of fluoride rinses in a Danish Public Child Dental Service

365 2nd through 4th graders completed a 3-yr clinical trial on the caries-preventive effect of rinsings every second week during the school year with 10 ml of an 0.2% neutral solution of sodium fluoride. All children received regular dental examinations and treatment in clinics established by the municipality in which the study took place. The trial was performed under double-blind conditions. The caries increment on teeth erupted at baseline was 1.75 DMFS in the fluoride group and 1.83 DMFS in the placebo group (P greater than 0.05; 95% confidence limits for percentage caries reduction: -20.7% and 29.5%). The caries increment on teeth erupting during the trial was 0.73 DMFS in the fluoride group and 0.99 DMFS in the placebo group (P greater than 0.05; 95% confidence limits for percentage caries reduction: 1.0% and 51.6%).     

含氟涂料与含氟泡沫对儿童龋病预防效果的对比研究

目的比较含氟涂料和含氟泡沫对儿童乳牙龋病的预防效果,为在我国开展乳牙龋病防治工作提供理论依据。方法随机整群抽样的方法抽取2所幼儿园的3~4岁儿童共220名,进行口腔检查,记录患龋情况。随机将这些儿童分为含氟泡沫组和含氟涂料组,分别用氟泡沫和氟保护漆进行龋齿预防,每半年1次,2年共干预4次,每年进行口腔检查,比较2组基线后1年和2年的乳牙新生龋均、新生龋面均及龋齿发病率。结果含氟泡沫组干预1年及2年后新生龋面均分别为2.58±4.36、3.85±5.15;含氟涂料组干预1年及2年后新生龋面均分别为0.95±2.28、1.94±3.32,均显著低于含氟泡沫组(P<0.01)。结论含氟涂料对儿童龋病的预防效果优于含氟泡沫。     

Fluoride supplements and caries in a non-fluoridated child population

In Norway, there is no water fluoridation and little naturally occurring fluoride in drinking water. Fluoride toothpaste is used by 95% of the population and there is a long tradition of use of fluoride supplements. The purpose of this study was to analyse whether children who used fluoride toothpaste regularly and complied with the recommendations for use of fluoride supplements had less caries than other children at the age of 8 years. Most fluoride supplements sold in Norway are lozenge-type tablets, which allow for extended enamel exposure to fluoride. All children (n = 551) born in 1988 living in a suburban community in Norway were invited to participate. In those who participated (n = 470), caries was registered clinically and radiographically and parents provided data on use of supplements. Thirty-eight percent of the children had used fluoride supplements regularly during the period 0.5 to 4.0 years of age and 66% used supplements regularly at the age of 6 to 8 years. Multivariate analyses showed that the children complying with the recommendations for use of fluoride supplements during the period 0.5 to 4.0 years of age had lower caries experience (dmfs) and fewer decayed surfaces (ds) in primary teeth than other children. No significant associations were found between supplement use in childhood and caries prevalence (DMFS) or number of decayed surfaces (DS) in permanent teeth at the age of 8 years. Supplement use from 6 to 8 years of age was not associated with caries occurrence either in primary or in permanent teeth. Both mother's education and the quality of dental hygiene were inversely associated with caries occurrence.     

早期矫治乳牙反牙合的临床研究

目的 介绍儿童乳牙反He的早期矫治方法和意义。方法 反覆He深的用下颌联冠式斜面导板，反覆He浅的用He垫式活动矫治器附双曲舌簧，来调整上下颌骨间的关系。结果 经X线投影测量SNA SNB ANB MP/FH S-Gn/FH U1-FH MP-L1 1-NP 1-NB都发生了变化。结论 乳牙期的反He多为功能性的，宜早期矫治。     

Fluoride Supplements in Caries Prevention: A Literature Review and Proposal for a New Dosage Schedule

