The potential benefits of sugar-free chewing gum on the oral health and quality of life of older people living in the community: a randomized controlled trial.

OBJECTIVES: To determine the effects of prescribing sugar-free chewing gum on the oral health and quality of life of dentate older people living in the community and attending for routine dental care. METHODS: A randomized controlled trial was conducted on 186 older people who were not regular chewers of gum, (aged 60 years and over with ≥ 6 teeth) recruited from primary care clinics. Participants were randomly allocated to a gum-chewing group (chewing xylitol-containing gum twice a day for 15 min; n = 95) or a control group (no gum; n = 91). Both groups were examined at baseline and at the end of the study (6 months later). The primary outcome measure for the study was increased in stimulated saliva flow rate. Secondary measures included improvements in Plaque and Gingival Indices, and self-perceived change in oral health. RESULTS: The retention rate for the study was 78.5% (n = 146 at follow-up); reported compliance with the protocol was 84% (ranged between 12% and 100%). There was no significant change in the saliva flow of the gum-chewing group (1.20-1.17 ml/min), while the control group experienced an increase in flow rate (1.06-1.32 ml/min; P = 0.001). The gum-chewing group, however, demonstrated significant improvement in Plaque and Gingival Index scores over the control group. For the Plaque Index, the mean scores (±SD) were 0.29 (±0.29) and 0.56 (±0.46) for the gum-chewing group and control groups, respectively (P < 0.001), at the second examination, which remained significant after controlling for age and saliva flow rate. For the Gingival Index, the scores were 0.73 (±0.30) and 0.92 (±0.32), respectively (P < 0.001), which persisted after controlling for age. A significantly higher proportion of participants in the gum-chewing group perceived that their oral health had improved during the study period in comparison with the control group (40% cf 21%; P = 0.016). CONCLUSIONS: Prescription of sugar-free chewing gum to dentate older people living in the community and attending routine dental services was not associated with a significant increase in stimulated saliva flow. There were, however, significant improvements in Plaque and Gingival Index scores, and in self-perceived oral health.

Child oral health concerns amongst parents and primary care givers in a Sure Start local programme.

AIM: To conduct an oral health promotion needs assessment amongst parents and primary care givers of pre-school children in a South East London Sure Start Local Programme (SSLP). OBJECTIVE: To explore the oral health concerns and oral health literacy with regard to children's oral health amongst parents and primary care givers in a South East London SSLP. DESIGN: A qualitative study using four in-depth focus groups with a purposive sample of 20 participants. Data were analysed using the framework method. RESULTS: The SSLP was identified as an important source of information, support and social interaction for participants. Participants rated the informal networks of the programme as equally authoritative as other formal sources of information. Oral health concerns included: introducing healthy eating, establishing tooth brushing, teething and access to dental care. While participants had adequate knowledge of how to prevent oral disease they cited many barriers to acting on their knowledge which included: parents' tiredness, lack of confidence in parenting skills, confusing information, widespread availability of sugary foods and drinks, and lack of local child friendly dentists. Parenting skills and the social support provided by the SSLP appeared to be integral to the introduction of positive oral health behaviours. CONCLUSIONS: SSLPs were seen as a trusted source of support and information for carers of pre-school children. Integration of oral health promotion into SSLPs has the potential to tap into early interventions which tackle the wider support needs of carers of pre-school children while also supporting the development of positive oral health behaviours.

Oral Bifidobacteria: caries-associated bacteria in older adults.

Bifidobacteria are aciduric bacteria that might play a role in the caries process. To test the hypothesis that Bifidobacteria behave as caries-associated organisms, as predicted by the ecological plaque hypothesis, we determined salivary levels of Bifidobacteria and caries-associated organisms for 156 older adults. Salivary levels of Bifidobacteria, mutans streptococci, lactobacilli, and yeasts were correlated with each other (p < 0.001), negatively correlated with salivary flow rate (p < 0.001), and positively correlated with plaque index (p < 0.05). Salivary Bifidobacteria levels were positively associated with the number of filled (p < 0.001) and decayed (p = 0.036) tooth surfaces and negatively associated with number of teeth (p < 0.001) and salivary flow rate (p = 0.049). In regression analyses, caries experience was significantly associated with only salivary Bifidobacteria (p < 0.001) and yeast (p < 0.001) levels and the individual's age (p = 0.021). Bifidobacteria should be regarded as caries-associated organisms whose role in the caries process and as markers of caries risk requires further investigation.

