Ulla Moberg Sköld

Effect of school-based fluoride varnish programmes on approximal caries in adolescents from different caries risk areas

The aim was to evaluate, in a 3-year RCT study, school-based fluoride varnish programme on approximal caries incidence and approximal caries progression in 13- to 16-year-olds in high, medium and low caries risk areas on the Swedish west coast. Seven hundred and fifty-eight (89%) fulfilled the trial. Using a simple mobile unit, 2 dental nurses treated the adolescents with F varnish: (1) twice a year at 6-month intervals, (2) 3 times a year within 1 week, (3) 8 times per year during the semesters with 1-month intervals, and (4) no treatment (control). Radiographic caries recording was performed blindly by one of the authors. Concerning total approximal caries incidence, control groups in all areas developed more caries than F varnish groups, with the largest difference in the high risk area: 3.05 ± 3.37 new approximal caries lesions (mean ± SD) compared to 0.54 ± 1.26 for group 3, 0.95 ± 1.67 for group 1 and 1.40 ± 1.89 for group 2 (p < 0.001). More than 90% of the new approximal lesions in all the groups and in all areas consisted of new enamel lesions. Regarding progression of enamel lesions, there were only significant differences between groups 1–3 and group 4 in the high caries risk area. Prevented fraction for fluoride varnish treatment twice a year at 6-month intervals was 69% in high, 66% in medium and 20% in low risk areas. To conclude, school-based F varnish treatment every 6 months in 13- to 16-year-olds is excellent to prevent approximal caries in medium and high caries risk areas.

Approximal caries development in adolescents with low to moderate caries risk after different 3-year school-based supervised fluoride mouth rinsing programmes.

The aim was to evaluate a 3-year randomised controlled trial of school-based fluoride mouth rinsing (FMR) on approximal caries development in 13- to 16-year-olds with low to moderate caries risk. The adolescents used F toothpaste at home and underwent prophylactic treatment at yearly check-ups at public dental clinics. Out of 788 randomly selected 13-year-olds, 622 completed the trial, carried out in 1999–2003. Supervised by a dental nurse, the subjects rinsed with a 0.2% NaF solution at different intervals. Group 1 rinsed their teeth on the first three schooldays every semester; group 2 on the first three and the last three schooldays every semester; group 3 on three consecutive days once a month during semesters; group 4 once every fortnight during semesters, and group 5 (control) did not rinse. Radiographic recording of approximal caries was performed. FMR on the three first and the three last schooldays every semester (group 2) had a prevented fraction of 59%, with approximal enamel lesions as a diagnostic threshold. Corresponding figures for groups 1, 3 and 4 were 30, 47 and 41%, respectively. The control group differed statistically from groups 2–4 for new enamel and dentin lesions and fillings (p < 0.01). Enamel lesions constituted more than 90% of the new caries lesions. Caries progression was low for all groups and no significant differences were found between groups. The main conclusion from this randomised controlled trial is that school-based FMR, as a supplement to the daily use of F toothpaste, reduces caries incidence on approximal surfaces in adolescents with low to moderate caries risk.

Is the use of fluoride toothpaste optimal? Knowledge, attitudes and behaviour concerning fluoride toothpaste and toothbrushing in different age groups in Sweden.

OBJECTIVES The most effective method to prevent caries is the regular use of fluoride toothpaste. The aim of this study was to evaluate self-care routines in a population by identifying knowledge, attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits. METHODS A questionnaire was sent to 3200 individuals in two municipalities in Sweden. Four age groups representing different life stages were chosen: 15-16, 31-35, 61-65 and 76-80 years of age. The participants were selected from the population register by random selection of birth dates. RESULTS Totally 2023 (63%) individuals answered the questionnaire. The majority (84-94%) in all age groups brushed their teeth twice a day or more often. Good toothpaste behaviour identified as brushing at least twice a day, using at least 1 cm toothpaste, brushing 2 minutes or longer and using a small amount of water when rinsing was reported by only 10% of the respondents. The factors that increased the odds for having good caries-preventive behaviour were: (i) being female, (ii) being younger than 35 years, (iii) having knowledge about fluoride, (iv) finding use of fluoride toothpaste important and (v) rating own oral health as good. CONCLUSIONS The population seems to have embraced regular toothbrushing with fluoride toothpaste to a large extent. However, regarding techniques for using fluoride toothpaste effectively, there was great potential for improvement, especially among the older respondents.

