Vuokko Anttonen

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.

Geographical Distribution of Dental Caries Prevalence and Associated Factors in Young Adults in Finland

Oral health of the young has been reported to be associated with the place of residence, due to differences in socio-economic status. The results of studies on the effect of fluoride in drinking water on caries prevalence have been contradictory. The main aim of our study was to investigate the geographical distribution of dental caries prevalence in Finland and analyse possible regional, associated factors. Oral health of 13,564 men born between 1990 and 1992 was screened using a method based on criteria of the World Health Organization for epidemiological studies by 15 calibrated dentists in 20/24 garrisons of the Finnish Defence Forces in 2011. Mean DMFT and DT values in provinces were calculated. Multilevel analysis was applied to the data using generalized linear mixed models and a logit link function. The binary outcome variable was the cariological treatment need (yes/no) and the garrison was treated as random effect. Mean DMFT and DT values varied significantly between provinces in Finland. Increased levels of fluoride in drinking water, Swedish as the main language in the municipality, and living in urban areas were protective factors against cariological treatment need. Dentist density did not affect caries prevalence. The geographical distribution of dental caries further supported estimates of the protective effects of high fluoride levels in drinking water, Swedish as the main language in the municipality, as well as living in urban areas. Effect of fluoride on caries prevalence still exists, and association with the socio-economic status was confirmed.

Prevalence and polarization of dental caries among young, healthy adults: Cross-sectional epidemiological study

Abstract Objective. Oral health of young people has improved in the industrialized countries during past decades. However, stagnation of this progress has been reported recently. The main aim of this epidemiological study was to investigate the level of cariological treatment history and need (DMFT, DT) and polarization of dental caries among a healthy young male population born in the early 1990s. Materials and methods. Oral health of 13,564 men and 255 women born in 1990, 1991 or 1992 was screened based on the WHO criteria for epidemiological studies by 15 calibrated dentists in 20 garrisons (of a total 24) of the Finnish Defence Forces in January and July 2011. Mean DMFT and DT (SD) values and their distribution were calculated excluding wisdom teeth. Polarization was investigated using the Lorentz analysis. Results. Mean DMFT, DT and FT values were DMFT = 4.1 (SD = 4.2), DT = 1.4 (SD = 2.5) and FT = 2.7 (SD = 2.9). Almost half of the men (45.1%) and one third of the women (37.3%) had at least one tooth needing restorative treatment. About 30% of the conscripts had 90% of all caries lesions and ∼ 10% of the conscripts had half of all lesions. Conclusions. Oral health of young males has not improved since the previous study among conscripts 15 years ago. Polarization of dental caries still exists. About half of the young male population still has manifested dental caries. Oral health promotion must not be neglected, even in countries with low caries prevalence.

Clinical study on the effect of professional cleaning of occlusal tooth surfaces on laser fluorescence measurements.

Manufacturer’s advice is to professionally clean teeth before using a laser fluorescence (LF) device in order to avoid false-positive diagnoses. Professional cleaning is not included in routine dental check-ups in children in Finland because it is time-consuming. The aim of our present study was to evaluate the effect of professional cleaning of teeth on LF in children. A total of 642 occlusal surfaces in permanent molars and premolars in 9- to 16-year-olds (n = 46) were first examined visually. After that the first measurements with LF were made without cleaning the teeth. At the same appointment the second measurements were carried out after professional cleaning using a soft rubber cup and either polishing paste or plain water spray. The differences in LF of uncleaned and cleaned teeth were determined separately for teeth with a visual score of 0 (sound) and >0. In premolars cleaning had no significant effect on LF. In molars, the values increased when the teeth were cleaned, the difference of the measurements being statistically significant in molars with visual score >0 cleaned with plain water spray. For molars that were cleaned with paste, the differences were not statistically significant. Sealants did not modify the effect of cleaning. As a conclusion cleaning with a rotating instrument and water spray before LF measurements is recommended in teeth with visible plaque. Also in clean teeth, cleaning is advisable in cases where LF readings approach threshold level for operative intervention. The finding that uncleaned teeth gave lower values than cleaned teeth is opposite to what has been suggested.

