Liisa Seppä

Clinical study of the use of the laser fluorescence device DIAGNOdent for detection of occlusal caries in children.

Diagnosis of non-cavitated occlusal caries is generally considered problematic. The aim of this study was to evaluate the utility of the laser fluorescence device DIAGNOdent as part of routine dental check-ups in children. A total of 613 occlusal surfaces on permanent molars and 436 surfaces on primary molars in children aged 7–8 (n = 55) and 13–14 years (n = 54) were examined visually, using DIAGNOdent and for most 13- to 14-year-olds also using radiographs. The teeth were not cleaned professionally before examination. To provide a gold standard for carious teeth, the depth of the caries lesion was determined in those lesions that were judged visually to need opening by drilling (51 teeth). The higher the visual score, the higher were the mean DIAGNOdent values, but in each visual category the variation among values was large. The presence of a clear sealant did not affect DIAGNOdent measurements. The values for permanent and primary molars differed slightly. For permanent teeth, Youden’s index value was highest (60%) at a cut-off value of 30, which indicates that the overall performance for DIAGNOdent in detecting dentinal caries was best at this point. Using this cut-off, sensitivity was 92% and specificity 69% with visual examination for validation, while sensitivity was 92% and specificity 82% with validation by fissure opening. Of the three methods, radiographic examination was the least accurate. In routine dental check-ups of children, DIAGNOdent appears to be useful as an adjunct to visual examination.

Noninvasive Control of Dental Caries in Children with Active Initial Lesions

The aim of this study was to investigate whether DMFS increment can be decreased among children with active initial caries by oral hygiene and dietary counseling and by using noninvasive preventive measures. Except for mentally disabled and handicapped children attending special schools, all 11- to 12-year-olds in Pori, Finland, with at least one active initial caries lesion were invited to participate in the study and were then randomized into two groups. Children in the experimental group (n = 250) were offered an individually designed patient-centered preventive program aimed at identifying and eliminating factors that had led to the presence of active caries. The program included counseling sessions with emphasis on enhancing use of the children’s own resources in everyday life. Toothbrushes, fluoride toothpaste and fluoride and xylitol lozenges were distributed to the children. They also received applications of fluoride/chlorhexidine varnish. The children in the control group (n = 247) received basic prevention offered as standard in the public dental clinics in Pori. For both groups, the average follow-up period was 3.4 years. A community level program of oral health promotion was run in Pori throughout this period. Mean DMFS increments for the experimental and control groups were 2.56 (95% CI 2.07, 3.05) and 4.60 (3.99, 5.21), respectively (p < 0.0001): prevented fraction 44.3% (30.2%, 56.4%). The results show that by using a regimen that includes multiple measures for preventing dental decay, caries increment can be significantly reduced among caries-active children living in an area where the overall level of caries experience is low.

Caries Trends 1992–1998 in Two Low–Fluoride Finnish Towns Formerly with and without Fluoridation

Water fluoridation in Kuopio, Finland, was stopped at the end of 1992. In our previous study, no increase in caries was found in Kuopio 3 years after the discontinuation of water fluoridation. The aim of the present study was to further observe the occurrence and distribution of caries in Kuopio and Jyväskylä, which was used as the reference town for Kuopio. In 1992, 1995 and 1998 independent random samples of all children aged 3, 6, 9, 12 and 15 years were drawn in Kuopio and Jyväskylä. The total numbers of subjects examined were 688, 1,484 and 1,530 in 1992, 1995 and 1998, respectively. Calibrated dentists registered caries clinically and radiographically. No indication of increasing caries could be found in the previously fluoridated town during 1992–1998. In both towns the mean dmfs and DMFS values either decreased or remained about the same during the observation period. When all study years and both towns were pooled, 25% of the 12– and 15–year–olds with the highest DMFS counts accounted for 79 and 67%, respectively, of all affected surfaces. The mean numbers of fluoride varnish and sealant applications had markedly decreased in 1993–1998 compared to 1990–1992. The fact that no increase in caries was found in Kuopio despite discontinuation of water fluoridation and decrease in preventive procedures suggests that not all of these measures were necessary for each child.