Cost-analysis of school-based fluoride varnish and fluoride rinsing programs

Objective. From a dental care perspective, we analyze whether the prevention of approximal caries by fluoride varnish treatment (FVT) or by fluoride mouth rinsing (FMR) could contain costs in an extended period of follow-up after the end of school-based prevention programs.Material and methods. It is assumed in a model that, after 3 years of prevention with either FVT or FMR according to published studies, the “natural course” of approximal caries progression would follow for 5 consecutive years, as described in a Swedish longitudinal study. The outcome and costs of FVT, FMR and controls were modelled from years 4 to 8.Results. The FVT program had a better outcome in reducing approximal caries than FMR, and costs were lower. The FVT was expected to result in cost containment compared to controls 3 years after the end of the preventive FVT program. The ratio benefits to costs were 1.8: 1 for FVT and 0.9: 1 for FMR.Conclusions. Prevention of approximal caries by FVT may result in cost containment, at a benefit cost ratio of 1.8: 1, given that the program can be administered at school.

Caries incidence in adolescents with low caries prevalence after cessation of weekly fluoride rinsing.

The aim of this study was to determine whether cessation of weekly fluoride rinsing leads to an increase in caries incidence in a group of adolescents with low caries prevalence. Sixty randomly selected 12- to 14- year-olds were asked to stop rinsing at school (test group). After 3 years caries increment and caries progression were compared with an age- and sex-matched control group (n = 60), who continued to rinse weekly with a 0.2% sodium fluoride solution. All children in both groups had followed a school-based fluoride rinsing program from the age of 6 years. The mean (standard deviation) caries increment, including only open lesions, during the 3 years was 1.58 (1.73) in the test group and 1.48 (1.80) in the control group. The corresponding figures for incipient lesions were 3.13 (3.63) and 4.03 (4.23), respectively. The mean caries progression was 0.92 (1.34) in the test group and 0.72 (1.03) in the control group. None of these differences were statistically significant. Thus, this study showed that a cessation of weekly fluoride rinsing did not lead to an increase of caries incidence in a group of adolescents with low caries prevalence.

Simplified methods of topical fluoride administration: effects in individuals with hyposalivation

The aim was to compare fluoride (F) levels in individuals with normal salivary secretion and hyposalivation in connection with their use of F solutions and toothpaste. Seven individuals with normal salivation and nine with hyposalivation rinsed with 0.2% NaF solution for 1 minute. In addition, individuals with hyposalivation performed the following: (i) 0.2% NaF rinsing for 20 seconds, (ii) rubbing oral mucosa with a swab soaked with 0.2% NaF solution, and (iii) brushing with 5,000 ppm F (1.1% NaF) toothpaste. Subjects characterized by hyposalivation reached approximately five times higher peak values of F concentrations in saliva after 1 minute rinsing with the F solution and higher area under the curve (AUC) values. The simplified methods exhibited the same AUC values as did 1 minute of rinsing. Brushing with 5,000 ppm F toothpaste resulted in higher AUC values than did the simplified methods. The F concentrations reached higher levels in individuals with hyposalivation compared to those with normal salivation. The simplified methods tested showed similar effects as conventional methods.

Self-reported changes in using fluoride toothpaste among older adults in Sweden: An intervention study

Abstract Objective. The aim of the study was to investigate the possibility of increasing knowledge about the caries-reducing effects of fluoride (F) toothpaste and to increase the use of F toothpaste among older adults through an intervention. Materials and methods. 63–67-year-olds in Sweden, who 2 years earlier had answered a questionnaire about their knowledge of F toothpaste, toothbrushing and toothpaste habits and who had shown less favourable habits with regard to toothpaste use, were invited to participate. The 20-min intervention, performed at a Public Dental Clinic, was implemented by a dental hygienist (author OJ) and consisted of individual information and instruction on the use of F toothpaste. The questionnaire was repeated 4 months after the intervention and a population in another city in Sweden served as control. Results. In the intervention group, 68 individuals responded and 151 in the control group. Knowledge of the benefits of F toothpaste in the intervention group had improved between the times of the first and second questionnaires, but the same effect was also noted in the control group. After the intervention, a clear improvement concerning the use of F toothpaste was reported: the individuals brushed for a longer time, used more toothpaste and used less water during and after brushing. In the control group, there were no changes of habits between the first and second occasions. Conclusion. Individually-based interventions performed by a dental hygienist had a positive effect on changing the way older adults used F toothpaste.