Factor analytic study of two questionnaires measuring oral health-related quality of life among children and adults in New Zealand, Germany and Poland.

A questionnaire designed to measure oral health-related quality of life (OHRQOL) in adults and children was assessed for its factorial structure and reliability using data from the Second International Collaborative Study on Oral Health Outcomes in New Zealand, Poland and Germany. Principal component analysis with orthogonal and oblique rotation was applied. The three-factor structure hypothesized for the children's questionnaire (self-reported oral disease symptoms, perceived oral well-being, social and physical functioning) was confirmed in New Zealand and Poland, and two self-reported oral disease symptom dimensions emerged in Germany. Five factors instead of the three hypothesized were identified for adults: two dimensions of symptoms were identified, and social and physical functioning appeared to be independent dimensions of OHRQOL. Similarity between the factors was demonstrated in all three countries. The reliability of the questionnaire ranged from moderate to excellent depending on the dimension and the country. These findings provide preliminary evidence of the cross-cultural stability of the OHRQOL questionnaire in New Zealand, Poland and Germany, for both children and adults. Further investigations by the present authors of the properties of the instrument in other samples will focus on demonstrating the stability and replicability of the factor structure identified here.

Noma: public health problem in Senegal and epidemilogical surveillance.

Noma or cancrum oris is currently a real public health problem for developing countries. In Senegal, awareness of the disease has led the country to be included in the noma programme initiated by the WHO as early as 1994. The objectives are to evaluate the incidence of necrotizing ulcerative gingivitis (NUG) among children, to evaluate the prevalence of noma and infantile diseases, and to promote prevention strategies among vulnerable populations. Data processing was carried out in two phases: manual processing consisted of checking the questionnaires by nurses, and computer processing started as early as the first collection of data. Noma occurs owing to fever and similar cases. Successfully fighting against malnutrition would allow us to reduce the noma rate.

The World Health Organization initiative on noma.

Oro-facial noma is a worldwide scourge in a context where the World Health Report 1998 gives a global incidence of 140,000 cases, a prevalence in 1997 of 770,000 persons surviving with heavy sequelae. The background and the five steps of the WHO oral health programme to control noma including: (i) ensuring training and awareness on early diagnosis and treatment for each public health structure, (ii) raising awareness and informing populations, (iii) promoting epidemiological research, (iv) promoting aetiological research, (v) setting up an African regional centre for the treatment of after-effects, are developed in this paper.

Oral health status in 65-74 years old adults in France, 1995.

BACKGROUND: A study was carried out to assess the oral health status of the non-institutionalized population aged 65-74 years and living in the Rhône-Alpes region, France, in 1995. METHODS: The representative sample was composed of 603 subjects comprised of 41.5% of men of which 24.5% lived in rural areas--i.e. less than 2,000 inhabitants--and 75.5% of urban areas. The quota sample used was stratified by socio-economic status, residence and gender. Oral health was defined by dentate status, D (Decayed), M (Missing), F (Filled) components and DMFT components. Carious lesions, fillings, missing teeth were recorded using the World Health Organization criteria. An indicator of treatment need--the ratio of decayed teeth over decayed and filled teeth--D/D+F was used. RESULTS: The DMFT index at 65-74 years for the French population was 23.3 +/- 4.0. The dental condition of the study group in the Rhônes-Alpes region of France appears satisfactory considering the low percentage of untreated decayed teeth at 65-74 years old (17.4%) and the low rate of edentate people (16.3%). Gender, location and socio-economic variables in relation to the dental status were discussed. CONCLUSION: The relatively good oral health status of the senior citizens and the low rate of need for treatment of dental decay together with the level of oral care available provided a solid base for further development of a qualitative national dental care system.

Epidemiology of the incidence of oro-facial noma: a study of cases in Dakar, Senegal, 1981-1993.

Oro-facial noma is an oral gangrene occurring in early childhood in extremely poor areas. As many as 70-90% of those with noma die, and to date, there is no satisfactory treatment to fight this disease. Within the context of the World Health Organization international program against noma, a 13-year retrospective study based on clinical records was carried out in Dakar, Senegal in an attempt to understand the epidemiology of noma. Between 1981 and 1993, 199 cases of noma were identified, among them; 36.7% were acute cases and 63.3% showed sequelae. Chronic sequelae of noma were seen in patients 2-41 years of age, but the acute phase of noma was found only in young children (77.7% in those 1-4 years of age, maximum age = 9 years, mean age +/- SD age = 3.4 +/- 1.9 years). A total of 73.1% of the cases with acute disease were reported in the Dakar, Diourbel and Kaolack regions during the dry season (57.0% of the cases). The lesions of progressive noma were localized mainly on the upper lip (42.4%) and the cheek (31.1%). A total of 96.9% of the patients with acute diseases were had poor general health with serious associated diseases; only 20.0% had a good vital prognosis. The development of epidemiologic surveillance programs for noma should be a public health priority in Senegal.

Gathering data on oral mucosal diseases: a new approach.

