Validation of the Oral Survey-B System for Electronic Data Capture in National Oral Health Surveys.

The aims of the present study were to incorporate and to validate the electronic capture of participant-related outcomes into the Oral Survey-B System, which was originally developed for the electronic capture of clinical data. The validation process compared the performances of electronic and handwritten data captures. The hypothesis of noninferiority would be established if participants performed electronic data capture of the questionnaire survey with an effectiveness of at least 95% of that of handwritten data capture. In this multicenter, randomized, one-period crossover study design, participants (n = 261) were allocated to start with either electronic or handwritten data capture. The incorporation of the electronic self-completed questionnaire into the Oral Survey-B System was successful. The validation of the electronic questionnaire was performed by participants aged from 18 to 75 years. The interrater reliability of participants performing electronic and handwritten data capture of nonclinical assessments per questionnaire and per entry showed a kappa value of 0.72 (95% CI: 0.53-0.94). The noninferiority of electronic data capture in relation to that of the handwritten data capture and transfer was shown (p < 0.0001; 95% CI: 1.47-2.99). In conclusion, the electronic capture of participant-related outcomes with the Oral Survey-B System, originally designed for capture of clinical data, was validated. The electronic data capture was accurate and limited the number of errors. The participants were able to perform electronic data capture effectively, supporting its implementation in further National Oral Health Surveys. With the consideration of participant preference and time savings, this could lead to the implementation of electronic data capture worldwide in National Oral Health Surveys.

Validity of an information and communication technology system for data capture in epidemiological studies.

The Belgian National Institute of Health Insurance is implementing an oral health data registration and surveillance system. This study aimed to develop and validate a system of electronic data capture for oral health surveys at a national level - Oral Survey-B - and to identify the advantages and disadvantages of the electronic system in comparison with the traditional handwritten data capture. Six series of full-mouth recordings simulating the clinical examination of 6 patients were set up in a Powerpoint presentation. The validation was undertaken by 52 general practitioners. A randomized one-period crossover design was used with two formats of data capture, i.e. electronic followed by handwritten or handwritten followed by electronic system. Further, 6 benchmarked handwritten forms were transferred to the electronic format. For the electronic data capture, 86.5% of the practitioners had a correct completion rate of ≥95%. The corresponding value for the handwritten data capture and transfer was 78.8% (p = 0.25, McNemar test). The overall accuracy of forms without any error was 73.4% for the electronic and 62.5% for the handwritten data capture (p < 0.001, signed-rank test). Significantly lower percentages of errors and less time were observed for the electronic data capture (p < 0.001, signed-rank test). Practitioners considered the electronic data capture as being much more difficult to carry out (p < 0.001). As information technology has turned into an ever more necessary working tool in epidemiology, there should be an important potential for uptake of further improvements in electronic data capture in the future.

Antibiotic prescribing in dental practice in Belgium.

AIM: To assess the types and frequency of antibiotic prescriptions by Belgian dentists, the indications for antibiotic prescription, and dentists' knowledge about recommended practice in antibiotic use. METHODOLOGY: In this cross-sectional survey, dental practitioners were asked to record information about all antibiotics prescribed to their patients during a 2-week period. The dental practitioners were also asked to complete a self-administered questionnaire regarding demographic data, prescribing practices, and knowledge about antibiotic use. A random sample of 268 Belgian dentists participated in the survey. RESULTS: During the 2-week period, 24 421 patient encounters were recorded; 1033 patients were prescribed an antibiotic (4.2%). The median number of prescriptions per dentist for the 2 weeks was 3. Broad spectrum antibiotics were most commonly prescribed: 82% of all prescriptions were for amoxycillin, amoxycillin-clavulanic acid and clindamycin. Antibiotics were often prescribed in the absence of fever (92.2%) and without any local treatment (54.2%). The most frequent diagnosis for which antibiotics were prescribed was periapical abscess (51.9%). Antibiotics were prescribed to 63.3% of patients with periapical abscess and 4.3% of patients with pulpitis. Patterns of prescriptions were confirmed by the data from the self-reported practice. CONCLUSIONS: Discrepancies between observed and recommended practice support the need for educational initiatives to promote rational use of antibiotics in dentistry in Belgium.

[Manual or rotary root canal preparation? Nickel-titanium or stainless steel? Review of the literature]. / Préparation canalaire manuelle et/ou mécanisée ? Nickel-titane et/ou acier inoxydable? Revue de la littérature.

