A Colorimetric Interdental Probe as a Standard Method to Evaluate Interdental Efficiency of Interdental Brush.

The aim of this study is to evaluate the concordance between the empirical choice of interdental brushes of different diameters compared to the gold standard, the IAP CURAPROX(©) calibrating colorimetric probe. It is carried out with the aim of facilitating the consensus development of best practices. All the subjects' interproximal spaces were evaluated using the reference technique (colorimetric probe), then after a time lapse of 1.2 ± 0.2 hours, using the empirical clinical technique (brushes) by the same examiner. Each examiner explored 3 subjects. The order the patients were examined with the colorimetric interdental probe (CIP) was random. 446 sites were selected in the study out of 468 potential sites. The correspondence of scores between interdental bushes vs. colorimetric probe is 43.0% [95%-CI: 38.5-47.6]. In 33.41% of the 446 sites, the brush is inferior to the probe; in 23.54% of cases, the brush is superior to the probe. Among the discrepancies there is thus a tendency for the subjects to use brushes with smaller diameter than that recommended by the colorimetric probe. This review has found very high-quality evidence that colorimetric probes plus interdental brushing is more beneficial than interdental brushing alone for increase the concordance between the empirical choice of interdental brushes of different diameters compared to the gold standard. Uncertainties remain and further research is required to provide detailed data on user satisfaction.

Association of the oral health impact profile with malnutrition risk in Spanish elders.

The objective of this study was to determine any relationship between oral health-related quality of life (OHR-QoL) and malnutrition risk in the elderly using the oral health impact profile (OHIP). We studied 250 institutionalized elderly people, 162 females and 88 males, with and without teeth. Data were gathered on: general health; oral health; malnutrition risk, measured with the Mini Nutritional Assessment (MNA); and OHR-QoL, evaluated with the OHIP. A multivariate binary logistic regression model was constructed with malnutrition presence/risk as dependent variable. Mean age was 82.7 ± 8.2 years. Malnutrition or malnutrition risk was shown by 36.8% of the sample. OHIP was associated with malnutrition/risk after adjustment for age, sex, functional status, and mild dementia diagnosis. Malnutrition/risk was 3.43-fold more likely in participants with OHIP-reported "problems" than in those with none. The conclusion of the study was that OHIP-measured OHR-QoL is associated with malnutrition risk.

Strategies to promote better access to over the counter products for oral health in Europe: a Delphi survey.

OBJECTIVES: 'Over The Counter' (OTC) is a pharmaceutical product or medicine whose distribution or the administration does not require medical authorisation, and which can be used by consumers on their own initiative. This can be to prevent, relieve or treat symptoms or moderate pathologies and whose use, under the forms, packaging and authorised formulation are safe for the consumer. A Delphi consultation in the perspective of coming to a consensus was initiated to identify the current and future orientations on the best strategies of administration of OTC products for oral health in Europe. METHODS: A Delphi Survey was conducted with 54 experts from 23 countries in Europe. Each indicator statement was considered to be in consensus if the expert's opinion rating was of 4 or 5 for more than 75% in a scale of seven categories. The first questionnaire concerned self medication and the situation of OTC prescriptions in 2006. The second included 19 statements focused on the possible role of OTC products in dental practice. Both qualitative and quantitative analyses were created. RESULTS: There was a strong consensus that the population's common practices towards OTCs should be modified. Practitioners should possess communication qualities allowing them to share their power and to advise patients of their decision-making concerning oral care. CONCLUSIONS: The Delphi Survey was successful in underlining that dentists have to be involved in oral health OTC prescription which, currently, seems unsatisfactory. OTC products and especially fluoride toothpaste improve oral health but have to be available, accessible and used advisedly.

Report of the EGOHID I Project. Selecting a coherent set of indicators for monitoring and evaluating oral health in Europe: criteria, methods and results from the EGOHID I project.

