Changes in oral health from 1973 to 1982 of 13-15-year-old schoolchildren residing in three different fluoride areas in Finland.

The aim of the present study was to analyze the change from 1973 to 1982 in the oral health conditions of 13-, 14-, and 15-year-old school-children residing in three different fluoride areas in Finland. Oral hygiene, as measured with the Visible Plaque Index (Ainamo and Bay, 1975), had improved significantly both among 13-year-old girls (P less than 0.01) and among boys of the same age (P less than 0.05). A highly significant improvement (P less than 0.001) of gingival health, as measured with the Gingival Bleeding Index (Ainamo and Bay, 1975), was observed for boys but not for girls. The striking change was for the DFST (T = total) and FSAA (A = approximal) scores for the totals of 180 girls and 180 boys. This improvement in dental health was mainly due to a dramatic decline of caries in the low-fluoride (0.2 ppm F) area, whereas in the high-fluoride area (2.5 ppm F), the improvement in oral hygiene and gingival health was the greatest. The results support earlier assumptions that caries and gingivitis are separate and mutually independent disease entities. The study further suggests that local fluoride treatments can provide caries-preventive benefits similar to those achieved by community water fluoridation, although at greater cost. The comparison in time revealed that most of the differences in oral health, observed in 1973 both between sexes and between the different fluoride areas, had disappeared by the time of the 1982 examination.

The development during pregnancy of pyogenic granulomas superimposed upon a congenital hemangioma: a case report.

A case of a 25-year old female school teacher with pyogenic granulomas of the gingiva developing during her first pregnancy in the area of a congenital hemangioma is described. The recurrence of the pyogenic granulomas of the gingiva during the second pregnancy could be successfully prevented by scaling and root planing prior to and bi-weekly professional tooth cleaning during pregnancy period. Hormonal changes during pregnancy were in this case found not to influence the development of gingival pyogenic granulomas during maintenance of optimal dental hygiene.

Morphometric analysis of cellular and vascular changes in gingival connective tissue in long-term insulin-dependent diabetes.

This study examined cellular and vascular changes in gingival connective tissue samples by stereologic point-counting procedures and interactive digital analyzing systems in long-term insulin-dependent diabetes mellitus patients. Gingival connective tissue capillaries representing a clinically healthy sulcus with no evidence of periodontal disease at the site of biopsy were studied in 29 patients with diabetes. Based upon their long-term medical records, 19 were identified as having poorly controlled (PIDD) and 10 as controlled insulin-dependent diabetes mellitus (CIDD). Ten nondiabetic, age- and gender-matched individuals served as controls. Thirty-nine biopsies were processed for light microscopy, and the blood vessel area was analyzed using an interactive digital analyzing system; 9 gingival biopsies, 5 diabetic and 4 controls, were processed for morphometric electron microscopic analysis. For each individual, site-specific recordings were made for the plaque index, bleeding index, probing depth, loss of attachment, and radiographic loss of interproximal alveolar bone. No evident signs of periodontitis occurred at the biopsy sites. For each PIDD patient, respective volumetric and numeric densities of cellular components including fibroblasts, neutrophilic granulocytes, monocyte/macrophages, mast cells, lymphocytes, blast cells, and plasma cells were recorded in the inflamed connective tissue (ICT). Non-cellular components such as collagen fibers and blood vessels were also recorded. PIDD patients had elevated plasma cell levels relative to controls and they appeared also to have a decreased collagen fiber density. In addition, fibroblasts occupied less volume in the ICT of PIDD patients than in controls. PIDD patients had the largest mean area of cross-section of the blood vessels, but this difference was not statistically significant (P > or = 0.211; t-test). No specific characteristics of ICT or vascular changes were detectable in adult well-controlled long-term diabetics under similar plaque conditions. Swollen and proliferated endothelial cells were frequently found in PIDD patients and the mean distance from the lumen to the outer border of basement membrane was greater in the PIDD than in the controls (P < 0.001; t-test). Overall, our findings that cellular, vascular, and connective tissue changes indicative of increased catabolism rather than anabolism detected in gingiva are especially associated with poorly controlled long-term insulin-dependent diabetes.