The aim of this review was to determine the advantages and disadvantages of rotative nickel-titanium endodontic instruments compared with stainless steel manual instruments on the basis of in vitro studies. Indeed, many articles about this topic have been published these last few years and it has now been demonstrated that these new instruments show many advantages compared with classical manual instruments. However, they cannot solve every clinical situation and the use of manual stainless steel instruments still remains essential.

[Determination of canal length in endodontics]. / Détermination de la longueur canalaire en endodontie.

Although the reliability of the electronic apex locator is agreed upon in the endodontic literature, the general practitioner has difficulties to integrate the device in his daily practice. The authors of this paper conclude that the apex locator should be used to confirm the information obtained from the pre-operatory radiograph (imperatively taken with the parallel technique) and they assert that the data obtained electronically have still to be interpretated. The apex locator can be considered an essential tool as long as its limitations are known.

[Endodontic treatment in one or several sessions? Review of the literature]. / Traitements endodontiques en une ou plusieurs séances? Revue de la littérature.

This literature review compares the endodontic treatment in one or more appointments on the healing of periapical lesions and the occurrence of postoperative pain and flare-ups. It turns out that the root canal treatment completed in one session has many advantages and may he considered the prime option in the majority of clinical cases.

[Comparison of calcium hydroxide and chlorhexidine as intracanal medications in endodontics: review of the literature]. / Comparaison de l'hydroxyde de calcium et de la chlorhexidine comme médications intracanalaires en endodontie: une revue de la littérature.

Calcium hydroxide has found its use in endodontic treatments. On the other hand, chlorhexidine is more and more proposedfor uses in clinical endodontics. Could chlorhexidine surpass calcium hydroxide and what are the benefits of chlorhexidine? This literature overview concludes that both medications are useful and that further studies are necessary before chosing one above the other.

Caries decline in the primary dentition of Belgian children over 15 years.

OBJECTIVES: (1) To investigate changes in caries prevalence in the primary dentition of children resident in Brussels, Belgium between 1983 and 1998, (2) to analyse associations between changes in caries and children's socioeconomic and ethnic aspects. METHODS: In the Brussels region, children in the first grade at the same schools were sampled in cohort 1983 (n = 396) and cohort 1998 (n = 473). Caries experience of Belgian and non-Belgian nationals was summarized in dmf scores. The socioeconomic status of the children was established based on their parents' education and profession. The children were categorized in eight subgroups in relation to their socioeconomic status, ethnic origin and cohort (SESEC subgroups). RESULTS: The percentage of caries-free children increased significantly from 31.5% to 47.5%. A reduction was observed in the dmft scores from 3.9 to 2.3 (P < 0.001) and in the dmfs scores from 6.9 to 5.0 (P < 0.001). The odds ratio of being caries-free was 2.5 times higher for privileged children and 2.3 times higher for children belonging to cohort 1998. The ANCOVA analyses revealed that most of the SESEC subgroups showed significant reduction in dmft scores from 1983 to 1998 (P < 0.003). CONCLUSIONS: Children resident in Brussels showed caries decline in their primary dentition over 15 years. Diversity in caries decline was associated with children's socioeconomic status and ethnic origin.

Long-term evaluation of extensive restorations in permanent teeth.

OBJECTIVES: The present prospective, longitudinal study assessed the outcome of posterior extensive restorations and identified risk factors for failure of the restorations. MATERIALS AND METHODS: The sample consisted of 722 amalgam restorations, 115 composite resin restorations and 89 crowns placed in 428 adults by one dentist from 1982 to 1999 in Belgium. Well-defined criteria were used for cavity preparation design, type of retention and selection of restorative material. RESULTS: At the closure of the study 48% of the restorations were well functioning, 24% were lost to lack of follow-up, and 28% had failed. The most frequent reasons for failure were fracture of restoration (8%), secondary caries (6%) and fracture of cusp (5%). Failures were more often found in premolar teeth (34%) than in molars (27%) (P=0.05) and occurred in 28% of the amalgam restorations, 30% of the resin restorations and 24% of the crowns (P=0.55). Molar restorations were more frequently repaired than replaced in contrast to premolar restorations. The highest percentage of extractions was related to complete amalgam restorations in premolars. The Kaplan-Meier median survival times were 12.8 years for amalgam restorations, 7.8 years for resin restorations, and more than 14.6 years for crowns, considering all retreatment as failures (P=0.002). The survival was influenced by extension of restoration, age of patient, pulpal vitality, 3-year period of treatment, use of base material and dentinal retentive pins. CONCLUSION: Within the limits of the study the data support the view that extensive amalgam restorations but not composite resin restorations can be used as an appropriate alternative to crowns, with due consideration to the longevity of the restorations.