OBJECTIVES: The EGOHID I (European Global Oral Health Indicators Development) project started in 2002 under the European Health Monitoring Programme. The aim was to develop a set of indicators for monitoring and describing oral health morbidity and different facets of oral health care systems in Europe. The challenge was to define valid indicators that would cover common concerns and would have the same meaning throughout the different European health care systems. METHODS: EGOHID included i) a review of existing recommendations on oral health indicators, ii) a European study of the availability of national/or regional statistics to construct recommended indicators; iii) a consensus process using aggregation of preferences methods to select a list of essential indicators; iv) the production of a catalogue for information users, including descriptions for all indicators. RESULTS: A set of 40 indicators in oral public health were identified which, even though restricted to a minimal essential list, still addressed four key dimensions. The 40 indicators were described in four categories. Part A. indicators for monitoring the oral health of children and adolescents; Part B. indicators for monitoring the oral health of general population; Part C. indicators for monitoring oral health systems and Part D. indicators for monitoring oral health quality of life. This work has enabled a feasibility study (EGOHID II, which is now in progress), which is an essential part of an overall project, since it will allow Member States to evaluate their capability to use these indicators. CONCLUSIONS: The EGOHID 1 project was successful in identifying a set of 40 indicators which drew on and consolidated previous work. Consensus was achieved from a wide group of stakeholders on precise indicators in areas where uncertainty about appropriate indicators was high; some areas were also targeted for future development.

Sealant and fluoride varnish in caries: a randomized trial.

Little is known about the effect of discontinuation of sealant or fluoride varnish. The purpose of this study was to compare sealant with fluoride varnish in the prevention of occlusal caries in permanent first molars of children over a nine-year period: 4 yrs for program evaluation plus 5 yrs of discontinuation. A clinical trial was conducted on three groups of six- to eight-year-old schoolchildren: a control group (n = 45); a group (n = 37) in which sealant was applied and reapplied up to 36 mos; and a group (n = 38) in which fluoride varnish was applied and re-applied up to 42 mos. Percent caries reduction was studied in these initially healthy molars with complete occlusal eruption: 129 (control), 113 (sealant), and 129 (varnish) molars met inclusion criteria. Of these, 76.7%, 26.6%, and 55.8% had developed occlusal caries at 9 yrs, which implies caries reductions of 65.4% (SE = 8.5%) for sealants vs. control and 27.3% (SE = 10.2%) for varnish vs. control. Furthermore, the varnish program was not effective during the discontinuation period.

Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial.

We hypothesized that the six-monthly application of silver diamine fluoride (SDF) can arrest the development of caries in the deciduous dentition of six-year-old schoolchildren and prevent caries in their first permanent molars. A prospective controlled clinical trial was conducted on the efficacy of a 38% SDF solution for caries reduction. Four hundred and twenty-five six-year-old children were divided into two groups: One group received SDF solution in primary canines and molars and first permanent molars every 6 mos for 36 mos. The second group served as controls. The 36-month follow-up was completed by 373 children. The mean number of new decayed surfaces appearing in primary teeth during the study was 0.29 in the SDF group vs. 1.43 in controls. The mean of new decayed surfaces in first permanent molars was 0.37 in the SDF group vs. 1.06 in controls. The SDF solution was found to be effective for caries reduction in primary teeth and first permanent molars in schoolchildren.

Mutans streptococci and lactobacilli in saliva after the application of fissure sealants.

Because dental fissures may serve as reservoirs for mutans streptococci, preventive measures should be taken to control microbial concentrations at these sites. This study estimated the influence that sealing permanent first molars would have on the levels of mutans streptococci and lactobacilli in saliva of healthy seven-year-old schoolchildren. Permanent first molars were sealed in 31 children without caries (NC group) and in 32 children with caries (C group). None of the children had caries in their permanent first molars. Conventional methods were used to count mutans streptococci and lactobacilli in saliva before applying the sealant and again at 4 and 12 weeks after application. Baseline counts of lactobacilli and mutans streptococci were significantly higher in the C group. A significant reduction in mutans streptococci was observed in the NC group at 4 and 12 weeks. It was concluded that fissure sealants in permanent first molars can help reduce salivary levels of mutans streptococci in children without caries.

A 24-month study comparing sealant and fluoride varnish in caries reduction on different permanent first molar surfaces.

OBJECTIVE: The aim of this study was to determine the separate effects of dental sealants and fluoride varnish on dental caries in fissured and nonfissured surfaces of permanent first molars. METHODS: A clinical trial was conducted with three groups of 6- to 8-year-old schoolchildren: a sealant group (n = 100), in which Delton was applied to first molars; a varnish group (n = 98), in which Duraphat was applied to first molars; and a control group (n = 116), which had no intervention as part of the study. Absolute and percent caries reductions were compared at 24 months. RESULTS: Compared to the controls, sealants resulted in a 68 percent and 87 percent reduction on fissured and nonfissured surfaces, respectively. The corresponding figures for varnish were 38 percent and 66 percent. CONCLUSION: Sealant and fluoride varnish are effective in preventing caries in both fissured and nonfissured surface.

A 48-month survival analysis comparing sealant (Delton) with fluoride varnish (Duraphat) in 6- to 8-year-old children.