A new approach to gathering epidemiological data on oral mucosal diseases has been tested with encouraging results in Sri Lanka. Its main advantage is that it does not depend on the examiner's ability to make a diagnosis, so it can be carried out by non-professionals such as dental students.

Standard descriptive tables in WHO Oral Health epidemiological studies.

For many years the Oral Health Programme of the World Health Organization has promoted the development of oral health epidemiological surveys. The objective of this article is to make oral health researchers aware of the variables and statistical tables recommended by WHO for the standardization, presentation and comparability of international surveys. The influence of the growing impact of computer technology in providing better knowledge of oral health systems is also discussed in this article.

Inter-country application of standard epidemiology tools in oral health.

If there is a single project which could demonstrate the intensive use of the WHO standard oral epidemiology methods which have been discussed and demonstrated in papers published elsewhere, it is the series of collaborative studies of oral health care systems referred to in brief as ICS-I and II. These consist of multi-country studies from which to assess the relative merits of different delivery systems based on interlinked clinical and sociological data for the consumer and sociological data for the provider. In both the ICS-I and II, each participating country team followed the same protocol and every effort was made to retain, for ICS-II, not only the same research strategy, but also as much of the methodology as possible. ICS-I covered the years 1973 to 1983: ICS-II began in 1988 and is due to end in 1995. A detailed description of the sampling, survey and analysis approaches is given in the first part of this article and highlights of the inter-country clinical data in the second part. Although ICS-I was hampered in its objective to compare relative strengths of delivery systems, or elements thereof, by the lack of comparative longitudinal data, its results had tremendous impact both for participating countries and others which could learn from the study findings. That impact was evident in the most practical form of wholesale changes in various systems and approaches and in application of study findings in constructing new systems. ICS-II data are intriguing both in the new examples they present and in comparisons over time, as well as in the improved methods developed as a result of lessons learned in ICS-I. The full report will be available in 1995.

The application of the theoretical model WHO/FDI planning system to an industrialised country: France.

The results of the application of the WHO/FDI planning system to a specific situation in an industrialised country provide valid arguments in favour of its use. It is shown to be an aid to planners when estimating oral health personnel requirements and emphasises the necessity of obtaining basic information on the oral health status and demand for treatment in industrialised countries. The strength of the system lies in the fact that it enables the user to forecast requirements, by age cohort and by type of care, while at the same time including socio-economic variables which have a major influence in industrialised countries with moderate caries levels. This flexibility of use enables the system to be adapted, if necessary, or even improved, according to the constraints which may result from a specific situation analysis.

Evaluation of the World Health Organisation pathfinder methodology for oral health surveys in industrialised countries.

The aim of this study was to carry out a survey using the pathfinder methodology developed by the World Health Organisation for international surveys and to compare the results (DMFT, DT, MT, FT) with those obtained from a national survey in France. The statistically significant difference observed between the results of the DMFT and DT indices obtained by using the two methods does not affect the classification of France at the 'moderate' level on the World Health Organisation scale for caries prevalence at the age of 12 years. The observed DMFT difference is an argument in favour of using the World Health Organisation pathfinder methodology, as it provides a satisfactory degree of precision on the oral health status of a population for planning purposes.

Profiles of periodontal conditions in older age cohorts, measured by CPITN.

Results of more than 80 CPITN surveys from almost 30 countries for the age groups of 45 years and above are assembled. In this first overview, data for the older age cohorts are presented, showing the percentages of persons according to the highest score per person and the mean numbers of sextants affected per person. Results for three age groups are presented: 45-54, 55-64 and 65-74 years, with two additional surveys in older persons. There were marked variations in periodontal conditions between surveys. The assumed differences between industrialized and non-industrialized countries with regard to periodontal diseases did not show in the data examined. Also, the expected increase in periodontal destruction with increasing age was not reflected in values for pocketing or deep pocketing in the successive age groups. Some variations between surveys was also noted for the rate of tooth loss, expressed in the mean number of excluded CPITN sextants. However, on average, at age 50, almost one sextant was excluded, increasing to 1.5 sextants at 60 and almost 2.5 sextants at age 70. It is therefore suggested that the progress of periodontal destruction with age is not shown in an increase in periodontal CPITN scores, but in increased tooth loss, specified by an increasing number of excluded CPITN sextants. For the age group 65-74 years, this results in, on average, almost half of all sextants being excluded. Of the remaining sextants, approximately half had shallow and/or deep pockets.

WHO pathfinder caries survey in Beijing extended with data for prevalence of mutans streptococci.

