R D Holt

CARIES IN PRE-SCHOOL CHILDREN IN CAMDEN 1993/94

Previous surveys carried out in the inner city area of Camden between 1966 and 1986 gave indication of a deterioration in dental health in pre-school children during the 1980s. Four hundred and six children were included in the current survey, which used the same sampling and methodology as previously. The aims of the present survey were to determine the current prevalence of caries and of rampant caries and to relate prevalence to social factors, to infant feeding habits and to the use of sweetened comforters, and to determine the extent of dental care received. Caries affected 11% of 2-year-old children and 29% of 3-year-olds, rampant caries affected 6% and 14% respectively. A higher likelihood of caries occurred in children of Asian origin and those given a sweetened comforter. For rampant caries, likelihood was greater amongst those of Asian origin and those given a sweet drink in a bottle for 2 years or longer. Comparison with results of the last study provides little evidence of improvement in dental health in young children in this low fluoride area, with a small proportion suffering relatively severely from caries

Smoking and tooth discolouration: findings from a national cross-sectional study

BackgroundSmoking is a risk factor of a number of oral diseases; the extent to which tobacco products influence dental aesthetics has not been widely investigated. The aim of this study was to determine satisfaction with own tooth colour of smokers and non-smokers and to investigate whether smokers have higher levels of self-assessed tooth discolouration compared to non-smokersMethodsA cross sectional national study was conducted on sample of 6,000 UK adults. A total of 3,384 adults was interviewed. Smoking behaviour was recorded together with satisfaction with own tooth colour. Prevalence of perceived discolouration was measured by asking respondents to match their own tooth colour to one of a set of seven photographs of differing severities of discolouration.ResultsTwenty eight percent of smokers reported having moderate and severe levels of tooth discolouration compared to 15% in non-smokers. As well as more often perceiving discolouration smokers were also more likely to be dissatisfied with their own tooth colour compared to non-smokers.ConclusionThe study provides further evidence of the negative impact of tobacco smoking on dental aesthetics in the general public. The evidence provided by the study may be of value in short interventions for smoking cessation in the dental setting.

Aesthetically objectionable fluorosis in the United Kingdom

Objectives A cross-sectional national survey to explore perceptions of dental fluorosis and to determine the proportion of people regarding fluorosis as aesthetically objectionable at differing levels of defect.Methods A survey using a multistage stratified random probability sample of 6,000 UK adult households. Face-to-face interviews were carried out using a structured questionnaire and photographs of different levels of dental fluorosis. Respondents were interviewed about the parameters of satisfaction, attractiveness and need for treatment for dental fluorosis.Results The proportion of respondents perceiving teeth as unattractive, unsatisfactory and requiring treatment increased with increasing severity of dental fluorosis. Using agreement between the three negative perceptions as a measure, 14% of the sample perceived mild dental fluorosis as aesthetically objectionable, 45% at moderate level and 91% at severe levels.Conclusion Negative perceptions of dental fluorosis were lower than reported previously. Three parameters were included in the approach to estimate aesthetically objectionable fluorosis which may provide a more realistic measure than those used previously. The nature of the index and the sample included suggest that findings of this survey provide a reasonable indicator of the likely impact of water fluoridation. Findings may have important implications for fluoridation policies in the United Kingdom and elsewhere.

Evaluating web-based learning modules during an MSc programme in dental public health: a case study

The introduction of web-based learning in dentistry has raised important educational questions about the efficacy of different teaching approaches. However, studies to date have drawn conclusions that appear conflicting, or at the least, ambiguous. In this paper, it will be argued that an over-simplistic view of education and an inappropriate use of methodology have both contributed to this confusion. These points will be illustrated through the use of a case study of web-based learning in dental public health.

Dental damage, sequelae, and prevention.

DISEASE Caries and inflammatory periodontal disease are the most prevalent oral diseases, and both result from the activity of dental bacterial plaque. Plaque is a complex biofilm that contains various microorganisms and forms mainly on teeth and particularly between them, along the gingival margin, and in fissures and pits (figure 1). This biofilm adheres by a variety of mechanisms. If plaque is not removed regularly, the flora evolve, and plaque may calcify, forming calculus (tartar) (figure 2). Fermentation of sucrose and other nonmilk extrinsic sugars to lactic and other acids causes tooth decalcification and, with proteolysis, results in caries (decay)(figure 3). The main organism involved in this process is Streptococcus mutans. Caries is seen less commonly because of the protective effect of fluoride, but it is still prevalent in disadvantaged and deprived people, especially in preschool-aged children. Accumulation of plaque and a change in the microflora may also cause gingival inflammation (gingivitis). Gingivitis may progress to damage the periodontal membrane (chronic periodontitis) and lead to tooth loss. OTHER DAMAGE Trauma Trauma is common in sport, road accidents, violence, and epilepsy. It occurs mainly in men and boys and usually affects the maxillary incisors.