The objective of this study was to compare Delton visible-light fissure sealant with Duraphat fluoride varnish in the prevention of occlusal caries in permanent first molars. A 48-month clinical trial was carried out in three groups of 6- to 8-year-old schoolchildren: a sealant group (104 children), in which Delton was used; a varnish group (112 children), in which Duraphat was used; and a control group (128 children). Sealant or varnish was applied to all sound permanent first molars, according to group. Replacement (sealant) and reapplication (varnish) was carried out every 6 months. A survival analysis was used to describe the molar failures over time in the three groups. A Cox proportional hazards regression model was built to test the influence of group on molar failure. The median survival times were 28.6 months for the control molars and more than 48 months for both sealed and varnished molars. The Cox model indicated a hazard ratio of 0.177 for the sealant vs control comparison, 0.463 for varnish vs control and 0.382 for sealant vs varnish.

Effectiveness of visible light fissure sealant (Delton) versus fluoride varnish (Duraphat): 24-month clinical trial.

The present study compares visible-light Delton with Duraphat fluoride varnish for the prevention of occlusal caries in permanent first molars. A clinical trial was carried out in three groups of 6-8-yr-old schoolchildren: a sealant group (100 children), in which Delton light-polymerized fissure sealant was applied to permanent first molars; a varnish group (98 children), in which Duraphat was applied to permanent first molars; and a control group (116 children). Replacement (sealant) and reapplication (varnish) was carried out every 6 months. Percent effectiveness at 24 months (percentage of saving from caries taking molars as analysis unit) for those molars initially healthy and with complete occlusal eruption was analyzed. 272, 252 and 238 molars met the inclusion criteria in the control, varnish and sealant groups, respectively. Of these, 45.2%, 28.2% and 10.5% developed caries after 24 months. The effectiveness was greater in the sealed molars than in the varnished molars (62.7%).

The influence of dft index on sealant success: a 48-month survival analysis.

Early loss of pit and fissure sealants is considered to be primarily dependent on inadequate isolation of the tooth from salivary contamination during application. Gradual additional loss is considered to be caused by occlusal wear, shearing forces, and marginal failure. Our hypothesis is that the caries risk of the child may be an additional factor in sealant loss. The objective of this study was to analyze the influence of caries history in primary teeth (dft index) on the success of sealants. Delton light-polymerized sealant was applied in 104 six- to eight-year-old children, followed for four years on a six-month-visit basis. All sound permanent first molars were sealed during the study. A survival analysis was used to describe sealant success over time. A Cox proportional hazards regression model was built to test the influence on sealant success of the dft index and site of sealant application (mandibular occlusal surface, maxillary fossae, and maxillary distolingual fissure), controlling for some potential confounders. Sealant half-life was 46 months. Site and dft index were related to sealant survival. The maxillary fossae showed the best retention, followed by the mandibular occlusal site and the maxillary disto-lingual fissure. The higher the dft, the higher the risk of sealant failure. This study has implications for sealant study designs and public sealant programs.

Factors influencing the effectiveness of sealants--a meta-analysis.

Meta-analysis of published studies was applied to analyze the effectiveness of fissure sealants in preventing dental caries. Studies were identified by a MEDLINE search, supplemented by a hand search of the references in the articles recovered. All articles were assessed on the basis of quality, and were combined with the Mantel-Haenszel method. The prevented fraction in the exposed population (PF) was estimated using pooled relative risk. Heterogeneity of the effect and publication bias were also analyzed. Twenty-four studies were included in the meta-analysis. The overall effectiveness of autopolymerized fissure sealants was 71.36% (95% confidence interval 69.69-72.94%). Effectiveness in preventing caries decreased with time, and increased when drinking water was fluoridated (82.69% vs 72.28%). Heterogeneity was significant in most cases, and was further studied with multiple linear regression analysis. It is concluded that autopolymerizing sealants should be used. More research is needed to compare the effectiveness of dental hygienists and dentists in applying sealants.

Phagocytosis and adhesiveness of peripheral blood polymorphonuclear leukocytes in patients with rapidly progressive periodontitis.

Phagocytosis and adhesiveness of peripheral blood polymorphonuclear leukocytes were studied in patients diagnosed with generalized rapidly progressive (form A) periodontitis. All patients belonged to a single family and were first degree relatives. In the patients' leukocytes there was a statistically significant reduction in phagocytic index and adhesiveness, in comparison with leukocytes from controls. However, adhesiveness approached control values in the presence of autologous serum, thus implying that serologic factors may enhance this function in patients with this type of periodontitis.