A 7-month study of sulcular fluid flow in the assessment of healing after debridement of deep pockets.

The purpose of this investigation was to assess the value of sulcular fluid flow (SFF) measurements in evaluation of the healing of deep periodontal pockets after scaling and root planing. Fourteen adult patients with advanced periodontal disease received supragingival prophylaxis and instructions in oral hygiene. Immediately after baseline examination, meticulous scaling and root planing were performed. One to five selected pockets per patient were monitored on Days 0, 30, 120 and 210. Subgingival microbial proportions, sulcular fluid flow, probing depth, Gingival Index and bleeding after probing were assessed and recorded. The subgingival microbial proportions were determined with darkfield microscopy. The periodontal conditions were markedly improved by Day 210 as depicted by the microbial proportions. The proportion of motile micro-organisms was reduced from 51% at baseline to 9% on Day 30. This result was sustained until Day 210. Healing was also evident from the changes in Gingival Index scores and bleeding after probing. Probing depth was reduced from a mean of 8.3 to 4.5 mm. Correlations between the individual means recorded for the clinical parameters and bacterial proportions were calculated for the pooled data of all four examinations. Sulcular fluid flow did not correlate with the clinical parameters. Gingival Index, bleeding after probing or probing depth. The latter three parameters correlated significantly with the microbial proportions and each other. When the pooled tooth surface recordings of Days 30, 120 and 210 were divided into two groups according to the proportion of motile bacteria (the groups with less than 18% of spirochetes and motile rods and the groups with greater than 18% of spirochetes and motile rods), a significant difference in the mean amount of sulcular fluid flow (P less than 0.01) and mean probing depth (P less than 0.001) could be demonstrated between the two groups.

Reliability of standardized narrow strips in the Periotron.

In clinical practice the authors have found the 2-mm wide Periopaper slightly too large for insertion into the gingival crevice. This study investigated the reliability of Periotron readings for quantitation of gingival fluid when using filter paper strips which are narrower than the Periopaper. The round-ended strips were cut to a standard size 1 mm wide and 15 mm long using a conchotome. A microsyringe was used to deposit 0.1 microliter of four different fluids (distilled water, undiluted horse serum, diluted horse (1:2) and human (1:2) sera) onto Periopaper and the narrow S-690 strips. The moistened end of each strip was placed between the jaws of both the Periotron 600 and the Periotron 6000, and the maximum digital reading was recorded in two series of 20 measurements for each of the four fluids and two strips, giving a total of 640 assessments. A comparison between the two series confirmed the excellent reproducibility of Periotron readings. The comparison between strips revealed from 10% (Periotron 600) to 20% (Periotron 6000) lower readings for the S-690 than for the Periopaper strips for all fluids. The SD of the readings for both the S-690 and the Periopaper strip was low enough to make the difference between strips statistically significant. The slightly lower readings obtained with the narrow S-690 strip were found as reliable as those recorded when using Periopaper.

Changes of the marginal periodontium as a result of labial tooth movement in monkeys.

Tooth position has been suggested to be an important factor in gingival recession. Due to conflicting reports in the literature, this study was undertaken to examine the effects of labial tooth movement on changes in the marginal periodontium. Orthodontic tooth movement was performed in five monkeys (Macaca nemistrina). Oral health was established and exploratory surgery was performed to assess the level of the connective tissue attachment and marginal bone. Measurements of the gingival margin and mucogingival junction were taken and orthodontic forces were applied. The central incisors were moved labially a mean distance of 3.05 mm. Posttherapy measurements were performed to assess the change which occurred as a result of tooth movement. Significant recession of the gingival margin, connective tissue level and marginal bone was found.

