Oral health in Slovenia, Yugoslavia

An oral health epidemiological survey using WHO assessment forms was conducted in the Republic of Slovenia (Yugoslavia) in 1987. The study population consisted of 1623 persons aged 6, 12, 15, 18, 35-44 and over 65 yr. The survey included 10 towns in 9 geographical areas of Slovenia. The results showed the prevalence of dental caries in the Slovenian population to be very high (93.6% in 12-yr-olds). The mean decayed, missing, and filled teeth (DMFT) scores were as follows: 5.1 at age 12 yr, 10.2 at 15 yr, 12.9 at 18 yr, 20.5 at 35-44 yr, and 27.0 in persons aged over 65 yr. Assessment of the periodontal status showed calculus to be the predominant disorder in the age groups 18 and 35-44 yr, while shallow pockets prevailed in persons aged over 65 yr.     

Oral health in SFR Yugoslavia in 1986

A pilot oral health epidemiological survey using WHO assessment forms was conducted in Yugoslavia in the year 1986. The study population consisted of 2600 persons aged 6, 12, 15, 18, 35-44, and over 65 yr. The survey included 22 towns (11 developed and 11 underdeveloped) in the six Republics and two Provinces of Yugoslavia. The results showed the prevalence of dental caries in the Yugoslav population to be very high (98.7% in 12-yr-olds). The mean decayed, missing, and filled teeth (DMF) scores were as follows: 6.1 at age 12 yr, 9.6 at age 15, 10.9 at age 18, 18.0 at age 35-44, and 28.0 in persons aged over 65 yr. Assessment of the periodontal status showed calculus to be the predominant disorder in the age groups 18 and 35-44 yr, while loss of sextants prevailed in persons aged over 65 yr.     

Tooth and root conditions in the middle-aged and the elderly in Hong Kong

Abstract In an oral health survey of Hong Kong Chinese conducted in 1991, a sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were interviewed and clinically examined. The examination procedures, instruments, and diagnostic criteria used to detect coronal caries followed those recommended by the World Health Organization (1987). The diagnostic criteria used to assess root-surface caries were based on those used in a national oral health survey of US employed adults (National Institute of Denial Research. 1987). Calibration of examiners was conducted before the survey and the interexaminer reliability was found to be very high; the kappa statistics were 0.93 and 0.91 for the younger and older age groups, respectively. None of the 35–44-yr-olds were edentulous and 96% had 21 teeth or more. The prevalence of edentulousness among the elderly was 12%. The DMFT indices of the younger and older age groups were 8.7 and 18.9, respectively. In both age groups, MT was the major component of the DMFT index, and female subjects had a slightly higher score. The prevalences of decayed/filled roots were 7% and 26%i for the 35–44- and 65–74-yr-olds, respectively. As compared with previous surveys conducted in Hong Kong, there has been a 40% reduction in the DMFT index of the 35–44-yr-olds since 1968, but little change in the tooth and root conditions was noted between 1984 and 1991.     

Dental caries status and treatment needs of the permanent dentition of 6–12-year-olds in Hong Kong

An oral health survey was conducted in 1986 on a representative sample of primary school children in Hong Kong. 1483 Chinese children of both sexes, aged 6-12 yr, attending 56 primary schools were surveyed. The DMFT index for the 6-yr-olds was 0.1, and for the 12-yr-olds it was 1.5. Forty percent of the 12-yr-olds were clinically caries-free. The permanent molars constituted 90% of the total caries experience of the 12-yr-olds. Over 90% of the caries lesions were found in pits and fissures. The dental caries treatment need in the permanent dentition was low and of the simple type. A great reduction in the dental caries experience of the permanent dentition of children has occurred since the introduction of water fluoridation 25 yr ago. In addition to treatment care, preventive measures should be provided by the School Dental Care Service for children with a high caries risk.     

