Post-treatment effect of fluoride varnishes in children with a high prevalence of dental caries in a community with fluoridated water.

Children with a high prevalence of dental caries living in a community with fluoridated water had received semi-annual half-mouth applications of one of two fluoride varnishes for three years. Two years after the applications were discontinued, we studied the post-treatment effect of the varnishes. The absolute reduction in caries found during the treatment was retained, but the cariostatic effect did not continue after treatment. This finding suggests that fluoride varnish applications should not be discontinued after three years.

Dentist and patient opinions about the ideal dentist and patient--developing a compact questionnaire.

The aims of the study were to determine what according to lay people and dentists in the Kuopio and North Karelia provinces of Finland characterizes the ideal dentist and the ideal patient and to develop a proper questionnaire for further studies in dentist-patient relationship. A questionnaire containing 124, five-class Likert scale statements and questions about background variables was sent in November 1988 to a representative sample of lay people and to all dentists in these regions. To extract areas of preferences for both dentists and patients, and to select questions for further studies on dentist-patient relationship, factor analysis was applied to the data. Similarities and differences in the opinions of dentists and patients were also evaluated by single statements. According to factor analyses, the perceptions of dentists and patients were in general similar, communicativeness and informativeness being the most important traits of dentists and activeness, compliance and motivation being the most important traits of patients. However, differences were also found which should be taken into consideration when teaching dentists about the dentist-patient relationship. Based on the current results we also propose a compact questionnaire to be used in further studies.

Opinions of different subgroups of dentists and patients about the ideal dentist and the ideal patient.

The aim was to study whether subgroups of lay people and dentists differ in their opinions about the ideal dentist and the ideal patient. This was done by analyzing further a data set containing responses on single statements regarding different aspects of dentist-patient relationship that have been reported previously. A questionnaire containing 124 five-class Likert scale statements and questions about the background of the respondents was sent in November 1988 to a representative sample of lay people and to all dentists in Kuopio and North Karelia Provinces in Finland. To extract areas of interdependence for both dentists and patients, factor analyses were applied to the data and factor scores were calculated for further analyses. Differences in the opinions were studied between dentists and patients as well as among subgroups of patients and dentists. The power of the selected factors in discriminating between dentists and patients, and different subgroups of dentists and patients was evaluated by means of logistic regression analyses. The expectations of dentists and patients were similar about the ideal patient. About the ideal dentist, dentists and patients agreed only on one of the five factors, i.e. communicativeness and informativeness. Differences, especially in the opinions about the ideal patient, were found between following subgroups of patients: non-regular and regular attenders, males and females, old and young, patients with low and high education and different occupational status; and between private practitioners and community dentists.

Comparison of ideal and actual behavior of patients and dentists during dental treatment.

The ideal behavior of dentists and patients has seldom been studied with the aim of determining whether it is similar to the actual behavior of the two groups. Thus, the purpose of this study was to compare whether the ideal behavior of dentists and patients differed from their actual behavior. Thirty-three volunteering dentists and 271 of their patients from the public and private sectors in different parts of Finland participated in the study. The dentists first filled out a questionnaire with 5-scale Likert-type statements about the ideal patient and questions concerning their own background variables. In connection with normal dental practice their dental nurses selected 10 patients, who before treatment filled out a questionnaire containing statements about the desired behavior of an ideal dentist and their own background variables. Immediately after the treatment, both dentists and patients filled out another questionnaire containing similar statements, which this time indicated whether the dentist/patient actually behaved according to the ideal. Differences between each individual and the independent ideal and actual scores were compared by cross-tabulation and percentage agreement. With regard to the ideal behavior that was directly related to the treatment procedure, the expectations of both dentists and patients were usually met. In general, the patients did not disrupt the procedures and the dentists were able to concentrate on the treatment. The discrepancies most often found between the ideal and the actual behavior concerned the level of communication. The patients often would like to have been talked to more and wanted to be encouraged. The dentists were not sure whether their patients were interested in or motivated about the treatment or whether they followed the home care instructions. In general, there evidently is a clear gap in communication between dentists and patients, which may lead to frustration on both sides. It is thus suggested that when dentists are trained, more emphasis be placed on communication skills.

