Dental Caries Experience in Elementary School Students in Quebec: Surveillance Study Using ICDAS II.

OBJECTIVES: The main objective of a 2012-2013 clinical study on the oral health of Quebec elementary school students was to assess the oral health status of Grade 2 and Grade 6 students. We assessed various stages of caries and created caries indicators for primary and permanent dentitions combined. METHODS: Oral health examination of 2875 Grade 2 students and 2788 Grade 6 students, enrolled in public and private, French- and English-language schools, was carried out at schools. The examinations were performed by 16 trained and calibrated dentists using International Caries Detection and Assessment System (ICDAS) II criteria. A 3-level sampling design ensured that the study was representative for the province of Quebec. RESULTS: Mean indexes for decayed, missing, filled primary teeth (dmft) and secondary teeth (DMFT) or surfaces (dmfs and DMFS) for all stages of caries were as follows. Grade 2 students: dmft 3.96, DMFT 1.88, dmft + DMFT 5.84, dmfs 8.33, DMFS 2.96 and dmfs + DMFS 11.28. Grade 6 students: dmft 1.94, DMFT 4.98, dmft + DMFT 5.98, dmfs 4.04, DMFS 7.86 and dmfs + DMFS 9.96. Most students (90% for Grade 2 and 92% for Grade 6) had a dmfs + DMFS > 0. CONCLUSION: Tooth decay remains a public health problem in Quebec. The findings testify to the importance of reinforcing preventive measures to better control dental caries among youth. It is advantageous to use ICDAS II in the context of oral health surveillance at a population level and to present the results as a combination of primary and permanent dentitions.

Oral health care systems in developing and developed countries.

Health care systems are essential for promoting, improving and maintaining health of the population. Through an efficient health service, patients can be advised of disease that may be present and so facilitate treatment; risks factors whose modification could reduce the incidence of disease and illness in the future can be identified, and further, how controlling such factors can contribute to maintain a good quality of life. In developed countries, clinics or hospitals may be supported by health professionals from various specialties that allow their cooperation to benefit the patient; these institutions or clinics may be equipped with the latest technical facilities. In developing countries, health services are mostly directed to provide emergency care only or interventions towards certain age group population. The most common diseases are dental caries and periodontal disease and frequently intervention procedures aim, at treating existing problems and restore teeth and related structure to normal function. It is unfortunate that the low priority given to oral health hinders acquisition of data and establishment of effective periodontal care programmes in developing countries but also in some developed countries where the periodontal profile is also less than satisfactory. Despite the fact that in several developed countries there are advanced programmes oriented to periodontal disease treatments, the concern is related to the lack of preventive oriented treatments. According to data available on periodontal status of populations from developed countries, despite the number of dentists and trained specialists, dental health professionals do not presently meet adequately the need for prevention, focusing mainly on curative care. The need for strengthening disease prevention and health promotion programmes in order to improve oral health conditions and particularly periodontal status in the majority of countries around the world is evident. Unfortunately, in many countries, the human, financial and material resources are still insufficient to meet the need for oral health care services and to provide universal access, especially in disadvantaged communities, in both developing and developed countries. Moreover, even though the most widespread illnesses are avoidable, not all population groups are well informed about or able to take advantage of the proper measures for oral health promotion. In addition, in many countries, oral health care needs to be fully integrated into national or community health programmes. Improving oral health is a very challenging objective in developing countries, but also in developed countries, especially with the accelerated aging of the population now underway and intensifying over the coming years.

Oral hygiene in elderly people in hospitals and nursing homes.

DATA SOURCES: Searches were made using Medline, the Cochrane Library, the National Health Service Economic Evaluation database and, by hand, of relevant articles' reference lists. STUDY SELECTION: The search was limited to studies conducted in humans only. The predetermined inclusion criteria were: clinical studies and randomised controlled trials (RCT) that linked oral hygiene with healthcare-associated pneumonia or respiratory tract infection in elderly people. Publications in Dutch, English, German and any of the Nordic languages (Danish, Finnish, Icelandic, Norwegian, Swedish) were included. Articles about authority opinions and reports of expert committees were excluded, as were studies on subjects who required mechanical ventilation or tube feeding. DATA EXTRACTION AND SYNTHESIS: Data extraction from RCT was focused on the outcomes. Assessments were made of the quality and validity of the studies, using statistical methods to test these. To ensure the consistency of the assessments throughout the study, two authors (EN, PS) performed the data extraction independently, and any disagreements were resolved in consensus meetings. Pooling data from individual studies (meta-analysis) was not deemed appropriate because of heterogeneous study designs, quality of reporting methodological aspects and trial conduct. To provide an overview of additional clinical studies in this research area, the non-RCT studies that were identified were scrutinised for the authors' main conclusion(s). RESULTS: Fifteen publications, of which five were RCT, fulfilled the inclusion criteria and were considered throughout all the assessments. All of the RCT revealed positive preventive effects of oral care on pneumonia or respiratory tract infection in nursing home residents, with numbers needed to treat ranging from 8.6-15.3. CONCLUSIONS: Available results from RCT provide evidence that mechanical oral hygiene decreases mortality risk from pneumonia and seems to have a clinically relevant preventive effect on nonfatal pneumonia in independent elderly individuals. The data show that providing mechanical oral hygiene may prevent approximately 1 in 10 cases of death from pneumonia in dependent elderly people and indicate a largely similar effect for prevention of pneumonia.

Dental caries, problems perceived and use of services among institutionalized elderly in 3 regions of Quebec, Canada.

OBJECTIVES: To determine the changes, since 1980, in the number of nontreated caries in elderly people who have retained their teeth and are in residential and long-term care centres (CHSLDs) in the province of Quebec, Canada, and the changes in their perception of their oral health problems and use of dental services. METHODS: A secondary analysis of data from a 2004-2005 survey about the oral health problems of people who were at least 65 years of age and living in CHSLD institutions in the Montreal, Montérégie and Quebec City regions was done. The inclusion criterion for the secondary analysis was that the residents had to have at least 1 natural tooth. Data from the 152 residents who met the inclusion criterion were analyzed, and compared with those from a similar study done in 1980. RESULTS: Since 1980, the average number of teeth retained rose from 11.05 (SD 6.78) teeth to 12.91 (SD 7.82) in 2004. The average number of decayed teeth requiring treatment fell from 2.43 (SD 2.88) to 1.62 (SD 2.53); 49.3% (75/152) of the elderly participants had caries, compared with 74.1% in 1980. Only 3.4% (5/149) of the participants reported problems with, or pain or discomfort in their gums, compared with 8.9% in 1980. About half (48.7% or 74/152) of the participants examined needed periodontal treatment; 63.8% (83/130) had had recourse to services within the previous 5 years. The last time care was sought was, on average ,7.1 years ago, compared with 11.0 years in 1980. CONCLUSIONS: Between 1980 and 2004, the number of retained teeth increased and the number of untreated caries fell among institutionalized elderly people. Their perception of the need for dental care remained poor. Their use of services improved, but was not ideal, given the numerous oral health problems diagnosed in this population.