Göran Koch

Prevalence of Approximal Caries in Posterior Teeth in 15-Year-Old Swedish Teenagers in Relation to Their Caries Experience at 3 Years of Age

The aim of the present investigation was to study the prevalence of approximal caries lesions and fillings in posterior teeth at 15 years of age in a prospectively followed Swedish population (n = 568), with special reference to their caries experience at the age of 3 years. Only approximal surfaces were recorded, since all children in the Community of Jönköping have had fissure sealing performed on all caries-free permanent molars. At 15 years of age, the mean number of approximal tooth surfaces with initial caries lesions (Dia), manifest caries lesions and fillings (DmFa) and total caries experience and fillings (Di + mFa) – recorded on bitewing radiographs – was 2.78 , 0.45 and 3.23, respectively. One third of the adolescents had no approximal caries or fillings; the Dia constituted 86% of the Di + mFa. Children with manifest caries at 3 years of age had a higher risk of developing approximal caries in their permanent teeth than caries-free children at the same age (41 vs. 17%). Furthermore, children who were caries-free at 3 years of age were more likely to remain caries-free at 15 years of age compared to children with manifest caries (37 vs. 17%). All these differences were statistically significant (p < 0.001). Additionally, early childhood caries experience (developed before 3 years of age) had a greater predictive value than late childhood caries experience (developed between 3 and 6 years of age) concerning approximal caries at 15 years of age.

Analysis of caries-related factors in infants and toddlers living in Sweden

The aims of this study were 1) to investigate whether oral hygiene and dietary habits established at 1 year of age are maintained at 2 years of age and 2) to analyze caries-related factors with regard to oral health between the age of 1 and 3 years by using the salutogenic theory-that is, focusing on behavioral factors that do not result in impairment of health. Altogether 289 children were examined at 1, 2, and 3 years of age, and their parents were interviewed about the childrens oral hygiene and dietary habits at 1 and 2 years of age. The result shows that caries-related habits, such as oral hygiene and dietary habits, established during infancy are maintained throughout early childhood. The principles of the salutogenic theory were found to be applicable when studying caries-related habits and oral health. Thus, if a dietary risk behavior is established at 1 year of age, the chance of remaining caries-free until 3 years of age is highest if good oral hygiene habits, including the use of fluoride toothpaste, are present at 2 years of age. We therefore conclude that comprehensive knowledge of a childs future dental health can be obtained by using chairside information-that is, interview of the parents and clinical examination of the children.

Oral health in preschool children with asthma

OBJECTIVE The aim of this study was to investigate oral health and its determinants in 3-year-old and 6-year-old children with asthma. METHODS AND SUBJECTS Caries and gingivitis were examined in 127 asthmatic (all children with asthma in a selected area and born during a specific time period) and 117 matched, healthy control children. The parents were interviewed regarding various oral-health-related factors. RESULTS The mean dfs (+/- standard deviation) in the 3-year-old with asthma was 1.4 +/- 3.2 compared with 0.5 +/- 1.2 in the controls (P < 0.05). The corresponding figures for the 6-year-old were 2.5 +/- 3.9 and 1.8 +/- 2.8. The 3-year-old asthmatic children had more gingival bleeding than the healthy controls (P < 0.05). There were no significant differences in gingivitis in the 6-year-old children. Asthmatic children reported higher consumption of sugar-containing drinks and were more frequently mouthbreathers than healthy children (P < 0.05). In 3-year-old children with asthma and immigrant background, the mean dfs was higher compared with immigrant children in the control group (P < 0.01). CONCLUSION The results indicate that preschool children with asthma have higher caries prevalence than healthy children. The factors discriminating for caries in asthmatic children are higher intake of sugary drinks, mouth breathing, and immigrant background.

Incisal and occlusal tooth wear in children and adolescents in a Swedish population

The material consisted of 527 randomly selected children and adolescents from the community of Jönköping, Sweden, who in 1983 reached the age of 3, 5, 10, 15, or 20 years. The degree of incisal or occlusal tooth wear was evaluated for each single tooth in accordance with the following criteria: score 0 = no wear or negligible wear of enamel; score 1 = obvious wear of enamel or wear through the enamel to the dentin in single spots; score 2 = wear of the dentin up to one-third of the crown height; and score 3 = wear of the dentin more than one-third of the crown height. In the age groups 3 and 5 years the primary dentition was studied, and in the age groups 10, 15, and 20 years the permanent dentition. In the 3-year-old children 63% and in the 5-year-olds 19% had no or slight incisal or occlusal wear in the primary dentition. In the permanent dentition the corresponding figures for the 10-, 15-, and 20-year-olds were 78%, 51%, and 35%, respectively. The 5-year-olds had the highest percentage of primary teeth with incisal or occlusal wear related to existing teeth in accordance with criteria 1-3 (32.2%), and the 10-year-olds had the lowest score for permanent teeth (2.5%). There were small or no differences in tooth wear between the sexes in these age groups. Eighteen children (17%) among the 5-year-olds had one or more teeth with wear scored 2 in the primary dentition, and one individual had 4 primary teeth scored 3. The corresponding figures for the 3-, 10-, 15-, and 20 year-olds were 2%, 1%, 7% and 6%, respectively. No permanent teeth with wear scored 3 were found in these age groups. The number of teeth with incisal or occlusal wear increased with age both in the primary and in the permanent dentition.