Endodontic and periodontal treatments of a geminated mandibular first premolar.

AIM: To describe a rare case of gemination involving a mandibular first premolar. SUMMARY: The complex morphology of geminated teeth renders their endodontic and periodontal management difficult. Root canal and periodontal treatments were performed on a geminated mandibular first premolar with three canals. Clinical examination showed two separated crowns with united roots. Radiographically, two distinct pulp chambers with two joined and a third independent canal were seen. Conventional root canal treatment resulted in complete healing of the apical lesion. However, the occurrence of a vertical fracture led to the extraction of the mesial segment. At the follow-up visit, the distal segment was clinically healthy and continued to satisfy functional demands.

[Status of dental caries in Belgium and neighboring countries]. / Le point sur la carie dentaire en Belgique et dans les pays voisins.

The present review describes the evolution of dental health in the Belgian population in the last 30 years, comparing it to other European countries. The studies carried out in the individual regions of Wallonia, Brussels and Flanders and in some municipalities, give a general idea about dental health in the country. In the last decade, dental health in Belgian children and adolescents has improved markedly. However, a specific health policy is required for risk groups such as socio-economically underprivileged, disabled and immigrant children. Belgium may be placed among other European countries which show low caries prevalence in schoolchildren population. Further investigation in young adults and adults are required. The lack of representative data for the whole country suggests that the implementation of a data base system for monitoring the evolution of dental health in Belgium would be useful.

The decline in dental caries among Belgian children between 1983 and 1998.

OBJECTIVES: to investigate cross-sectionally a probable dental caries decline in Belgian 12-yr-olds and to analyse some factors that may be associated with dental caries during the study period. METHODS: In the region of Brussels, children in the 7th grade at the same schools were sampled in 1983 (n=533) and 1998 (n= 496). DMFT, DMFS and dental fluorosis were clinically recorded. Data on children's home-based and professional dental health care habits were registered. RESULTS: Caries-free children increased from 4% to 50%. A reduction of the mean number of teeth attacked by dental caries from 7.5 to 1.6 and of tooth surfaces from 11.5 to 2.5 (P<0.001) was observed. Early signs of dental fluorosis were identified in 5% in 1983 and 30% of the subjects in 1998. Multiple linear regression analyses revealed that tooth brushing with fluoridated toothpaste, dental appointments and dental fluorosis were significantly related to dental caries reduction. CONCLUSIONS: A remarkable decline in dental caries was observed during the 15-yr period. The factors related to the children's home-based and professional dental health care were associated with the observed decline.

[Oral hygiene and gingival condition among 12-year-old children in the Brussels Region]. / Hygiène buccale et conditions gingivales des enfants de 12 ans dans la Région de Bruxelles.

The study analyses oral hygiene and gingival status in a group of 12-yr-old children from the Region of Brussels. In 1998, a total of 496 children from eight selected schools participated in the sample. All children were interviewed about their socio-economic status and oral health care. Records of the plaque index and the gingival index were made. The mean plaque and gingivitis were 1.24 (+/- 0.03) and 1.32 (+/- 0.03), respectively. Seventy percent of the examined sites presented plaque and gingivitis. Privileged children showed lower means than non-privileged counterparts. Multiple linear regression showed that dental plaque was significantly associated to age, toothbrushing and appointment in case of discomfort or pain (P = 0.02). Age, gender, type of the toothbrush and use of dental floss were associated to gingivitis (P = 0.05). Daily home-based mechanical plaque removal is critical for the maintenance of gingival health and when efficiently performed it leads to remission of gingivitis. Dentists should be encouraged to give information and training on regular plaque removal to their patients.

[Test your decision-making. When to do endodontic retreatment? Results of a study]. / Testez votre prise de décision. Quand reprendre un traitement endodontique? Les résultats de l'enquête.