Patients' expectations of an ideal dentist and their views concerning the dentist they visited: do the views conform to the expectations and what determines how well they conform?

A convenience sample of patients (n = 271) from community health centres and private clinics in different parts of Finland were recruited for this study through their dental clinic. Equal numbers of regular and irregular clients were invited to participate. Before the treatment procedure, each patient filled out a questionnaire with forty Likertian statements dealing with their expectations of an ideal dentist, and nine about their own background, i.e., age, sex, regularity of dental visits. basic and professional education, and occupation. After the treatment subjects described their treating dentists' behaviour using similar statements. In the analyses two approaches were applied. First, factor analyses with orthogonal varimax rotation were conducted with the data about the ideal and actual dentist. For the ideal dentist, five factors were extracted: 1) mutual communication, 2) fair support, 3) personal appearance, 4) preferred type of practice, and 5) blaming; and for the actual dentist 5 factors were extracted: 1) mutual communication, 2) pain control, 3) fair support, 4) personal appearance, and 5) preferred type of practice. The factor structures were found to be similar when they were compared with transformation analysis. This justified the second analysis where the differences between the ideal and the actual factor scores were compared. The expectations of the patients were met on all the other dentist characteristics except mutual communication and fair support. There were not many differences between subgroups of patients. In further studies, other background variables, such as previous experiences of the patients, should be considered in order to obtain a more complete explanation of the variation in satisfaction. More attention should be paid to the communication skills of the dentists.

Ideal role behaviours as seen by dentists and patients themselves and by their role partners: do they differ?

The aim of this study was to determine whether patients and dentists differ in their ideal role expectations concerning each others behaviour. This was done by further analysing a set of data containing responses to 124 five-class Likertian statements about ideal role expectations and questions about the background of the respondents with regard to different aspects of the dentist-patient relationship. The study groups consisted of a representative sample of lay people and all dentists in the Finnish Provinces Kuopio and North Karelia. To extract areas of ideal role expectations for both dentists and patients, orthogonal factor analyses were applied to the data. To evaluate the dissimilarity of the structure of the factor analyses, rotated factor matrices were used to conduct transformation analysis. Similarities between the ideal role expectations of dentists and patients were studied. When studied with transformation analysis, the ideal role expectations of dentists and patients were found to differ for both the ideal patient and the ideal dentist. However, dentists and patients shared expectations concerning one characteristic of the ideal dentist i.e. the importance of mutual communication, which was also considered the most important characteristic of the ideal dentist. For the characteristics of the ideal patient, the two groups shared the same expectations concerning the manageability of the patient. Previous research has compared dentist and patient expectations based only on single statements. No reports based on factor analysed data have been published, but transformation analysis was found to provide a useful tool for statistical evaluation of the dissimilarity of the factor structures.

Further evidence for the reliability and validity of the Modified Dental Anxiety Scale.

AIM: To gain further evidence of the psychometric properties of the Modified Dental Anxiety Scale. SETTING: Dental admission clinics. DESIGN: Consecutive sampling, cross-sectional survey. PARTICIPANTS: Patients (n = 800) in four cities (Belfast, Northern Ireland; Helsinki, Finland; Jyväskylä, Finland and Dubai, UAE). METHODS: Questionnaire booklet handed to patients, attending clinics, for completion following an invitation by the researcher to be included in the study. MEASURES: Modified Dental Anxiety Scale (MDAS), together with further questions concerning dental attendance and nervousness about dental procedures. RESULTS: Overall 9.3 per cent of patients indicated high dental anxiety. MDAS showed high levels of internal consistency, and good construct validity. The relationship of dental anxiety with age was similar to previous reports and showed lowered anxiety levels in older patients. CONCLUSION: Data from three countries has supported the psychometric properties of this modified and brief dental anxiety scale.

The relationship of parental dental anxiety and child's caries status.

The objective was to determine whether parental dental anxiety is associated with the caries status of their children. A higher level of dental anxiety was found among caries-active children, probably due to their more negative experiences in treatment. Also, fathers from the lower socioeconomic group who had a high level of dental anxiety had children with lower df-scores.