Oral health in pre-school children with asthma--followed from 3 to 6 years.

OBJECTIVE The aim of this study was to investigate caries and its determinants in preschool children with and without asthma, followed from 3 to 6 years. METHODS AND SUBJECTS Caries, plaque, and gingivitis were examined at 3 and 6 years of age in 64 asthmatic children and 50 matched, healthy control children. Furthermore, at 6 years radiographic examination and saliva sampling were conducted. The parents were interviewed about various oral health-related factors. RESULTS Initial caries increment between 3 and 6 years of age was statistically significant higher for children with asthma compared with children without asthma (P < 0.05). Asthmatic children had more bleeding gingivitis and a higher consumption of sugary drinks than healthy children at 3 years of age (P < 0.05). At both 3 and 6 years of age, the asthmatic children were more frequently mouth breathers than healthy children, only statistically significant for 6-year olds (P < 0.05). CONCLUSION Preschool children with asthma at 3 years of age run a higher risk of developing caries lesions until 6 years of age compared with children without asthma. Children with asthma have a higher prevalence of bleeding gingivitis, a higher intake of sugary drinks and are more frequently mouth breathers than preschool children without asthma.

Behaviour Management Techniques in Paediatric Dentistry

BACKGROUND: Behaviour management is widely agreed to be a key factor in providing dental care for children. Indeed, if a child’s behaviour in the dental surgery/office cannot be managed then it is difficult if not impossible to carry out any dental care that is needed. It is imperative that any approach to behavioural management for the dental child patient must be rooted in empathy and a concern for the well being of each child. REVIEW: Based on various presentations given at Congresses of the European Academy of Paediatric Dentistry (EAPD), documents reviewing behaviour management prepared by the Clinical Affairs Committee of the EAPD, and written submissions to the Executive Board of the EAPD, a review of the various approaches to the behaviour management of the child dental patient was completed. All aspects of non-pharmacological behavioural management techniques described in the literature over the past 80 years were reviewed. FINDINGS: There is a very wide diversity of techniques used but not all are universally accepted by specialist paediatric and general dentists. Wide cultural and philosophical differences are apparent among European paediatric dentists that seem difficult to bridge when forming agreed guidelines. Accordingly, this review highlights those behaviour techniques that are universally accepted such as tell, show, do (TSD) or positive reinforcement, but nevertheless describes the most commonly mentioned techniques for which there are descriptions in the literature. CONCLUSION: A wide variety of behavioural management techniques are available to paediatric dentists which must be used as appropriate for the benefit of each child patient, and which, importantly, must take into account all cultural, philosophical and legal requirements in the country of dental practice of every dentist concerned with dental care of children.

Oral health in young adults with long-term, controlled asthma.

Abstract Objective. To study oral health in young adults with long-term, controlled asthma. Material and methods. Twenty 18- to 24-year-olds with a mean duration of asthma of 13.5 [standard deviation (SD) 5.4] years and 20 matched healthy controls were included. A clinical examination was performed and the prevalences of caries, erosions, gingival inflammation, cervicular fluid and periodontal pockets and the plaque formation rate were registered. The salivary flow rate and the numbers of mutans Streptococci and Lactobacilli in saliva were determined. Plaque pH was measured after a sucrose rinse for up to 40 min at two approximal sites. The participants were interviewed regarding dietary and oral hygiene habits. Results. The mean (SD) DFS, including manifest and initial caries, was 8.6 (10.6) in the asthma group and 4.0 (5.2) in the control group (P = 0.09). Initial caries lesions were more common in the asthma group than in the control group: 6.0 (8.1) and 1.3 (2.0), respectively (P = 0.02). The asthma group had more gingivitis (P = 0.01) and a lower stimulated salivary secretion rate than the controls (P = 0.01). The asthmatics also had a somewhat, although not statistically significant, lower initial pH value in plaque and a more pronounced pH drop compared with the controls. In the asthma group, 65% reported frequent mouthbreathing, compared with 10% of the controls (P = 0.01). No differences were found in tooth-brushing or dietary habits between the groups. Conclusion. Young adults with long-term, controlled asthma had more initial caries, more gingival inflammation and a lower stimulated salivary secretion rate than individuals without asthma.