Changes in the frequency of edentulousness and use of removable dentures in the adult population of Finland, 1970-80.

In 1970 an interview study was conducted which revealed that 23% of the adult population of Finland was edentulous. The sample comprised 1000 Finns aged 15 years and over and was rendered representative of the entire population by means of stratified random sampling. All interviews were performed by the commercial poll organization Suomen Gallup. In 1980 the same questions were presented to a new representative sample of equal size. A comparison of the results revealed that the frequency of edentulousness in the total population was exactly the same as in 1970. A decrease had occurred in age groups up to 49 years whereas in the oldest age group of over 64 years the frequency of edentulousness had further increased from 54% in 1970 to 67% in 1980. Insufficient periodontal treatment was suggested as one of the main reasons for frequent loss of teeth at advanced age. The comparison further revealed that edentulous subjects more often used removable dentures in 1980 than in 1970. It would seem that having neither natural nor artificial teeth has become socially less acceptable. The frequency of removable partial dentures had decreased.

Influence of increased toothbrushing frequency on dental health in low, optimal, and high fluoride areas in Finland.

In our previous report we found that the dental health of Finnish 13-15-yr-old children had significantly improved from 1973 to 1982. The aim of this study was to assess whether the improved dental health was associated with frequency of toothbrushing and associated use of fluoride dentifrice. In both 1973 and 1982 some 360 children were scored for the DFS index. In each of three towns with 0.2 ppm, 1.0 ppm, and 2.5 ppm fluoride in the drinking water, samples of about 40 children were randomly picked from each age cohort of 13, 14, and 15 yr. The children were grouped into "infrequent", "daily", or "frequent" brushers. Overall, from 1973 to 1982 the proportion of "daily" and "frequent" brushers had increased from 56% to 75% (P less than 0.001). The overall DFST (T = total) and DFSA (A = approximal) scores had declined significantly in all brushing frequency groups. Looking at separate fluoride areas, the actual decline was found to have occurred in the low fluoride area where in 1982 the DFS scores were 50% or less of the 1973 scores (P less than 0.05). In the low fluoride area in 1973, no association was found between brushing frequency and DFS scores whereas in 1982, high brushing frequency was found to be associated with low DFS scores (P less than 0.05). The decrease in DFS scores was suggested at least partly to be associated with the increased frequency of brushing the teeth with fluoride dentifrice.

Relative influence of calculus and overhangs of fillings on the frequency of score 2 of the CPITN.

Periodontal treatment needs of 895 dentate subjects aged 25, 35, 50 and 65 yr were studied according to the Community Periodontal Index of Treatment Needs (CPITN). The relative influence of calculus and overhanging margins of restorations on the need for professional debridement of shallow (less than or equal to 3 mm) pockets was calculated. The mean number of sextants per person scoring CPITN Code 2 decreased from 2.6 in the 25-yr group to 1.1 in the 65-yr group. Overhangs of fillings alone were detected in 0.8 sextants of the 25-yr-olds and in 0.1 sextants of the 65-yr-olds. The mean number of sextants containing calculus with or without overhangs decreased from 1.8 in the 25-yr group to 1.0 in the 65-yr group. The relative influence of calculus was higher in the aged than in the young population. The recording of overhangs is important for accurate assessment of periodontal treatment needs in populations with a high caries experience.

Role of health education among services rendered by dental personnel in Finland.

The quantity and origins of dental health education information were surveyed in June 1973 by interviews with a sample comprising 505 persons drawn to cover the total Finnish population aged 15 years and over. The interview revealed that tooth extraction was the most frequent (43%) of the measures performed during the last visit to dentist and tooth filling was the measure second in frequency (41%). Rare measures were periodontal treatment (13%) and teaching of home care (2%). Radio and television were the most frequently mentioned sources of information (47%); however, the evaluations of the reliability of information on dental health education in the mass media were skeptical. Dental service personnel was a not minor source of information (33%) and its effectiveness was recognized. Although dental health education performed on the personal level is a great challenge, which should be accepted by the whole dental personnel, a total of 58% of the interviewees were of the opinion that they had not received sufficient information on dental home care.

