Fluoride in drinking water in Madagascar and the development of a strategy for salt fluoridation.

OBJECTIVE: To update current knowledge of the distribution of drinking water fluoride content in Madagascar, in an effort to develop a strategy for the distribution of fluoridated salt to prevent tooth decay. BASIC RESEARCH DESIGN: In accordance with a strict protocol, water samples were collected from all the country's 22 regions. Fluoride concentration in ppm fluoride (F) was determined by use of a F ionselective electrode coupled with a pH/ion meter. RESULTS: A total of 651 sources of drinking water were sampled, of which 94% were found to have fluoride concentrations ≤ 0.7 ppm. The two regions with the highest number of water supplies with fluoride concentrations ⟩ 0.7 ppm are situated in the south and south-west of Madagascar. 87% of thermal springs have fluoride levels ⟩ 0.7 ppm, with a mean value of 2.21 ± 1.64 ppm. CONCLUSIONS: These findings confirm that, with the exception of certain districts in the extreme south of Madagascar, fluoridated salt distribution would be appropriate for most regions in the country. This could be achieved by encouraging salt producers in the north and west of Madagascar, who are responsible for over 88% of national salt production, to fluoridate their salt. Most of this salt is distributed throughout the north and centre of the country, whereas very little is distributed to the extreme south.

Fluoride content of toothpastes available in South Africa.

A high dental caries burden coupled with a lack of water or salt fluoridation make it imperative that toothpastes available to the South African consumer demonstrate adequate potential for caries control and contain between 1000ppm and 1500ppm total fluoride (TF), with at least 1000ppm F in free available/soluble form. METHODS: The objective was to determine TF, total soluble fluoride (TSF) and insoluble fluoride (IF) concentrations in 22 fluoride toothpastes commercially available in South Africa. Samples were purchased from a major pharmaceutical and food retailer located in the two metropolitan areas in South Africa. TF and TSF concentrations were determined potentiometrically, in quadruplicate, following acid hydrolysis of the samples using a calibrated Combination Fluoride Ion Selective Electrode. IF was calculated by subtracting TSF from TF. RESULTS: Although TF content was found to be statistically significantly lower than manufacturer declaration (3.2x10-7; p≤0.05), 77.3% of the samples still contained adequate free, available/soluble F levels. Relative mean TSF content for toothpastes formulated with a calcium-based abrasive was 85% (sd ±14.5; n=6) as opposed to 98.6% (sd ±2.6; n=16) for those containing silica. CONCLUSIONS: The total fluoride concentration of all the toothpastes was lower than that declared by the manufacturers, with one in four having TSF concentrations of less than 1000ppm F. The relative TSF concentrations for the calcium-containing toothpastes were lower than for the silica-based products, reducing their preventive and protective potential. The results call for strengthened regulation and quality control of fluoride toothpastes in South Africa, as well as international efforts to improve related norms.

Success rates of manual restorative treatment (MRT) with amalgam in permanent teeth in high caries-risk Filipino children.

OBJECTIVES: The objective of the study is to evaluate the success rate of amalgam restorations in manually prepared cavities under field conditions within a comprehensive school-based oral health-care program in high caries-risk children. MATERIALS AND METHODS: A total of 1322 restorations were placed in the permanent teeth of 619 high caries risk Filipino children by two dentists and two trained health-care workers. Only hand instruments and an encapsulated amalgam, mixed with a manually powered amalgamator, were used. The restorations were evaluated after a service time of 1 to 5 years using modified atraumatic restorative treatment (ART) criteria. RESULTS: The overall success rate of the amalgam restorations was 95.3% (n = 1260) after a mean service time of 2.7 years (SD = 1.4). Multiple-surface restorations showed significantly higher failure rates (11.4%) than single-surface occlusal (4.7%) and single-surface non-occlusal (2.1%) restorations; 93.6% of large restorations was performed successfully, but had a risk of failure twice to that of small restorations (odds ratio (OR) = 2.141). The score of the decayed, missing, and filled teeth (DMFT) index had significant influence on the success rate. The risk of restoration failure increased by 11.5% for each unit increase in DMFT (OR = 1.148). Neither the operator nor age nor gender of the patient had a significant effect on the success rate of the restorations. CONCLUSION: Amalgam was performed satisfactorily as a filling material when placed under field conditions in manually prepared cavities in the permanent dentition of high caries-risk children. Success of the restorations was influenced by the patient's caries experience (DMFT), restoration size, and service time. CLINICAL RELEVANCE: Manual restorative treatment (MRT) amalgam restorations were performed satisfactorily, but higher dental caries experience and large cavities contribute to lower success rates.

Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed?

BACKGROUND: Contrary to the World Health Organization's internationally recommended medical certificate of cause of death, the South African (SA) death notification form (DNF) does not allow for the reporting of the manner of death to permit accurate coding of external causes of injury deaths. OBJECTIVES: To describe the injury cause-of-death profile from forensic pathology records collected for the National Cause-of-Death Validation (NCoDV) Project and compare it with profiles from other sources of injury mortality data. In particular, the recording of firearm use in homicides is compared between sources. METHODS: The NCoDV Project was a cross-sectional study of deaths that occurred during a fixed period in 2017 and 2018, from a nationally representative sample of 27 health subdistricts in SA. Trained fieldworkers scanned forensic records for all deaths investigated at the forensic mortuaries serving the sampled subdistricts during the study period. Forensic practitioners reviewed the records and completed a medical certificate of cause of death for each decedent. Causes of death were coded to the International Statistical Classification of Diseases, 10th revision (ICD-10), using Iris automated coding software. Cause-specific mortality fractions for injury deaths were compared with Injury Mortality Survey 2017 (IMS 2017) and Statistics South Africa 2017 (Stats SA 2017) datasets. The cause profile for all firearm-related deaths was compared between the three datasets. RESULTS: A total of 5 315 records were available for analysis. Males accounted for 77.6% of cases, and most decedents were aged between 25 and 44 years. Homicide was the leading cause of death (34.7%), followed by transport injuries (32.6%) and suicide (14.7%). This injury cause profile was similar to IMS 2017 but differed markedly from the official statistics, which showed markedly lower proportions of these three causes (15.0%, 11.6% and 0.7%, respectively), and a much higher proportion of other unintentional causes. Investigation of firearm-related deaths revealed that most were homicides in NCoDV 2017/18 (88.5%) and IMS 2017 (93.1%), while in the Stats SA 2017 data, 98.7% of firearm deaths were classified as accidental. Approximately 7% of firearm-related deaths were suicides in NCoDV 2017/18 and IMS 2017, with only 0.3% in Stats SA 2017. CONCLUSION: The official cause-of-death data for injuries in SA in 2017 differed substantially from findings from the NCoDV 2017/18 study and IMS 2017. Accurate data sources would ensure that public health interventions are designed to reduce the high injury burden. Inclusion of the manner of death on the DNF, as is recommended internationally, is critically important to enable more accurate, reliable and valid reporting of the injury profile.

Out-of-hospital cardiac arrest: Causes according to autopsy and electrocardiography - Analysis of 781 patients with neither hospital care nor prescribed medication during the preceding two years.

BACKGROUND: There is a knowledge gap regarding aetiology of and potential for predicting out-of-hospital cardiac arrest (OHCA) among individuals who are healthy before the event. AIM: To describe causes of OHCA and the potential for predicting OHCA in apparently healthy patients. METHODS: Patients were recruited from the Swedish Register of Cardiopulmonary Resuscitation from November 2007 to January 2011. Inclusion criteria were: OHCA with attempted CPR but neither dispensed prescription medication nor hospital care two years before the event The register includes the majority of patients suffering OHCA in Sweden where cardiopulmonary resuscitation (CPR) was attempted. Medication status was defined by linkage to the Swedish Prescribed Drug Register. Cause of death was assessed based on autopsy and the Swedish Cause of Death Register. Prediction of OHCA was attempted based on available electrocardiograms (ECG) before the OHCA event. RESULTS: Altogether 781 individuals (16% women) fulfilled the inclusion criteria. Survival to 30 days was 16%. Autopsy rate was 72%. Based on autopsy, 70% had a cardiovascular aetiology and 59% a cardiac aetiology. An ECG recording before the event was found in 23% of cases. The ECG was abnormal in 22% of them. CONCLUSION: Among OHCA victims who appeared to be healthy prior to the event, the cause was cardiovascular in the great majority according to autopsy findings. A minority had a preceding abnormal ECG that could have been helpful in avoiding the event.

Evaluation of the use of anti-TNF-alpha in an LPS-induced murine model.