BDA special care case mix model.

Routine dental care provided in special care dentistry is complicated by patient specific factors which increase the time taken and costs of treatment. The BDA have developed and conducted a field trial of a case mix tool to measure this complexity. For each episode of care the case mix tool assesses the following on a four point scale: 'ability to communicate', 'ability to cooperate', 'medical status', 'oral risk factors', 'access to oral care' and 'legal and ethical barriers to care'. The tool is reported to be easy to use and captures sufficient detail to discriminate between types of service and special care dentistry provided. It offers potential as a simple to use and clinically relevant source of performance management and commissioning data. This paper describes the model, demonstrates how it is currently being used, and considers future developments in its use.

The performance of a screening test for urgent dental treatment need in a prison population.

OBJECTIVE: To compare the performance of a questionnaire-based assessment of dental pain delivered by non-dental prison nursing staff against a clinical examination performed by an experienced prison dentist (gold standard). SETTING: The research fieldwork took place in the healthcare department at HMP Brixton located in South London. METHODS: The cohort were those who had complained of dental/facial pain to the prison authorities and were therefore placed on the waiting list for emergency dental care. Subjects were asked to complete the screening test and were then clinically examined by trained and calibrated dentists. The screening test was in the form of a 12-item questionnaire designed to categorise a population reporting dental pain into one of three groups. The screening test results were compared with the diagnosis of a clinical examination. RESULTS: Ninety-six subjects were recruited during the 16-week study period. Of the 96 prisoners recruited, 27 of those failed to complete the screening test and/or the diagnostic examination even though they had reported pain previously. When sensitivity and specificity values were calculated for the 96 prisoners recruited, the sensitivity was fairly high (81%) and the specificity was poor (33%). However, when these values were calculated for the sub-population, those that completed both the screening test and diagnostic examination (n = 69), the sensitivity did not improve particularly (83%) but the specificity value fell substantially to 13%. CONCLUSIONS: This study highlighted the problems of conducting research in the prison environment, for example increased security preventing researchers from gaining access into the prison and general pressures on prison staff. Additionally, the study demonstrated that screening is not effective in local prisons with a high turnover of prisoners.

An investigation of the nature of research into dental health in prisons: a systematic review.

OBJECTIVES: To establish the nature of research into dental health undertaken in prisons. DATA SOURCES: Databases were searched electronically. This process was supplemented by hand searching of references. DATA SELECTION: Two independent reviewers made initial selections and subsequently carried out full text screening. Discrepancies were discussed with a third reviewer and disagreements were resolved by consensus. DATA EXTRACTION: Fifty potentially relevant studies were identified and further screened for inclusion. Of this number, 29 studies were excluded; the remaining 21 were deemed appropriate to include in the review. The primary focus of the papers identified was the oral health status of inmates, assessed by clinical examinations of decayed, missing and filled teeth (DMFT) and periodontal status, and self-report measures of oral health behaviours and service utilisation. Attempts were made to reduce sources of bias by selecting random samples of inmates and standardising measurement techniques, and addressing potential confounding effects. Few studies considered the potential impact of socio-economic status on disease levels. In some studies the oral health of inmate populations was compared to that of non-institutionalised individuals. Studies report high prevalence of oral disease, though precise levels differ according to the composition of the samples. CONCLUSIONS: The heterogeneity of populations studied and methods of assessment precludes simple generalisation, but the consistent trend appears to be that the oral health status of inmates is poor and also poor in comparison with non-institutionalised individuals where appropriate comparisons have been made.

The microflora of the erupting first permanent molar.