Dietary and oral hygiene intervention in secondary school pupils.

BACKGROUND To enhance the well-being of secondary school pupils by improving their eating habits, especially school-based eating, a joint project, including oral health intervention, was conducted during the academic year 2007-2008. AIM The aim was to study the effect of a dietary intervention on schoolchildrens eating habits and laser fluorescence (LF) values of teeth. METHODS Twelve schools in three cities, Finland, were randomly assigned to be intervention and control schools. Two of the intervention schools were further assigned in the instruction of oral hygiene. In 2007 and 2008, the pupils (n=739 and 647, respectively) answered a questionnaire on dietary and oral health habits, and LF values on the occlusal surfaces of molars and premolars were determined. RESULTS The frequency of eating a warm meal and drinking water at school to quench thirst increased in the intervention schools but decreased in the control schools (P<0.001 and P=0.005, respectively). LF values in molars decreased in schools with dietary intervention only (P=0.024). CONCLUSIONS   The 1-year dietary intervention was long enough to show improvement in eating habits and in habits for quenching thirst, and some decrease in the LF values of molars.

Self-reported oral health and associated factors in the North Finland 1966 birth cohort at the age of 31

BackgroundThe Northern Finland 1966 birth cohort (NFBC 1966) is an epidemiological study where the participants have been controlled since pregnancy both in field tests and using questionnaires. This study aimed to evaluate cross-sectionally the association of self-reported oral symptoms (dental caries and bleeding of gums) with sociodemographic and health behavior factors among the subjects.MethodsOf the 11,541 original members of the cohort, 8,690 (75%) responded to the questionnaire on oral health (dental decay, gingival bleeding and self-estimated dental treatment need) and sociodemographic factors, general health and health behavior. Cross-tabulation and chi-squared tests as well as multiple logistic regression analysis were used to analyze the association between the outcome and explanatory variables.ResultsThe study group was equally distributed between the genders. One third of the subjects reported having dental decay, one fourth gingival bleeding and a half a dental treatment need. As compared to women, men reported significantly more frequently symptoms (p < 0.05). Logistic regression analysis revealed low tooth brushing frequency increasing the odds most for all oral symptoms ((OR 1.57 (1.39–1.78) for dental decay, 1.94 (1.68-2.24) for gingival bleeding and 1.42 (1.26-1.61) for dental treatment need). Frequent smoking was associated with dental decay (OR 1.63 (1.44–1.84)) and treatment need OR (1.39 (1.23–1.56)), whereas poor general health (OR 1.71 (1.48–1.96)) and high BMI (OR 1.19 (1.03–1.36)) both were associated with gingival bleeding.ConclusionsMales with single marital status, BMI over 25, poor general health and poor oral health behaviors are at risk for self-reported poor oral health and dental treatment need.

Smoking, alcohol use, socioeconomic background and oral health among young Finnish adults

OBJECTIVES The aim of this study was to investigate the prevalence of smoking and alcohol use in association with dental caries experience and signs of periodontal disease in a Finnish male group born in the early 1990s. The impacts of health behaviour and socioeconomic factors were included in the analyses. METHODS Oral health of 8539 conscripts was screened in a cross-sectional study (DT, DMFT and CPI). They also answered a questionnaire covering their habits of smoking and alcohol use as well as other behaviours and background factors. The bleeding on probing index (BOP) was available on 6529 conscripts. Cross-tabulation together with a chi-squared test and generalized linear mixed models were used in the analyses. A mosaic figure was used to illustrate associations of smoking frequency, use of dental services and toothache. RESULTS Majority (80.9%) in the study group consumed alcohol at least once a month, and 39.4% were daily smokers. Smoking was statistically significantly associated with high caries experience and high bleeding values of gums. Consumption of alcohol was not associated with dental caries and periodontal disease. The high BOP value had the strongest association with infrequent tooth brushing and smoking. The participants own education level was the main protective factor of oral health. The smokers used dental services more frequently compared to the non-smokers mostly for acute care. CONCLUSIONS Young mens health behaviour, especially of those with low education, does not promote oral health, which may indicate need for extensive healthcare services in the future. Health promotion should not be neglected.

Evaluating performance of dental caries detection methods among third-year dental students.