OBJECTIVE: Tumor necrosis factor alpha (TNF-alpha) may play a critical role in inflammatory-mediated preterm labor. Medications blocking the activity of TNF-alpha have been shown to be effective in the treatment of conditions such as rheumatoid arthritis; however, the use of these medications for an event like preterm birth or fetal death is unknown. We hypothesized that treatment with anti-TNF-alpha may decrease the rate of fetal death and preterm birth in a LPS-induced murine model. METHODS: Pregnant C57BL/6J mice received intraperitoneal (IP) injections of either vehicle or 2mg anti-TNF-alpha. After 24h, 10 microg of LPS was administered IP. Mice were sacrificed 24h later and outcomes between groups were assessed. A second set of experiments utilizing RT-PCR was performed to determine the influence of anti-TNF-alpha on production of inflammatory cytokines in response to LPS. RESULTS: There were 72 resultant pups in the LPS+saline group, and 91 in the group receiving LPS+anti-TNF-alpha. Pretreatment with anti-TNF-alpha reduced the rate of fetal death and preterm birth after LPS administration (p<0.01). Expression of IL-6, IL-1beta, TLR-2, CD14 and COX-1 were found to be significantly reduced in mice treated with anti-TNF-alpha and LPS compared to LPS alone. CONCLUSION: The use of anti-TNF-alpha decreased fetal deaths and preterm deliveries in an LPS-induced model of preterm birth. In addition, there were critical gene expression alterations in the group receiving anti-TNF-alpha. Further evaluation of TNF-alpha blockade as a potential treatment for preterm labor is warranted.

CpG methylation regulates the Igf2/H19 insulator.

The differentially methylated 5'-flank of the mouse H19 gene unidirectionally regulates the communication between enhancer elements and gene promoters and presumably represses maternal Igf2 expression in vivo [1-6]. The specific activation of the paternally inherited Igf2 allele has been proposed to involve methylation-mediated inactivation of the H19 insulator function during male germline development [1-4, 6]. Here, we addressed the role of methylation by inserting a methylated fragment of the H19-imprinting control region (ICR) into a nonmethylated episomal H19 minigene construct, followed by the transfection of ligation mixture into Hep3B cells. Individual clones were expanded and analyzed for genotype, methylation status, chromatin conformation, and insulator function. The results show that the methylated status of the H19 ICR could be propagated for several passages without spreading into the episomal vector. Moreover, the nuclease hypersensitive sites, which are typical for the maternally inherited H19 ICR allele [1], were absent on the methylated ICR, underscoring the suggestion that the methylation mark dictates parent of origin-specific chromatin conformations [1] that involve CTCF [2]. Finally, the insulator function was strongly attenuated in stably maintained episomes. Collectively, these results provide the first experimental support that the H19 insulator function is regulated by CpG methylation.

The 5' flank of mouse H19 in an unusual chromatin conformation unidirectionally blocks enhancer-promoter communication.

BACKGROUND: During mouse prenatal development, the neighbouring insulin-like growth factor II (Igf2) and H19 loci are expressed monoallelically from the paternal and maternal alleles, respectively. Identical spatiotemporal expression patterns and enhancer deletion experiments show that the Igf2 and H19 genes share a common set of enhancers. Deletion of a differentially methylated region in the 5' flank of the H19 gene partially relieves the repression of the maternal Igf2 and paternal H19 alleles in the soma. The mechanisms underlying the function of the 5' flank of the H19 gene are, however, unknown. RESULTS: Chromatin analysis showed that the 5' flank of the mouse H19 gene contains maternal-specific, multiple nuclease hypersensitive sites that map to linker regions between positioned nucleosomes. These features could be recapitulated in an episomal-based H19 minigene, which was propagated in human somatic cells. Although the 5' flank of the H19 promoter has no intrinsic silencer activity under these conditions, it unidirectionally extinguished promoter-enhancer communications in a position-dependent manner, without directly affecting the enhancer function. CONCLUSIONS: The unmethylated 5' flank of the H19 gene adopts an unusual and maternal-specific chromatin conformation in somatic cells and regulates enhancer-promoter communications, thereby providing an explanation for its role in manifesting the repressed state of the maternally inherited Igf2 allele.

PKC activation sensitizes basal-like breast cancer cell lines to Smac mimetics.