Dental caries and its determinants among recent immigrants from rural Ethiopia

Adults (35-45 yr old) and children (5 and 12 yr old) recently arrived in Israel from rural areas in Ethiopia were examined. Caries levels were low: e.g. DMFT = 0.31 among 12-yr-olds, and 1.27 amongst adults. The 5-yr-olds were 86.8% caries-free, while 12-yr-olds were 81.8% and adults 54% caries-free respectively. According to interview data, the diet in Ethiopia had been based on local agricultural products and was almost sugar-free. The mean total count of salivary bacteria, as determined on blood agar, was 3.4 x 10(8); mean count of Streptococcus viridans, on mitis salivarius, was 6.7 x 10(7); and mean count of S. mutans, as determined on mitis salivarius with bacitracin, was 1.7 x 10(7). These levels were all high and were not significantly different from a control group of 20 Israelis. The mean number of lactobacilli, on Rogosa agar, was 2.75 x 10(4), which was significantly higher than among the controls (3.6 x 10(3). Salivary pH levels were generally similar between the Ethiopian group and the controls. Salivary flow was significantly higher for the Ethiopians (1.93 ml/min) than for controls (1.16 ml/min). Low levels of caries in this population can be attributed to an almost sugar-free diet and high salivary flow, but not to the composition of oral microflora.     

Dental caries experience in the Chiangmai/Lamphun provinces of Thailand

Thailand has a highly developed system of primary health care. Using the criteria and methods recommended by W.H.O., an oral health survey was undertaken of 2111 subjects from six districts with different types of dental service including two with no systematic service and two with ICOH-trained primary oral health care personnel - examiners, health educators and village scalers. Significant differences between districts, unrelated to the type of dental service, were found in the percent of children with caries-free primary teeth and in mean dmft at ages 5 and 6; and at ages 5-6, 12, 17-18 and 35-44 (but not 15-16) in the percent of subjects with caries-free permanent teeth. The prevalence of DMFT was uniformly low ranging from 0.0 at age 6 to 1.18 at age 35-44. There was an inverse relationship between CFI and DMFT in subjects aged 12-18 and a direct relationship between dental fluorosis and the fluoride content of well-water used for cooking and drinking. The most conspicuous feature of the data was the much greater prevalence of caries in the primary dentition with heavy involvement of the maxillary incisors. Comparisons with the Thai and International Goals for Oral Health by the Year 2000 show that all except two districts have already achieved the Thai, but not the FDI/WHO, Goal for 5-6-yr-olds with caries-free primary teeth and, except for one district, all of the national and international goals with respect to the status of the permanent dentition have also been achieved.     

Periodontal status and treatment needs in the Chiangmai/Lamphun provinces of Thailand

As part of an oral health survey concerned with the evaluation of a collaborative primary oral health care program, the CPITN system was used to determine the periodontal status and treatment needs of 2009 Thai people aged 12-44 yr. Calculus dominated the CPITN scores. The percentage of persons with healthy periodontal tissues was small, ranging from 0.7% at age 35-44 to 4.1% at age 12. Ranges for other highest scores were bleeding-0.4% at age 35-44 yr to 6.1% at age 12 yr; calculus-62% at age 35-44 yr to 92.6% at age 17-18 yr. Pocketing did not occur to any significant extent until age 35-44 where 23.9% had 3-5 mm pockets and 12.8% had pockets 6 mm or deeper. 15-18-yr-olds who had received prior care from a Village Scaler had a significantly higher number and proportion of healthy sextants than those who had not received such care. No such effect was demonstrated in 35-44-yr-olds. The need for caution in the interpretation of this result is stressed. Attention is drawn to the desirability of differentiating between supra- and sub-gingival calculus in the CPITN scoring system and to the excessive treatment requirements that arise from classifying everyone with calculus as requiring prophylaxis and scaling. A great deal of improvement will need to be affected if the Thai national and global goals for periodontal health are to be achieved in the districts covered by this survey.     

Caries and consumption of sweets in 15- and 18-year-olds interviewed with visualization.

Abstract – The aim of this study was first to investigate the relationship at group level between approximal caries, restorations in posterior regions and consumption of sweets during the past 3 yr in 15-yr-old schoolchildren selected for different caries experience. An interview method was used with the sweets on display. Secondly, the aim was to reinterview the subjects as 18-yr-olds using the same method in order to study the correlation between caries incidence and consumption of sweets during the past 3 yr. Seventy-five individuals from three groups, 30 with 0, 25 with 4-6, and 20 with 12-15 approximal DFS, were selected for the first interview. Sixtynine of them were reinterviewed 3 yr later. Caries incidence during the 3-yr period was expressed as a percentage of the number of caries-free approximal surfaces of premolars and molars at the age of 15. The results showed no statistically significant differences in mean number of intakes of sweets per day (2.2, 2.2, and 2.8) between the original DFS groups. The correlation coefficient between caries incidence and number of intakes of sweets in the second part of the study was 0.25 (p<0.05). After correction for the modifying effect of oral hygiene, the coefficient was 0.51 (P<0.01) in the less favorable fraction and 0.11 (P>0.05) in the favorable fraction.     