The relationship between microflora, eruption status and caries status in the first permanent molar of young children was investigated in 177 children aged 6-7 years. A significantly greater proportion of fully erupted teeth were classified as sound and plaque-free compared to partially erupted teeth. Fully erupted teeth yielded greater numbers and proportions of mutans streptococci compared with significantly greater numbers and proportions of Actinomyces israelii in partially erupted teeth. Logistical regression analysis showed significant associations between white spot lesions in partially erupted teeth and increased numbers of Streptococcus oralis, mutans streptococci and Streptococcus salivarius whereas the presence of Actinomyces naeslundii was associated with health. Significantly greater numbers and proportions of S. oralis and S. salivarius were isolated from partially erupted teeth with white spot lesions whereas Streptococcus mutans was isolated in significantly greater numbers and proportions from fully erupted molars with white spots. This study suggests that organisms other than mutans streptococci are associated with caries development in erupting permanent molar teeth.

Comparison between visual examination and a laser fluorescence system for in vivo diagnosis of occlusal caries.

This study compared a laser fluorescence (LF) system (DIAGNOdent) with a visual caries scoring system for in vivo detection and diagnosis of occlusal caries under the conditions of an epidemiological study, in 132 mandibular and 38 maxillary first permanent molars in 170 children (mean age: 6.85 +/- 0.58 years). The teeth were cleaned and occlusal caries status in a selected investigation site recorded using both visual and LF systems. The LF readings were interpreted both according to the cut-off points recommended by the manufacturers and those based on laboratory research with histological validation. The percentage agreement of the LF and visual scoring system was better using the cut-off limits recommended by the manufacturer. Histological validation was not possible in this clinical study, but it appeared that either the LF method was overscoring some lesions or the visual method was underscoring them. Since the LF instrument cannot be expected to differentiate caries from hypomineralisation, it should probably be used as an adjunct to a clinical examination.

Genotypic heterogeneity of Streptococcus oralis and distinct aciduric subpopulations in human dental plaque.

The genotypic heterogeneity of Streptococcus oralis isolated from the oral cavity was investigated using repetitive extragenic palindromic PCR. Unrelated subjects harbored unique genotypes, with numerous genotypes being isolated from an individual. S. oralis is the predominant aciduric bacterium isolated from noncarious tooth sites. Genotypic comparison of the aciduric populations isolated at pH 5.2 with those isolated from mitis-salivarius agar (MSA) (pH 7.0) indicated that the aciduric populations were genotypically distinct in the majority of subjects (chi(2) = 13.09; P = 0.0031). Neither the aciduric nor the MSA-isolated strains were stable, with no strains isolated at baseline being isolated 4 or 12 weeks later in the majority of subjects. The basis of this instability is unknown but is similar to that reported for Streptococcus mitis. Examination of S. oralis strains isolated from cohabiting couples demonstrated that in three of five couples, genotypically identical strains were isolated from both partners and this was confirmed by using Salmonella enteritidis repetitive element PCR and enterobacterial PCR typing. These data provide further evidence of the physiological and genotypic heterogeneity of non-mutans streptococci. The demonstration of distinct aciduric populations of S. oralis implies that the role of these and other non-mutans streptococci in the caries process requires reevaluation.

Dental attendance patterns and oral hygiene habits of 5-year-old children in Athens and in south London.

This study compared the dental attendance patterns and oral hygiene habits of 5-year-old children in the London boroughs of Lambeth, Lewisham and Southwark with those in the municipality of Athens in the light of differing provision of oral health education. Questionnaires were sent to the parents of 384 children in London and 318 children in Athens who took part in a survey of dental health. Response rates of 51% and 53% respectively were obtained. More children visit the dentist in South London than in Athens, the difference being highly significant. In South London the majority of children visit every 6 months, whereas in Athens they only visit when they have toothache. More London children brush their teeth than Athens children, the difference being significant. Of those brushing in London, most brush twice daily. The above findings indicate marked differences in dental attendance patterns and oral hygiene habits, and this may be partly attributable to differences in the delivery of dental care and oral health education in the two countries.