There is a need for novel strategies to initiate cancer cell death. One approach is the use of Smac mimetics, which antagonize inhibitor of apoptosis proteins (IAPs). Recent studies have shown that combinations of Smac mimetics such as LBW242 or LCL161 in combination with chemotherapeutic agents increase cancer cell death. Here we show that the protein kinase C (PKC) activator TPA together with the Smac mimetic LBW242 induces cell death in two basal breast cancer cell lines (MDA-MB-468 and BT-549) that are resistant to Smac mimetic as single agent. Ten other LBW242-insensitive cancer cell lines were not influenced by the TPA+LBW242 combination. The TPA+LBW242 effect was suppressed by the PKC inhibitor GF109203X, indicating dependence on PKC enzymatic activity. The PKC effect was mediated via increased synthesis and release of TNFα, which can induce death in the presence of Smac mimetics. The cell death, coinciding with caspase-3 cleavage, was suppressed by caspase inhibition and preceded by the association of RIP1 with caspase-8, as seen in complex II formation. Smac mimetics, but not TPA, induced the non-canonical NF-κB pathway in both MDA-MB-231 and MDA-MB-468 cells. Blocking the canonical NF-κB pathway suppressed TPA induction of TNFα in MDA-MB-468 cells whereas isolated downregulation of either the canonical or non-canonical pathways did not abolish the Smac mimetic induction of the NF-κB driven genes TNFα and BIRC3 in MDA-MB-231 cells although the absolute levels were suppressed. A combined downregulation of the canonical and non-canonical pathways further suppressed TNFα levels and inhibited Smac mimetic-mediated cell death. Our data suggest that in certain basal breast cancer cell lines co-treatment of TPA with a Smac mimetic induces cell death highlighting the potential of using these pathways as molecular targets for basal-like breast cancers.

Coincident spiking activity induces long-term changes in inhibition of neocortical pyramidal cells.

In pyramidal cells, induction of long-term potentiation (LTP) and long-term depression (LTD) of excitatory synaptic transmission by coincidence of presynaptic and postsynaptic activity is considered relevant to learning processes in vivo. Here we show that temporally correlated spiking activity of a pyramidal cell and an inhibiting interneuron may cause LTD or LTP of unitary IPSPs. Polarity of change in synaptic efficacy depends on timing between Ca(2+) influx induced by a backpropagating train of action potentials (APs) in pyramidal cell dendrites (10 APs, 50 Hz) and subsequent activation of inhibitory synapses. LTD of IPSPs was induced by synaptic activation in the vicinity of the AP train (<300 msec relative to the beginning of the train), whereas LTP of IPSPs was initiated with more remote synaptic activation (>400 msec relative to the beginning of the AP train). Solely AP trains induced neither LTP nor LTD. Both LTP and LTD were prevented by 5 mm BAPTA loaded into pyramidal cells. LTD was prevented by 5 mm EGTA, whereas EGTA failed to affect LTP. Synaptic plasticity was not dependent on activation of GABA(B) receptors. It was also not affected by the antagonists of vesicular exocytosis, botulinum toxin D, and GDP-beta-S.

Effectiveness of single-surface ART restorations in the permanent dentition: a meta-analysis.

Over the past few years, there has been an increase in the number of studies reporting on various aspects of the Atraumatic Restorative Treatment (ART) approach. Five randomized clinical trials in which ART restorations with glass ionomers were compared with amalgam restorations in permanent teeth for a maximum period of 3 yrs constituted the database. This meta-analysis divided the publications into 'early' (1987-1992) and 'late' (1995-) studies on the basis of improvements in the approach. The analysis showed that, in the 'early' studies, single-surface amalgam restorations survived statistically significantly longer than comparable ART restorations after 1, 2, and 3 yrs. This trend did not continue into the late group of studies; no statistically significant difference between the 2 types of restorations was found. Based on the available data, it appears that there is no difference in survival results between single-surface ART restorations and amalgam restorations in permanent teeth over the first 3 yrs.

Alienation and drinking motivations among adolescent females.

The present study examined a hypothesized relation between alienation and stated motivations for alcohol use. It was predicted that such a relation would emerge more clearly among adolescent females than among adolescent males, and this prediction was confirmed. Among females, problem-related drinking motivations correlated positively with alienation, whereas social-convivial motivations correlated negatively with this attribute. No comparable correlations were found among the male subjects. It was concluded that important sex differences in the dynamics of problem drinking in our society are worthy of additional study.

Periodontal implications of furcation entrance dimensions in Chinese first permanent molars.