Dental fear and oral health and family characteristics of Finnish children

Objectives: Our aim was to describe the occurrence of dental fear among Finnish children of different ages and to ascertain how oral health and family characteristics are associated with dental fear. Methods: The subject groups were aged 3, 6, 9, 12, and 15 years in two middle‐sized cities, and the 1474 participants were distributed over fairly equal samples of each age. A questionnaire given to each child to be filled out at home enquired about social background, oral hygiene habits, diet, and dental fear. Oral health status was examined clinically and radiographically by two calibrated dentists. Multiple logistic regression analyses were performed for each age group in order to study the associations between dental fear and selected factors. Results: Dental fear was higher among 12‐ and 15‐year‐old children than among the younger ones. Pain, drilling, and local anesthesia were reported to be the most frightening aspects. Excluding the 12‐year‐olds, children whose family members reported dental fear were more likely to report dental fear than children whose family members did not report dental fear. Six‐ and 12‐year‐olds who had experienced caries were more likely to report dental fear than were caries‐free children. Among 6‐year‐olds, fathers education modified the effect of a childs caries experience on child dental fear. Frequent intake of sugary items and a limit on eating candies to only one day per week were associated with higher dental fear. Conclusions: Fear of dental treatment is still fairly common among Finnish children, and the factors associated with it differ with the age of the child.

Caries Data Collected from Public Health Records Compared with Data Based on Examinations by Trained Examiners

Collecting data for dental caries studies is costly. In countries where uniform patient records are available for virtually the whole population, it is tempting to use them as a data source. Our aim was to compare data collected from patient records to those obtained by trained examiners. In 1992 and 1995, dentists who were specially trained and calibrated examined random samples of 12– and 15–year–olds living in two towns in Finland. The dental record of each child was obtained from public dental clinics, the dental status was entered into a computer file, and the DMFS value was calculated. Data were available for 824 children. In the two data sets, 1.3% of the tooth surfaces were recorded differently (DMF vs. sound) with the related ĸ value being 0.70. In two thirds of the discrepancies, the reason was that a filling was marked in only one of them, which confirms the known difficulty in discerning a white filling. For 48% of the subjects, the DMFS values calculated from the two sets of data were equal. The difference was 1 and 2 surfaces for 28 and 11%, respectively. Public health dentists had almost equally often registered more and less DMF surfaces compared to trained examiners. The results suggest that data collected from public health records are not decisively inferior to those obtained from examinations by trained examiners. In large enough settings, data obtained from patient records could possibly be used as a replacement for separate surveys.

Fluoride Varnishes in Caries Prevention

The first fluoride varnishes were developed during the 1960s (Duraphat® sodium fluoride varnish) and 1970s (Fluor Protector® silane fluoride varnish) to prolong the contact time between fluoride and enamel. Fluoride varnishes adhere to enamel, and calcium fluoride formed after application acts as a long-term reservoir of fluoride. Currently Duraphat varnish is the most widely used topical fluoride for professional application in Europe, and the use of fluoride varnishes is increasing in the USA. Duraphat varnish has been effective in three decades of clinical studies, but the results of Fluor Protector varnish are inconclusive. The percent caries reductions found in the 1990s have generally been lower than those reported in earlier studies, probably because of the higher exposure to other preventive measures in the more recent studies. In studies comparing Duraphat varnish and APF gel, Duraphat varnish was equally or more effective than APF gel. Sealants were most effective in preventing occlusal caries. Four applications per year, or three weekly applications once a year, have been found to be effective. However, several studies have shown that two applications per year may provide comparable results. Application is fast and easy. Professional prophylaxis is not necessary, and the patient can leave immediately after the treatment. No acute toxicity has been reported after using any fluoride varnish.

Changes in children's oral health-related behavior, knowledge and attitudes during a 3.4-yr randomized clinical trial and oral health-promotion program.