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.     

Caries and consumption of sweets in 15- and 18-year-olds interviewed with visualization

The aim of this study was first to investigate the relationship at group level between approximal caries, restorations in posterior regions and consumption of sweets during the past 3 yr in 15-yr-old schoolchildren selected for different caries experience. An interview method was used with the sweets on display. Secondly, the aim was to reinterview the subjects as 18-yr-olds using the same method in order to study the correlation between caries incidence and consumption of sweets during the past 3 yr. Seventy-five individuals from three groups, 30 with 0, 25 with 4-6, and 20 with 12-15 approximal DFS, were selected for the first interview. Sixty-nine of them were reinterviewed 3 yr later. Caries incidence during the 3-yr period was expressed as a percentage of the number of caries-free approximal surfaces of premolars and molars at the age of 15. The results showed no statistically significant differences in mean number of intakes of sweets per day (2.2, 2.2, and 2.8) between the original DFS groups. The correlation coefficient between caries incidence and number of intakes of sweets in the second part of the study was 0.25 (P less than 0.05). After correction for the modifying effect of oral hygiene, the coefficient was 0.51 (P less than 0.01) in the less favorable fraction and 0.11 (P greater than 0.05) in the favorable fraction.     

Reasons for the caries decline in Slovenia

In 1987, 1993 and 1998, nationwide surveys on the prevalence of dental caries were carried out in Slovenia. Sampling and examinations were performed according to WHO standards. The age groups 6, 12, 15, 18, 35-44 and 65 years or older were studied. In each age group, 200 persons or more were examined on each occasion. The results showed that the proportion of caries-free children and adolescents increased considerably over the 12-year period between the first and the last survey (from 6% to 40% for 12-year-olds). In the same period, the mean DMFT values decreased as follows: from 5.1 to 1.8 for 12-year-olds, from 10.2 to 4.3 for 15-year-olds, from 12.9 to 7.0 for 18-years-olds, from 20.5 to 14.7 for 35-44-year-olds, and from 27.0 to 22.5 for subjects aged 65 years or more. The notable improvement of dental health can be explained by the preventive programmes in operation in various periods. The most recent decline was most likely due to supervised brushing (with concentrated fluoride gel) taking place some 16-18 times a year in primary schools attended by children aged 7-15 years, improved oral hygiene, and a comprehensive programme of applying fissure sealants, particularly on first molars.     

Variation of posterior approximal caries incidence with consumption of sweets with regard to other caries-related factors in15–18-year-olds

The aim of this study was to analyze the relationships between caries incidence and a number of caries-related factors in 15-18-yr-olds, in order to estimate the explanatory value of consumption of sweets under different conditions. Sixty-nine 18-yr-olds were interviewed about consumption of sweets and other sugar-containing products during the past 3 yr. Data on oral hygiene, salivary counts of mutans streptococci and lactobacilli, salivary flow rate and oral sugar clearance time were collected when the individuals were 15 and 18 yr old. Caries incidence for the 3-yr period was expressed as a percentage of the number of caries-free approximal surfaces of premolars and molars at the age of 15. Simple linear correlations between caries incidence and the different variables showed that lactobacilli count ranked first (r = 0.26), sweets second (r = 0.25), and mutans streptococci count third (r = 0.24). The r value for caries incidence and consumption of sweets increased in subgroups with combinations of poor oral hygiene, a high intake of other sugary products and a low salivary flow rate (r = 0.67-0.70). In conclusion, consumption of sweets should still be considered an important caries-related factor and particularly harmful when oral hygiene is poor and consumption of other sugary products is high.     

Dental caries and Streptococcus mutans in a rural child population in Iceland.