Caries Prevalence, Caries-Related Factors and Plaque pH in Adolescents with Long-Term Asthma

The aim of the present case-control study was to investigate dental caries, various caries-related factors as well as gingival condition, in 12- to 16-year-olds with long-term asthma (n = 20) and a matched healthy control group (n = 20). Data on dietary and oral hygiene habits, numbers of mutans streptococci and lactobacilli in saliva were also obtained. The plaque pH drop after a sucrose rinse was measured up to 40 min at 2 approximal tooth sites. A lower salivary flow rate was found in the asthma group compared to the control group (p < 0.05). The mean (± SD) of DFS, including manifest and initial caries, was 4.9 ± 5.5 in the asthma and 1.4 ± 2.3 (p < 0.01) in the control group. Only 1 adolescent in the asthma group was caries free compared to 13 in the control group. Concerning pH in plaque, adolescents with asthma had a lower initial value (p < 0.01) and final pH (p < 0.05) than the control group. The Cariogram data showed that 55% of the subjects in the control group had ‘a high chance of avoiding caries’ compared to 10% in the asthma group (p < 0.01). The asthmatic adolescents had higher numbers of sites with gingival bleeding (p < 0.01). To conclude, adolescents with long-term asthma had a higher total DFS and caries risk (according to Cariogram), decreased salivary rate, more gingival bleeding and lower plaque pH than adolescents without asthma.

Oral Administration of Lactobacillus reuteri during the First Year of Life Reduces Caries Prevalence in the Primary Dentition at 9 Years of Age

The aim of this study was to evaluate the effect on oral health, at age 9 years, of daily oral supplementation with the probiotic Lactobacillus reuteri, strain ATCC 55730, to mothers during the last month of gestation and to children through the first year of life. The study was a single-blind, placebo-controlled, multicenter trial involving 113 children: 60 in the probiotic and 53 in the placebo group. The subjects underwent clinical and radiographic examination of the primary dentition and carious lesions, plaque and gingivitis were recorded. Saliva and plaque were sampled for determination of mutans streptococci (MS) and lactobacilli (LB) in saliva and plaque as well as salivary secretory IgA (SIgA). Forty-nine (82%) children in the probiotic group and 31 (58%) in the placebo group were caries-free (p < 0.01). The prevalence of approximal caries lesions was lower in the probiotic group (0.67 ± 1.61 vs. 1.53 ± 2.64; p < 0.05) and there were fewer sites with gingivitis compared to the placebo group (p < 0.05). There were no significant differences between the groups with respect to frequency of toothbrushing, plaque and dietary habits, but to intake of fluoride supplements (p < 0.05). There were no intergroup differences with respect to L. reuteri, MS, LB or SIgA in saliva. Within the limitation of this study it seems that daily supplementation with L. reuteri from birth and during the first year of life is associated with reduced caries prevalence and gingivitis score in the primary dentition at 9 years of age.

Caries Prevalence in Swedish 20-Year-Olds in Relation to Their Previous Caries Experience

Background/Aim: There are few studies of caries development and caries-related factors from early age to young adulthood. The aim of the present study is to analyse caries prevalence in 20-year-olds in relation to their previous caries experience. Method: Oral health from 3 to 20 years of age was followed longitudinally in a cohort of 499 individuals. The clinical and radiographic incidence of caries and restorations in 494 20-year-olds was related to caries data at 3, 6 and 15 years of age. Results: Twenty-six per cent of the 20-year-olds were caries-free. The mean number of initial and manifest lesions and restorations (Di + mFS) was 5.8. Initial lesions comprised 40% of the Di + mFS. Of the occlusal surfaces of molars and premolars, 12 and 4%, respectively, had manifest caries or restorations. Compared with individuals who had been caries-free during childhood (primary dentition) and adolescence, those with a history of caries activity while growing up had statistically significantly more approximal lesions at the age of 20 (DmFSa 0.6 vs. DmFSa 4.6, respectively). Those with manifest caries during childhood but caries-free at 15 years had a low caries prevalence at 20 years of age (DmFSa 1.3). Few new lesions developed after age 15. However, 50% of initial lesions at this age had progressed to manifest lesions at age 20. Conclusion: There is a relationship between caries prevalence at age 20 and early caries experience.