Prevalence of occlusal traits and orthodontic treatment need in 14 year-old adolescents in Northeast Italy.

AIM: Studies on prevalence of malocclusion support the planning and provision of public dental services. The aim of the study was to assess the prevalence of malocclusion and occlusal traits in adolescents aged 14 years from public secondary schools in the area of Health District n.15 - Veneto region, Italy. STUDY DESIGN: Cross-sectional survey. METHODS: Out of a randomly selected sample of 1187 subjects, 444 adolescents (55% males, 45% females) were evaluated in the school settings according to the criteria adopted by Brunelle et al. [1996]. Alginate impressions were then taken for 380 students together with a wax bite. The occlusal traits of the cast were analysed and IOTN was established. RESULTS: The most common occlusal traits measured on casts were overjet >3 mm (48%), overbite >3 mm (39%), midline misalignment (32%), crowding (30%), 99% of the sample showed at least one occlusal trait. Class I molar relationship prevailed (75.5%) and the prevalence of molar asymmetries was 21.9%. The prevalence of anterior and posterior crossbite and open bite was significantly higher in females, while the mean values of overjet and overbite were higher in males. The distribution of IOTN in the study population showed that only 49.5% had no or little need of treatment, and more than one third (35.8%) were assigned a 4 or 5 score. STATISTICS: Descriptive statistics are expressed as a percentage (± confidence interval) or mean ± standard deviation, according to the nature of the variable. CONCLUSIONS: These outcomes indicate a high prevalence of the aforementioned occlusal traits and also a high need for orthodontic treatment among adolescents in Northeast Italy.

Prevalence of cross-bite in a sample of Italian preschoolers.

AIM: To clinically evaluate the prevalence of cross-bite in a sample of 1960 children in our Local Health Unit n. 15 Alta Padovana (Veneto region, Northeast Italy). METHODS: Study design: A cross-sectional study was carried out in the area of Health District n. 15, Veneto region, including 7,364 children from 3 to 5 years, attending a total of 88 nursery schools A convenience sample of 27 nursery schools (30% of total) was randomly selected, for a total of 2,603 eligible children; of these, 1960 children formed our study base (76%). The day of examination 566 children were absent and 77 did not meet the inclusion criteria by age (less than 3 or more than 5 years old). Anterior cross-bite was considered when one or more primary or permanent mandibular incisors occluded labially to their antagonists. Posterior cross-bite (uni- or bilateral) was considered when the buccal cusps of one or more maxillary teeth was lingual to the buccal cusps of the mandibular teeth of the primary dentition. In this definition, edge to edge occlusion is not regarded as cross-bite. The examination was carried out by two calibrated dentists with children sitting on a dental chair with good operative lighting. The data were recorded in a special clinical chart. RESULTS: The prevalence of cross-bite was 3.7%. We observed a slight prevalence of cross-bite in females, but with no overall statistical significance. CONCLUSION: The prevalence of cross-bite in this area was low compared with European and American data.

The Italian perspective on fluoride intake in children and adolescents.

AIM: This paper represents the outcome of the meetings of the Committee composed by Pedodontists (SIOI - Italian Society of Paediatric Dentistry) and Paediatricians (FIMP - Italian Association of Paediatricians) with the aim to share an evidence- based common approach in caries prevention during childhood and adolescence. The most important topic was an update on fluoride administration methods in order to minimise the risk of fluorosis and maximise its caries-preventive effect. CONCLUSION: The conclusions of this work are exposed in a synoptic table.

Public community orthodontics in Italy. Description of an experience.

