Development of a standardized method for comparing fluoride ingested from toothpaste by 1.5-3.5-year-old children in seven European countries. Part 1: Field work

Abstract -  Objectives: To develop a standardized method for measuring the variables affecting fluoride ingestion from toothpaste in young children between the ages of 1.5 and 3.5 years, and to use the method at seven European sites. Methods: Random samples of children were invited to take part in the study. Parents who gave consent were visited at home. The children brushed their teeth using the toothpaste brand and toothbrush type currently in use. Variables measured were: type of toothpaste used, fluoride concentration of toothpaste used, weight of toothpaste used, frequency of brushing and body weight of the child. Results: It was not possible to follow the agreed protocol in all seven countries and in three countries appropriate alternative methods were employed. There was considerable variation between countries in the variables investigated. Use of children's toothpaste ranged from 69% in Ireland to 98% in Portugal. In the Netherlands up to 60% of the children were using toothpaste containing <400 ppm F and in Finland up to 27% of children were using toothpaste containing >1200 ppm F. Over half of the children used <0.25 g of toothpaste per brushing and the majority of children brushed once or twice per day. Conclusion: Although adherence to the agreed protocol was not possible at all study sites there was a clear picture of considerable variation in the oral hygiene practices of young children throughout Europe.     

A European perspective on fluoride use in seven countries

Abstract -  Objectives: The aim of this study was to collate data on national policies for the use of fluoride in the seven European countries participating in the FLINT project. Methods: Policies on the use of fluoride were obtained for each of the study areas. Data collected included the presence of water fluoridation and regulations governing fluoride toothpaste and fluoride supplements. Results: In Ireland 74% of the population had a fluoridated water supply but in all the other countries fluoride toothpaste was the principal form of delivering fluoride, usually recommended as a dose of a pea-sized amount. Fluoride supplement use varied considerably between countries. The Netherlands had the clearest regulations covering the use of fluoride supplements and definition of at-risk individuals. Most countries, even if they recognized particular caries-risk did not define the term clearly. In Iceland all children were regarded as being at high risk of developing caries. Conclusion: Considerable variation exists between European countries in their policies for fluoride use and no clear definitions of high-caries-risk individuals were found. The results show that there is even a lack of coherent thought and planning within the different countries, let alone between them.     

Dental maturity in children of short stature, with or without growth hormone deficiency

The aim of this investigation was to study dental maturity in healthy prepubertal children of short stature (height < −2 SD), with or without growth hormone (GH) deficiency, compared to healthy controls. The GH-deficient group (GH level < 10.0 μg/l) included 29 children (11 female. 18 male) with a mean age of 10.2 ± 2.2 years. The GH non-deficient group consisted of 17 children (5 female. 12 male) with a mean age of 8.5 ± 2.1 years. All the children were evaluated for serum concentrations of IGF-1, alkaline phosphatase (ALP), triiodthyronin (T3), thyroxine (T4). thyroid-stimulating hormone (TSH). and fasting plasma insulin: height and bone age were also recorded. Dental maturity was determined from panoramic radiographs. The mean difference between the dental and chronological ages was −0.67 ± 0.89 years in the GH-deficient group compared to 0.23 ± 1.07 years in their controls: in the GH non-deficient group the difference was −0.95 ± 0.82 years compared to controls 0.16 ± 1.06 years in their controls. Compared to chronological age. both bone and dental age were lower in the GH-deficient and GH non-deficient groups. It is concluded that children of short stature, both GH-deficient and GH non-deficient, exhibit a delayed dental age compared to their chronological age- and sex-matched controls. A multiple stepwise regression analysts showed that the sitting height and GH level were the only significant factors associated with dental maturity.     

The distribution of plaque and gingivitis and the influence of toothbrushing hand in a group of South Wales 11–12 year-old children

Numerous factors may affect the distribution of plaque and gingivitis in any individuals mouth. Of considerable importance must be the oral hygiene habits of each person, which will be influenced by compliance and dexterity with tooth cleaning methods. The pattern of gingivitis seen at a young age may, with time, reflect the eventual distribution of attachment loss. This in part, could explain the considerable variation in chronic periodontal disease seen between individuals and at different sites within the same mouth. This study reports the baseline data for the distribution of plaque and gingivitis in 1105, 11-12-year-old children in South Wales. The children were selected by disproportionate stratified random sampling and examined by a multidisciplinary group with the long-term aim of evaluating the importance of malocclusion to dental health and psychosocial variables. Toothbrushing frequency had a very low but significant correlation with the distribution of plaque and gingivitis, accounting therefore for only a small % of the variance in the group. For the total group and right-handed toothbrushers, buccal plaque and gingivitis was significantly increased on right contralateral teeth. No specific pattern for plaque and gingivitis distribution by side was seen for 100 left-handed toothbrushers. Plaque and gingivitis also showed significant differences dependent upon arch, tooth number, and surface. The population is being followed at 4-year intervals to monitor the pattern of periodontal disease with time and correlate changes with these baseline findings.     

Guidelines for the management of traumatic dental injuries. III. Primary teeth

Abstract –  Trauma to the primary dentition present special problems and the management is often different as compared with permanent teeth. An appropriate emergency treatment plan is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence based on literature research and professional opinion. In this third article out of three, the IADT Guidelines for the management of traumatic injuries in the primary dentition, are presented.     