Fluoride supplements have contributed significantly to caries prevention; however, better information about the dynamic nature of fluoride's effect on caries has made a reappraisal desirable. It seems, from a review of the literature, that the benefit from supplement use that can be expected today in populations in low-fluoride areas is small. Possible reasons include the low caries incidence in children of recent years. Few people are willing to use supplements with sufficient regularity to achieve an effect. The principal mode of action of fluoride in supplements, topical exposure of teeth to fluoride, can be achieved with toothpastes and other means. Supplement use has been associated with dental fluorosis in children. This is displeasing to look at and may put at risk the undoubted benefits of water fluoridation if the public associates fluoride with negative cosmetic effects. This reason alone should be sufficient to compel a reconsideration of existing recommendations. An appropriate new dosage schedule for fluoride supplements should be aimed only at identifiable high caries-risk individuals, not at groups defined by age or residence and should result in much lower fluoride intake in the age span birth-eight years than many current recommendations. It should start at six months or later, expressly recommend lozenges rather than tablets for swallowing to maximize the topical effect, stipulate that the maximum fluoride ion content of a tablet be 0.50 mg to reduce the chances of fluorosis and over consumption, and have no upper age limit, as caries risk may occur at any age. A dosage schedule meeting these requirements is proposed.     

Associations Between Exposure to Fluoridated Drinking Water and Dental Caries Experience among Children in Two Australian States

Objectives : This study assessed associations between exposure to fluoride in water and dental caries experience among children in two Australian states. Methods : Cross-sectional data were obtained from 9, 690 South Australian children aged 5–15 years and 10, 195 Queensland children aged 5–12 years. School dental service practitioners recorded DMFS and dmfs data. A questionnaire to parents gained information about residential history that was used to calculate children's percent of lifetime exposed to fluoridated water. Results : Greater exposure to fluoride in water was associated with lower dmfs and DMFS in both states (P<. 01), although in South Australia the effect for DMFS was statistically significant only after controlling for extent of unknown fluoridation exposure and for fluoride supplements. Caries-fluoridation associations were stronger for dmfs compared with DMFS and for Queensland (5% of population fluoridated) compared with South Australia (70% of population fluoridated). Effects for DMFS persisted after controlling for socioeconomic factors. Conclusions : Fluoridation was associated with lower caries experience. The weaker association with DMFS in South Australia may be due to less caries and more fissure sealants in that state, and is consistent with a "diffusion" effect, whereby a high proportion of the population exposed to fluoridation diminishes differences among exposure groups.     

The Efficiency of Semiannual Silane Fluoride Varnish Applications: a Two-year Clinical Study in Preschool Children

Objective : The aim of this two-year community demonstration trial was to study the caries inhibitory effects of semiannual applications of a fluoride varnish in preschool children. Methods : Twenty-four public dental health clinics in the county of Halland, Sweden, with 5,137 preschool children, 4 and 5 years of age, were matched and equally allocated to a fluoride varnish group ( n =2,535) and a reference group ( n =2,602). The children in the fluoride varnish group were treated every six months with topical applications of a silane fluoride varnish, Fluor Protector (0.1% F), while no fluoride varnish was used in the reference group. Both groups received a basic preventive program at annual checkups consisting of dietary counseling and instructions to parents to brush their children's teeth at least once daily with fluoridated dentifrice. Caries data were collected by clinical examinations at baseline and after one and two years. Results : Caries prevalence at baseline did not differ significantly between the groups. After two years, the mean caries incidence was low and no statistical difference was found in the total number of carious and filled surfaces (dfs) between the two groups. However, the incidence of approximal lesions (dfsa) was significantly lower ( P <.05) in the fluoride varnish group than the reference group. Children in the fluoride varnish group with dfs scores of 1–4 and ≥5 at the start of the study exhibited a statistically significant ( P <.05) reduction in approximal caries incidence of 19 percent and 25 percent, respectively, when compared with the reference group. Conclusion : Preschool children 4 and 5 years of age with clinical caries who receive semiannual applications of a silane fluoride varnish containing 0.1 percent F experience a reduced incidence of approximal caries over two years.     