Investigation of an index to measure tooth wear in primary teeth

UNLABELLED Tooth wear, in particular erosion, has been reported to be widespread in children in the UK. Wear may affect either dentition, but epidemiological measurement has proved difficult. OBJECTIVES The objectives of this study were: (a) to investigate use of a simple index of wear in primary teeth; and (b) to compare findings from visual examination and from photographs with those at histological examination of the same teeth. SAMPLE AND METHODS Forty-one exfoliated or extracted primary anterior teeth were assessed visually and using photographs. Ground sections of the teeth were prepared and examined using polarised light microscopy. RESULTS On visual examination, 31 of the 41 teeth had evidence of wear. In 14 teeth, tissue loss was confined to enamel and in 17 it extended into dentine. Findings on photographs were very similar to those on visual examination. Of the 10 teeth without erosion visually, two had evidence of loss on histological examination. Of the 14 with visual evidence of erosion confined to enamel, dentine was exposed in 11 cases. Diffuse demineralisation was evident histologically in 11 of the 31 teeth with evidence of erosion. CONCLUSIONS It was concluded that clinical assessment of erosion may underestimate the extent of the condition. Under the conditions of the study, photographs gave results similar to those on visual examination.

Oral health and disease

A healthy dentition and mouth is important to both quality of life and nutrition; oral disease may affect systemic health.

epidemiology: A survey of caries in 3-year-olds in Greater Manchester

Objective To measure the prevalence of caries, including nursing caries, amongst 3-year-old children in three districts of Greater Manchester in the North West of England.Design A cross-sectional survey of 762 randomly selected 3-year-old children using the dmft and dmfs indices. Three definitions of nursing caries were used in order to assess the varying prevalence of the disease according to which definition was applied.Subjects Children, aged 36–48 months, attending day nurseries, playgroups and nurseries attached to primary schools were examined by three trained examiners under standardised conditions in three health districts in Greater Manchester. A random selection process was used to produce a quota sample to reflect the balance of childcare provision in each district.Results The overall proportion of children affected by general caries was 32%. The mean dmft score was 1.4 (sd = 2.8) and the mean dmfs was 2.8 (sd = 7.3). There were significant differences across the three districts. The prevalence of nursing caries varied widely when differing definitions of types were applied; 1.6% of the children had nursing caries according to the narrow definition, 7.2% showed the wider definition type and 9.8% had nursing caries of the broadest definition. In total 19% of children had caries which affected their upper incisors. Children of Asian origin had the highest levels of nursing and overall caries.Conclusions Caries is a widespread problem in some very young children in the districts involved. Caries of upper anterior teeth contributes significantly to the overall level of caries in each of the localities in question. The prevalence of nursing caries is highly dependent on the case definition used.

caries prevention: Prevalence of caries and developmental defects of enamel in 9-10 year old children living in areas in Brazil with differing water fluoride histories

Aims To assess the prevalences of caries, of developmental defects of enamel and their interrelationship in Brazilian 9–10-year-olds from areas of contrasting fluoridation histories.Methods Systematic random sampling procedures were used to select children from an area where water had been fluoridated in 1963 and from a second area where water had been fluoridated since 1998. Clinical examinations for caries were carried out using the DMFT index and WHO diagnostic criteria. Developmental defects of enamel on upper incisors were diagnosed using the DDE index.Results A difference of 40% in DMFT was observed, with a lower prevalence of disease in the area fluoridated since 1963. Diffuse opacities affected 14.3% of the children from the area fluoridated since 1963 compared with only 2.4% in the area fluoridated in 1998. Children living in the area fluoridated in 1963 who had diffuse defects had twice the chance of being free from caries compared with those living in the same area who had no defects or who had only demarcated or hypoplastic defects.Conclusions This study confirms previous ones in showing the benefits of water fluoridation. Diffuse opacities of upper incisors affected relatively few subjects in either of the two areas.

Cleft lip and palate

Suite 6105 Doctor’s Office Tower 2200 Children’s Way Nashville, TN 37232-9780 Phone: 615.343.4673 Fax: 615.322.0370 / www.vanderbiltchildren’s.com Cleft Lip and Palate What are Cleft Lip and Cleft Palate? In the early weeks of fetal development, parts of the lip or palate (the roof of the mouth) usually fuse together. In some cases, however, this fusion does not occur and a cleft or separation occurs in the tissue, as seen in the diagrams below.