Narrow dimensions of the entrance to furcations of multi-rooted teeth can complicate the periodontal management of furcation involvements. The objectives of this study were to measure the furcation entrance dimensions of first permanent molars from Hong Kong Chinese, and to compare these dimensions with those of the blade widths of periodontal instruments generally advocated for root surface instrumentation. A total of 363 first permanent molars, of which 185 were maxillary, were examined under 1.5 x magnification. Furcation entrance dimensions were measured using calibrated test gauges ranging from 0.3 mm to 1.5 mm. Furcation entrance dimensions equal to or less than 0.75 mm (the blade width of a new Gracey curet being 0.76 mm) in maxillary first molars were found in 79% of buccal entrances, 39% of mesial entrances, and 43% of distal entrances. In mandibular first molars, entrance dimensions equal to or less than 0.75 mm were encountered in 36% and 47% of buccal and lingual furcation entrances respectively. One-half of all furcation entrance dimensions of these first molars were less than the blade width of new Gracey curets. This high prevalence of narrow furcation entrances should be considered in the periodontal management of furcation involvement of first molars in Chinese.

How effective is ART in the management of dental caries?

The ART approach involves excavating cavitated dentine caries with hand instruments, then restoring the cavity and sealing any associated fissures and pits with an adhesive restorative material, resulting in a sealant restoration. Until recently, ART has mainly been used under field conditions, and thus the adhesive restorative material used has been glass ionomer which does not require mixing machines and curing lights. Since the inception of ART, a growing number of studies world-wide have taken place. A total of four studies have reported 3-year survival percentages for one-surface ART restorations. The highest 3-year survival percentage in permanent teeth was 88%, which is comparable to the 85% survival of one-surface amalgam restorations placed under the same field conditions after 3 years. The outcomes depend to some extent on the material used, operator experience and presence of caries. The presence of caries as a reason for failure was higher in the early than in the most recent studies. Only one study has reported on the use of ART restorations in the deciduous dentition. It is concluded that: a very large proportion of dentine lesions in the permanent teeth can be treated using the ART approach; the 3-year survival rate of the more recently placed one-surface ART restorations in permanent teeth was higher than that of ART restorations placed in the beginning; the survival of one-surface ART restorations in the permanent dentition with newer glass ionomers is comparable to that of one-surface conventional restorations placed using amalgam in a comparable setting after 3 years; more studies of longer duration are needed to confirm these findings; ART should be considered a caries treatment modality that benefits people; and educational courses need to be organised before the approach is applied in the clinic.

Painting the future for ART.

The objective of this paper is to review recent research and developments with respect to the atraumatic restorative treatment (ART) approach and to outline future areas of research and development. Areas identified as requiring further investigation include the evaluation of: ART restorations for longer than 3 years duration using recognised evaluation criteria, multi-surface ART restorations, ART restorations in primary teeth and ART sealants. In addition, the possibility and potential dangers of caries remaining after cavity cleaning with hand instruments must be investigated and the findings balanced against the known damage to sound tooth tissue caused by more routine cavity preparation techniques. New bioactive restorative materials which offer the possibility of healing dentinal caries lesions should be developed and evaluated. Finally, behavioural and educational aspects of the ART approach should be investigated.

ART restorations and sealants placed in Chinese school children--results after three years.

OBJECTIVES: These were to assess whether ART restorations and sealants could be provided to children in a school environment in China, to assess patient acceptability of the ART approach, and to evaluate on a longitudinal basis the treatments performed. METHODS: This study was conducted in Deyang, Sichuan Province, in western China. A total of 294 ART restorations were placed in 197 children and 191 fissure sealants were placed in 140 children by five middle-level dentists in four secondary schools. Standard instruments and procedures for ART were used. The restorative material used was a high-strength glass-ionomer (Ketac-Molar, ESPE). The treatments were evaluated annually after placement by the same examiner who had not been involved in the placement of the restorations nor sealants using explorers and mouth-mirrors. At the 3-year examination an independent external examiner evaluated the restorations using USPHS criteria. RESULTS: Most of the children did not report discomfort during treatment and 92% were willing to receive ART restorations again. The cumulative 1-year and 3-year survival rates of small Class I restorations were 99% and 92% respectively. The corresponding figures for large Class I restorations were 90% and 77%. After 3 years, 72% of the sealants were either partially or completely retained. Only 2% of the sealed teeth developed fissure caries and these involved teeth where the sealants had been lost. Similar success rates were found using USPHS criteria. CONCLUSIONS: The ART approach for preventing and treating tooth decay in Chinese school children was shown to be appropriate, effective and acceptable. The 3-year survival rates of the restorations were high but were related to the size and type of the restoration.