AIM: To assess the reliability and simplicity of a method chosen for selecting subjects to be treated in the orthodontic system and for the acceptance of the method by the community. MATERIALS AND METHODS: 490 orthodontic patients received full dental examination. For each patient a table was prepared for the detection of malocclusion in which the occlusal characteristics according to the Norwegian Orthodontic Treatment Index (NOTI), the molar class and the teeth present were recorded. The parents of the examined children completed a questionnaire aimed at identifying their social ranking. In the same questionnaire, how many siblings the patient had was also asked. Each of the three parameters were rated alphanumerically and a score of 1 was given to each child; the sum of three scores gave the final result for the subject. Acceptance of the procedure in the general community was evaluated by the number of complaints received by the Public Relations Office (URP). RESULTS: The social classes most represented in the sample are "blue collar class" (42.2%) and "white collar class" (35.6%). There was an average of 2.1 children per family (SD=0.6). The distribution of the type and grading of the treatment need was similar throughout the different social classes. CONCLUSION: The chosen method proved reliable for two reasons: no complaints with the local URP and ease of application of the selected criteria.

A rare case of unerupted second deciduous molar located inferior to the second premolar: case report.

AIM: Tooth eruption is defined as the movement of a tooth from its site of development within the alveolar process to its functional position in the oral cavity [Massler et al., 1941]. The process of tooth eruption can be divided into different phases: pre-eruptive bone stage, alveolar bone stage, mucosal stage, preocclusal stage, occlusal stage and maturation stage [Andreasen et al., 1997]. Any disturbance in these phases can lead to eruptive anomalies. The incidence of unerupted teeth is usually higher among permanent teeth than among deciduous ones [Walker et al., 2004; Otsuka et al., 2001; Amir et al., 1982; Broadway, 1976; Pinborg et al., 1970]. Of the primary teeth reported as unerupted, second primary molars are the teeth most frequently involved [Walker et al., 2004; Otsuka et al., 2001; Bianchi et al., 1991; Ranta et al., 1988; Tsukamoto et al., 1986; Amir et al., 1982], followed by primary central incisors [Otsuka et al., 2001]. CASE REPORT: This paper presents a case of inversion of the intraosseous position of a second unerupted deciduous molar and the succedaneous second premolar.

Caries experience in 14-year-olds from Northeast Italy. Is socioeconomic-status (SES) still a risk factor?

AIM: Prevalence and severity of dental caries in 14-year-olds of Northeast Italy were estimated, evaluating the dependence to SES. MATERIALS AND METHODS: An epidemiological survey was performed among a randomised cluster sample of 560 (290 M and 270 F) 14-year-olds attending secondary schools, to evaluate DMFS following WHO indications. Association between caries occurrence and SES was evaluated in a logistic regression model. To account for high proportion of zero scores (DMFS and DS distribution highly positively skewed) data was moreover modelled with negative binomial regression and zero-inflated models. RESULTS: Caries prevalence was 63.4% with a mean DMFS of 3.0 ± 3.8. A significant trend between means was observed regarding DS in the different SES levels: z = 2.22 p = 0.03 (occupational level) and z = 3.45 p<0.01 when SES was based on educational level. The Negative Binomial Regression model resulted more appropriate than the Poisson model because the dispersion parameter was significantly different from zero (alpha=1.5, 95% CI=1.3-1.8). Working class status showed significant association with DMFS (p=0.04) while using DS as dependent variable, working class subjects and subjects with medium-low and low educational level, showed a statistically significant association. CONCLUSION: Socioeconomic status is still a predictor for dental decay in the Italian 14-year-olds.

Social differences in tooth decay occurrence in a sample of children aged 3 to 5 in north-east Italy.