Conceptions of Finnish people about their periodontal situation.

The conceptions of Finns regarding their own periodontal status were surveyed in 1972. The interviewed sample, drawn to cover the total Finnish population aged 15 years and over, comprised 965 persons. After exclusion of 233 edentulous subjects, a total of 732 dentulous persons were accepted for the present interview study. 10 percent of the interviewees were aware of their having gingivitis at that time. 57 percent were of the opinion that they had never had gingivitis. On the other hand, 20 percent of the interviewed persons had recently observed gum bleeding while 54 percent stated that they had never observed it. 21 percent of the interviewees were aware of their having dental calculus and 46 percent had the impression that they had never had calculus. 24 oercent of those interviewees who presently had calculus or had had calculus stated that they had never had it removed. Generally Finns failed to realize that gingival bleeding is a symptom of gingival inflammation. This point should be made clear in the dental health education of the future. The knowledge could help individuals to evaluate the state of their own periodontal tissues in order to obtain the best possible benefit from efficient home care.

Occurrence of dental caries and gingivitis in low, medium and high fluoride areas in Finland.

The study was performed on a material of 365 Finnish schoolchildren aged 13--15 years. One-third of the children were from Jyväskylä, with 0.2 parts/10(6) fluoride in the drinking water, one-third from Kuopio, with an artificially corrected 1.0 parts/10(6) fluoride content since 1959, and one-third from Hamina, where the natural fluoride content of the drinking water varies between 2.5 and 5.0 parts/10(6). All the children were scored for the Visible Plaque Index (VPI), the Gingival Bleeding Index (GBI) and for past caries experience (DFS). With increasing fluoride content of the drinking water the DFS scores were found to decrease significantly. No such difference was observed with regard to the VPI scores. The prevalence of gingival bleeding was found to be highest in Hamina (2.5 parts/10(6)). A highly significant positive correlation was found between individual VPI and GBI scores in all three towns. No corresponding correlations were found between the individual VPD and DFS scores. The latter finding is in desagreement with the generally accepted view that oral hygiene is an efficient caries-preventive measure.

Conceptions of Finnish people about the etiology and prevention of dental caries and periodontal disorders.

Conceptions among the general public in Finland regarding the etiology and prevention of dental caries and periodontal disorders were surveyed in two interviews in 1971 and 1972. Both population samples interviewed comprised about 1,000 people aged 15 years and over. Inadequate oral hygiene was the most common (65%) possible cause chosen by the subjects among the causes of dental caries. Only 44% of the interviewees considered sugar to be a cause of cariers. Thorough cleaning of the teeth (83%) and dentist's check-ups twice a year (67%) were the factors most frequently chosen in caries prevention. Avoidance of sugar (56%) ranked as the third in frequency. As regards symptoms of periodontal disorders, tender gingiva, gingival bleeding, and loosening of the teeth were correctly suggested as symptoms by 62, 61 and 45%, respectively. Poor oral hygiene (77%) was the cause of gingivitis most commonly chosen by the interviewees, while simultaneous systemic disease (37%) was considered more important than, for example, dental calculus (31%). As regards treatment of periodontal disorders, careful toothcleaning (73%) received most support. However, this factor was closely followed by misconceptions regarding the supposed advantageous value of drug and rinses (50%), chewing of fibrous foods (45%), and vitamin therapy (38%).

Periodontal treatment needs in populations under 20 years of age in Espoo, Finland and Chiangmai, Thailand.