Periodontal conditions among the middle-aged and the elderly in Hong Kong.

The aim of this study was to describe the periodontal conditions in 372 35-44-yr-old and 537 noninstitutionalized 65-74-yr-old Hong Kong Chinese who were examined clinically for loss of attachment, recession, probing depth, calculus, and bleeding after probing. Community Periodontal Index (CPI) data and treatment need indications were compiled from index teeth or their substitutes. The prevalence of loss of attachment varied considerably in both cohorts according to the definition of the threshold (> or = 6, > or = 9, and > or = 12 mm, respectively). The mean numbers of teeth with loss of attachment at the > or = 6-mm threshold and at higher thresholds were small. In both age cohorts, about one-fifth of subjects had probing depths > or = 6-mm, while at the > or = 9-mm threshold only 2-3% were so affected. Although recession was an important component of loss of attachment in the younger cohort, in the older cohort the prevalence and extent of recession were greater than for probing depths at thresholds > or = 4 mm. All subjects had one or more teeth with calculus, bleeding, or both, most teeth being so affected. Eighty-four of the 537 65-74-yr-old subjects were excluded either because of edentulousness or because extractions indicated for the remaining teeth would have rendered the subjects edentulous. The distribution of subjects according to their highest CPI score was remarkably similar for the two cohorts. No subjects in either age group were assessed as "healthy" (CPI code 0) or had "bleeding only" (code 1) as their highest score. While most subjects scored CPI code 2 or 3 as their highest score, only 17% of the younger and 15% of the older cohort scored Community Periodontal Index of Treatment Needs (CPITN) code 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Oral mucosal lesions in 65-74-year-old Hong Kong Chinese.

There have been no reported surveys of oral mucosal lesions among the elderly in Asian countries. Therefore, the purpose of this study was to determine the prevalence of oral mucosal lesions among 65-74-yr-old, community-dwelling elderly Chinese in Hong Kong and to determine the prevalence of lesions in denture wearers, tobacco smokers, and alcohol drinkers. A total of 537 noninstitutionalized 65-74-yr-olds were interviewed and clinically examined in an oral health survey conducted in 1991. In the survey, the elderly underwent a systematic examination of their oral mucosa by one of the three examiners with the aid of an overhead light. The examiners were trained and calibrated before and during the survey, and a specially prepared colour atlas of oral mucosal lesions was used for lesion recognition. No mucosal lesions were detected in 64% of the elderly. In the 193 elderly subjects with lesions, 80% exhibited only one lesion. There was no difference in prevalence between men and women. The more common lesions, each being found in 5-7% of the elderly, were lingual varicosities, frictional keratosis on the buccal mucosa, denture stomatitis on the palatal mucosa, and denture-induced hyperplasia in the maxillary and mandibular buccal sulcus. Denture wearers had a higher prevalence of lesions (40%) than nonwearers (32%). There was no difference in the prevalence or number of oral mucosal lesions between those defined as users of tobacco and alcohol and those defined as nonusers in this study. No confirmed oral malignancies were found.

Oral health care needs among the middle-aged and the elderly in Hong Kong.

A sample of 372 35-44-yr-olds and 537 noninstitutionalized 65-74-yr-olds were clinically examined in an oral health survey of Hong Kong Chinese conducted in 1991. The examination procedures and diagnostic criteria for assessing restorative and extraction treatment need followed those recommended by the World Health Organization. The Community Periodontal Index-based periodontal treatment needs involving index teeth or their replacements were computed from separate clinic scores for maximum probing depth, presence of calculus, and bleeding after probing. A set of criteria for assessing prosthodontic treatment need was specially laid down for this survey. Examiners were calibrated before the survey, and the interexaminer reliability was found to be generally good. Besides reporting the various individual normative treatment need items in the traditional way, the present analysis used some holistic treatment-need categories which may have manpower-requirement implications for the classification of subjects. All dentate subjects surveyed required some treatment. Only 6% of the elderly, all edentulous, required denture work only. Of the 35-44-yr-olds, 42% needed scaling and oral hygiene instruction only, which could be provided by dental hygienists. The treatment needs of the vast majority of the middle-aged and the elderly (mainly scaling; simple fillings; and extractions, dentures, or both) could be easily handled by general dentists. Only about one-fifth of the subjects in both age groups required some complex care such as endodontics, crowns, and advanced periodontal treatment, which could be delivered by senior dentists or dentists with specialist training.