Comparison of numbers of remaining teeth from questionnaires and clinical examination.

The purpose of this study was to compare numbers of remaining teeth from questionnaires and clinical examination and to find out whether information collected through questionnaires is sufficiently valid for use by various institutes in national level. The group studied consisted of 255 adult patients from Savonlinna, not representative of the municipal population. Numbers of remaining teeth were determined from replies to a questionnaire by the subjects and by clinical examination by two dentists. Agreement about numbers of remaining teeth as estimated by the subjects and counted by the dentists was significant when tested using Somer's D and the t-test. Correlations between estimates by subjects and counting by dentists were high (0.98 for men and 0.99 for women). Underestimation of numbers of teeth was more common than overestimation for men and women. On the basis of the results it would seem that questionnaires can give sufficiently valid data about numbers of remaining teeth if samples are large enough.

A 2-year report on caries prevention by fluoride varnishes in a community with fluoridated water.

The benefit of semi-annual applications of sodium fluoride varnish (Duraphat) and silane fluoride varnish (Fluor Protector) was studied in 11-13 year-old children with life-long exposure to fluoridated drinking water (1-1.2 parts/10(6)). Annual clinical and radiographic examinations were made on 67 children in the Duraphat group and 71 children in the Fluor Protector group. Fluoride varnish was applied semi-annually using the half-mouth technique. At the end of 2 years, the mean overall DMFS-increments on the control side and test side of the Duraphat group were 5.0 and 3.8 (p less than 0.01), respectively, and of the Fluor Protector group 3.7 and 3.3 (NS). The caries reductions were 24% and 12%, respectively. Since there were no differences between initial mean DMFS scores of the groups, it was assumed that lower increments in the Fluor Protector group were due to Fluoride ions crossing the midline and providing protection on the control side as well. When increments in the Duraphat control side and the Fluor Protector test side were compared, the caries reduction of Fluor Protector was 35% (p less than 0.01). Fluoride varnishes provide additional benefit even when fluoride intake from drinking water is optimal.

Three-year report on caries prevention of using fluoride varnishes for caries risk children in a community with fluoridated water.

The benefit of semiannual application of the sodium fluoride varnish Duraphat and the silane fluoride varnish Fluor Protection was studied in 11--13-year-old children with high caries activity and life-long exposure to fluoridated drinking water (1--1.2 parts/10(6)). Annual clinical and radiographic examinations were made of 62 children in the Duraphat group and 70 children in the Fluor Protector group. Fluoride varnish was applied semiannually using the half-mouth technique. After 3 years, for the Duraphat group mean total DMFS increments on the control side were 6.2 and on the test side 4.3 (P less than 0.001); for the Fluor Protector group the DMFS increments were 4.9 and 4.4, respectively (NS). The caries reductions were 30% and 11%. Since there were no differences between initial mean DMFS scores of the groups, it is possible that the increment in the Fluor Protector control side compared to the Duraphat control side was due to fluoride ions from Fluor Protector crossing the midline and providing protection on the control side as well. Therefore, we conclude that Duraphat proved effective, but definite conclusion of the effect of Fluor Protector cannot be made. Children with the highest DMFS increment on the control side (Duraphat) gained most from the applications.

Acceptability of fluoride use in Finnish municipalities.

The aim of this study was, firstly, to determine what methods of delivering fluorides might be acceptable to Finnish municipalities and, secondly, to investigate which characteristics of the municipalities best explain the variation in acceptability of fluorides. A sample, composed of 46 Finnish municipalities and representing the communes according to number of inhabitants was drawn and a mail survey sent to decision-makers (n = 1922). In this survey we assessed the characteristics of each commune and its decision-makers and asked how acceptable various methods of fluoride delivery were. The acceptability of the various methods was: toothpaste 95%, gels and varnishes 81%, rinses 63%, salt 48%, piped water 33%, and milk 11%. In industrialized communes these methods of delivery were usually slightly better accepted than in non-industrialized areas. Acceptability of fluorides seemed to differ in the various regions of Finland, Uusimaa region being the most liberal towards use of fluorides. Members of the labour parties seemed to accept piped water containing fluoride and fluoridated milk significantly more often than did conservatives. Among decision-makers, the various methods of delivery were best accepted by dentists, physicians and members of health councils.