In spite of having a high socioeconomic standing, in Iceland caries prevalence has remained stubbornly high. This study reports findings from a mixed fishing and farming community in East Iceland that has traditionally been associated with the highest prevalence of caries. A total of 188 children aged 3-16 yr (96.4% of residents of that age group) were examined. At 6 yr the mean dmfs score was 4.1, DMFS 0 and 48% were caries-free. The mean DMFS score at 12 yr was 4.7 and 22.6% remained caries-free but at 16 yr the DMFS score was 11.6 and no children were caries-free. Caries was unevenly distributed within each age group and was more prevalent among residents of the fishing town than the surrounding farming district. In a pilot study conducted in 1989 mean counts of Streptococcus mutans for children aged 4-7 yr were 2.6 x 10(5) cfu/ml and declined to 4.6 x 10(4) cfu/ml in 1990 after a program of chlorhexidine brushing had been added to the routine caries preventive measures adopted in this community. It may therefore be possible to screen Icelandic children for caries risk and apply preventive measures to those demonstrated to be most in need.     

Relationships between free smooth surface and proximal caries in the young permanent dentition

Abstract Cross-sectional relationships between free smooth surface and proximal caries were assessed in 3 age groups, comprising 252 subjects aged 12 yr, 301 aged 15–16 yr and 102 aged 18–19 yr. Caries diagnosis was clinically on while spot and radio graphically on enamel lesion level. Fair correlation between buccallingual and proximal caries observed among 12-yr-olds (r=0.47) declined in the older subjects (r=0.24). While statistically significant the variability in proximal caries, explained by buccal-lingual lesions, was low (range 6–22%). Sensitivity and specificity for buccal-lingual lesions as an indicator for proximal caries in the same tooth ranged from 0.37–0.44 and 0.84–0.91, respectively, with associated Pv+ and Pv– ranging from 0.41–0.44 and 0.84–0.91, respectively. Sensitivity and specificity for buccal-lingual caries in identifying subjects with proximal caries ranged from 0.33–0.44 and 0.67–0.98, respectively. Pv+ ranged from 0.94–0.99 and Pv- from 0.06–0.35. ROC curve analysis yielded A_z-values of about 0.76 in the two younger age groups and 0.57 in the oldest. The results imply that information obtained from visual examination should be applied with caution when inferences about current caries status on proximal surfaces are made from the presence of buccal-lingual caries.     

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.     

Dental caries and Streptococcus mutans in a rural child population in Iceland

In spite of having a high socioeconomic standing, in Iceland caries prevalence has remained stubbornly high. This study reports findings from a mixed fishing and farming community in East Iceland that has traditionally been associated with the highest prevalence of caries. A total of 188 children aged 3–16 yr (96.4% of residents of that age group) were examined. At 6 yr the mean dmfs score was 4.1, DMFS 0 and 48% were caries-free. The mean DMFS score at 12 yr was 4.7 and 22.6% remained caries-free but at 16 yr the DMFS score was 11.6 and no children were caries-free. Caries was unevenly distributed within each age group and was more prevalent among residents of the fishing town than the surrounding farming district. In a pilot study conducted in 1989 mean counts of Streptococcus mutans for children aged 4–7 yr were 2.6 × 10⁵ cfu/ml and declined to 4.6 × 10⁴ cfu/ml in 1990 after a program of chlorhexidine brushing had been added to the routine caries preventive measures adopted in this community. It may therefore be possible to screen Icelandic children for caries risk and apply preventive measures to those demonstrated to be most in need.     

Periodontal treatment needs in populations under 20 years of age in Espoo, Finland and Chiangmai, Thailand

The aim of this study was to assess the periodontal treatment needs at under 20 yr of age in the affluent area of Espoo, Finland, offering comprehensive public dental health care, as compared to a less advantaged area in Chiangmai, Thailand. In Espoo, 50 girls and 50 boys were examined in each age group of 7, 12 and 17 yr. In Chiangmai equal numbers of girls and boys were examined to obtain a group of 89 subjects aged 18.5 + 0.6 yr. According to the Community Periodontal Index of Treatment Needs (CPITN) the need of scaling increased in Espoo from 6% of the 7-yr-olds to 39% of the 17-yr-olds. Moderate pocketing (4-5 mm) occurred in one subject at age 12 and in three subjects at age 17. In Chiangmai, deep pockets (6 mm and over) were recorded for 1%, moderate pockets for a total of 44%, and dental calculus as the highest treatment need indicator in the remaining 55%, indicating a need for professional treatment in 100% of the group examined. The mean number of sextants requiring scaling was 0.6 per person at age 17 in Espoo as compared to 4.5 at 18.5 yr of age in Chiangmai. Three or more healthy sextants per subject were recorded for 47% of the 17-yr-olds in Espoo and for only 6% of the 18.5-yr-olds in Chiangmai. It was concluded that already at young age vast differences occur between periodontal treatment needs in industrialized and developing countries.     

