Gunilla Nordenram

Caries-preventive effect of fluoride toothpaste: a systematic review

With a questionnaire addressed to general dental practitioners in Sweden, the Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on various caries preventive methods. The aim of this article was to report findings concerning the caries preventive effect of fluoride toothpastes in various age groups, with special emphasis on fluoride concentration and supervised versus non‐supervised brushing. A systematic search in electronic databases for articles published between 1966 and April 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years follow‐up and caries increment in the permanent (ΔDMFS/T) or primary (Δdmfs/t) dentition as endpoint. Out of 905 articles originally identified, 54 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A–C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF), expressed as percent. The results revealed strong evidence (level 1) (i) for the caries preventive effect of daily use of fluoride toothpaste compared to placebo in the young permanent dentition (PF 24.9%), (ii) that toothpastes with 1,500 ppm of fluoride had a superior preventive effect compared with standard dentifrices with 1,000 ppm F in the young permanent dentition (PF 9.7%), and (iii) that higher caries reductions were recorded in studies with supervised toothbrushing compared with non‐supervised (PF 23.3%). However, incomplete evidence (level 4) was found regarding the effect of fluoride toothpaste in the primary dentition. In conclusion, this review reinforced the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long‐term studies in age groups other than children and adolescents are still lacking.

Caries-preventive effect of fissure sealants: a systematic review

The objectives of this study were to evaluate systematically the evidence of the caries‐preventive effect of fissure sealing of occlusal tooth surfaces and to examine factors potentially modifying the effect. The search strategies included electronic databases, reference lists of articles, and selected textbooks. Inclusion criteria were randomized or quasi‐randomized clinical trials or controlled clinical trials comparing fissure sealing with no treatment or another preventive treatment in children up to 14 years of age at the start; the outcome measure was caries increment; the diagnostic criteria had been described; and the follow‐up time was at least 2 years. Inclusion decisions were taken and grading of the studies was done independently by two of the authors. The main measure of effect was relative risk reduction. Thirteen studies using resin‐based or glass ionomer sealant materials were included in the final analysis. The results showed that most studies were performed during the 1970s and a single application had been utilized. The relative caries risk reduction pooled estimate of resin‐based sealants on permanent 1st molars was 33% (relative risk=0.67; CI=0.55-0.83). The effect depended on retention of the sealant. In conclusion, the review suggests limited evidence that fissure sealing of 1st permanent molars with resin‐based materials has a caries‐preventive effect. The evidence is incomplete for permanent 2nd molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations with a low and a high caries risk, respectively.

Economic evaluation of dental caries prevention: a systematic review.

The aim of the present study was to perform a systematic review of economic evaluations of caries prevention. A search in Medline from 1966 until May 2003 and a manual search in a number of journals identified 154 references, 74 of which were included. There were 17 original studies including an economic evaluation, and these form the basis of the present article. The rest were reviews, model studies and reports concerning economic practice in dentistry. The results show that the reviewed original studies on economic evaluation of caries prevention do not provide support for the economic value of caries prevention. The scarcity of well‐conducted studies, as well as contradictory evidence in the reviewed articles, makes it difficult to judge the health‐economic effect of the studied caries‐prevention methods.

Effect of combined caries-preventive methods: a systematic review of controlled clinical trials.

The aim of this systematic review was to evaluate the caries‐preventive effect of combined caries‐preventive methods, defined as two or more different interventions in combination, each expected to prevent dental caries. The Medline database was searched for articles published in the period January 1966 to June 2003. Twenty‐four controlled studies met the inclusion criteria, and their value as evidence was assessed according to predetermined criteria. The level of evidence for the overall conclusion regarding each method was graded according to the protocol of the Swedish Council on Technology Assessment in Health Care. The scientific evidence for the combination of treatments involving fluoride that had a preventive effect on caries in children and adolescents was graded as moderate. However, for elderly patients the scientific evidence for the caries‐preventive effect of different combinations of treatments was found to be incomplete. No conclusion could be drawn regarding the evidence for combinations of treatments being effective for groups at high caries risk, as the results from the identified clinical studies were conflicting.