A school‐based fluoride mouth rinsing programme in Sarawak: a 3‐year field study

Chen CJ‐A, Ling KS, Esa R, Chia JC, Eddy A, Yaw SL. A school‐based fluoride mouth rinsing programme in Sarawak: a 3‐year field study. Community Dent Oral Epidemiol 2010; 38: 310–314. © 2010 John Wiley & Sons A/S Abstract – Background: This study was undertaken to assess the impact of fluoride mouth rinsing on caries experience in a cohort of schoolchildren 3 years after implementation. Methods: 270 children aged 8–9 years from four schools in Sarawak were selected at baseline. Baseline data was collected to ensure that the selected schools did not differ significantly. Children from two schools rinsed with 0.2% sodium fluoride under supervision, while those from the other schools did not. Results: After 3 years, 242 schoolchildren remained in the study. At the end of the study, the mean DMFT for the test group was 2.3 (95% CI, 1.93–2.67) while the mean DMFT for the control group was 4.01 (95% CI, 3.39–4.63). The mean DMFS for the test group was 3.40 (95% CI, 2.68–4.12) while the mean DMFS for the control group was 6.67 (95% CI, 5.47–7.87). After 3 years, 24.2% of those in the test group remained caries free compared to 11.5% in the control group. The risk of developing caries decreased 0.52 times among the children from the ‘test’ group exposed to the fluoride mouth rinsing programme as compared to the unexposed ‘control’ group (RR = 0.48, 95% CI, 0.26–0.85). Discussion and conclusion: The findings show that a school‐based weekly 0.2% sodium fluoride mouth rinsing programme is an effective caries preventive measure and should be implemented in fluoride‐deficient areas as a means of reducing the prevalence of dental caries in these communities.     

A systematic review on fluoridated food in caries prevention

Abstract

Objective. This paper aims to provide a systematic review of the caries-prevention effect of fluoridated food, excluding water. The main aim of this review was to evaluate the presence of scientific evidence relating to the effects of fluoride intake via food on the occurrence of carious lesions. The outcome was defined as a clinical outcome, so only papers evaluating a decrease in caries indices were included. Materials and methods. Relevant databases (Medline®, Embase®, The Cochrane Library) were searched. The date range was set from 01.01.1966 to 03.31.2011. One hundred and thirty-nine reports were identified and assessed. Only three papers fulfilled the inclusion criteria and were discussed in detail. Results. No paper related to the use of fluoridated salt in caries prevention fulfilled the inclusion criteria. The use of milk as a vehicle for providing additional fluoride in a dental public health programme was evaluated in two papers. The consumption of fluoridated milk was an effective measure to prevent caries in the primary teeth. The use of fluoridated sugar demonstrated a reduction in caries increment in the permanent dentition in one paper. Conclusions. Literature on the effectiveness of fluoridation in foods in caries prevention is scant and almost all the studies have been conducted in children. There is low evidence that the use of milk fluoridation is effective in reducing the caries increment.     

The place of fluoride supplements in caries prevention today

A bstract — There are very few scientifically good clinical trials of fluoride supplements, and those that can be considered methodologically adequate suggest that the contribution of fluoride supplements to caries prevention is slight. This may be partly a consequence of the fact that fluoride is much more widely available today than was the case a generation ago when fluoride toothpaste was not widely used and water fluoridation was not fully implemented. Although some families are conscientious in their use, compliance with fluoride supplement recommendations is generally poor over longer periods, making them a poor public health measure. There is substantial evidence that supplements cause dental fluorosis when used in accordance with recommendations for infants and small children. If the public becomes concerned about dental fluorosis as an aesthetic problem, all fluoride use may be put at risk. Supplements should no longer be recommended for caries prevention in children in areas with little fluoride in water but may be useful for persons with intractable caries risks. If supplements are recommended for children, a more cautious dosage schedule should be used. The fact that supplements have been recommended uncritically for many years on the basis of inadequate research raises questions about the standards of dental science.     

氟化物在儿童和青少年龋病防治中的应用

氟是人体所需的微量元素之一,适量的氟可预防龋病.氟化物的防龋机制体现在降低釉质溶解度,促进釉质再矿化,抑制细菌代谢和菌斑形成,影响牙体形态等方面.氟在龋病预防中的应用主要有氟的全身应用和局部应用.前者包括饮水氟化:将饮水中的F-调整到适宜质量浓度,使其能预防龋病,又不会导致并发症;食盐氟化:以食盐为载体加入氟化物;牛奶氟化:将适量氟化物添加到牛奶中以预防龋病;氟片和氟滴剂:兼有局部和全身的双重作用,以全身作用为主.全身用氟有优点有缺点,需根据不同国家和不同地区的实际情况选择性应用.后者包括个人用氟:使用含氟牙膏、含氟漱口水、含氟牙线和茶叶水漱口等多种方式;专业用氟:氟溶液涂布、含氟涂料、含氟凝胶、含氟泡沫、含氟材料和缓释氟材料等.局部用氟在临床及家庭预防中较为普遍,防龋效果较佳.     