A pathfinder caries survey was carried out in Beijing, People's Republic of China, using WHO standard methodologies, in order to estimate the trend by comparing the results with the 1981 caries survey, performed in the same area. Simultaneously, the levels of mutans streptococci in the group were estimated in order to define the proportion of children with high and low mutans levels. Twelve-year-old children were randomly selected from schools in five districts within the city limits. Examinations for caries were performed according to 'WHO Oral Health Surveys' by two calibrated examiners. A total of 178 children were examined for caries and 156 of them were randomly selected for saliva sampling of mutans streptococci, using the 'Strip mutans' method. The number of colonies adhering to the strips were compared with a chart, supplied by the manufacturer, and given a score between 0 and 3, indicating low to very high saliva mutans counts, respectively. The results showed a mean DMFT of 1.87 (1.61-0.06-0.20, for decayed, missing and filled teeth respectively); 66.3 per cent of the children were affected. Fourteen per cent had mutans class 0, 28 per cent class 1, 35 per cent class 2 and 23 per cent class 3. The mean DFT, for each mutans class was 0.82, 1.48, 2.09 and 2.69, respectively. The differences were statistically significant (P = 0.0015). In the lowest mutans class, 50 per cent had caries and the mean number of teeth requiring conservative care was 0.68. For the high mutans group, the corresponding values were 72 per cent and 2.11 teeth.(ABSTRACT TRUNCATED AT 250 WORDS)

Profiles of periodontal conditions in adolescents measured by CPITN.

Results of more than 100 CPITN surveys from over 60 countries for the age group 15-19 years, stored in the WHO Global Oral Data Bank as of 1 August 1990, are assembled. They are presented in the form of graphs showing the mean number of sextants affected per person and arranged by country according to WHO regions. It is hoped that these overviews provide a frame of reference for the evaluation of periodontal conditions in populations and population subgroups. The most frequently observed condition in adolescents was score 2 (calculus with or without bleeding). Calculus seems to be much more prevalent in non-industrialized than in industrialized countries. Although some shallow pocketing of 4 or 5 mm was present in two-thirds of all populations observed, it affected mostly only a minority of the sample and then only in one or two sextants. However, a few surveys showed a relatively high prevalence of pocketing. As the surveys were carried out in adolescents, such high figures indicate serious problems ahead.

Profiles of periodontal conditions in adults measured by CPITN.

Results of almost 100 CPITN surveys in more than 50 countries for the age group 35-44 years, stored in the WHO Global Oral Data Bank as of 1 August 1990, are assembled. They are presented in the form of graphs showing the percentages of persons according to the highest score per person and arranged by country according to WHO regions. It is hoped that these overviews provide a frame of reference for the evaluation of periodontal conditions in populations and population subgroups. Calculus and shallow pocketing were the most frequently observed conditions. With a few exceptions, the percentages of persons and the mean number of sextants per person with deep pockets were small to very small. The assumed differences between industrialized and non-industrialized countries with regard to periodontal health were not reflected in the survey data examined. Severe periodontal destruction seems to be a limited problem, seldom leading to tooth loss before the age of 50. For the large majority in most of the populations observed, the progress of periodontal diseases seems to be compatible with the retention of a natural dentition into older age. Nevertheless, the periodontal problem is of considerable magnitude and importance, as 5-20 per cent of populations are affected by a serious, irreversible condition at the age of 40, which is a high percentage compared with almost every other disease that afflicts mankind.

International collaborative studies in oral health: a practical illustration of WHO research policy.

The International Collaborative Study (ICS) initiated by the World Health Organization (WHO) and supported by the United States Public Health Service is a meaningful practical example of international scientific collaboration. It involves 12 study sites within eight different countries. The main objective embodied in the global strategy of WHO is to focus on action for the better health of all people. The ultimate purpose of the project is to improve the effectiveness and efficiency of oral health care systems by providing policy makers and researchers with detailed, reliable and valid data on the oral health situation in their country together with comparative data from other countries' oral health care systems. The ICS I (1973-1981) is described and the main outcomes are discussed with regard to their impact on national health policies. The ICS II which was launched in February 1988 and is currently ongoing is presented. Differences and similarities between the two projects are discussed as well as the main expected achievements.

Periodontal conditions in adolescents, 15-19 years of age: an overview of CPITN data in the WHO Global Oral Data Bank.

Results of 61 CPITN surveys in 39 countries for the age group 15-19 yr, stored in the WHO Global Oral Data Bank as of 1 July 1987, are assembled in an overview showing percentages of persons according to the highest score for each person and the mean numbers of sextants affected per person. The most frequently observed condition was score 2 (calculus with or without bleeding), although some shallow pocketing of 4 or 5 mm was present in most populations surveyed. It should thus be emphasized that the major thrust of activities in periodontal care should be in health promotion and education, leading to improved oral hygiene.

Periodontal conditions in adults, 35-44 years of age: an overview of CPITN data in the Who Global Oral Data Bank.

Results of 28 CPITN surveys in 24 countries for the age group 35-44 years, stored in the WHO Global Oral Data Bank as of 1 July 1986 are assembled in an overview presenting: percentages of persons according to the highest score for each person, the estimated national percentages of edentulousness and the mean numbers of sextants affected per person. It is concluded that for a large majority in most of the populations observed, the progress of periodontal disease has been slow and seems to be compatible with retention of a natural dentition until at least the age of 50.