The goals of this survey were to determine the most frequent therapeutic option and to evaluate the consensus among a sample of Belgian practitioners managing the same simulated cases of root treated teeth. On average, conservative options (nonsurgical retreatment 35.27% and no retreatment 29.61%) are the most selected alternatives. Surgical options and extraction respectively constitute 21.18% and 13% of the treatment propositions. As expected, the presence of radiographic and/or clinical signs resulted in a more aggressive attitude, but the presence of symptoms does not seem to be a valid reason for reintervention. The results of the study demonstrate considerable interindividual variations in clinical management of root treated teeth, regardless of personal factors, such as gender, years of experience and graduation institution. Even if a consensus appears within a group of professionals, it is not necessarily applied by a majority of practitioners; this contributes certainly to the explanation of the geographical or institutional variations noted in the medical practices.

[Test your decision-making. When to do endodontic retreatment? Some therapeutic alternatives]. / Testez votre prise de décision. Quand reprendre un traitement endodontique? Un exemple de choix thérapeutiques.

The aim of the present article was to propose examples of treatment alternatives for the management of 14 clinical cases. All these cases involved endodontically treated teeth and have been managed by the same practitioner. In this paper, the authors tried to show the variety of treatment alternatives as well as the complexity of the decision-making process and, not to consider that proposed alternatives were the most adequate.

Endodontic retreatment decisions: no consensus.

AIM: The objectives of the present study were to: (i) evaluate the consensus, if any, amongst dental schools, students and their instructors managing the same clinical cases, all of which involved endodontically treated teeth; and (ii) determine the predominant proposed treatment option. METHODOLOGY: Final year students, endodontic staff members and instructors of 10 European dental schools were surveyed as decision makers. Fourteen different radiographic cases of root canal treated teeth accompanied by a short clinical history were presented to them in a uniform format. For each case the decision makers were requested to: (i) choose only one out of nine treatment alternatives proposed, from 'no treatment' to 'extraction' via 'retreatment' and 'surgery' (ii) assess on two 5-point scales: the difficulty of making a decision, and the technical complexity of the retreatment procedure. RESULTS: The results indicate wide inter- and also intra-school disagreements in the clinical management of root canal treated teeth. Analysis of variance showed that the main source of variation was the 'school effect', explaining 1.8% (NS) to 18.6% (P < 0.0001) of the treatment variations. No other factor explained as much variance. Decision difficulty was moderately correlated to technical complexity (Pearsons' r ranging from 0.19 to 0.35, P < 0.0001). CONCLUSIONS: No clear consensus occurred amongst and within dental schools concerning the clinical management of the 14 cases. The lack of consensus amongst schools seems to be due mainly to chance or uncertainty, but can be partly explained by the 'school effect'.

[Test your decision making skills. When should endodontic treatment be redone?]. / Testez votre prise de décision. Quand reprendre un traitement endodontique?

Research has shown wide variations in dentists' clinical attitude towards root canal treated teeth. Simulated cases are used as tools in the investigation of practitioners' clinical behavior and decision making. We therefore used simulated cases (clinical histories and radiographs) of 14 endodontically treated teeth to: (1) determine the predominant proposed treatment strategy for each case, (2) evaluate the consensus, if any, among practitioners, (3) identify pathology and dentist factors influencing the treatment choice.

[Electronic determination of the length of the root canal]. / Détermination électronique de la longueur des canaux radiculaires.

The endpoint of an endodontic treatment must be situated at the cemen-to-dentinal junction to preserve the biological potential of the periapical area and to realize a complete disinfection of the principal root canal system. Thus, the determination of working length is a crucial factor in endodontic therapy. The conventional radiographic method cannot provide the accurate location of the apical constriction. For this reason, the electronic apex locators have been developed. Now, the last generation of apex locators has become more sophisticated and the electronic measurements seem to be accurate and reliable with electrolytic solutions in the canal.

[Clinical considerations apropos of topical fluorides in the control of dental caries]. / Considérations cliniques à propos des fluorures topiques dans le contrôle de la carie dentaire.

Studies on the caries reducing effect of topical fluorides have provided a great understanding of their therapeutic role in caries control. It is believed that topically applied fluorides interfere with dental tissue demineralisation and reduce the rate of caries progression. According to this assumption, topical fluorides are recommended to both children and adults as a measure to control coronal as well as root caries. In the present review, some aspects of caries development and arrest are considered and the reasoning behind topical fluoride application is discussed. Guidelines concerning self-applied and professionally applied topical fluorides regimes according to the patient's caries risk and caries activity are presented.