Dental Management of Alzheimer Patients: A Predictive Test of Dental Cooperation in Individualized Treatment Planning

The aim of the study was to investigate a possible relationship in Alzheimer patients between the stage of dementia, cognitive and functional capacity, and behavior as a dental patient. A special index for assessing behavior in the dental setting was used. The 40 participants were inmates of a nursing home and fulfilled the criteria for Alzheimers disease in accordance with DSM-III-R. A deficiency in the dental behavior index (DBI) of 50% or less did not correlate with cognitive, functional, or graphic capacity. These subjects were generally aware of earlier regular dental treatment and behaved as if dental visits were familiar to them, although their cognitive, functional, and graphic capacities were more impaired than disclosed by the dental behavior index. A deficiency in the dental behavior index of 50% or more was more correlated with the other capacity assessments. Finding a proper treatment level for an Alzheimer patient is a delicate task in which it is essential to balance awareness of various aspects of impairment and realistic anticipation of benefit. The dental behavior index can be an appropriate instrument in this complex process.

The district nurse's perceptions of elderly patients' oral health: a qualitative interview study.

Objective. The aim of this qualitative study based on interviews was to explore the perceptions that district nurses have of the oral health of elderly patients. Material and methods. The criterion for inclusion was being a district nurse working in a primary health-care centre in the County of Stockholm. The respondents were asked open-ended questions about their perceptions of oral health and about the impact of oral problems on the general health and well-being of elderly patients. The analyses started at the first interview and proceeded in parallel until no further relevant information could be obtained. Analysis of the open-ended questions was inspired by grounded theory methodology and comprised four stages: native reading, open coding, axial coding, and selective coding. Results. The one core category identified, namely indistinct professional duties of the district nurse, formed the central meaning of the district nurses perceptions of oral health in elderly patients. This related to two other categories labelled ‘insights into the district nurses professional role’ and ‘obstacles for the district nurse’, with sub-categories. Conclusion. Although the district nurses in this study were aware of the impact of oral health in old age, their attitude was that this was a matter for dentistry.

Dental health Health in Sweden: The National Public Health Report 2012. Chapter 16

The dental health of children in Sweden is good and continues to improve. Today the majority of all children are caries-free, that is, they have never had any cavities in their teeth. The percentage of caries-free 12-year-olds tripled between 1985 and 2005, from just over 20 per cent to nearly 60 per cent. However, the situation among children with the worst dental health has deteriorated in the past decade. The main improvement among adults in recent years has been the dental health of the elderly. A growing number of elderly people have their own teeth, supplemented by crowns, bridges and implants, and their chewing ability has improved. As the number of elderly people with their own teeth increases so does the need for oral care to ensure that their dental health is maintained throughout their lifetime. There is a need for dental care for elderly people who suffer from multiple illnesses and are still living at home. This need has not been adequately met. Many young people who are no longer entitled to free child dental care do not seek preventive dental care until they have problems with their teeth. Others who risk having or already have poor dental health belong to socioeconomically weak groups such as single parents, the long-term unemployed and early retirees. Many homeless and mentally ill people also suffer from very poor dental health. However their needs are not being met by outreach dental care.

Macroscopic and radiographic examination of proximal root surface caries.

The purpose of the study was to compare macroscopic and radiographic examination of proximal root surface caries of extracted teeth from patients aged 65-95 years. Although the study conditions for macroscopic and radiographic diagnosis favored more sensitive evaluations than routine clinical conditions, there was a 24% disagreement in diagnosis. This finding indicates that under routine clinical conditions it is difficult to register with certainty all superficial root carious lesions. Even in the absence of clinically detectable root surface caries, preventive measures should be considered for elderly people with exposed root surfaces.

Unexpected dental behavior in five Alzheimer patients Differences between cognitive and functional capacity, graphic performance, and dental behavior

The aim of the study was to analyze five patients with Alzheimers disease in whom the degree of dementia assessed by cognitive and functional tests was at variance with the behavior in the dental setting and to relate these factors to the outcome of the graphic test. Possible reasons for the differences were discussed. The subjects were diagnosed as having Alzheimers dementia on the basis of the DSM-III-R. Their cognitive and functional impairments were assessed with the Mini-Mental State Examination test and Katzs index of activities of daily living. Behavior in the dental office was registered in a structured form. The graphic function was assessed as Human Figure Drawing. Besides the stage of dementia, the patients personality, social and medical background, and memories of previous dental care influence the demented patients behavior in the dental office. To provide secure conditions for treating demented patients, the dentist must be able to interpret the patients unique personality in the context of the dental situation.