应用氟化泡沫预防幼儿龋齿的防龋效果观察

目的：抽样调查东西湖区儿童使用氟化泡沫预防龋齿的效果。方法：对东西湖区8所幼儿园进行随机抽样,实验组儿童采用氟化泡沫护齿,每年2次,对照组儿童不做任何处理,2年后观察两组儿童之间患龋率及新龋发生率。结果：2年后实验组患龋率及新龋发生率均低于对照组,差异有统计学意义。结论：氟化泡沫能有效预防学龄前儿童龋病发展。     

A 2-year report on caries prevention by fluoride varnishes in a community with fluoridated water

Abstract – The benefit of semi-annual applications of sodium fluoride varnish (Duraphat®) and silanc fluoride varnish (Fluor Protector®) was studied in 11-13-year-old children with life-long exposure to fluoridated drinking water (1–1.2 parts/ 10⁶). Annual clinical and radiograpic examinations were made on 67 children in the Duraphat group and 71 children in the Fluor Protcctor group. Floride varnish was applied semi-annually using the half-mouth tecnique. At the end of 2 years, the mean overall DMFS- increments on te control side and test side of the Duraphat group were 5.0 and 3.8 ( P 0.01), respectively, and of te Fluor Protector group 3.7 and 3.3 (NS). The caries redutions were 24%and 12%, respectively. Since there were no differences between initial mean DMFS scores of te groups, it was assumed that lower increments in the Fluor Protector group were due to fluoride ions crossing the midline and providing protectioon on the control side as well. When increments in the Duraphat control side and the Fluor Protector test side were compared, the caries reducation of Fluor Protector was 35% ( P <0.01). Fluoride varnishes provide additional benefit even when fluoride intake from drinking water is optimal.     

An evaluation of a primary preventive dental programme in non-fluoridated areas of Victoria,Australia

A primary preventive dental programme targeting adolescents living in non-fluoridated areas of Victoria, Australia was evaluated for a three-year period. The programme comprised annual placement or replacement/repair of fissure sealants combined with a weekly 0.2 per cent sodium fluoride mouthrinse and was evaluated in terms of acceptance by the providers and the community to which it was directed. Acceptance was measured using accessibility, availability, continuity, quality of care, role responsibility, provider and consumer satisfaction, and cost-effectiveness. In general, the programme was considered to represent an acceptable model for future preventive interventions, although there were areas of its design that were found to require improvement. In particular, deficiencies in the manner in which the fluoride mouthrinsing component was delivered indicate that further investigation would be required before a recommendation to adopt its use could be made.     

The Prevalence of Dental Fluorosis in a School-based Program of Fluoride Mouthrinsing, Fluoride Tablets, and Both Procedures Combined

Objectives: The objective of the study was to describe and compare the prevalence and severity of dental fluorosis in children who participated in an eight-year clinical trial of the effectiveness of school-based fluoride procedures according to three treatment regimens and age of regimen initiation. Methods : At baseline in 1981, 1,640 kindergarten and first grade children residing in a fluoride-deficient community (Springfield, OH) were assigned randomly to a group that(1) rinsed once a week with a 0.2 percent neutral NaF solution; (2) chewed, rinsed, and swallowed daily a neutral 2.2 mg NaF tablet; or (3) carried out both procedures. DMFS examinations were conducted at baseline and after two, five, and eight years of treatment. As a follow-up in 1992, fluorosis examinations using Dean's index were conducted on 448 remaining subjects. Results : Overall, the prevalence of fluorosis was 4.4 percent with 20 children classified as having some definitive level of the condition. No statistically significant differences existed in the prevalence or severity of fluorosis: (1) among the preventive regimens; (2) among children who began the regimens at ages 5, 6, or 7; or (3) by eruptive status of teeth. Conclusion : These results reiterate the safety of school-based fluoride mouthrinse, fluoride tablet, or combined regimens in communities with fluoride-deficient water supplies.