The aim of this study was to assess the periodontal treatment needs at under 20 yr of age in the affluent area of Espoo, Finland, offering comprehensive public dental health care, as compared to a less advantaged area in Chiangmai, Thailand. In Espoo, 50 girls and 50 boys were examined in each age group of 7, 12 and 17 yr. In Chiangmai equal numbers of girls and boys were examined to obtain a group of 89 subjects aged 18.5 + 0.6 yr. According to the Community Periodontal Index of Treatment Needs (CPITN) the need of scaling increased in Espoo from 6% of the 7-yr-olds to 39% of the 17-yr-olds. Moderate pocketing (4-5 mm) occurred in one subject at age 12 and in three subjects at age 17. In Chiangmai, deep pockets (6 mm and over) were recorded for 1%, moderate pockets for a total of 44%, and dental calculus as the highest treatment need indicator in the remaining 55%, indicating a need for professional treatment in 100% of the group examined. The mean number of sextants requiring scaling was 0.6 per person at age 17 in Espoo as compared to 4.5 at 18.5 yr of age in Chiangmai. Three or more healthy sextants per subject were recorded for 47% of the 17-yr-olds in Espoo and for only 6% of the 18.5-yr-olds in Chiangmai. It was concluded that already at young age vast differences occur between periodontal treatment needs in industrialized and developing countries.

Gingival recession in schoolchildren at 7, 12 and 17 years of age in Espoo, Finland.

The present study was undertaken in response to a growing concern among clinicians about an increase in gingival recession among children and adolescents. Groups of 50 boys and 50 girls aged respectively 7, 12, and 17 yr were examined at Espoo Health Centre in 1983. Gingival recession was measured on the facial and lingual aspects of all permanent teeth. Whenever the gingival margin was located on root cementum, the distance from the gingival margin to the enamel border was measured to the nearest 0.5 mm. Recession was categorized as "slight" (0.5 or 1 mm) or "extensive" (1.5-3.5 mm). The prevalence of gingival recession was 5% at 7 yr, 39% at 12 yr, and 74% at 17 yr of age. More girls than boys had recession in the two youngest age groups. At 17 yr recession was equally common in both sexes and both "slight" and "extensive" recession was most often recorded on facial surfaces of first molars, premolars and canines. The alarmingly high prevalence of gingival recession at young age warrants further study of both the reasons and the consequences of early cementum exposure.

Self-reported gingivitis and bleeding gums among adolescents in Helsinki.

The purpose of this descriptive cross-sectional community based investigation was to analyze the relationship between professionally measured and perceived gingival health in a sample of 1217 adolescents (age 14.0 +/- 0.7 yr). The responses to two questionnaire items relating to self-reporting of "gingivitis" ("inflammation of gums" in Finnish) and "bleeding from gums" are reported along with Community Periodontal Index of Treatment Needs (CPITN), percentage of bleeding sites (BOP%) and modified Papillary Bleeding Index (PBI) scores. It was found that current or past "gingivitis" was less often reported than "bleeding from gums" by this sample and that responses to both items exhibited low levels of agreement with the clinical measures. The results suggest that the self-reporting of gingival health may be useful in monitoring the gingival health of populations but does not have sufficient validity for screening individuals for gingivitis as defined by dental professionals. Furthermore, it is suggested that the term "bleeding from gums" rather than "gingivitis" should be used during clinical or group oral health promotion.

Time estimates for dental treatment in four age cohorts of an adult population.

Needs for tooth extractions, conservative dental treatment--including periodontal and caries treatment--and occlusal rehabilitation--including stomatognathic and prosthetic treatment or a combination of these--in a Finnish adult population were summarized and time estimates for the treatment calculated. The study population consisted of 1,275 adults in four age cohorts--25, 35, 50, and 65 years. A decrease was observed from five hours of total dental treatment time needed at ages 25 and 35 years to four hours at age 50 years and three hours at 65 years. At the age of 25 years, 86 percent of the treatment time (255 min) was needed for conservative therapy, the corresponding figures at 65 years being 35 percent (66 min). On the other hand, a fivefold increase (from 13% to 62%) in the proportion of time needed for occlusal rehabilitation was observed between age 25 and 65. A combination of stomatognathic and prosthetic treatment was most frequently needed. The percent of time needed for tooth extractions varied from 1 to 3 percent among the four age cohorts.