OBJECTIVE: To correlate the occurrence of tooth decay with a social class indicator (occupational level) and the immigrant status in a sample of pre-school children in Veneto region. BASIC RESEARCH DESIGN: Cross-sectional survey. CLINICAL SETTING: Twenty nursery schools in the area of Health District n.15. PARTICIPANTS: A total of 1,410 children aged 3 to 5 years old visited between September 2005-May 2006. OUTCOMES: Occurrence of dental caries into dentine threshold was made visually and confirmed with a probe when necessary by two calibrated examiners. Information on immigrant status and occupational level of parents was obtained by a questionnaire. Children were categorized as immigrant or non-immigrant on the basis of their mother's country of origin. Means and standard deviation were calculated for continuous variables; for categorical variables the results were provided as proportions. Comparisons between groups were made using Pearson chi-square test. The association between caries occurrence and the independent variables gender, age, immigrant status and family social class was evaluated by means of a logistic regression model. RESULTS: Caries occurrence was higher among children from lower social class families (1.7 +/- 3.2) than among children from higher social class (0.8 +/- 2.1). The prevalence of dental caries in immigrant preschool children was significantly higher than in indigenous ones (15% vs 40%; p = 0.000) while the severity in immigrants was almost 4 times higher (2.2 +/- 3.6 vs 0.6 +/- 1.8). CONCLUSIONS: Our data on preschoolers confirm the worldwide literature shared statement that social class as well as immigration status are determinants of oral health.

Caries prevalence and tooth surface distribution in a group of 5-year-old Italian children.

AIM: This was to investigate caries experience and patterns in a sample of 5-year-old children attending nursery schools in the Veneto Region (Italy). STUDY DESIGN: Cross sectional study. METHODS: The study was carried out between September 2005 and May 2006 with 348 randomly selected 5-year-old children. Two calibrated dentists using an artificial light, a plane dental mirror and a dental probe performed clinical dental examination. World Health Organisation (WHO) diagnostic criteria for dental caries: dmft, dmfs and SiC indexes were used to measure the severity of the disease. STATISTICS: dmfs scores were analysed either as a continuous continuous (calculating means and standard deviations) or as a categorical variable (providing proportions). Pearson's chi square test for comparison between groups and Wilcoxon signed-rank test for distribution of dmfs scores between pairs of contiguous molars were used. RESULTS: The most commonly affected teeth were primary molars, (78% of the overall sample), especially in the mandible. The surfaces of molars most often affected were the occlusal (52%). Proximal surfaces were affected more in first than in second primary molars. Dental caries occurred most often in the maxilla. The frequency of caries in anterior teeth was low (12%). CONCLUSIONS: Caries experience in the primary dentition showed a symmetrical distribution localized on primary molars, most often in their occlusal surface. Caries in anterior teeth was uncommon.

Oral health problems and needs in nursing home residents in Northern Italy.

OBJECTIVE: To describe the oral health status and treatment needs of a sample of elderly people residing in nursing homes in Northern Italy. RESEARCH DESIGN: a sample of 595 elderly residents (mean age 83.2+/-9.2 yrs), with adequate cognitive skills were examined by six calibrated dentists. RESULTS: The sample (82% women) was divided into two groups: edentulous (43%) and dentate. In the edentulous group 58% wore dentures in both jaws, 8% in only one jaw and 34% had no dentures. The main problems were dirty or loose dentures and poor oral hygiene. In the dentate group the mean number of teeth was 8.4+/-7.4, 53% wore dentures (removable, fixed or a combination). Poor oral hygiene was found in 86%, root caries in 51% and coronal caries in 46%. Their main needs were professional cleaning (72%), oral hygiene instructions (62%) and tooth/root extractions (56%). While normative needs were noted for 82% of the whole sample, oral treatment needs were accurately perceived by only 20% of residents, poorly by 24%, while 46% indicated that they had no oral treatment needs.

Prevalence and severity of dental caries in 5- and 12-year old children in the Veneto Region (Italy).