BackgroundReliable caries detection is a cornerstone in the modern caries treatment schema. This study aimed to evaluate adopting traditional and new caries detection methods by third-year dental students.MethodsFifty-seven students were given lectures on caries detection, after which they evaluated 27 extracted carious teeth using traditional clinical assessment (CE), Nyvad’s, and ICDAS methods. On three teeth they also performed DIAGNOdent pen® (LF) scanning. Histological scores of the sectioned teeth (ICDAS, LF) and activity estimations of the lesions by the supervisors were used as golden standards (Nyvad, CE). For the ICDAS method , sensitivity and specificity were calculated using dentine caries (D3) as a cut-off point. Mean ICC and kappa values were calculated to evaluate interexaminer agreement for all lesions and methods. Spearman’s correlation coefficient evaluated LF scanning.ResultsICDAS method presented good sensitivity ( 0.78) and specificity (0.87). The inter-examiner agreement for different methods was fair or good (CE ICC = 0.69, κ = 0.53; Nyvad’s method ICC = 0.68, κ = 0.48, ICDAS ICC = 0.66, κ = 0.47). Variation in LF values was the greatest with lesions extending to middle third of dentin. In that case, the Spearman’s correlation coefficient was also the weakest.ConclusionsTo follow the guidelines by the European Core Curriculum on Cariology, the third year dental students are introduced to methods for detecting lesion depth and assessing lesion activity as well as using new caries detection methods. Their performance in estimating lesion depth is good, and fair to good in estimating lesion activity even after basic training only.

Outcome of a Community-Based Oral Health Promotion Project on Primary Schoolchildren's Oral Hygiene Habits.

The aim of this study was to evaluate the effect of a school-based intervention project conducted in a mid-sized Finnish city, Laukaa on schoolchildrens oral health behavior. Material and Methods. In the intervention, all children received dental education and some of the 7–12-year-old schoolchildren received individual tooth brushing instructions by a dental nurse in 2009-2010. Parents were present at the instruction sessions. In 2009 and 2010, all the children answered a questionnaire or an oral hygienist on their oral health behavior without identification. Results. Tooth brushing frequency increased significantly among the schoolchildren between the years 2009 (61.2%) and 2010 (65%) (P < 0.05); more so among younger children (7–10-year-olds) compared to the older ones (11-12-year-olds). The 2010 results showed a slight trend of decreasing tooth brushing frequency by age both among girls and boys. Younger children got significantly more often parental help or reminding. The girls brushed their teeth significantly more frequently (71.9%) than boys (57.0%). Conclusions. Our findings indicate that oral health intervention can be beneficial on health behavior especially for children at low grades. All children, 11 to 12 years of age, especially boys, need continuous health promotion.

Association of smoking and snuffing with dental caries occurrence in a young male population in Finland: A cross-sectional study

Abstract Objective. The aim of this study was to investigate the prevalence of smoking and snuffing habits in association with dental caries occurrence in a male cohort born in the early 1990s in Finland. The impact of health behaviours and factors related to the place of residence were included in analyses. Materials and methods. Oral health of 8537 conscripts was screened in a cross-sectional study. In the same occasion they also answered a questionnaire covering their smoking and snuffing habits and other background factors. The residence-related factors were obtained from the Defence Forces’ database. Cross-tabulation together with chi-squared test and generalized linear mixed models were used for analyses. Results. Almost forty per cent (39.4%) of the men reported smoking daily and 9.0% reported daily snuffing. Restorative treatment need of those who reported frequent smoking was more than 2-fold (mean DT = 2.22) compared to the non-smokers (mean DT = 1.07). Smoking was statistically significantly associated with other harmful health behaviours. The snuffers reported more snacking than the non-smokers, but were most frequent brushers. The result from the statistical modelling showed that smoking, low tooth brushing frequency, eating sweets and consuming energy drinks frequently were significantly associated with restorative treatment need. Conclusion. In this cross-sectional study, association between smoking and dental caries was distinct. The high rate of restorative treatment need among smokers may be explained by their poor health behaviours. Dietary habits of the snuffers seem harmful too, but are compensated by good tooth brushing frequency.