Oral health status in a Finnish village.

The aim of this study was to describe edentulousness, numbers of remaining teeth, dental caries, caries experience, periodontal pockets, and background factors in a Finnish village. It was particularly aimed at determining the incidence of simultaneous occurrence of untreated caries lesions and periodontal pockets. It was carried out in 1988 in Viekijärvi, a village in North Karelia. Half of the population was invited to participate in the investigation. Seventy-two percent of those invited participated (n = 179). The subjects were examined clinically using standard WHO methods and criteria. The subjects were interviewed to establish socioeconomical factors and health habits. Thirty-five per cent of subjects were edentulous. Numbers of remaining teeth decreased with age, except in the age group 55-59 years. Numbers of teeth and edentulousness were strongly associated with use of dental services but not with health habits. More than half of the dentate population had untreated caries. Of habits affecting health, only smoking was associated with caries. Twenty-nine per cent of the dentate population had shallow pockets and 7% deep pockets. The occurrence of pockets was negatively associated with frequency of handwashing. Only 20% of the dentate population were orally healthy. The age group 55-59 years was healthier than the younger and older groups.

Determinants of cariogenic snacking in adolescents in Belfast and Helsinki.

The aim of the study was to investigate the determinants of reported snack consumption in adolescents residing in Belfast, Northern Ireland and Helsinki, Finland. Ten % random samples of 14-15 yr old Belfast (n = 628) and Helsinki (n = 600) adolescents were obtained. A questionnaire assessed their demography, oral health knowledge, attitudes and the consumption of cariogenic snacks containing non-milk extrinsic sugars (NMES). Five hundred and eighty-nine (94%) questionnaires were returned in Belfast and 441 (74%) questionnaires in Helsinki. Belfast adolescents had significantly higher levels of oral health knowledge and higher consumption rates for snacks containing NMES. The Helsinki adolescents had more positive attitudes towards their oral health. Multivariant analysis showed that demography was the most direct determinant of cariogenic snacking. The acquisition of oral health knowledge played a minor role. There is a need to develop tailored and focused programmes to promote healthier snacking regimes in adolescents.

Health habits in a Finnish village.

This study is part of a collaborative study entitled "Life-style and health" which is being conducted in Finland, India and Tanzania, using the same methods. The aim of the study is to describe health habits (smoking, alcohol consumption, use of medical drugs, exposure to sugars and hygiene habits) in Viekijärvi, a village in eastern Finland. Of the villagers 50% of those aged 20 years and over were randomly selected to take part in the study. Of these, 72% (n = 179) returned the standard questionnaire they had been sent. Smoking was as common among men in Viekijärvi as in Finland in general, but less common among women. Alcohol consumption reflected the national consumption. The use of medical drugs was high: 45% of respondents used such preparations daily. The most common exposure to sugar on a daily basis was sugar-sweetened coffee. Most people in Viekijärvi (89%) brushed their teeth at least once a day. A strong positive correlation was found between frequencies of toothbrushing and handwashing mirroring unidimensional hygienic behaviour. The results of this study will form a basis for a health promotion programme, to be developed by the villagers themselves.

Effect of a sodium fluoride varnish on the progress of initial caries lesions.

Effect of applications of a sodium fluoride varnish, Duraphat, on progress of initial caries lesions was studied in 11-13-year-old children. All 60 children included in the study had high caries activity and life-long exposure to fluoridated drinking water. The varnish was applied semiannually using the half mouth technique, and annual clinical and radiographic examinations were made for 3 years. The treatment had little effect on the progress of initial caries lesions present before the first application of varnish. The progress of caries lesions formed during the study was inhibited more distinctly, and the difference between test and control side in the rate of progress of caries lesions was highly statically significant. Use of fluoride varnish seems to help prevent further development of early caries lesions.