Prevention of periodontal disease in the dental office.

The presence or absence of periodontal disease is determined by the equilibrium between the challenging microbial deposits, adhering to the tooth surface, and the host response of the individual patient. The possibility of affecting host response is limited. In primary prevention the main emphasis is therefore on the daily brushing of the teeth at home. The susceptible patient needs, in addition, suitable interdental hygiene measures. At school age, bleeding from more than three sextants of the dentition should be used as a sign of treatment need. Whenever calculus or other retentive factors prevent proper home care, secondary prevention, i.e. professional debridement, is indicated before oral hygiene instruction. Professional cleaning of the teeth at regular intervals has lately been found to greatly enhance the maintenance of periodontal health. Tertiary prevention of periodontal disease is the complex treatment of advanced periodontal breakdown. Recent research findings indicate that patients who have received treatment for advanced periodontal disease should, due to their initially poor host response, automatically be maintained in the high risk group and given meticulous professional cleanings as often as two to four times annually. The possibility of using chemotherapeutic agents for plaque control is limited to short term elimination of supragingival bacterial deposits. Mechanical oral hygiene is thus the method of choice in the prevention of periodontal disease. Regular surveillance of the patient's periodontal health is necessary for evaluation of the effect of such treatment.

The monitoring process and its importance for achievement of the global goals for oral health by the year 2000.

The establishing of the global goals for oral health in the year 2000 automatically implies an increased need to collect epidemiological data on various oral health problems in the specified age groups of the world's population. Baseline data for 1980 on dental caries in the young age groups and on the prevalence of edentulousness among adults are available only in some countries. Where baseline data are available, continuous surveillance at suitable time intervals is required to monitor changes in oral health. Where baseline data are not available, the main emphasis should be put upon clarification of the present situation. In this review, data on recent changes in oral health in some European industrialized countries are used to evaluate future trends. The predictions seem promising for the young age groups which, without difficulty, should be able to surpass the specified global goal by the year 2000. The proposed 50 per cent reduction in edentulousness at age 35-44 also seems to be realistic. The goal which will be difficult to achieve, at least for both the United Kingdom and Finland, is the 25 per cent reduction in edentulousness in the age group of 65 years and over. This part of the population may prove to be the 'lost generation' with regard to oral health. In developing countries very little information is available on this age group. It is concluded that the need to monitor will in itself initiate world-wide activity in epidemiological research. Monitoring is important not only because it provides data on the current situation but also because it is the only known way to predict the probable extent of future improvements in oral health.

The dentition is intended to last a lifetime.

During the twentieth century total loss of teeth has become prevalent in many countries, for example in New Zealand, in the United Kingdom and also in Finland. At age 65 and over more people have lost than retained their teeth in these countries. This situation does not, however, seem to represent the development originally intended by Nature. In a series of studies it has been possible to demonstrate that human teeth erupt with their supporting tissues throughout adult life. Between ages 43 and 65 years this eruption is only slightly slower than between ages 23 and 43 years. The purpose of this genetically predetermined eruption of human teeth seems to be to compensate for the natural wear of the occlusal surfaces and incisal edges. It seems that Nature has done its best. Why then have so many people lost their teeth in modern society? A review of the prevalence of, and the reasons for, edentulousness indicates that the total loss of teeth is historically closely related to rather rapid changes in dietary habits, combined with ignorance of prevention, unfortunate social circumstances and insufficient dental manpower resources at the right time in the right place. Against this background there is a great challenge to the dental profession to teach people how to care for their teeth and avoid needless destruction of the dentition by dental caries and periodontal disease.