Consumption of nonpublic water: implications for children's caries experience

There are concerns that the consumption of unfluoridated bottled and tank water may put children at increased risk of developing caries. OBJECTIVES: The aim of this study was to investigate the relationship between nonpublic water consumption (either from bottles or rainwater tanks) and socioeconomic status (SES) and both deciduous and permanent caries experience. METHODS: A random sample of children enrolled in the School Dental Service of South Australia participated in the study (response rate = 71.8%, n = 9988). RESULTS: Forty-five per cent of children had greater than 50% lifetime consumption of nonpublic water while 36% of children had 0% lifetime consumption. Increased use of nonpublic water occurred for children from lower socioeconomic groups, two-parent families and children from nonmetropolitan areas, with these results most likely a result of the residential location of the children. Multivariate modelling revealed a significant positive relationship between deciduous caries experience and consumption of nonpublic water, even after controlling for the age and sex of the child, SES and residential location. This relationship was significant only for those children with 100% lifetime availability of fluoridated water. The effect of consumption of nonpublic water on permanent caries experience was not significant. It is postulated that these findings may result from the lower caries activity in the permanent dentition of children aged 10-15 and possible dietary confounders. CONCLUSION: Recommendations are made for the addition of fluoride to bottled water, especially with regard to the oral health of younger children.     

Pre-school child oral health in rural Western Australia

BACKGROUND: In light of the various challenges faced by public dental health services, especially when large geographical areas and isolated communities are concerned, targeting of high risk groups within these populations needs to be investigated. This study aimed to assess caries experience, dental health behaviour and dental service utilization among a sample of pre-school children in a rural community in Western Australia. METHODS: The study was a cross-sectional oral health survey of pre-school children between the ages of 2 and 5 in Carnarvon, Western Australia. RESULTS: In total, 70 pre-school children (representing approximately 15 per cent of the total 2-5 year old population of Carnarvon) were examined. Less than half of the children were caries free. Both caries prevalence and severity (mean dmft) were significantly higher among Aboriginal children than non-Aboriginal children. Caries prevalence and severity were also significantly higher among children who often consumed carbonated drinks. CONCLUSIONS: This survey indicates that some pre-school children in rural areas, and especially Aboriginal pre-school children, are at high risk of developing dental caries. Effective oral health programmes commencing well before the usual first contact with dental services at age 5 are needed for young children at high risk of dental caries.     

Oral health disparities in children of immigrants: dental caries experience at enrollment and during follow-up in the New England Children's Amalgam Trial

OBJECTIVES: Previous research shows increased dental decay among immigrants, but little is known about the oral health of the growing population of children of immigrants. We compared the children of immigrants to the children of US-born caregivers in their caries experience at enrollment and their new caries increments during the 5-year New England Children's Amalgam Trial (NECAT). METHODS: NECAT recruited 283 Boston-area children aged 6 to 10 with untreated caries and offered free semiannual preventive and restorative dental care during the trial. Sociodemographic factors and caregiver immigrant status were assessed through interviews. Multivariate negative binomial models evaluated the association between caregiver immigrant status and clinically assessed carious surfaces. RESULTS: Forty percent of these Boston-area children had immigrant caregivers. At baseline, the children of immigrants had more carious surfaces (11.5 versus 9.4, adjusted for race/ethnicity, age, gender, and caregiver smoking status). Caregiver language preference explained some of this association. Immigrant status and language preference were not associated with 5-year caries increments. CONCLUSIONS: Prevalent disparities in the unmet dental needs of the immigrants' children were quickly ameliorated during participation in NECAT Dental initiatives that target neighborhoods and are sensitive to acculturation levels may help improve and maintain the oral health of immigrant families.     

PCR detection of 5 putative periodontal pathogens in dental plaque samples from children 2 to 12 years of age

BACKGROUND, AIMS: The purpose of this study was to detect the presence of Prevotella intermedia, P. nigrescens, Bacteroides forsythus, Treponema denticola, and Campylobacter rectus in plaque samples from 119 children, collected from their toothbrushes using a polymerase chain reaction (PCR). METHOD: The subjects were 24, 83, and 12 children with healthy gingiva, gingivitis, and periodontitis, respectively, ranging in age from 2-12 years old. Plaque samples were collected from all erupted teeth sites using a sterile toothbrush. The mean concentration of DNA recovered from the plaque samples was approximately 640 microg/ml, which was deemed sufficient for performing a PCR-based survey. RESULTS: The prevalence by PCR in healthy, gingivitis, and periodontitis subjects was 0.0%, 6.0% and 25.0% for P. intermedia, 45.8%, 79.5% and 50.0% for P. nigrescens, 33.3%, 63.9% and 58.3% for B. forsythus, 0.0%, 18.1% and 16.7% for T. denticola, and 100% in duplicate for C. rectus, respectively. CONCLUSION: Our survey indicated that P. intermedia and T. denticola were more associated with periodontal diseases, B. forsythus and P. nigrescens had a moderate prevalence in all clinical groups, while C. rectus were the most commonly detected species in the oral cavities of children suggesting establishment in their early years.