OBJECTIVES: To evaluate the occurrence of dental caries among 5- and 12-year-old children in Northeastern Italy and to compare dental status between immigrants and native-born children. BASIC RESEARCH DESIGN AND PARTICIPANTS: A cross-sectional survey of 260 5-year-olds and 862 12-year-olds was carried out between October 2003 and May 2004. Dental caries were diagnosed at the caries into dentine (D3) threshold. Differences in dental health status were compared between immigrant and native-born children for both age groups. RESULTS: Among 5-year-old children, mean dmft was 1.45 (SD=2.69), SiC=4.31, 65.8% had no caries. Immigrant 5-year-olds (6.2%) scored more poorly than their Italian counterparts: mean dmft was 5.12 (vs. 1.21; p<0.001) and only 25.0% were caries free (vs. 68.4%; p<0.001). Among 12-year-olds, mean DMFT was 1.44 (SD=2.00), SiC=3.88, 55.1% had DMFT=0: 5.6% also had poorer dental status: mean DMFT was 3.23 (vs. 1.33; p<0.001), SiC=6.69 (vs. 3.66), and only 17.1% had DMFT 0 (vs. 56.8%). CONCLUSIONS: The prevalence of dental caries and care obtained for both age groups are similar to those of other industrialised countries. When our results for 12-year-olds were compared with those of two previous surveys (1984 and 1994), a major decline in the prevalence of dental caries was observed. Being immigrant was a strong determinant in caries occurrence.

Oral health inequalities in preschool children in North-Eastern Italy as reflected by caries prevalence.

AIM: To investigate dental caries experience among preschool children aged 3-5 years living in 2 Health Districts in North- Eastern Italy and to compare caries experience between indigenous and immigrant children. STUDY DESIGN: Cross-sectional observational survey. METHODS AND STATISTICS: In this study 4,198, 3-5-year-old children, drawn from a total population of 9,829 were asked to participate. The examinations were performed at school between October 2004 and June 2005 and only lesions that penetrate the dentine were recorded (according to the BASCD criteria, 1997), by 2 calibrated examiners using artificial light, mouth mirrors and dental probes. The participants were categorised into 2 subgroups according to the country of origin of their mothers: indigenous mothers, almost all born in Italy, plus a very small number of mothers born in other highly developed western countries--"western origin"--(Nordic countries, Western Europe, North America, New Zealand and Australia), and immigrant mothers from Eastern Europe, Asia, Africa, Turkey, South and Central America, "non-western origin". Comparisons between groups were made using Pearson chi-squared test. Caries risk estimation was established by logistic regression analysis to assess the influence of gender, age and ethnicity on caries experience. Risk was summarised as odds ratio plus 95% CI. RESULTS: A total of 3,401 pre-school children were examined. The overall prevalence of dentinal caries was: 15.4% in 3-year-olds, 24.2% in 4-year-olds and 31.1% in 5-year-olds. At the same ages, children of immigrant mothers ("non-western origin") showed a significantly higher prevalence of caries compared with their counterparts of "western origin". As expected, older children had more caries. "Non-western origin" had a negative effect on caries experience. CONCLUSIONS: Inequalities associated with mothers with an immigrant background were observed in the distribution of caries experience among the children. These children represent the first generation settling in and growing up in Italy, and their dental status-related data are comparable to those observed at the same ages in first generation "non-western" children living in other industrialised countries.

Preschoolers' dental caries experience and its trend over 20 years in a North-East Italian Health District.

AIM: To describe dental caries occurrence among preschool children in a Health District in the North-East of Italy by age, gender and immigrant background; 2) to plot a trend of primary dentition dental caries over a 20 year time span. STUDY DESIGN: Observational cross-sectional survey. METHODS: 41 out of 88 kindergartens were randomly selected, originating a sample of 3470 preschoolers out of 7,061 overall school attenders. Dentinal caries occurrence was evaluated by 2 calibrated examiners at school on 2,524 3-5-year-olds from October 2004 to June 2005. The participants were divided into 2 subgroups depending on the country of origin of their mothers: non-western (IG or immigrant group) and western (WG). Two previous surveys performed in the same area were used to plot a trend over a 20 year period. STATISTICS: Comparisons between groups were made using the Pearson chi-squared test and caries risk estimation was established by logistic regression analysis to assess the influence of sex, age and ethnicity (independent variables) on caries experience (dependent variable). Risk was summarised as odds ratio plus 95% CI. RESULTS: Prevalence (%) and severity (mean dmft +/- SD) increased by age (15% - 0.6 +/- 1.9 at 3 years of age; 25% - 1.1 +/- 2.6 at 4; 32% - 1.3 +/- 2.7 at 5) and were significantly different (p<0.01) between the two groups: 23% (WG) vs 54% (IG) and 0.9 +/- 2.2. (WG) vs 3.4 +/- 4.3. The level of untreated caries was high: 88.9% in WG vs 97.1% in IG. From 1984 to 2004 prevalence and severity of dental caries declined at all examined ages. CONCLUSION: The current dental scores in preschoolers are low and similar to those reported in other Western European countries. These good scores have been achieved through a strong decline occurred over the last two decades. As regards the Italian recent social phenomenon of immigration, nowadays being an immigrant child is a strong determinant of dental caries.