Mutans streptococci, lactobacilli and caries prevalence in 11-and 12-year-old Icelandic children

Since the caries prevalence has not declined in Iceland as it has in other European countries, it was of interest to study the presence of cariogenic bacteria in Icelandic children. The prevalence of salivary mutans streptococci and lactobacilli was examined in 217 11- and 12-yr-old Icelandic children and was related to their caries prevalence. In 2% of the children mutans streptococci were not found whereas 31% and 35% of the 11-yr-olds and 12-yr-olds respectively carried more than 10(6) CFU per ml saliva. Lactobacilli were not detected in 8% of the children whereas 28% of the 11-yr-olds and 23% of the 12-yr-olds had more than 10(5) CFU per ml saliva. The mean caries prevalence (DFS), initial caries included, for 11-yr-olds was 21.6 and for 12-yr-olds 28.8. Both mutans streptococci and lactobacilli were significantly correlated to each other as well as to caries prevalence. An increased number of these microorganisms, especially the mutans streptococci, were associated with an increased DFS. Children with high salivary counts of mutans streptococci and lactobacilli showed four times higher DFS than children with low numbers. The magnitude of salivary cariogenic bacteria as well as caries prevalence was found to resemble the situation in Sweden 10 yr ago. S. mutans (serotype c/e/f) was carried by all mutans streptococci positive children. S. sobrinus (serotype d/g) was found in 60 children (30.2%). Children with both S. mutans and S. sobrinus had significantly higher salivary counts of mutans streptococci and lactobacilli as well as caries prevalence than children with only S. mutans.     

Past caries recordings made in Public Dental Clinics as predictors of caries prevalence in early adolescence

The aim of the present study was to evaluate the power of past caries experience in primary and permanent dentition in predicting caries prevalence at the age of 13 yr. Clinical and radiographical examination was performed in 512 13-yr-olds by a trained research team. The 6-12-yr dmfs and DMFS values were obtained from the Public Dental Care records. For evaluating the accuracy of predictions, the children were cross-classified according to each past caries score and the 13-yr score. The cutting points were selected to that the children in the upper quartile of caries experience formed the predicted and true high caries groups, leaving about 75% in the low caries groups. Pearson correlations were also calculated. Sensitivity and specificity of caries in primary teeth (6 yr) were 57% and 85%, respectively. For permanent dentition, sensitivity was the lowest (28%) at the age of 6, reached 68% at the age of 9 and remained at that level until age 12. Specificity decreased from 92% (6 yr) to 85% (9 yr) and then steadily increased to 93% (12 yr). Correlation increased with age from 0.37 to 0.82. When screening for high caries increment in young children, caries in primary dentition seems a better screening criterion than caries in permanent first molars. When the aim is to identify those subjects with high caries increment later on, screening at age 9 seems as accurate as that done later.     

Dental caries prevalence in youth from the Hague. Have the differences in dental health between social groups closed?

In 1998 a dental survey amongst 6- and 12-year-old schoolchildren in the Hague was carried out. The 1998-survey showed differences in caries experience between SES groups that had increased in the period 1989-1998. The decline in caries experience among 6-year-old children of low SES groups had come to an end after 1983, whereas among 12-year-old children the decrease in mean DMFS values had stopped in the early nineties. However, the survey showed that during 1989-1998, the percentages of caries-free children in medium and high SES groups continued to rise. Of the medium SES 6- and 12-year-old children, In 1998, the percentage of caries-free 6- and 12-year-old children in medium SES group were 79 and 87, respectively. The comparable results in the high SES group were 87 (6-yr-olds) and 93 (12-yr-olds).