Dental caries and caries-associated micro-organisms in the saliva and plaque of 3- and 4-year-old Afro-Caribbean and Caucasian children in south London.

Three and four-year-old Caucasian and Afro-Caribbean children (n = 641) attending childcare facilities in the London boroughs of Lambeth, Lewisham and Southwark were studied in order to determine the prevalence of caries and caries-associated micro-organisms and the interactions between these for each of the racial groups; dmft (decayed, missing or filled teeth) scores were recorded using British Association for the Study of Community Dentistry criteria. Saliva and plaque samples were taken from each child and the numbers of mutans streptococci, lactobacilli and yeasts per sample were determined. The mean dmft scores of the 3- and 4-year-old Afro-Caribbean children were 0.36 +/- 0.10 and 0.51 +/- 0.13, respectively, compared to 0.80 +/- 0.17 and 1.48 +/- 0.24 for the equivalent Caucasian children (p < 0.001). Mutans streptococci and lactobacilli were recovered less frequently from the Afro-Caribbean children than from the Caucasian, but in both groups there were significant correlations between the plaque and salivary levels of mutants streptococci and caries experience. In both groups, children from whom both mutans streptococci and lactobacilli were isolated had the greatest mean dmft scores and these were not significantly different. Multiple regression analyses demonstrated that, after controlling for age and dmft, there were still significant associations between race and salivary levels of mutans streptococci and lactobacilli, p = 0.0013 and p = 0.0167, respectively. These data indicate that Afro-Caribbean children had lower levels of dental caries than Caucasian children living in the same London boroughs and attending the same preschool care facilities and, after controlling for age and caries experience, they also had lower salivary levels of mutans streptococci and lactobacilli.

Caries prevalence of 5-year-old children in Athens and in South London.

This study compared the dental health of 5-year-old children in the London boroughs of Lambeth, Lewisham and Southwark with that in the municipality of Athens, Greece. Three hundred and eighty-four children were examined in London, and 318 in Athens; both samples had a mean age of 5 years 6 months. The proportion of London children who were caries free was 56%, and of Athens children 57.5%, and the mean dmft was 1.63 and 1.48, respectively; these differences were not statistically significant. However, excluding caries-free children from the analysis, the London children had significantly fewer decayed teeth (mean 2.35 compared with 2.93 in Athens) and significantly more missing teeth (mean 0.63 compared with 0.02), indicating marked differences in treatment patterns.

Community dental service based out of hours emergency dental care--a pilot study.

Twenty-nine out-of-hours calls were received during the 6-week period. Advice was offered to 27 patients and two call-outs were made for treatment of acute abscesses in children. Eight patients claimed to be under treatment with the CDS, 17 claimed to be registered with a general dental practitioner, while four claimed not to be registered. A demand for an emergency service was demonstrated, as was the need to define accurately the categories of patients eligible for emergency treatment within the CDS. The pilot study also highlighted the requirement to fund this service adequately.

Referral of child patients from the Community Dental Service to the General Dental Service: one year's experience.

The Community Dental Service has been encouraged to refer regular attending patients to General Dental Practice whilst maintaining a monitoring system to ensure that referred patients do not 'fall through the net'. The referral and monitoring system run by Halton Health Authority for one year is described. During this period 112 motivated patients were identified as being suitable for referral to general practice. Of these, 85 agreed to referral and 27 refused. Of those referred, 69 subsequently attended but 16 failed to attend and 14 of these did not respond to a further recall by the CDS. Far from acting as a safety net service the CDS may, in pursuing this referral policy, be actually increasing the number of irregular attenders in some localities and for this reason Halton is reviewing the speed with which the referral policy is being implemented.

Simple methods for denture identification: a clinical trial.

The persistence of identification marks applied to dentures with two spirit solvent based fibre tip pens and graphite pencil covered with an experimental and a proprietary sealant were studied under service conditions. In general, the marks applied with the pens were rapidly lost, but those covered with the sealants persisted satisfactorily. The experimental sealant performed slightly better than the proprietary product.