The aim of our study was to compare the changes in childrens oral health-related behavior, knowledge, and attitudes obtained using an oral health-promotion approach, a risk-strategy and promotion approach, and reference area, and to report changes in the behavior of children between the experimental and the control groups of a randomized clinical trial (RCT). The study population consisted of all fifth and sixth graders who started the 2001-2002 school year in Pori, Finland (n = 1,691), where the RCT and program of oral health promotion were implemented for 3.4 yr. Children with at least one active caries lesion were randomly assigned to experimental (n = 250) and control (n = 247) groups. Children in Rauma (n = 807) acted as the reference. Changes in childrens self-reported behavior, knowledge, and attitudes were compared between groups. The subjects in the oral health-promotion group and in the risk-strategy and promotion group in Pori tended to show greater improvement in most of their oral health-related behaviors than those in the reference group, and children in the RCT experimental group showed greater improvement in most of their oral health-related behaviors than those in the RCT control group. Children can be helped to improve their oral health-related behavior by intervention, including oral hygiene and dietary counseling, or by implementing a multilevel-approach oral health-promotion program.

The Future of Preventive Programs in Countries with Different Systems for Dental Care

From 1990 onward the decline of caries has leveled off in economically developed countries and the effectiveness of preventive programs seems to have diminished. The aim of this paper is to consider the future of caries prevention in the light of the studies conducted during the past decade. A shift from population-based prevention to a high-risk strategy has been promoted in countries where caries is strongly polarized. In Finland, however, an intensive preventive program targeted to high-risk individuals had little effect on caries increment, which suggests that the utility of a high-risk strategy is questionable. The relative effects of population-based methods have also decreased during the last decades. Although discontinuation of water fluoridation had no effect on caries in Kuopio, Finland, water fluoridation is still effective in countries with a lower level of basic prevention and a less homogenous social structure. From the standpoint of cost-effectiveness, the use of professionally applied fluoride gels has been questioned in children with a low caries rate, and the same is probably true for fluoride varnishes. In countries with a high caries rate, a low level of basic prevention, and an unorganized dental care system any preventive program seems to be effective. The importance of fluoride toothpastes as a cost-effective and feasible method of fluoride delivery is indisputable and will be so in all countries irrespective of the caries level and dental care systems. Population-based dental health education continues to be important, also in the countries where the caries rate has so far been low.

Enamel and Plaque Fluoride following Glass Ionomer Application in vivo

Glass ionomer fillings have been suggested to act as a fluoride-releasing system in the mouth. The aim of the present study was to evaluate whether a glass ionomer slab applied on the enamel can increase the fluoride content of the enamel and plaque of adjacent teeth in real-life conditions with frequent exposure to fluoride from other sources. Twenty-five adults living in a town with fluoridated drinking water participated in the study. The initial enamel fluoride content on the buccal surface of the contralateral premolars was determined using the acid etch biopsy technique. A round glass ionomer slab was placed buccally on the first molar on a randomly chosen side of the mouth (test side). After 2 weeks, the enamel fluoride content of premolars on the test and control sides was again determined whilst avoiding the site of the first biopsy. In addition, one biopsy was made on a previously etched area. After 2 and 4 weeks, plaque was collected from three approximal surfaces both on the test and control side, and the total fluoride content of the plaque was analysed. There were no significant differences in the fluoride content of sound or etched enamel before and after placement of glass ionomer. The fluoride content of approximal plaque of teeth close to glass ionomer was not higher than that of the control teeth, either after 2 or 4 weeks. Using the present method, no increase in the fluoride level of teeth adjacent to glass ionomer could be demonstrated. This may be due to the masking effect of fluoride from other sources.

Streptococcus mutans Counts Obtained by a Dip-Slide Method in Relation to Caries Frequency, Sucrose Intake and Flow Rate of Saliva

The level of Streptococcus mutans in saliva was determined by a dip-slide method in 841 13-year-old children in order to identify children with high caries risk. For each child, the flow rate of saliva was determined. Caries scores were obtained from Public Dental Health records. A sucrose intake score was calculated based on self-reported frequency of intake of six types of sugary products. As S. mutans counts increased, there was a significant trend of increased DMFS and DS scores. No linear correlation was observed between reported intake of sucrose and S. mutans counts, but the children with the highest counts (class 3) tended to have significantly higher sucrose intake than the rest of the children. The flow rate of saliva decreased significantly as S. mutans increased.