Dental caries experience in preschool children in Veneto region (Italy).

OBJECTIVES: The aim of this study was to assess the dental caries experience in deciduous dentition among preschool children attending nursery-schools in the area of Ulss n.15 of Veneto Region (Italy). BASIC RESEARCH DESIGN AND PARTICIPANTS: A cross sectional survey in maternal schools in an area of North-East of Italy was carried out between October 2002 to May 2003 enrolling 1,006 2-6 year-old children randomly selected. WHO diagnostic criteria for dental caries were adopted; dmft and SiC indices were used to measure the severity of the disease. In this paper the "umbrella" term ECC to define caries in primary dentition prior to eruption of permanent teeth (Horowitz, 1998) was used as well. RESULTS: ECC prevalence and mean dmft by age were: 3 years: 13.28% and 0.53 (SD +/- 1.83); 4 years: 18.95 % and 0.83 (SD +/- 2.24) ; 5 years: 26.9% and 1.34 ( SD +/- 2.8). SIC index values were 1.6 at 3 years, 2.4 at 4 years and 4 at 5 years. CONCLUSIONS: The prevalence of dental caries increased with age: the mean dmft increased 2 1/2 times (0.53 to 1.34) and the percentage of children affected by caries doubled (13.28% to 26.9%) between ages 3 and 5 years. Comparing the data for 4 year-old children with those of two surveys carried out in the same area in the last two decades, it is concluded that as in the other industrialised countries, dental caries in preschool children of this area of North-East of Italy has declined.

Comparison of data on Early Childhood Caries (ECC) with previous data for Baby Bottle Tooth Decay (BBTD) in an Italian kindergarten population.

AIM: This was to assess the prevalence of Early Childhood Caries (ECC) among preschool children attending nursery schools and to compare the results with those of a previous survey where the investigators used the term and diagnosis for Baby Bottle Tooth Decay (BBTD) syndrome. METHODS: A cross-sectional survey of 1006 children aged 1-6 years was carried out. WHO recommendations for oral health surveys were used for caries diagnosis (non cavitated lesions were excluded). In addition, a comparison was made for prevalence of ECC between immigrant and native born children. Data were compared for ECC in the present survey with BBTD data in a previous study (1994) in the same area with a sample of 401 children aged 4 years. All examinations were by one examiner (Cohen's Kappa=0.96). RESULTS: Of the 1006 children originally selected 52 children aged more than 71 months were excluded according to published ECC definition and diagnostic criteria. The overall sample was 29 children aged <36 months; 271 aged 3 years; 364 aged 4 years and 290 aged 5 years. ECC was diagnosed in 19.7% of the overall sample. The prevalence of ECC (and S-ECC) were respectively by age: <36 months S-ECC=17.2%; at 3 years: 13.28% (6.64%); at 4 years: 18.95% (9.34%); at 5 years: 26.9% (12.75%). In the native born children (916) the ECC was 18.34%, while in immigrants (38) it was 52.63% (p<0.001). In 1994 the prevalence of BBTD syndrome was 11.9% and in the present study 6.5%. CONCLUSION: The ECC prevalence, as, ECC and severe (S-ECC),increased with age. In immigrant children ECC was 3 times (S-ECC 6 times) more frequent than in native born. Using the BBTD diagnosis the prevalence had dropped from 11.9% in 1994 to 6.5% in the present survey.